Do Positive Surgical Margins Predict Biochemical Recurrence in All Patients Without Adjuvant Therapy After Radical Prostatectomy?

Lee, Jun Woo; Ryu, Jin-Sook; Kim, Yun Beom; Yang, Seung Ok; Lee, Jeong Kee; Jung, Tae Young

doi:10.4111/kju.2013.54.8.510

Cited by 10 publications

(11 citation statements)

References 24 publications

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“…PSMs may be caused not only by incomplete cancer excision, but also by inadvertent capsular incision during surgery, artifacts associated with tissue processing, and remnant normal prostatic tissue 6, 12. The incidence of PSMs is 10–60% 13, 14, 15. Our incidence was 34.7% in a single-surgeon series, comparable to previous data.…”

Section: Discussionsupporting

confidence: 81%

Correlation between postoperative prostate-specific antigen and biochemical recurrence in positive surgical margin patients: Single surgeon series

Seo

Kang

Yoon

et al. 2017

Prostate International

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BackgroundTo evaluate the relationship between postoperative prostate-specific antigen (PSA) levels and biochemical recurrence (BCR) after radical prostatectomy, especially in patients with positive surgical margins (PSMs).Materials and methodsA total of 144 patients who underwent radical prostatectomies performed by a single surgeon without any neoadjuvant or adjuvant treatment were analyzed. Differences in clinicopathological factors were compared by surgical margin status, and the relationship between postoperative PSA level and BCR in patients with PSMs was evaluated.ResultsFifty of the 144 patients (34.7%) had PSMs. Of these, 74% experienced BCR. The negative surgical margins and PSMs groups differed significantly in terms of PSA level at diagnosis, clinical T stage, and risk group by the cancer of the prostate risk assessment score (P = 0.002, P = 0.002, and P = 0.004, respectively). Also, the nadir PSA level, tumor volume, and BCR rate differed between the two groups (P = 0.007, P = 0.015, and P = 0.005, respectively) On Kaplan–Meier analysis, BCR-free survival was better in the negative surgical margins than the PSMs group (64.1 vs. 55.4 months, log-rank test, P = 0.011). BCR-free survival did not differ significantly in PSMs patients according to whether PSA level was or was not detectable at 1 month postoperatively. However, BCR-free survival improved when the nadir PSA level was undetectable (compared to detectable) in PSMs patients (64.3 vs. 26.1 months, log-rank test, P < 0.001). In PSMs patients belonging to the high risk group by cancer of the prostate risk assessment score, BCR-free survival was significantly better when the PSA level attained the nadir within 3 months, compared to > 6 months, postoperatively (64.2 vs. 29.5 months, log-rank test, P = 0.022).ConclusionIf PSA is detectable in PSMs patients until 1 month after operation, cautious observation may be possible. If the nadir is attained within 3 months postoperatively in high-risk patients with PSMs, better BCR-free survival may be expected.

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Section: Discussionsupporting

confidence: 81%

Correlation between postoperative prostate-specific antigen and biochemical recurrence in positive surgical margin patients: Single surgeon series

Seo

Kang

Yoon

et al. 2017

Prostate International

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“…39 Our overall rate of margin positivity was 26.79% (71/265). Overall rates reported in the literature vary greatly (6.7–45.5%), 12 13 40 41 42 presumably in part due to differing rates of extra capsular extension between studied cohorts. Assessing surgical margins relative to pathological T-stage, we found a PSM rate of 15.2% (26/170) in T2 disease, and 47.37% (45/95) in T3 disease.…”

Section: Discussionmentioning

confidence: 94%

“…This compares to literature reported rates of margin positivity in 6.8–34.24% of patients with pT2 disease, and in 23–71.8% of patients with pT3 disease. 14 35 37 41…”

Section: Discussionmentioning

confidence: 99%

Oncological Outcomes of Open Radical Retropubic Prostatectomy in Ireland: A Single Surgeon's 5-Year Experience

