Prognostic impact of positive surgical margins in surgically treated prostate cancer: Multi-institutional assessment of 5831 patients

Karakiewicz, Pierre I.; Eastham, James A.; Graefen, Markus; Cagiannos, Ilias; Stricker, Phillip D.; Klein, Eric A.; Cangiano, Thomas; Schröder, Fritz H.; Scardino, Peter T.; Kattan, Michael W.

doi:10.1016/j.urology.2005.06.108

Cited by 253 publications

(179 citation statements)

References 19 publications

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“…The positive margin rate in British Columbia in pT3 cases (57%) are also comparable to the range of regional rates seen in Ontario (42%-83%), 11 and within the ranges of rates reported in the literature (24%-80%). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In comparison to the recent large SEER series, need for, and use of, post prostatectomy radiotherapy our margin positive rates exceed those reported for SEER (18% for pT2, and 44% for pT3). 39 Unlike the SEER study, which was also population-based, our study detailed patient data on postoperative PSA, which allowed us to distinguish adjuvant and early salvage radiotherapy.…”

Section: Discussioncontrasting

confidence: 62%

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Tyldesley

Peacock

Morris

et al. 2012

CUAJ

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Introduction: Three randomized trials have demonstrated that post-radical prostatectomy (RP) radiotherapy decreases biochemical relapse for those with adverse pathology. Our purpose was to describe the incidence of pathologic risk factors for recurrence in a contemporary series of patients treated with RP and to describe the use of post-RP radiotherapy. Methods: All incident prostate cancers diagnosed between January 2005 and December 2007 were identified from the tumour registry. Cases were then linked to radiotherapy records which included dose and modality (external beam radiotherapy and brachytherapy). The pathology reports in the tumour registry were reviewed for pathologic stage, grade and margin status. Results: We identified 9223 patients with prostate cancer. Overall, 36.3% of patients treated with RP had positive margins, and may have benefited from adjuvant radiotherapy. After RP, 332 (15%) patients had radiotherapy to the prostate bed; of these, only 25 (1.1%) received truly adjuvant radiotherapy (delivered within 6 months with a prostate-specific antigen of <0.2 ng/mL). Of the 2181 patients treated with RP, 270 (12%) were seen by a radiation oncologist within 6 months of RP. Of the 1015 patients (47%) with adverse RP pathology (positive margins, extracapsular extension or seminal vesicle invasion), 230 (23%) were seen by a radiation oncologist within 6 months of RP. Conclusion: Not all patients with adverse prostatectomy pathology were seen by a radiation oncologist post-prostatectomy, and very few received adjuvant radiotherapy despite almost half of them having risk factors for relapse.

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Section: Discussioncontrasting

confidence: 62%

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Tyldesley

Peacock

Morris

et al. 2012

CUAJ

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“…Because the assessment of surgical margin does not require long-term follow-up, it provides a relatively “clean” end point for comparing varying operative approaches, one that is free from the complicated interplay of risk factors that can occur during long-term follow-up. Although surgical margin status has well-known limitations as an oncologic outcome, it has been shown in multiple RP studies to be an independent predictor of BCR that can help to guide the use of adjuvant or salvage therapies[30,31]. …”

Section: Comparison and Discussion Of Orp And Ralpmentioning

confidence: 99%

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Lowrance

Tarin

Shariat

2010

The Scientific World JOURNAL

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The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP) has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP). This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

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“…In the pooled data of RP among 8 institutions (22), the risk of PSA relapse was 19% at 10 years for pathologically organ-confined disease with negative surgical margins. The risk of PSA relapse increased substantially with the presence of extracapsular tumor extension, positive surgical margins, or the combination of both.…”

Section: E F I N I T I O N a N D P R E V A L E N C E O F P S A R E mentioning

confidence: 98%

Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges

Choo

2010

Cancer Res Treat

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Prognostic impact of positive surgical margins in surgically treated prostate cancer: Multi-institutional assessment of 5831 patients

Cited by 253 publications

References 19 publications

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges

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