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John A, Lim A, Catterwell R, Selth L, O'Callaghan M. Length of positive surgical margins after radical prostatectomy: Does size matter? - A systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26:673-680. [PMID: 36859711 PMCID: PMC10638086 DOI: 10.1038/s41391-023-00654-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES The prognostic capacity of positive surgical margins (PSM) for biochemical recurrence (BCR) is unclear, with inconsistent findings across published studies. We aimed to systematically review and perform a meta-analysis exploring the impact of Positive surgical margin length on biochemical recurrence in men after radical prostatectomy. METHODS A search was conducted using the MEDLINE, Scopus, Embase and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of the studies was assessed using the Newcastle-Ottawa scale, and the protocol was registered in advance (PROSPERO: CRD42020195908). This meta-analysis included 16 studies with BCR as the primary outcome measure. RESULTS Studies used various dichotomised thresholds for PSM length. A subgroup meta-analysis was performed using the reported multivariable hazard ratio (Continuous, 3, and 1 mm PSM length). PSM length (continuous) was independently associated with an increased risk of BCR (7 studies, HR 1.04 (CI 1.02-1.05), I2 = 8% p < 0.05). PSM length greater than 3 mm conferred a higher risk of BCR compared to less than 3 mm (4 studies, HR 1.99 (1.54-2.58) I2 = 0%, p < 0.05). There was also an increased risk of BCR associated with PSM length of less than 1 mm compared to negative surgical margins (3 studies, HR 1.46 (1.05-2.04), I2 = 0%, P = 0.02). CONCLUSION PSM length is independently prognostic for BCR after radical prostatectomy. Further long-term studies are needed to estimate the impact on systemic progression.
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Affiliation(s)
- Athul John
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia.
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
| | - Alicia Lim
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Rick Catterwell
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Luke Selth
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute (FHMRI) and Freemasons Centre for Male Health and Wellbeing, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael O'Callaghan
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute (FHMRI) and Freemasons Centre for Male Health and Wellbeing, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Urology, Southern Adelaide Local Health Network, South Australia Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia, Australia
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Beckmann KR, O'Callaghan ME, Vincent AD, Moretti KL, Brook NR. Clinical outcomes for men with positive surgical margins after radical prostatectomy-results from the South Australian Prostate Cancer Clinical Outcomes Collaborative community-based registry. Asian J Urol 2023; 10:502-511. [PMID: 38024435 PMCID: PMC10659979 DOI: 10.1016/j.ajur.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 10/14/2022] Open
Abstract
Objective Positive surgical margins (PSMs) after radical prostatectomy (RP) indicate failure of surgery to completely clear cancer. PSMs confer an increased risk of biochemical recurrence (BCR), but how more robust outcomes are affected is unclear. This study investigated factors associated with PSMs following RP and determined their impact on clinical outcomes (BCR, second treatment [radiotherapy and/or androgen deprivation therapy], and prostate cancer-specific mortality [PCSM]). Methods The study cohort included men diagnosed with prostate cancer (pT2-3b/N0/M0) between January 1998 and June 2016 who underwent RP from the South Australian Prostate Cancer Clinical Outcomes Collaborative database. Factors associated with risk of PSMs were identified using Poisson regression. The impact of PSMs on clinical outcomes (BCR, second treatment, and PCSM) was assessed using competing risk regression. Results Of the 2827 eligible participants, 28% had PSMs-10% apical, 6% bladder neck, 17% posterolateral, and 5% at multiple locations. Median follow-up was 9.6 years with 81 deaths from prostate cancer recorded. Likelihood of PSM increased with higher pathological grade and pathological tumor stage, and greater tumour volume, but decreased with increasing surgeon volume (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.88-0.98, per 100 previous prostatectomies). PSMs were associated with increased risk of BCR (adjusted sub-distribution hazard ratio [sHR] 2.5; 95% CI 2.1-3.1) and second treatment (sHR 2.9; 95% CI 2.4-3.5). Risk of BCR was increased similarly for each PSM location, but was higher for multiple margin sites. We found no association between PSMs and PCSM. Conclusion Our findings support previous research suggesting that PSMs are not independently associated with PCSM despite strong association with BCR. Reducing PSM rates remains an important objective, given the higher likelihood of secondary treatment with associated comorbidities.
