Do Margins Matter? The Prognostic Significance of Positive Surgical Margins in Radical Prostatectomy Specimens

Swindle, Peter; Eastham, James A.; Ohori, Makoto; Kattan, Michael W.; Wheeler, Thomas M.; Maru, Norio; Slawin, Kevin M.; Scardino, Peter T.

doi:10.1097/01.ju.0000169475.00949.78

Cited by 351 publications

(228 citation statements)

References 20 publications

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“…Although the extent of the PSM has been shown to be associated with BCR after RP, few reports have shown its significance in relation to clinical outcomes or PC-specific mortality [2,4]. Furthermore, several studies have demonstrated that PSM is an independent predictor of BCR [3,18]. However, BCR is not a universally accepted surrogate endpoint for clinical failure or PC-specific mortality [19,20].…”

Section: Discussionmentioning

confidence: 99%

“…BCR after RP has been associated with multiple factors, including the preoperative PSA level, the pathological stage, the GS of the prostatectomy specimen, and the surgical margin status [2,3,4,7,16,17]. Although the extent of the PSM has been shown to be associated with BCR after RP, few reports have shown its significance in relation to clinical outcomes or PC-specific mortality [2,4].…”

Section: Discussionmentioning

confidence: 99%

“…In patients with clinically localized PC operated with RP, the prognostic factors in clinical use are the serum prostate-specific antigen (PSA) level, the pathological tumor stage, the Gleason score (GS), and the surgical margin status [2,3]. Whereas the tumor stage and histological differentiation are inherent to the biological aggressiveness of the disease, the surgical margin status is influenced by different factors such as the surgical technique, tumor features, patient factors, and the method of pathological tissue processing [4].…”

Section: Introductionmentioning

confidence: 99%

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The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

Servoll

Vlatkovic²,

Sæter

et al. 2014

Urol Int

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Objective: To establish predictors of clinical failure in patients operated with radical prostatectomy (RP) for clinically localized prostate cancer (PC) by analyzing the pathological characteristics of positive surgical margins (PSM). Patients and Methods: The RP specimens of 303 consecutive patients operated with RP between 1985 and 2009 were reviewed. PSM were analyzed with regard to the PSM length, location and multifocality and the Gleason score (GS) at the PSM. Results: Of the 163 patients with PSM, 79 (48%) progressed to clinical failure compared to 30 (22%) in the negative-margin-status group. In univariate analysis, a GS at the PSM ≥4 + 3 = 7 (p = 0. 013) and a PSM length >3.0 mm (p < 0.005) were significantly associated with higher clinical failure rates compared to a GS at the PSM ≤3 + 4 = 7 and ≤3.0 mm in extent, respectively. A linear extent of the PSM ≤3.0 mm appeared to have the same clinical outcome as in the group with a negative margin status. In multivariate analysis, a PSM length >3.0 mm remained an independent predictor of clinical failure. Conclusions: PSM length is an independent predictor of clinical failure following RP.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

Servoll

Vlatkovic²,

Sæter

et al. 2014

Urol Int

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“…The aim of the radical prostatectomy (RP), as also that of the robot-assisted laparoscopic radical prostatectomy (RARP) is to remove the entire cancer and to strive for clear surgical margins. Positive surgical margins (PSMs) remain a real risk and result in an increased risk for biochemical recurrence (BCR) and a decrease in disease-free survival [1,2], especially in organ-confined disease [3]. PSMs in organ-confined PCa are iatrogenic [1] and are the only poor prognostic factor influenced by the surgeon [4].…”

Section: Introductionmentioning

confidence: 99%

“…Positive surgical margins (PSMs) remain a real risk and result in an increased risk for biochemical recurrence (BCR) and a decrease in disease-free survival [1,2], especially in organ-confined disease [3]. PSMs in organ-confined PCa are iatrogenic [1] and are the only poor prognostic factor influenced by the surgeon [4]. In addition, it has been postulated that the nerve-sparing approach could also increase the PSM rate.…”

