Prognostic Significance of Location of Positive Margins in Radical Prostatectomy Specimens

Eastham, James A.; Kuroiwa, Kentaro; Ohori, Makoto; Serio, Angel M.; Gorbonos, Alex; Maru, Norio; Vickers, Andrew J.; Slawin, Kevin M.; Wheeler, Thomas M.; Reuter, Victor E.; Scardino, Peter T.

doi:10.1016/j.urology.2007.08.040

Cited by 181 publications

(158 citation statements)

References 18 publications

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“…The PSM location has been documented to have an impact on the prognosis [23,24,25]. Eastham et al [23] found that patients with a posterolateral PSM location had a higher risk of BCR, while Blute et al [24] and Aydin et al [25] demonstrated the same for a PSM location at the base.…”

Section: Discussionmentioning

confidence: 99%

The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

Servoll

Vlatkovic²,

Sæter

et al. 2014

Urol Int

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Objective: To establish predictors of clinical failure in patients operated with radical prostatectomy (RP) for clinically localized prostate cancer (PC) by analyzing the pathological characteristics of positive surgical margins (PSM). Patients and Methods: The RP specimens of 303 consecutive patients operated with RP between 1985 and 2009 were reviewed. PSM were analyzed with regard to the PSM length, location and multifocality and the Gleason score (GS) at the PSM. Results: Of the 163 patients with PSM, 79 (48%) progressed to clinical failure compared to 30 (22%) in the negative-margin-status group. In univariate analysis, a GS at the PSM ≥4 + 3 = 7 (p = 0. 013) and a PSM length >3.0 mm (p < 0.005) were significantly associated with higher clinical failure rates compared to a GS at the PSM ≤3 + 4 = 7 and ≤3.0 mm in extent, respectively. A linear extent of the PSM ≤3.0 mm appeared to have the same clinical outcome as in the group with a negative margin status. In multivariate analysis, a PSM length >3.0 mm remained an independent predictor of clinical failure. Conclusions: PSM length is an independent predictor of clinical failure following RP.

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Section: Discussionmentioning

confidence: 99%

The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

Servoll

Vlatkovic²,

Sæter

et al. 2014

Urol Int

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“…8,12,13,15,30 Such patients are therefore unlikely to benefit from immediate secondary prostate cancer treatment, which is not without attendant cost and treatment-related toxicity. 5 The potential multifactorial causality of positive margins, which may result from cancer extent, technical error (capsulotomy), surgical artifact or pathological processing, likely underlies the conflicting reports on the link between surgical margin status and subsequent patient outcome, both in terms of BCR rates 8,12,13,15,30 and SP. 9,21,22 Indeed, then, the continued debate around the optimal postoperative management of patients with a PSM is not surprising.…”

Section: Discussionmentioning

confidence: 99%

“…11,12 Moreover, the primary endpoint which reports on margin status have assessed has been biochemical recurrence (BCR). 1,7,8,[10][11][12][13][14][15] Importantly, the use of BCR as a clinical outcome measure remains questionable, as the natural history of BCR is variable. That is, although approximately 35% of patients experience PSA failure within 10 years following RRP, 16,17 BCR does not always translate into systemic progression (SP) and prostate cancer death.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

Boorjian

Tollefson

Rangel

et al. 2011

Prostate Cancer Prostatic Dis

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BACKGROUND: Although a positive surgical margin (PSM) at radical prostatectomy (RRP) has been consistently linked to an increased risk of biochemical recurrence, the impact of margin status on patient survival continues to be debated. We evaluated long-term outcomes of patients with a PSM at RRP and determined predictors of systemic progression (SP) and mortality in these men. METHODS:We reviewed our institutional registry of 16 749 patients who underwent RRP between 1990 and 2008 to identify 2895 patients with a PSM. Median follow-up was 10.6 years. Postoperative survival was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyze clinicopathological variables associated with SP and death from prostate cancer. RESULTS:A 15-year SP-free and cancer-specific survival was 90 and 93%, respectively. On multivariate analysis, higher tumor volume, increased pathological Gleason score and advanced pathological tumor stage were associated with significantly increased risks of SP and death from prostate cancer, whereas number and location of PSM did not predict mortality. CONCLUSIONS:The risks of SP and prostate cancer death in patients with a PSM remain low on long-term follow-up. Tumor variables are the primary determinants of cancer death. These results should be considered when evaluating patients with a PSM for adjuvant therapy.

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“…Other authors have confirmed the significantly increased risk of biochemical recurrence associated with a positive posterolateral margin. 25 Saether et al 5 reported a greater likelihood of postoperative PSA recurrence with positive margins at the anterior prostate and apex of the prostate on univariate analysis, but that this significance was lost when other risk factors were factored into the multivariate analysis. Somewhat in support of this, Sofer et al 26 noted that the location of surgical margin positivity did not independently predict biochemical recurrence.…”

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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Prognostic Significance of Location of Positive Margins in Radical Prostatectomy Specimens

Cited by 181 publications

References 18 publications

The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy

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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