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Affiliation(s)
- Kerri R. Beckmann
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
- Translational Oncology and Urology Research, Division of Pharmaceutical and Cancer Studies, Kings College London, London, UK
| | - Michael E. O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia
| | - Andrew D. Vincent
- The Freemason's Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Kim L. Moretti
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia
- Discipline of Surgery, University of Adelaide, Adelaide, Australia
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Panunzio A, Sorce G, Hoeh B, Hohenhorst L, Tappero S, Nimer N, Rajwa P, Tian Z, Terrone C, Chun FKH, Briganti A, Saad F, Shariat SF, Cerruto MA, Antonelli A, Karakiewicz PI. Effect of positive surgical margins at radical prostatectomy on cancer-specific mortality in high/very high-risk prostate cancer patients with Gleason Grade Group 4-5. Prostate 2023; 83:268-276. [PMID: 36336728 DOI: 10.1002/pros.24458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/18/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of positive surgical margins (PSM) on cancer specific mortality (CSM) in high/very high-risk (HR/VHR) prostate cancer (PCa) with aggressive Gleason Grade Group (GGG) is unknown. We tested PSM effect on CSM in this setting, in addition to testing of radiotherapy (RT) benefit in PSM patients. METHODS We relied on Surveillance, Epidemiology, and End Results database (2010-2015), focusing on HR/VHR patients with exclusive GGG 4-5 at radical prostatectomy (RP). Kaplan-Meier plots and multivariable Cox regression models tested the relationship between PSM and CSM. Moreover, the effect of RT on CSM was explored in PSM patients. RESULTS Of 3383 HR/VHR patients, 15.1% (n = 511) exhibited PSM. Patients with PSM harbored higher rates of GGG 5 (60.1% vs. 50.9%, p < 0.001), pathologic tumor stage T3a (69.1% vs. 45.2%, p < 0.001) and lymph node involvement (14.1% vs. 9.4%, p < 0.001), relative to patients without PSM. PSM rates decreased over time (2010-2015) from 16.0% to 13.6%. Seven-year CSM-free survival rates were 91.6% versus 95.7% in patients with and without PSM, respectively. In multivariable Cox regression models, PSM was an independent predictor of CSM (hazard ratio = 1.6, p = 0.040) even after adjustment for age, prostate specific antigen, pathologic tumor stage and lymph node status. Finally, in PSM patients, RT delivery did not reduce CSM in either univariable or multivariable Cox regression models. CONCLUSIONS In HR/VHR PCa patients with exclusive GGG 4-5, PSM at RP adversely affect survival. Moreover, RT has no protective effect on CSM. In consequence, lowest possible PSM rates are crucial in such patients.
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Affiliation(s)
- Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Nancy Nimer
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York City, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Sasaki T, Ebara S, Tatenuma T, Ikehata Y, Nakayama A, Kawase M, Toide M, Yoneda T, Sakaguchi K, Teishima J, Makiyama K, Kitamura H, Saito K, Koie T, Koga F, Urakami S, Inoue T. Prognostic differences among the positive surgical margin locations following robot-assisted radical prostatectomy in a large Japanese cohort (the MSUG94 group). Jpn J Clin Oncol 2023; 53:443-451. [PMID: 36708227 DOI: 10.1093/jjco/hyad004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 01/10/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND To investigate whether subgroups of prostate cancer patients, stratified by positive surgical margin locations, have different oncological outcomes following robot-assisted radical prostatectomy. METHODS A retrospective multicenter cohort study in prostate cancer patients undergoing robot-assisted radical prostatectomy was conducted at 10 institutions in Japan. Pre- and post-operative outcomes were collected from enrolled patients. Biochemical recurrence and clinical and pathological variables were evaluated among subgroups with different positive surgical margin locations. RESULTS A total of 3195 patients enrolled in this study. Data from 2667 patients (70.1% [N = 1869] with negative surgical margins and 29.9% [N = 798] with positive surgical margins based on robot-assisted radical prostatectomy specimens) were analyzed. The median follow-up period was 25.0 months. The numbers of patients with apex-only, middle-only, bladder-neck-only, seminal-vesicle-only and multifocal positive surgical margins were 401, 175, 159, 31 and 32, respectively. In the multivariate analysis, PSA level at surgery, pathological Gleason score based on robot-assisted radical prostatectomy specimens, pathological T stage, pathological N stage and surgical margin status were independent risk factors significantly associated with biochemical recurrence-free survival. Patients undergoing robot-assisted radical prostatectomy with multifocal positive surgical margins and seminal-vesicle-only positive surgical margins were associated with worse biochemical recurrence-free survival than those with apex-only, middle-only and bladder-neck-only positive surgical margins. Patients undergoing robot-assisted radical prostatectomy with apex-only positive surgical margins, the most frequent positive surgical margin location, were associated with more favorable biochemical recurrence-free survival that those with middle-only and bladder-neck-only positive surgical margins. The study limitations included the lack of central pathological specimen evaluation. CONCLUSIONS Although positive surgical margin at any locations is a biochemical recurrence risk factor after robot-assisted radical prostatectomy, positive surgical margin location status should be considered to accurately stratify the biochemical recurrence risk after robot-assisted radical prostatectomy.
