Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Original Paper Urol Int 2011;86:156–160 DOI: 10.1159/000322840 Stage-by-Stage Effects of Surgical Margin Status on Biochemical Failure after Radical Prostatectomy in Patients with Clinically Localized Prostate Cancer Alp Ozgur Akdemir   a Cuneyt Ozden   b Cetin Volkan Oztekin   a Binhan Kagan Aktas   b Mesut Cetinkaya   a Ali Memis   b Omer Gokhan Doluoglu   a Clinics of a  Urology II and b  Urology I, Ankara Numune Education and Research Hospital, Ankara, Turkey Introduction Radical prostatectomy (RP) provides perfect disease control in the majority of patients with clinically local- ized prostate cancer (CaP). However, 20–30% of the pa- tients will eventually experience serum PSA elevations after RP without any clinical or radiological evidence of disease metastasis [1]. Biochemical failure (BF) suggests the presence of residual prostatic epithelial cells and that may indicate a failure in cancer control. The actual incidence, clinical significance and natural history of BF remain unclear. Numerous factors were re- ported to be associated with BF after RP, one of which is a positive surgical margin (PSM) [2–5]. Rates of PSM vary between 14% and 46% in the literature [6–8]. Higher postoperative failure rates and worse prognosis are ex- pected in patients with extraprostatic disease and PSMs [2]. Probability of a PSM strongly correlates with stage [9]. PSM acts as an independent prognostic factor for BF after RP, either alone or when analyzed in pairs with patho- logical stage, lymph node involvement and Gleason score [10, 11]. However, to our knowledge, there is not an ade- quate number of studies evaluating the cumulative im- pact of pathological stage and surgical margin status on BF. Disease course after BF is also variable; while the dis- ease remains silent in some patients, rapid progression into metastatic disease occurs in the others. A wide range Key Words Biochemical failure  Prostate cancer  Prostate-specific antigen  Radical prostatectomy  Surgical margin Abstract Purpose: To evaluate the effects of pathological stage and surgical margin status on biochemical failure rates after rad- ical prostatectomy (RP). Materials and Methods: The rec- ords of 205 patients who underwent RP for clinically lo- calized prostate cancer (CaP) were evaluated. Known risk factors for biochemical failure (BF) were analyzed using uni- variate and multivariate logistic regression analysis. The ef- fects of surgical margin status together with pathological stage on BF were evaluated. p values lower than 0.05 were accepted to be statistically significant. Results: Pathological stage, positive surgical margin (PSM), seminal vesicle inva- sion, lymph node involvement, biopsy Gleason score and postoperative Gleason score were the factors associated with BF in univariate analysis. Logistic regression analysis re- vealed that pT3a patients with PSM had a significant BF rate when compared to pT2 patients with a negative surgical margin (NSM) (OR 7.46, p = 0.002). pT3a patients with a NSM had a similar BF rate to that of pT2 patients with PSM. Con- clusions: pT2 patients with PSM had a similar biochemical prognosis to that of pT3a patients without PSM, implicating that a PSM may have a negative effect on prognosis similar to that of extracapsular invasion. Copyright © 2011 S. Karger AG, Basel Received: August 3, 2010 Accepted after revision: October 28, 2010 Published online: February 9, 2011 Internationalis Urologia Omer Gokhan Doluoglu, MD Department of Urology II Clinic of Ankara Numune Education and Research Hospital TR–06100 Ankara (Turkey) Tel. +90 5 332 157 809, E-Mail drdoluoglu  @  yahoo.com.tr © 2011 S. Karger AG, Basel 0042–1138/11/0862–0156$38.00/0 Accessible online at: www.karger.com/uin