Post–radical prostatectomy management options for the positive surgical margin: Argument for adjuvant radiotherapy

Chin, Joseph L.

doi:10.1016/j.urolonc.2008.04.005

Cited by 6 publications

(3 citation statements)

References 13 publications

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“…PSM suggests the presence of remnant cancer in the prostate bed, whether viable or not [19, 20]. It is recognized as a strong predictive factor for BCR, and attempting regional control with radiotherapy is known to yield favorable results [21]. Along with PSM, LVI is reported to increase BCR as well in T3 patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin

et al. 2017

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BackgroundThe association between lymphovascular invasion and lymphatic or hematogenous metastasis has been suspected, with conflicting evidence. We have investigated the association between the risk of biochemical recurrence and lymphovascular invasion in resection margin negative patients, as well as its association with lymph node metastasis.MethodsOne thousand six hundred thirty four patients who underwent radical prostatectomy from 2005 to 2014 were selected. Patients with bone or distant organ metastasis at the time of operation were excluded. Survival analysis was performed to assess biochemical recurrence, metastasis and mortality risks by Kaplan-Meier analysis and multivariate Cox proportional hazard regression. Odds of lymph node metastasis were evaluated by Logistic regression.ResultsLVI was detected in 118 (7.4%) patients. The median follow-up duration was 33.1 months. In the Kaplan-Meier analysis, lymphovascular invasion was associated with significantly increased 5-year and 10-year BCR rate (60.2% vs. 39.1%, 60.2% vs. 40.1%, respectively; p < 0.001), 10-year bone metastasis rate and cancer specific mortality (16.9% vs. 5.1%, p = 0.001; 6.8% vs. 2.7%, p = 0.034, respectively) compared to patients without LVI. When stratified by T stage and resection margin status, lymphovascular invasion resulted in significantly increased 10-year biochemical recurrence rate in T3 patients both with and without positive surgical margin (p = 0.008, 0.005, respectively). In the multivariate Cox regression model lymphovascular invasion resulted in 1.4-fold BCR risk and 1.7-fold metastasis risk increase (95% CI 1.045–1.749, 1.024–2.950; p = 0.022, 0.040, respectively). Lymphovascular invasion was revealed to be strongly associated with lymph node metastasis in the multivariate Logistic regression (OR 4.317, 95% CI 2.092–8.910, p < 0.001).ConclusionLymphovascular invasion increases the risk of recurrence in T3 patients regardless of margin status, by accelerating lymph node metastasis and distant organ metastasis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-017-3307-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin

et al. 2017

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“…Positive surgical margins (PSMs) are associated with a 3.7 times greater risk of prostate cancer recurrence [3] and have significant implications in patients with otherwise organ‐confined disease [4]. Despite the advances in prostate surgery, once a patient with organ‐confined disease has a PSM, his/her prognosis is similar to those with extracapsular extension of prostate carcinoma with or without PSMs [5,6].…”

Section: Introductionmentioning

confidence: 99%

Cumulative summation graphs are a useful tool for monitoring positive surgical margin rates in robot‐assisted radical prostatectomy

et al. 2010

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Study Type – Therapy (case series)  Level of Evidence 4 What’s known on the subject? and What does the study add? Whilst the technique of robot‐assisted radical prostatectomy has rapidly been adopted by surgeons there is little information on techniques used for quality control when a surgeon is learning this new surgical technique. Cummulative summation graphs have been used in cardiothoracic surgery to monitor complications with good effect and have been shown to be useful in monitoring outcomes from cystectomy. We demonstrate that using the technique of cumulative summation graphs a surgeon can monitor their progress prospectively through a learning curve without having to wait to perform a retrospective analysis. This study demonstrates that margin positive rates in radical prostatectomy can be monitored in real time and adjustments in technique applied to allow a surgeon to continually monitor and improve their surgical results. OBJECTIVE • To explore the usefulness of cumulative summation (CUSUM) graphs for monitoring positive surgical margin (PSM) rates during a surgeon’s transition from open to robot‐assisted radical prostatectomy (RARP). PATIENTS AND METHODS • Data were prospectively collected from patients undergoing RARP by a single surgeon. • Preoperatively all patients were either low or moderate risk under the D’Amico classification system. • A CUSUM graph was charted retrospectively to analyse the PSM rate in patients undergoing RARP for pathological stage T2 (pT2) disease. • Acceptable and unacceptable PSM rates were set at 10% and 15% respectively. RESULTS • From a cohort of 226 patients, 158 patients with pT2 disease were selected. The mean (range) age of these patients was 59.2 (39–73) years, the median (range) Gleason score was 6 (4–9), the mean (range) PSA was 6.43 (0.52–17.5) ng/mL and the mean (range) prostate volume was 44 (18–120) cm3. In all, 21 patients had PSMs (13%). • CUSUM graphs were produced and clearly demonstrated the change in PSM rate over time. CONCLUSION • CUSUM graphs are a novel and useful visual representation of the learning curve for surgeons. • PSM rates in patients with pT2 disease are a good outcome to monitor using CUSUM graphs as they are binary and lack the confounding factors associated with other outcomes such as continence and erectile dysfunction. • We advocate the use of CUSUM graphs as a method of quality assurance with the introduction of a robotics programme.

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“…The overall results of randomized series, including a series with 385 participants from Germany published only in abstract form thus far, 3 indicate a 20%-50% reduction in risk of prostate-specific antigen (PSA) relapse and disease recurrence, with improved biochemical progression-free survival and local control. On meta-analysis of 1743 patients from the 3 randomized trials, ART resulted in improved biochemical progression-free survival (HR = 0.47, p < 0.001) and deferred requirement for adjuvant therapies (radiation and androgen ablation) with their associated adverse effects.…”

Section: Evidence From Randomized Controlled Trialsmentioning

confidence: 99%

Salvage versus adjuvant radiotherapy after radical prostatectomy: argument for adjuvant radiotherapy

Chin

2013

CUAJ

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Post–radical prostatectomy management options for the positive surgical margin: Argument for adjuvant radiotherapy

Cited by 6 publications

References 13 publications

Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin

Impact of lymphovascular invasion on lymph node metastasis for patients undergoing radical prostatectomy with negative resection margin

Cumulative summation graphs are a useful tool for monitoring positive surgical margin rates in robot‐assisted radical prostatectomy

Salvage versus adjuvant radiotherapy after radical prostatectomy: argument for adjuvant radiotherapy

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