Estimated Costs Associated With Radiation Therapy for Positive Surgical Margins During Radical Prostatectomy

Martini, Alberto; Marqueen, Kathryn E.; Falagario, Ugo Giovanni; Waingankar, Nikhil; Wajswol, Ethan; Khan, Fahad; Fossati, Nicola; Briganti, Alberto; Montorsi, Francesco; Tewari, Ashutosh; Stock, Richard G.; Rastinehad, Ardeshir R.

doi:10.1001/jamanetworkopen.2020.1913

Cited by 16 publications

(20 citation statements)

References 31 publications

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“…Men with PSM are more likely to undergo additional treatments such as radiotherapy following RP. 2,4 This is associated with significant healthcare costs as well as potential morbidity. Also, not all of these men would benefit from this additional treatment.…”

Section: Discussionmentioning

confidence: 99%

“…2,7,8 However, as presented by the International Society of Urological Pathology (ISUP), Gleason 7 CaP is a heterogeneous group of patients, more usefully stratified into ISUP 2 and 3. 9 Therefore, we hypothesized that the prognostic value of PSMs pathological characteristics as classified by Martini et al 4,6 might be different in these patients. This study aims to investigate the impact of the extent and location of PSM on BCR, in a cohort of men with Gleason 7 (ISUP Groups 2 and 3) localized or locally advanced CaP.…”

Section: Introductionmentioning

confidence: 98%

“…3 The presence of a PSM often leads to additional treatments such as adjuvant radiotherapy. 2,4 This may improve cancer outcomes but can also contribute to treatment related morbidity as well as cost, which negatively influence the cancer survivors' journey.…”

Section: Introductionmentioning

confidence: 99%

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The impact of the extent and location of positive surgical margins on the risk of biochemical recurrence following radical prostatectomy in men with Gleason 7 prostate cancers

et al. 2021

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Background: Positive surgical margins (PSM) after radical prostatectomy (RP) have been associated with increased risk of biochemical recurrence (BCR). This is heavily influenced by other clinicopathological factors. This study aims to assess the impact of the extent and location of PSM on BCR following RP for Gleason 7 carcinoma of the prostate (CaP). Materials and Methods: All men treated with RP between 2008 and 2017 in our region for localized or locally advanced Gleason 7 CaP, were included. Clinical (age, year, preoperative prostate specific antigen) and pathological (prostate weight, positive or negative surgical margins, International Society of Urological Pathology [ISUP] grade, T stage) data were collected. PSM were subcategorised according to Extent into favourable (unifocal and <3 mm in length) or unfavourable (multifocal or≥3 mm in length), and Location into apical only or others. The outcome was the risk of BCR which was calculated with univariable and multivariable regression models and reported as hazard ratio (HR) with 95% confidence interval (CI). Results:The cohort constituted of 1433 men. Majority had ISUP 2 (71.2%) or localized (62%) disease. Men with PSM (n = 506) were at greater risk of BCR when compared to those with negative margins (adjusted HR = 1.52, [CI: 1.14-2.04], p = .005). Similar observation was demonstrated for both PSM location subgroups. As for the PSM extent category, only men with unfavourable PSM demonstrated an increase in BCR risk over negative margin (adjusted HR = 1.67, [CI: 1.23-2.28], p = .001).Conclusions: Within this study settings, PSM were generally associated with increased BCR risk. This, however, was not demonstrated in favourable PSM extent cases. Observation rather than active treatment in these men should be considered.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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The impact of the extent and location of positive surgical margins on the risk of biochemical recurrence following radical prostatectomy in men with Gleason 7 prostate cancers

et al. 2021

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“…Based on this rate (5-year BCR rate, 44%; 10-year BCR rate, 52%), we do not recommend regular aRT on all pT2+ conditions, for only half of them will experience BCR in 10 years following RARP. In addition to marginal benefits from aRT and controversies on improving cancer specific-free survival[ 26 ], the costs may be a bother to the other half with no recurrence[ 27 ].…”

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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“…Studies such as this highlight the need for clinicians to consider the entirety of the patient and to stratify risk according to tumor characteristics and clinical scenario before recommending adjuvant therapies after RP with a PSM.Although the oncological outcome is difficult to determine, PSMs often do lead to adjuvant therapy, specifically radiation therapy (RT). Martini and colleagues5 queried the US National Cancer Database to answer an important question regarding the financial outcomes of a PSM in terms of further treatment for prostate cancer. The authors specifically looked at the end point of adjuvant RT after prostatectomy.…”

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confidence: 99%

Financial Impact of Positive Surgical Margins During Radical Prostatectomy and the Odds of Receiving Adjuvant Radiation Therapy

Witthaus

Bloom

2020

JAMA Netw Open

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Estimated Costs Associated With Radiation Therapy for Positive Surgical Margins During Radical Prostatectomy

Cited by 16 publications

References 31 publications

The impact of the extent and location of positive surgical margins on the risk of biochemical recurrence following radical prostatectomy in men with Gleason 7 prostate cancers

The impact of the extent and location of positive surgical margins on the risk of biochemical recurrence following radical prostatectomy in men with Gleason 7 prostate cancers

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

Financial Impact of Positive Surgical Margins During Radical Prostatectomy and the Odds of Receiving Adjuvant Radiation Therapy

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