P. H. JOHNSTON ET AL.
186
underpowered to reveal statistical significance.
The authors acknowledge this study’s retrospective
nature is subject to the selection bias inherent in its de-
sign. Furthermore, pelvic lymph node dissection was not
undertaken in 18.6% patients. While nodal dissections in
all patients would be advantageous from a statistical
analysis point-of-view, the finding of pathologic SVI was
not routinely anticipated pre-operatively, thus the deci-
sion to forgo nodal dissection in a subset of the cohort is
reflective of real-world oncologic decision-making. It
must also be noted that a mean follow-up of 37 months is
relatively short for prostate cancer, although a mean time
to progression of 17 months suggests that the vast major-
ity of patients who were going to progress biochemically
had done so by the time mean follow-up was reached.
Furthermore, given the high-risk nature of SVI patients
as a whole, follow-up as observed in this study is likely
adequate for the endpoint of biochemical recurrence.
Finally, it is worth acknowledging that a more robust
data set of SVI patients would be helpful in further de-
lineating the role of tumor volume as a prognostic patho-
logic parameter [1].
5. Conclusion
This data set fails to demonstrate progression-free sur-
vival differences for men with SVI, according to surgical
margin and lymph node status. While there remains equi-
poise in this patient population with respect to which
clinico-pathologic parameters confer survival advantage,
this paper suggests lower tumor volume is advantageous
to patients with SVI at the time of RP.
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