Section: Introductionmentioning

confidence: 99%

Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy

Bütow

Schunk²,

Janssen³

et al. 2015

Urol Int

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Purpose: Positive surgical margins (PSM) during robot-assisted radical prostatectomy (RARP) negatively influence patients' prognosis. The aim of our study was to identify risk factors for PSM in patients with organ-confined prostate cancer (PCa). Methods: A clinical database of all patients that underwent a RARP at our institution was used. Uni- and multivariable logistic regression analyses were conducted on the PSM rates for all patients with organ-confined PCa. Results: Altogether, 1,600 patients were identified, including 1,085 organ-confined PCa with a PSM rate of 7.8%. On multivariable analysis, bilateral nerve-sparing (OR 3.025, 95% CI 1.587-5.765), surgeon volume <200 cases (OR 1.881, 95% CI 1.120-3.159) and a preoperative PSA >10 ng/ml (OR 3.674, 95% CI 1.379-9.796) remained independent prognostic factors. In a subgroup of patients undergoing a nerve-sparing RARP, the quality of the prostate biopsy (OR 2.398, 95% CI 1.325-4.341) was the sole independent risk factor for a PSM. Conclusion: An elevated preoperative PSA, surgical experience and a nerve-sparing procedure are all significantly associated with a higher risk for a PSM after RARP. For those undergoing a nerve sparing RARP, an accurate preoperative biopsy with detailed information on the location of positive cores is essential to prevent PSMs.

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Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy

Goldin¹,

Sheets²,

Meyer³

et al. 2013

JAMA Intern Med

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Importance: Comparative effectiveness research of prostate cancer therapies is needed because of the development and rapid clinical adoption of newer and costlier treatments without proven clinical benefit. Radiotherapy is indicated after prostatectomy in select patients who have adverse pathologic features and in those with recurrent disease.Objectives: To examine the patterns of use of intensitymodulated radiotherapy (IMRT), a newer, more expensive technology that may reduce radiation dose to adjacent organs compared with the older conformal radiotherapy (CRT) in the postprostatectomy setting, and to compare disease control and morbidity outcomes of these treatments.Design and Setting: Data from the Surveillance, Epidemiology, and End Results-Medicare-linked database were used to identify patients with a diagnosis of prostate cancer who had received radiotherapy within 3 years after prostatectomy.Participants: Patients who received IMRT or CRT. Main Outcomes and Measures:The outcomes of 457 IMRT and 557 CRT patients who received radiotherapy between 2002 and 2007 were compared using their claims through 2009. We used propensity score methods to balance baseline characteristics and estimate adjusted incidence rate ratios (RRs) and their 95% CIs for measured outcomes.Results: Use of IMRT increased from zero in 2000 to 82.1% in 2009. Men who received IMRT vs CRT showed no significant difference in rates of long-term gastrointestinal morbidity (RR, 0.95; 95% CI, 0.66-1.37), urinary nonincontinent morbidity (0.93; 0.66-1.33), urinary incontinence (0.98; 0.71-1.35), or erectile dysfunction (0.85; 0.61-1.19). There was no significant difference in subsequent treatment for recurrent disease (RR,1.31; 95% CI, 0.90-1.92).Conclusions and Relevance: Postprostatectomy IMRT and CRT achieved similar morbidity and cancer control outcomes. The potential clinical benefit of IMRT in this setting is unclear. Given that IMRT is more expensive, its use for postprostatectomy radiotherapy may not be cost-effective compared with CRT, although formal analysis is needed.

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Do Margins Matter? The Prognostic Significance of Positive Surgical Margins in Radical Prostatectomy Specimens

Cited by 351 publications

References 20 publications

The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy

Comparative Effectiveness of Intensity-Modulated Radiotherapy and Conventional Conformal Radiotherapy in the Treatment of Prostate Cancer After Radical Prostatectomy

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