Purpose: Fear of cancer recurrence (FCR) has been shown to be a significant source of distress in men diagnosed with prostate cancer. While the clinical significance of positive surgical margins (PSM) after radical prostatectomy (RP) continues to be debated, PSM’s effect on FCR, a facet of health related quality of life (HRQOL), is unknown. We examined the impact of PSM on FCR in men undergoing RP as primary therapy.
Methods: We identified 584 men who underwent RP from 1999 to 2002 from CaPSURE™, a longitudinal, national cohort with prospectively collected clinical and HRQOL data. All men had both baseline and at least one follow-up assessment of FCR using a validated (Kornblith) scale. Statistical analysis included chi-squared test, Wald test and ANOVA mixed model for longitudinal FCR associations.
Results: One hundred and sixty (27%) men had PSM. Baseline FCR and clinical variables did not differ based on margin status. Men with PSM experienced increased FCR (OR = 1.94, 95% CI = 1.22-3.07) compared to those with negative margins even after adjusting for adjuvant therapy. Repeated measures analysis showed a significant increase in FCR over time (14 month mean follow-up) for those with PSM compared to negative margins (p=0.019). There were no significant differences in HRQOL based on margin status.
Figure
Figure 1: FCR score over time based on margin status. Higher FCR corresponds to higher anxiety. p=0.0190
Conclusion: PSM is associated with greater FCR. FCR increases over time in men with positive margins compared with negative margins. This increase is unaffected by adjuvant therapy use. PSM increases psychological distress and can create difficulty for patients when planning their futures.