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Affiliation(s)
- Takeshi Sasaki
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Shin Ebara
- Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | | | - Akinori Nakayama
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tatsuaki Yoneda
- Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Jun Teishima
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, Kobe, Japan
| | | | | | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Mie, Japan
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Baba H, Sakamoto S, Zhao X, Yamada Y, Rii J, Fujimoto A, Kanesaka M, Takeuchi N, Sazuka T, Imamura Y, Akakura K, Ichikawa T. Tumor Location and a Tumor Volume over 2.8 cc Predict the Prognosis for Japanese Localized Prostate Cancer. Cancers (Basel) 2022; 14:cancers14235823. [PMID: 36497304 PMCID: PMC9740872 DOI: 10.3390/cancers14235823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Objective: Our study investigated the prognostic value of tumor volume and location in prostate cancer patients who received radical prostatectomy (RP). (2) Methods: The prognostic significance of tumor volume and location, together with other clinical factors, was studied using 557 patients who received RP. (3) Results: The receiver operating characteristic (ROC) curve identified the optimal cutoff value of tumor volume as 2.8 cc for predicting biochemical recurrence (BCR). Cox regression analysis revealed that a tumor in the posterior area (p = 0.031), peripheral zone (p = 0.0472), and tumor volume ≥ 2.8 cc (p < 0.0001) were predictive factors in univariate analysis. After multivariate analysis, tumor volume ≥ 2.8 cc (p = 0.0225) was an independent predictive factor for BCR. Among them, a novel risk model was established using tumor volume and location in the posterior area and peripheral zone. The progression-free survival (PFS) of patients who met the three criteria (unfavorable group) was significantly worse than other groups (p ≤ 0.001). Furthermore, multivariate analysis showed that the unfavorable risk was an independent prognostic factor for BCR. The prognostic significance of our risk model was observed in low- to intermediate-risk patients, although it was not observed in high-risk patients. (4) Conclusion: Tumor volume (≥2.8 cc) and localization (posterior/peripheral zone) may be a novel prognostic factor in patients undergoing RP.
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Affiliation(s)
- Haruki Baba
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
- Correspondence: ; Tel.: +81-43-226-2134; Fax: +81-43-226-2136
| | - Xue Zhao
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Yasutaka Yamada
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Junryo Rii
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Ayumi Fujimoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Manato Kanesaka
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Nobuyoshi Takeuchi
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Tomokazu Sazuka
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Yusuke Imamura
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
| | - Koichiro Akakura
- Department of Urology, Japan Community Health-Care Organization Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba 260-8670, Japan
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The Effect of Adverse Surgical Margins on the Risk of Biochemical Recurrence after Robotic-Assisted Radical Prostatectomy. Biomedicines 2022; 10:biomedicines10081911. [PMID: 36009458 PMCID: PMC9405399 DOI: 10.3390/biomedicines10081911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Positive surgical margins (PSM) after radical prostatectomy are associated with a greater risk of biochemical recurrence (BCR). However, not all PSM harbour the same prognosis for recurrence. We aim to determine the impact of different PSM characteristics and their coexistence on the risk of BCR. This retrospective study included 333 patients that underwent robotic-assisted radical prostatectomy for prostate cancer between 2015−2020 at a single institution. The effect of PSM and their adverse characteristics on the risk of BCR was assessed using Cox proportional hazard models. Kaplan−Meier was used to represent BCR-free survival stratified by margin status. With a median follow-up of 34.5 months, patients with PSM had a higher incidence of BCR, higher risk of relapse and lower BCR-free survival than negative margins (p < 0.001). We established as adverse characteristics: PSM length ≥ 3 mm, multifocality and Gleason at margin > 3. PSM ≥ 3 mm or multifocal PSM were associated with an increased risk for BCR compared to favourable margins (HR 3.50; 95% CI 2.05−5.95, p < 0.001 and HR 2.18; 95% CI 1.09−4.37, p = 0.028, respectively). The coexistence of these two adverse features in the PSM also conferred a higher risk for biochemical relapse and lower BCR-free survival. Adverse Gleason in the margin did not confer a higher risk for BCR than non-adverse margins in our models. We concluded that PSM are an independent predictor for BCR and that the presence of adverse characteristics, such as length and focality, and their coexistence in the PSM are associated with a greater risk of recurrence. Nevertheless, subclassifying PSM with adverse features did not enhance the model’s predictive performance in our cohort.
