Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer

Martini, Alberto; Gandaglia, Giorgio; Fossati, Nicola; Scuderi, Simone; Bravi, Carlo Andrea; Mazzone, Elio; Stabile, Armando; Scarcella, Simone; Robesti, Daniele; Barletta, Francesco; Cucchiara, Vito; Mirone, Vincenzo; Montorsi, Francesco; Briganti, Alberto

doi:10.1016/j.euo.2019.03.006

Cited by 55 publications

(53 citation statements)

References 30 publications

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“…Positive surgical margins (PSM) have been associated with an increased risk of biochemical failure. Recently, a single PSM of >3 mm or multifocal PSM was associated with an increased risk of metastasis [30], whereas a single focus of PSM was not associated with biochemical failure [31]. Interestingly, the frequency of MRD subtypes detected was not significantly different between patients with pT3a PSM negative and positive prostate cancer although there were a limited number of pT3a-positive PSMs in the study [29].…”

Section: Discussionmentioning

confidence: 86%

“…This quiescent state may last for years and is seen in the clinical as the time between primary treatment and failure in patients without evidence of metastatic disease. Changes in the tumour cells such as clonal progression [30] or changes in immune surveillance may lead to tumour activation. The CAPRA-S score was not significantly different between men MRD negative and those micrometastasis positive (Group B), and thus, unlike the MRD prognostic classification was unable to identify those men at risk of late failure.…”

Section: Discussionmentioning

confidence: 99%

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The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

Murray

Aedo

Fuentealba

et al. 2020

ecancer

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Objective: The objective of this study was to compare the CAPRA-S score (based on clinicopathological findings) and the subtypes of minimal residual disease (MRD) (based on the biological properties of cancer cells) to predict biochemical failure (BF) after prostatectomy radical. Patients and methods: This was a prospective single-centre study of men who underwent radical prostatectomy. One month after surgery, the blood and bone marrow were taken for circulating prostate cell (CPC) and micrometastasis detection, identified using anti-PSA immunocytochemistry and defined as positive or negative. Patients were classified as Group A: CPC and micrometastasis negative, Group B: micrometastasis positive and CPC negative and Group C: CPC positive. CAPRA-S scores were classified as low, intermediate and high risk. Kaplan-Meier curves for biochemical failure-free survival (BFFS) and restricted mean survival time (RMST) to biochemical failure were determined and compared for up to 10 years. Results: 347 men participated with a median follow-up of 7 years, BFFS decreased proportionally with increasing CAPRA-S score and HR 1.13 and 1.65 for intermediate and high risk, respectively. After 10 years, the BFFS and RMST were 68%, 47% and 16% and 9, 7 and 6 years, respectively. The BFFS curves for MRD were not proportional; Group A and B BFFSs were similar up to 5 years, and then, there was an increasing failure in Group B patients After 10 years, the BFFS and RMST were 95%, 57% and 27% and 10, 9 and 6 years respectively. The CAPRA-S score failed to distinguish between Groups A and B, and one-third of high-risk Group C had low-risk CAPRA-S scores. MRD hazard ratios were Group B 1.76 and Group C 4.03. Research

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

Murray

Aedo

Fuentealba

et al. 2020

ecancer

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“…Our study groups had PSM in a favorable single pattern within a length of 1 mm, except for one with a multifocal finding. This condition indicates a better result than the unfavorable (multifocal or single but > 3 mm) PSM[ 22 ]. Non-apical PSM, which constituted 73% of our cases, was meta-analyzed and was found to increase the likelihood of BCR[ 23 ] and negatively affect the BCR rate to a certain degree.…”

Section: Discussionmentioning

confidence: 99%

Biochemical recurrence of pathological T2+ localized prostate cancer after robotic-assisted radical prostatectomy: A 10-year surveillance

