Does size matter when it comes to the surgical margins after radical prostatectomy?

Yes, in a word.

This is the conclusion of Australian researchers who performed a systematic review, meta-analysis.

According to Athul John MD, a leading author and a urology registrar at Flinders Hospital in Adelaide, South Australia, the length of the positive surgical margins following prostatectomy is a prognostic indicator of biochemical recurrence.

John presented the results July 1, at the European Association of Urology (2022 Congress)

The importance of positive margins in radical prostatectomy patients with prostate cancer remains controversial. There have been inconsistent results reported in the literature.

John and his colleagues conducted a literature search using the MEDLINE and EMBASE databases to find studies that explored the importance of positive margins after radical prostatectomy. They also followed strict protocols to ensure the isolation of high-quality studies.

The study team found 14 studies that had sample sizes of 117 to 579 patients and mean follow-ups of 1.6 to 7.1 years.

An estimated 27%-44% patients with positive margins experienced biochemical recurrence and 6.8%-24.3% experienced systemic progression.

Continuous linear extension of positive surgical margins in eight studies was associated with biochemical recurrence. Hazard ratio [HR], 1.03, P .05). Two studies showed that a positive margin extension of more than 1 mm was associated to a twofold greater risk of biochemical recurrence. (HR, 2.2; P.05). In the four remaining studies, a positive margin extension greater than 3 mm was associated to biochemical recurrence (HR, 1.69, P.05).

John stated that the results suggest that randomised controlled trials of adjuvant treatment in patients with greater positive surgical margins (e.g., 3 mm or more) are warranted.

Steven Canfield MD, co-moderated the session, but was not involved with the research. He applauded that only high-quality studies were included and stressed the importance meta-analyses to help answer difficult questions that can only been answered by exploring larger datasets.

“Real-world evidence, big data claims, will shed more light onto prognostic factors such as that,” Canfield, chief of Urology at the University of Texas Houston McGovern Medical School told Medscape Medical News.

Institutionally supported, the study was approved. John and Canfield did not disclose any financial information.

Congress 2022 of the European Association of Urology. Abstract A0165. Presented July 1, 2022.

Neil Osterweil is an award-winning journalist in the medical field and a regular contributor to Medscape.

Follow Medscape on Facebook and Twitter.