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Preisser F, Heinze A, S Abrams-Pompe R, Budäus L, Chun FKH, Graefen M, Huland H, Tilki D. Impact of positive surgical margin length and Gleason grade at the margin on oncologic outcomes in patients with nonorgan-confined prostate cancer. Prostate 2022; 82:949-956. [PMID: 35344221 DOI: 10.1002/pros.24341] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE Positive surgical margins (PSM) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality and the Gleason grade at the PSM, on the oncologic outcomes in nonorgan-confined RP patients. METHODS Within a high-volume center database, we identified patients who harbored non-organ-confined (pT3) prostate cancer (PCa) at RP between 2010 and 2016. Only patients without lymph node invasion were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of PSM on biochemical recurrence (BCR), metastasis, and cancer-specific death after RP in patients without adjuvant radiotherapy. RESULTS Overall, 3705 patients were identified. Of those, 27.2% (n = 1007) harbored PSM. At 96 months after RP, BCR-free, metastasis-free and cancer-specific survival was 41.6 versus 57.5%, 82.7 versus 88.6%, and 94.7 versus 98.5% for patients with versus without PSM (all p < 0.001). BCR-free, metastasis-free and cancer-specific survival rates at 96 months were 56.7 versus 26.5% (p < 0.001), 94.4 versus 67.4% (p < 0.001), and 100.0 versus 87.1% (p < 0.01) for Gleason pattern 3 versus ≥ 4 at the margin and 45.0 versus 27.8% (p < 0.01), 83.3 versus 82.3% (p = 0.2), and 95.2 versus 92.7% (p = 0.3) for <4 mm versus ≥4 mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (hazard ratio [HR]:1.53, p < 0.001) and cancer-specific death (HR:2.75, p = 0.02). In subgroups of patients with PSM only, Gleason ≥ 4 at the margin (HR:1.60, p < 0.01) and length of PSM (HR:1.02, p < 0.05) was an independent predictor of BCR. CONCLUSION PSM represents an independent predictor for worse oncologic outcome in nonorgan-confined PCa at RP. Gleason ≥ 4 at the margin was associated with the development of BCR, metastasis, and with cancer-specific death after RP. Next to margin status, Gleason at the margin and its length carry important information that should be reported for the specimen.
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Affiliation(s)
- Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Alexander Heinze
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | | | - Lars Budäus
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, Koc University Hospital, Istanbul, Turkey
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8
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Francolini G, Timon G, Matrone F, Marvaso G, Nicosia L, Ognibene L, Vinciguerra A, Trodella LE, Franzese C, Borghetti P, Jereczek-Fossa BA, Arcangeli S. Postoperative radiotherapy after upfront radical prostatectomy: debated issues at a turning point-a survey exploring management trends on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology). Clin Transl Oncol 2021; 23:2568-2578. [PMID: 34286475 DOI: 10.1007/s12094-021-02665-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/07/2021] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Postoperative prostate cancer patients are a heterogeneous population, and many prognostic factors (e.g., local staging, PSA kinetics, margin status, histopathological features) may influence their clinical management. In this complex scenario, univocal recommendations are often lacking. For these reasons, the present survey was developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of Italian radiation oncologists and delineate a representation of current clinical practice in our country. METHODS A questionnaire was administered online to AIRO (Italian Association of Radiotherapy and Clinical Oncology) members registered in 2020 with a clinical interest in uro-oncological disease. RESULTS Sixty-one per cent of AIRO members answered the proposed survey. Explored topics included career and expertise, indications to adjuvant RT, additional imaging in biochemical recurrence setting, use of salvage radiotherapy (SRT), management of clinically evident locoregional recurrence and future considerations. CONCLUSIONS Overall, good level of agreement was found between participants for most of the topics. Most debated issues regarded, as expected, implementation of new imaging methods in this setting. Notably, trend in favour of early SRT vs. immediate adjuvant RT was underlined, and preference for global evaluation rather than isolated risk factors for RT indications was noticed.
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Affiliation(s)
- G Francolini
- Radiotherapy Department, University of Florence, Florence, Italy.
