Prognostic Significance of Positive Surgical Margins in Radical Prostatectomy Specimens

Abstract

Prognosis was adversely affected by positive surgical margins only in moderately differentiated cancers with extracapsular extension alone. If the cancer is otherwise confined, positive surgical margins are associated with an excellent prognosis unlikely to be improved by adjuvant therapy.

Adverse prognostic impact of capsular incision at radical prostatectomy for Japanese men with clinically localized prostate cancer

“…As shown in Table 4, the incidences of capsular incision noted in pT2 disease varies widely ranging from approximately 2 to 40% in the literature [6][7][8][9][10]. In this series, capsular incision was detected in 19.9% of patients with pathologically confirmed pT2 prostate cancer, which is relatively high compared with those in previous series.…”

“…We initially would like to emphasize various definitions of capsular incision used in previous studies. As in the present study, some studies defined capsular incision as margin positive and pathologically organ-confined disease, where the surgeon inadvertently developed the resection plane within rather than exterior to the prostate; hence, these studies regarded not only exposed tumor tissues but also adjacent benign glands as capsular incision [6,8,9,11]. Others broadened the definition to that including other equivocal margins [10,12].…”

“…Of several factors identified as prognostic predictors following RP, surgical margin status is the only factor that can be affected by surgical technique of an individual surgeon [2][3][4]. Positive surgical margin could also occur even if tumor tissue is localized within the prostate by iatrogenic capsular incision at RP [5]; however, it remains controversial whether capsular incision influences the prognosis of patients with prostate cancer treated with RP [5][6][7][8][9][10]. For example, Barocas et al [5] did not show significant difference in the likelihood of early recurrence between isolated capsular incision and other specimen-confined disease, while Shuford et al [10] reported that the presence of capsular incision has a prognostic impact similar to pT3a disease with positive surgical margin.…”

“…In this series, recurrence-free survival in patients with capsular incision was significantly poorer than that in those without capsular incision, and despite the lack of independent significance, capsular incision was identified as one of the significant factors predicting time to biochemical recurrence. However, the previous data associated with the prognostic impact of capsular incision are conflicting [6][7][8][9][10] (Table 4). For example, Shuford et al [10] reported that patients with capsular incision were greater than 8-and 6-times more likely to have biochemical recurrence than those with pT2 and pT3a disease without capsular incision, respectively, whereas there was no adverse prognostic effect of capsular incision in the studies by Ohori et al [6].…”

“…Although several studies have presented data on patients with capsular incision [5][6][7][8][9][10][11][12][13], only a few studies have addressed the prognostic outcome of patients with capsular incision, and these findings remain controversial [5][6][7][8][9][10]. Accordingly, in order to clarify the prognostic significance of capsular incision at RP, we retrospectively reviewed the clinicopathological outcomes in 267 Japanese men with clinically localized prostate cancer who underwent RP according to whether capsular incision was detected or not in RP specimens.…”