Croghan

Matanhelia

Foran

et al. 2018

Surg J

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Objectives There is a little published data on the outcomes of radical prostatectomy in the Irish context. We aimed to determine the 5-year oncological results of open radical retropubic prostatectomy (RRP) performed by a single surgeon following appointment. Methods A retrospective review of RRPs performed between 2011 and 2016 was conducted. Patient demographics, preoperative parameters (clinical stage on digital rectal exam, prostate-specific antigen (PSA) levels, biopsy Gleason's score and MRI [magnetic resonance imaging] findings), pathological variables (T-stage, Gleason's score, nodal status, and surgical margin status), and treatment decisions (lymphadenectomy or adjuvant radiotherapy) were recorded. Oncological outcome at last follow-up was ascertained. Results 265 patients underwent RRP between 2011 and 2016. Median age was 62 years (range: 41–74). Mean follow-up was 32.24 months (range: 8–72) months. Pathological disease stage was T2 in 170/265 (64.15%), T3a in 65/265 (24.53%), and T3b in 30/265 (11.32%). Final Gleason's score was upgraded from diagnostic biopsy in 16.35% (43/263) and downgraded in 27% (71/263). Pelvic lymph node dissection was performed in 44.25% (118/265) patients. A positive surgical margin (PSM) was seen in 26/170 (15.2%) patients with T2 disease and in 45/95 (47.37%) patients with T3 disease. Of the 265 patients, 238 (89.81%) were disease-free at last follow-up, of whom 24/238 (10.08%) had received adjuvant and 17/238 (7.14%) received salvage radiotherapy. Adjuvant/salvage treatment was ongoing in 19/265 (7.17%) of patients. Conclusion Good oncological outcomes of RRP in the Irish context are seen in this 5-year review, with the vast majority of patients experiencing biochemical-free survival at most recent follow-up.

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“…PCa is the fastest growing cancer in Korea . Compared with USA men, a significant proportion of PCa shows poor differentiation in Korean men, regardless of the preoperative serum PSA level or clinical stage …”

Section: Introductionmentioning

confidence: 99%

Predictors of positive surgical margins and their location in Korean men undergoing radical prostatectomy

et al. 2014

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Results:The preoperative prostate-specific antigen, prostate volume, biopsy Gleason scores and clinical stage were significantly associated with an increased risk of positive surgical margins. The predictive variables for positive apical margin were small prostate volume (less than 29 mL) and positive apical biopsy. There were no statistically significant predictors for positive posterolateral or basal margin. Positive apical biopsy was the predictor of positive apical margin in open (odds ratio 1.7, P = 0.009) and robotic prostatectomy (odds ratio 2.2, P = 0.041). Small prostate volume was the predictor of positive apical margin in open prostatectomy (odds ratio 1.6, P = 0.012), but for positive basal margin in robotic radical prostatectomy (odds ratio 4.5, P < 0.001). In survival analysis, positive basal margin showed worse prognoses on biochemical recurrence than positive apical margin. Conclusions: High prostate-specific antigen and small prostate volume are predictive factors of positive surgical margin in Korean patients undergoing radical prostatectomy. Apical positivity on extended transrectal biopsy represents a predictive factor of positive surgical margin. Small prostate volume is associated with higher risk of positive surgical margins at the apex in open radical prostatectomy and at the base in robotic-assisted laparoscopic radical prostatectomy.

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Do Positive Surgical Margins Predict Biochemical Recurrence in All Patients Without Adjuvant Therapy After Radical Prostatectomy?

Cited by 10 publications

References 24 publications

Correlation between postoperative prostate-specific antigen and biochemical recurrence in positive surgical margin patients: Single surgeon series

Correlation between postoperative prostate-specific antigen and biochemical recurrence in positive surgical margin patients: Single surgeon series

Oncological Outcomes of Open Radical Retropubic Prostatectomy in Ireland: A Single Surgeon's 5-Year Experience

Predictors of positive surgical margins and their location in Korean men undergoing radical prostatectomy

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