| | - G Timon
- Radioterapia Oncologica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Matrone
- Department of Radiation Oncology, Centro di Riferimento, Oncologico di Aviano CRO-IRCCS, Aviano, PN, Italy
| | - G Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - L Nicosia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - L Ognibene
- Radiotheray Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy
| | - A Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100, Chieti, Italy
| | - L E Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - C Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
| | - P Borghetti
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - S Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
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Preisser F, Coxilha G, Heinze A, Oh S, Chun FKH, Sauter G, Pompe RS, Huland H, Graefen M, Tilki D. Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ-confined prostate cancer. Prostate 2019; 79:1832-1836. [PMID: 31553506 DOI: 10.1002/pros.23908] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/22/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Positive surgical margins (PSMs) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality, and the PSM Gleason, on biochemical recurrence (BCR) in organ-confined RP patients. METHODS Within a high-volume center database, we identified patients who harbored organ-confined (pathologic stage T2 disease) prostate cancer (PCa) at RP (2010-2016). Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of the PSM on the BCR risk. RESULTS Overall, 8770 patients were identified. Of those, 6.6% (n = 579) harbored PSM. BCR-free survival at 72 months after RP was 77.7% vs 89.0% for patients with vs without PSM (P < .001). BCR-free survival rates at 72 months were 77.4% vs 73.6% (P = .1) for unifocal vs multifocal PSM, 77.2% vs 71.8% (P = .03) for Gleason pattern 3 vs ≥4 at the margin and 88.4% vs 66.3% (P < .001) for <3 vs ≥3 mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (hazard ratio [HR] = 2.40, P < .001). However, in subgroups with PSM, only ≥3 mm PSM represented an independent predictor (HR = 1.93, P = .04), while focality and Gleason at the margin were no significant predictors. CONCLUSION PSM represents an independent predictor for BCR in organ-confined PCa at RP. Moreover, Gleason ≥4 at the margin and ≥3 mm PSM length were associated with worse BCR-free survival. Closer surveillance of patients with organ-confined PCa at RP and PSM can help to identify those who qualify for early salvage radiotherapy.
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Affiliation(s)
- Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Gilberto Coxilha
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Alexander Heinze
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Su Oh
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Guido Sauter
- Department of Pathology, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Raisa S Pompe
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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10
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Rates of Positive Surgical Margins and Their Effect on Cancer-specific Mortality at Radical Prostatectomy for Patients With Clinically Localized Prostate Cancer. Clin Genitourin Cancer 2019; 17:e130-e139. [DOI: 10.1016/j.clgc.2018.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022]
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11
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Marcq G, Michelet A, Hannink G, Rizk J, Sauvain J, Villers A, Saffarini M, Rochat CH. Risk of biochemical recurrence based on extent and location of positive surgical margins after robot-assisted laparoscopic radical prostatectomy. BMC Cancer 2018; 18:1291. [PMID: 30587172 PMCID: PMC6307117 DOI: 10.1186/s12885-018-5229-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 12/17/2018] [Indexed: 11/20/2022] Open
Abstract
Background There are no published studies on the simultaneous effect of extent and location of positive surgical margins (PSMs) on biochemical recurrence (BCR) after robot-assisted laparoscopic prostatectomy (RALP). The aim was to report the incidence, extent, and location of PSMs over the inclusion period as well as the rates of BCR and cancer-related mortality, and determine if BCR is associated with PSM extent and/or location. Methods Retrospective review of 530 consecutive patients who underwent RALP between 2003 and 2012. Kaplan-Meier (KM) survival analyses and Cox regressions were performed to determine variables associated with BCR. Results For the 530 operated patients, evaluated at a median of 92 months (IQR, 87–99), PSMs were observed in 156 (29%), of which 24% were focal. Out of 172 PSMs, 126 (73%) were focal and 46 (27%) were extensive. The KM survival using BCR as endpoint was 0.81 (CI, 0.78–0.85) at 5 years and was 0.67 (CI, 0.61–0.72) at 10 years; and using cancer-related mortality as endpoint was 0.99 (CI, 0.99–1.00) at 5 years and 0.95 (CI, 0.92–0.98) at 10 years. Multi-variable analysis revealed the strongest predictors of BCR to be Gleason score ≥ 8 (HR = 7.97; CI, 4.38–14.51) and 4 + 3 (HR = 3.88; CI, 2.12–7.07), lymph nodes invasion (HR = 3.42; CI, 1.70–6.91), pT stage 3b or 4 (HR = 3.07; CI, 1.93–4.90), and extensive apical PSMs (HR = 2.62; CI, 1.40–4.90) but not focal apical PSMs (HR = 0.86; CI, 0.49–1.50; p = 0.586). Conclusion Extensive apical PSMs significantly increased the risk of BCR, independently from pT stage, Gleason score and lymph nodes invasion, while focal apical PSMs had no significant effect on BCR. Electronic supplementary material The online version of this article (10.1186/s12885-018-5229-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Gautier Marcq
- Urology Department, CHU Lille, F-59000, Lille, France.,University of Lille, GIVRE - MERCS - Module for Education and Research Collaboration in Statistics, F-59000, Lille, France
| | - Aude Michelet
- ReSurg SA, chemin de la Vuarpillière 35, 1260, Nyon, Switzerland
| | - Gerjon Hannink
- Orthopaedic Research Laboratory, Radboud University Medical Center, PO, Box 9101, 6500HB, Nijmegen, The Netherlands
| | - Jerome Rizk
- Urology Department, CHU Lille, F-59000, Lille, France
| | - Jean Sauvain
- Urology Department, Clinique Générale Beaulieu, 1204, Genève, Switzerland
| | | | - Mo Saffarini
- ReSurg SA, chemin de la Vuarpillière 35, 1260, Nyon, Switzerland.
