Positive surgical margins with radical retropubic prostatectomy: anatomic site-specific pathologic analysis and impact on prognosis

Öbek, Can; Sadek, Samih; Lai, Shenghan; Civantos, Francisco; Rubinowicz, Diego; Soloway, Mark S.

doi:10.1016/s0090-4295(99)00204-6

Cited by 138 publications

(106 citation statements)

References 24 publications

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“…This rate can be further decreased by obtaining intra-operative frozen sections and resecting any residual tissue. Our final positive margin status of 0% at the bladder neck is improved from other reports Table-3 (2,3,12). There was no significant relationship between positive bladder neck margin and any preoperative factors, thus we found it difficult to predict preoperatively who would have a positive bladder neck margin.…”

Section: Commentscontrasting

confidence: 47%

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Positive surgical margins at radical prostatectomy: importance of intra-operative bladder neck frozen sections

et al. 2007

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Objective: To determine if intraoperative frozen sections of the bladder neck during radical prostatectomy (RP) could decrease the incidence of final positive surgical margins at the bladder neck. Materials and Methods:This prospective cohort study included 51 consecutive men who underwent anatomic RP at University of Florida & Shands Jacksonville. All patients had intraoperative frozen section of bladder neck sent for analysis. Preoperative, operative, and postoperative data were collected and analyzed. Main Outcome Measures: Outcome measures were intraoperative bladder neck margin status, final pathologic bladder neck margin status, and postoperative urinary complications. Median follow-up for the 51 patients was 22 months. Results: The final positive surgical margin rate was 20% (10 patients). An additional three patients had positive surgical margins at the bladder neck intraoperatively. These patients then had a wider resection of the affected bladder neck until the frozen sections were negative for cancer or prostatic tissue. Final pathologic evaluation of bladder neck margin was negative for tumor or persistent prostatic tissue in all 51 men. Conclusion: With intra-operative frozen sections, we were able to obtain a negligible positive bladder neck margin rate. Surgeons who are still on the learning curve for RP should consider intra-operative frozen section of the bladder neck.

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Section: Commentscontrasting

confidence: 47%

“…One of the oncologic outcomes routinely assessed is surgical margins. The most frequent site of a positive margin is the apex, followed by the posterolateral, anterior, and bladder neck (2). Incompletely resected cancers (i.e., positive surgical margin or positive lymph nodes) are at increased risk of treatment failure (3).…”

Section: Introductionmentioning

confidence: 99%

Positive surgical margins at radical prostatectomy: importance of intra-operative bladder neck frozen sections

et al. 2007

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“…5 Biochemical recurrence may occur in up to 35% of men within 10 years following radical prostatectomy. 19 Additional studies have reported a 15% biochemical recurrence rate after a median followup of 5 years, 20 a 13% recurrence rate at 2 years, 21 or 22% at 5 years. 22 Of those men with biochemical recurrence, 34% will ultimately develop metastatic disease.…”

Section: Discussionmentioning

confidence: 99%

Maximum tumor diameter is an independent predictor of prostate-specific antigen recurrence in prostate cancer

et al. 2005

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Maximum tumor diameter has been shown to correlate with multiple predictors of clinical outcome in prostate cancer. In the current study, we prospectively analyze whether maximum tumor diameter is a significant predictor of prostate-specific antigen (PSA) recurrence. The study population consisted of 364 patients who underwent radical prostatectomy for prostate cancer. Prostatectomy specimens were evaluated by wholemount processing of the entire prostate. Maximum tumor diameter was measured from the whole-mount sections of the prostate. Spearman's coefficient of rank correlation was used to correlate tumor diameter with continuous variables. T-tests or analysis of variance (ANOVA) tests were performed to determine if tumor diameter was significantly associated with other clinical and pathologic variables. The effect of clinical and pathologic variables on time to recurrence was analyzed using Cox regression. The mean tumor diameter for all patients was 1.73 cm (range, 0.02-4.40 cm). Maximum tumor diameter was associated with preoperative PSA (r ¼ 0.22, Po0.0001), prostate weight (r ¼ À0.12, P ¼ 0.028), tumor volume (r ¼ 0.87, Po0.0001), Gleason score (r ¼ 0.29, Po0.0001), and pathologic stage (Po0.0001). Cox multiple regression was performed to test the prognostic value of maximum tumor diameter adjusting for pathologic stage, Gleason score, and surgical margin status. Increased maximum tumor diameter was associated with shorter time to PSA recurrence (hazard ratio ¼ 1.70, 95% confidence interval 1.13-2.56, P ¼ 0.01), controlling for risk factors, Gleason score, and surgical margin status. We conclude that maximum tumor diameter is a significant predictor of biochemical recurrence in patients with prostate cancer. Modern Pathology (2005) 18, 886-890.

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“…3 been corroborated by other workers. 2 Obek et al 24 concluded that positive margins at multiple sites, bladder neck or the posterolateral surface of the prostate increased the risk of disease progression. Other authors have confirmed the significantly increased risk of biochemical recurrence associated with a positive posterolateral margin.…”

Section: Location Of Positive Surgical Marginsmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

et al. 2011

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The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

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Positive surgical margins with radical retropubic prostatectomy: anatomic site-specific pathologic analysis and impact on prognosis

Cited by 138 publications

References 24 publications

Positive surgical margins at radical prostatectomy: importance of intra-operative bladder neck frozen sections

Positive surgical margins at radical prostatectomy: importance of intra-operative bladder neck frozen sections

Maximum tumor diameter is an independent predictor of prostate-specific antigen recurrence in prostate cancer

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

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