Yang¹,

Yang²,

Ou³

et al. 2021

WJCC

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BACKGROUND pT2+ prostate cancer (PCa), a term first used in 2004, refers to organ-confined PCa characterized by a positive surgical margin (PSM) without extracapsular extension. Patients with a PSM are vulnerable to biochemical recurrence (BCR) following radical prostatectomy (RP); however, whether adjuvant radiotherapy (aRT) is imperative to PSM after RP remains controversial. This study had the longest follow-up on pT2+ PCa after robotic-assisted RP since 2004. Moreover, we discussed our viewpoints on pT2+ PCa based on real-world experiences. AIM To conclude a 10-year surveillance on pT2+ PCa and compare our results with those of the published literature. METHODS Forty-eight patients who underwent robotic-assisted RP between 2008 and 2011 were enrolled. Two serial tests of prostate specific antigen (PSA) ≥ 0.2 ng/mL were defined as BCR. Various designed factors were analyzed using statistical tools for BCR risk. SAS 9.4 was applied and significance was defined as P < 0.05. Univariate, multivariate, linear regression, and receiver operating characteristic (ROC) curve analyses were performed for statistical analyses. RESULTS With a median follow-up period of 9 years, 25 (52%) patients had BCR (BCR group), and the remaining 23 (48%) patients did not (non-BCR group). The median time for BCR test was 4 years from the first postoperative PSA nadir. Preoperative PSA was significantly different between the BCR and non-BCR groups ( P < 0.001), and ROC curve analysis of preoperative PSA suggested a cut-off value of 19.09 ng/mL (sensitivity, 0.600; specificity: 0.739). The linear regression analysis showed no correlation between time to BCR and preoperative PSA (Pearson’s correlation, 0.13; adjusted R 2 = 0.026). CONCLUSION Robotic-assisted RP in pT2+ PCa of worse conditions can provide better BCR-free survival. A surgical technique limiting the PSM in favorable situations is warranted to lower the pT2+ PCa BCR rate. Preoperative PSA cut-off value of 19.09 ng/mL is a predictive factor for BCR. Based on our experiences and review of the literature, we do not recommend routine aRT for pT2+ PCa.

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“…Long-term prediction of prostate cancer-specific mortality is mainly based on histopathology features as described by Eggener et al Poorly differentiated cancer, with a Gleason-Score of 8-10, and seminal vesicle invasion are prime determinants of prostate cancer specific mortality after radical prostatectomy (35). Findings of Martini et al demonstrate that only unfavorable positive surgical margins (≥3 mm and/or multifocal positive margins) have a significant influence on risk of metastasis in prostate cancer (36). Up to date intraoperative frozen section analysis is the gold standard to assess removal of all prostate cancer tissue.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative ⁶⁸Ga-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Feasibility Study

et al. 2020

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Objective: To assess the feasibility and accuracy of Cerenkov Luminescence Imaging (CLI) for assessment of surgical margins intraoperatively during radical prostatectomy (RPE). Methods:A single centre feasibility study included 10 patients with high-risk primary prostate cancer (PC). 68 Ga-PSMA PET/CT scans were performed followed by RPE and intraoperative CLI of the excised prostate. In addition to imaging the intact prostate, in the first two patients the prostate gland was incised and imaged with CLI to visualise the primary tumour. We compared the tumour margin status on CLI to postoperative histopathology. Measured CLI intensities were determined as tumour to background ratio (TBR).Results: Tumour cells were successfully detected on the incised prostate CLI images as confirmed by histopathology. 3 of 10 men had histopathological positive surgical margins (PSMs), and 2 of 3 PSMs were accurately detected on CLI. Overall, 25 (72%) out of 35 regions of interest (ROIs) proved to visualize a tumour signal according to standard histopathology. The median tumour radiance in these areas was 11301 photons/s/cm 2 /sr (range 3328 -25428 photons/s/cm 2 /sr) and median TBR was 4.2 (range 2.1 -11.6).False positive signals were seen mainly at the prostate base with PC cells overlaid by benign tissue. PSMA-immunohistochemistry (PSMA-IHC) revealed strong PSMA staining of benign gland tissue, which impacts measured activities.Conclusions: This feasibility showed that 68 Ga-PSMA CLI is a new intraoperative imaging technique capable of imaging the entire specimen's surface to detect PC tissue at the resection margin. Further optimisation of the CLI protocol, or the use of lower-energetic imaging tracers such as 18 F-PSMA, are required to reduce false positives. A larger study will be performed to assess diagnostic performance.

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Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer

Cited by 55 publications

References 30 publications

The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

Biochemical recurrence of pathological T2+ localized prostate cancer after robotic-assisted radical prostatectomy: A 10-year surveillance

Intraoperative ⁶⁸Ga-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Feasibility Study

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Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer

Cited by 55 publications

References 30 publications

The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

The CAPRA-S score versus subtypes of minimal residual disease to predict biochemical failure after radical prostatectomy

Biochemical recurrence of pathological T2+ localized prostate cancer after robotic-assisted radical prostatectomy: A 10-year surveillance

Intraoperative 68Ga-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Feasibility Study

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Intraoperative ⁶⁸Ga-PSMA Cerenkov Luminescence Imaging for Surgical Margins in Radical Prostatectomy: A Feasibility Study