| | - Charles H Rochat
- Urology Department, Clinique Générale Beaulieu, 1204, Genève, Switzerland
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12
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Evolution in Prostate Cancer Staging: Pathology Updates From AJCC 8th Edition and Opportunities That Remain. Adv Anat Pathol 2018; 25:327-332. [PMID: 29870405 DOI: 10.1097/pap.0000000000000200] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The Tumor-Nodes-Metastasis system at the core of prognostic staging has been recently updated in the American Joint Committee on Cancer (AJCC) 8th edition, published in 2016. For prostate cancer, significant changes in staging of organ-confined disease, inclusion of a new grade grouping, and provision of levels of evidence for these modifications are part of what differentiates the 8th edition AJCC from prior iterations. Herein, the rationale underlying these changes is detailed. In addition, data elements not well represented in the present system are highlighted as opportunities for fresh study that may impact future AJCC classifications.
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13
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Milovancev M, Russell DS. Surgical margins in the veterinary cancer patient. Vet Comp Oncol 2017; 15:1136-1157. [PMID: 28194921 DOI: 10.1111/vco.12284] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 09/26/2016] [Accepted: 09/27/2016] [Indexed: 12/14/2022]
Abstract
In veterinary oncologic specimens, histopathology is the gold standard for determining adequacy of excision. Despite limitations of this technique, the pathologist's interpretation of margin status significantly impacts patient management, including indications for adjuvant therapy. This article aims to summarize peer-reviewed literature as it relates to histologic margin evaluation in veterinary cancer patients. The value of histologic tumour-free margins and technical factors influencing histopathologic margin outcomes are also discussed. We review alternative strategies for determining excisional status, and discuss how an evolving understanding of tumour biology might inform clinical and research perspectives on surgical margins. In doing so, we aim to provide context and a stimulus for future investigations into this important yet incompletely understood topic.
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Affiliation(s)
- M Milovancev
- Department of Veterinary Clinical Sciences, Oregon State University, Corvallis, OR, 97331, USA
| | - D S Russell
- Department of Biomedical Sciences, Oregon State University, Corvallis, OR, 97331, USA
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14
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Long-term oncological outcomes of apical positive surgical margins at radical prostatectomy in the Shared Equal Access Regional Cancer Hospital cohort. Prostate Cancer Prostatic Dis 2016; 19:423-428. [DOI: 10.1038/pcan.2016.45] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/26/2016] [Accepted: 07/12/2016] [Indexed: 11/08/2022]
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15
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Lanchon C, Custillon G, Moreau-Gaudry A, Descotes JL, Long JA, Fiard G, Voros S. Augmented Reality Using Transurethral Ultrasound for Laparoscopic Radical Prostatectomy: Preclinical Evaluation. J Urol 2016; 196:244-50. [DOI: 10.1016/j.juro.2016.01.094] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Cecilia Lanchon
- Urology Department, Grenoble University Hospital, Grenoble, France
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Techniques de l’Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications-Grenoble, Unité Mixte de Recherche 5525, Université Joseph Fourier-Grenoble 1, Grenoble, France
| | - Guillaume Custillon
- Centre national de la recherche scientifique, Techniques de l’Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications-Grenoble, Unité Mixte de Recherche 5525, Université Joseph Fourier-Grenoble 1, Grenoble, France
| | - Alexandre Moreau-Gaudry
- Centre national de la recherche scientifique, Techniques de l’Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications-Grenoble, Unité Mixte de Recherche 5525, Université Joseph Fourier-Grenoble 1, Grenoble, France
- Centre d’Investigation Clinique, Innovation Technologique, Institut National de la Santé et de la Recherche Médicale, Centre Hospitalier Universitaire de Grenoble, Université Joseph Fourier-Grenoble 1, Grenoble, France
| | - Jean-Luc Descotes
- Urology Department, Grenoble University Hospital, Grenoble, France
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Techniques de l’Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications-Grenoble, Unité Mixte de Recherche 5525, Université Joseph Fourier-Grenoble 1, Grenoble, France
| | - Jean-Alexandre Long
- Urology Department, Grenoble University Hospital, Grenoble, France
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Techniques de l’Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications-Grenoble, Unité Mixte de Recherche 5525, Université Joseph Fourier-Grenoble 1, Grenoble, France
| | - Gaelle Fiard
- Urology Department, Grenoble University Hospital, Grenoble, France
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Techniques de l’Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications-Grenoble, Unité Mixte de Recherche 5525, Université Joseph Fourier-Grenoble 1, Grenoble, France
