Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy

Abstract

This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer diagnosed by prostate biopsy, and eventually treated with laparoscopic radical prostatectomy. The prognostic impact of age, prostate volume, preoperative prostate-specific antigen, biopsy Gleason score, maximum percentage tumor per core, number of positive cores, biopsy perineural invasion, capsule invasion on imaging, and tumor laterality on surgical margin was assessed. The overall positive surgical margin rate was 29.1%. Gleason score, number of positive cores, perineural invasion, tumor laterality in the biopsy specimen, and prostate volume significantly correlated with risk of positive surgical margin by univariate analysis (P < 0.05). Gleason score (odds ratio [OR] = 2.286, 95% confidence interval [95% CI] = 1.431–3.653, P = 0.001), perineural invasion (OR = 4.961, 95% CI = 2.656–9.270, P < 0.001), and number of positive cores (OR = 4.403, 95% CI = 1.878–10.325, P = 0.001) were independent predictors of positive surgical margin at the multivariable logistic regression analysis. Patients with perineural invasion, higher biopsy Gleason scores and/or a large number of positive cores in biopsy pathology had more possibility of capsule invasion. The positive surgical margin rate in patients with capsule invasion (49.5%) was much higher than that with localized disease (17.8%). In contrast, prostate volume showed a protective effect against positive surgical margin (OR = 0.572, 95% CI = 0.346–0.945, P = 0.029). Gleason score, perineural invasion, and number of positive cores in the biopsy specimen were preoperative independent predictors of positive surgical margin after laparoscopic radical prostatectomy while prostate volume was a protective factor against positive surgical margin.

Development and validation of a preoperative nomogram for predicting positive surgical margins after laparoscopic radical prostatectomy

“…In the meta-analysis conducted by Novara et al , [16] the mean PSM rate was 15%. However, Xu et al [24] and Yang et al [25] reported PSM rates of 44.2% and 29.1% in the Chinese population, which were comparable to our study. There are several possible reasons.…”

“…Tuliao et al 's study [20] suggested that the number of preoperative positive biopsy cores was a predictor of PSM. Yang et al [25] reported that PSM was more common in patients with a more positive core number and bilateral positive cores.…”

The association between prostate weight and positive surgical margins in prostate cancer: A meta‐analysis

“…It was worth noting that the higher risks of PSMs noted in patients with small prostates were correlated with tumour volume (TV), grade and extraprostatic extension (EPE) (Hong, Poon, Sjoberg, Scardino, & Eastham, 2014;Yadav et al, 2009;Yang et al, 2017).…”

“…The dose-response analysis between prostate weight and the risk of positive surgical margins pathologic characteristics by conducting a comparison of men with PW of ≥100 g and of <20 g, and indicated that older men with larger PW were more likely to have lower risks of seminal vesicle invasion than younger counterparts. Several studies found that greater biopsy Gleason scores and prostate-specific antigen (PSA) level both had positive associations with PSMs (Liss, Osann, & Ornstein, 2008;Yang et al, 2017). Nevertheless, there was a controversy in leadtime bias that patients with larger prostates had their cancers detected early based on biopsy PSA level, most probably due to an enlarged prostate gland (Foley et al, 2003).…”

Perineural invasion, Gleason score and prostate specific antigen; is there any association?

“…Journal of Nephropathology, Vol 8, No 4, October 2019 www.nephropathol.com 2 the invasion has been found to be in relation with PSA levels (2,9,10).…”