Does Gleason score of positive surgical margin after radical prostatectomy affect biochemical recurrence and oncological outcomes? Protocol for systematic review

Abstract

IntroductionPositive surgical margins (PSM) in cancer patients are commonly associated with worse prognosis and a higher risk of secondary treatment. However, the relevance of this parameter in prostate cancer patients undergoing radical prostatectomy (RP) remains controversial, given the inconsistencies in its ability to predict biochemical recurrence (BCR) and oncological outcomes. Hence, further assessment of the utility of surgical margins for prostate cancer prognosis is required to predict these outcomes more accurately. Over the last decade, studies have used the Gleason score (GS) of positive margins to predict outcomes. Herein, the authors aim to conduct a systematic review investigating the role of GS of PSM after radical prostatectomy in predicting BCR and oncological outcomes.Methods and analysisWe will perform a search using MEDLINE, EMBASE, SCOPUS and COCHRANE databases. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will screen titles and abstracts to select articles appropriate for full-text review. Studies discussing GS of PSM after RP will be included. Given the change in reporting of GS, only articles from 2005 to 2019 will be included. The quality of the studies chosen will be assessed using the Newcastle Ottawa tool for non-randomised and Cochrane risk of bias for randomised control studies. We will adopt the grading of recommendations, assessment, development and evaluation framework to comment on quality of cumulative evidence. The primary outcome measure will be time to BCR. Secondary outcome measures include secondary treatment, disease-specific survival, disease progression-free and overall mortality at follow-up period. We aim to perform a meta-analysis if the level of heterogeneity is acceptable (I2<50%).Ethics and disseminationThe review does not require ethics approval as it is a review of published literature. The findings of the review will be submitted for peer-reviewed publications and presented at scientific meetings.PROSPERO registration numberCRD42019131800.

The effect of the discrepancy between pre- and post-operative staging on decision-making and quality of life in men undergoing a radical prostatectomy

“…The usefulness of PSA and the Gleason score has been widely validated as pre-treatment prognostic markers [19]. In addition to these factors, other authors have highlighted how positive surgical margins after RP are in predicting the risk of biochemical recurrence and estimate oncological targets [47]. Although clinical staging has been found to be a good independent estimator of disease progression, there is a tendency to underestimate the final pathological stage at diagnosis [41].…”

Primary Gleason grade and Gleason grade group at positive surgical margins: a systematic review and meta‐analysis

“…Given the change in Gleason reporting in 2005 based on the ISUP Consensus Conference guidelines, the review only included studies published between 1 January 2005 and 31 October 2019 [13]. The search period was expanded by 1 month compared to the initial protocol published to include additional publications [14]. A further comprehensive literature search was also performed by examining the reference lists of included studies identified from the search.…”

“…A further comprehensive literature search was also performed by examining the reference lists of included studies identified from the search. The protocol was registered with the International Prospective Register of Systematic Reviews Database (CRD42019131800) and published [14]. Search terms were identified and adjusted to match the requirements of each database with the assistance of a librarian (Table S1).…”