| | - Sandrine Voros
- Centre National de la Recherche Scientifique, Institut National de la Santé et de la Recherche Médicale, Techniques de l’Ingénierie Médicale et de la Complexité-Informatique, Mathématiques et Applications-Grenoble, Unité Mixte de Recherche 5525, Université Joseph Fourier-Grenoble 1, Grenoble, France
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16
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Maxeiner A, Magheli A, Jöhrens K, Kilic E, Braun TL, Kempkensteffen C, Hinz S, Stephan C, Miller K, Busch J. Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009 International Society of Urological Pathology consensus. BJU Int 2016; 118:750-757. [PMID: 26915345 DOI: 10.1111/bju.13451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To verify retrospectively the margin status and analyse the location and characteristics of positive surgical margins (PSMs) in patients undergoing radical prostatectomy (RP), by a central pathology review, based on the consensus conference 2009 updated margin criteria from the International Society of Urological Pathology (ISUP). PATIENTS AND METHODS The detailed PSM characteristics of 441 patients who underwent laparoscopic RP (LRP) between 1999 and 2007 were centrally reviewed with regard to location, number, Gleason score at the PSM and tumour width. Predictors of PSMs and the impact of several PSM characteristics on clinical outcomes were examined. Patient characteristics were compared using the chi-squared test. Differences in recurrence-free survival (RFS) rates were analysed using the log-rank test and presented as Kaplan-Meier survival curves. Univariable and multivariable Cox regression analysis for the prediction of RFS was performed. RESULTS Central pathology review using the updated PSM definition according to ISUP 2009, resulted in reclassification of a substantial number of patients with PSMs (n = 113, 26.6%) as R0. Several PSM characteristics with a higher risk of biochemical recurrence (BCR) were identified as the strongest independent predictors of RFS: pathological stage; Gleason score; and the presence of multiple PSMs (hazard ratio [HR] 1.78; 95% confidence interval [CI] 1.08-2.96; P = 0.025). Further analysis replacing the location of PSM by the width categories of PSM showed that a PSM >3 mm was an independent predictor of RFS (HR 1.72; 95% CI 1.08-2.72; P = 0.022). CONCLUSIONS The impact of PSMs after LRP for prostate cancer remains unclear. PSMs in the present cohort of patients undergoing LRP had different characteristics and conferred different risks of BCR. A better understanding of PSM characteristics and a careful standardized pathological evaluation is needed to adequately counsel patients with respect to prognosis and adjuvant therapy after LRP.
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Affiliation(s)
- Andreas Maxeiner
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany.
| | - Ahmed Magheli
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Korinna Jöhrens
- Department of Pathology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Ergin Kilic
- Department of Pathology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Tom Lukas Braun
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Stefan Hinz
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Carsten Stephan
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Jonas Busch
- Department of Urology, Charité - Universitaetsmedizin Berlin, Berlin, Germany
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17
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Soulié M, Salomon L. [Oncological outcomes of prostate cancer surgery]. Prog Urol 2015; 25:1010-27. [PMID: 26519965 DOI: 10.1016/j.purol.2015.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 07/30/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Review of the oncological results of the radical prostatectomy as initial treatment of prostate cancer, according to the surgical approach and the risk stratification using D'Amico risk groups. MATERIALS AND METHODS Review of literature using Medline databases and MedScience based on scientific relevance. Research focused on the oncological results of the radical prostatectomy in series and meta-analysis published since 10 years, taking into consideration the surgical approach if mentioned. RESULTS The characteristics of the operated tumor highly impact the local control authenticated by the pathologic stage and the rates of positive surgical margins (PSM), in addition to the survival and the biochemical recurrence. Surgical technique adapted according to the tumor treated, was a constant challenge to the urologist, who counter balance between the oncological control and the conservation of urinary and sexual function by conditioning the type of radical prostatectomy. Results of radical prostatectomy acceptable in terms of PSM and survival are not influenced by the surgical approach but by the degree of surgical experience. CONCLUSION Results of radical prostatectomy show the efficient local control of prostate cancer, taking into consideration the oncological rules and indications validated by multidisciplinary meetings, based on the national (CCAFU) and European oncological guidelines. Tendency is going toward considering radical prostatectomy indicated for patients with higher risk of disease progression, so integrating surgery in a multidisciplinary personalized approach.
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Affiliation(s)
- M Soulié
- Département d'urologie-andrologie-transplantation rénale, CHU Rangueil, 1, avenue Jean-Poulhès, 31059 Toulouse cedex 9, France.
| | - L Salomon
- Service d'urologie et de transplantation rénale et pancréatique, CHU Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France
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18
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Salomon L, Ploussard G, Hennequin C, Richaud P, Soulié M. Traitements complémentaires de la chirurgie du cancer de la prostate et chirurgie de la récidive. Prog Urol 2015; 25:1086-107. [DOI: 10.1016/j.purol.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
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Kozal S, Peyronnet B, Cattarino S, Seisen T, Comperat E, Vaessen C, Mozer P, Renard-Penna R, Cussenot O, Rouprêt M, Drouin SJ. Influence of pathological factors on oncological outcomes after robot-assisted radical prostatectomy for localized prostate cancer: Results of a prospective study. Urol Oncol 2015; 33:330.e1-7. [PMID: 25998747 DOI: 10.1016/j.urolonc.2015.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 03/26/2015] [Accepted: 03/27/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the prognostic significance of lymphovascular invasion (LVI), maximum tumor diameter (MTD), high-grade prostatic intraepithelial neoplasia, perineural invasion, and length of positive surgical margins after robot-assisted radical prostatectomy (RARP). METHODS A single-institution prospective analysis of all patients who underwent RARP for localized prostate cancer was performed between January 2005 and June 2013. The primary end point was biochemical recurrence-free survival (BRFS). BRFS was estimated using the Kaplan-Meier method and compared to that from the log-rank test. Cox׳s proportional hazards regression univariate and multivariate analyses were performed to define the prognostic factors. RESULTS Overall, 742 men were included. After a median follow-up of 31.4 months, biochemical recurrence occurred in 80 patients (10.8%). BRFS was 93%, 87%, and 80.7% at 1, 3, and 5 years, respectively. Progression to local recurrence occurred in 49 patients (6.6%). During the follow-up period, 3 patients experienced progression to metastatic disease and were treated with hormonotherapy. No patient died of disease during the study period. In multivariate analyses, Gleason score was the strongest predictor of BRFS (hazard ratio [HR] = 3.4; P<0.001). There were 3 other predictive factors of BRFS were LVI (HR = 7.64; P = 0.005), MTD (HR = 4.04; P =0.009), and margin length ≥ 3 mm (HR = 1.25; P = 0.04). CONCLUSION In the era of serum prostate-specific antigen testing maturity in conjunction with a single approach to extirpation of the prostate gland by RARP, LVI, MTD, and positive surgical margins ≥ 3 mm are prognostic factors associated with BRFS after RARP. Consideration could be given to incorporate them in the pathology report of the radical prostatectomy specimens and they could assist physicians in clinical decision making.
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Affiliation(s)
- Sébastien Kozal
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | - Benoit Peyronnet
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France; Service d'Urologie, CHU Rennes, Rennes, France
| | | | - Thomas Seisen
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | - Eva Comperat
- Service d'Anatomopathologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | | | - Pierre Mozer
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
| | | | - Olivier Cussenot
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France
| | - Morgan Rouprêt
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France; UPMC Univ Paris 06, GRC5, ONCOTYPE-Uro, Institut Universitaire de Cancérologie, Paris, France.
| | - Sarah J Drouin
- Service d'Urologie, AP-HP, Hopital Pitié-Salpétrière, Paris, France
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Pettenati C, Neuzillet Y, Radulescu C, Hervé JM, Molinié V, Lebret T. Positive surgical margins after radical prostatectomy: What should we care about? World J Urol 2015; 33:1973-8. [PMID: 25939539 DOI: 10.1007/s00345-015-1580-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/26/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Positive surgical margins (PSMs) after radical prostatectomy (RP) are a known factor associated with biochemical recurrence (BCR) and raise the issue of adjuvant treatment by radiotherapy versus salvage treatment at recurrence. To help this choice, our study aimed to analyze BCR-free survival and factors associated with BCR in patients with PSM and undetectable postoperative prostate-specific antigen (PSA). METHODS Between 2005 and 2008, 630 patients had RP for localized prostate cancer in our center. We included patients with PSM, uninvaded nods, undetectable postoperative PSA and no adjuvant treatment. The 5-year BCR-free survival was calculated using Kaplan-Meier method. Logistic regression models were used to determine the factors associated with BCR in univariate and multivariate analyses (Cox model). RESULTS The PSM rate was 32.7 % (n = 206 patients), and 110 patients corresponded to the inclusion criteria. The median follow-up was 72 months. The BCR rate was 30 % with a 5-year BCR-free survival of 83.9 %. The factors significantly associated with BCR were preoperative PSA, predominance and percentage of Gleason 4, tumor volume, PSM length and predominance of Gleason 4 at the margin. In the multivariate analysis, the remaining two significant factors were PSM length [OR 4.35, 95 % CI (1.011-1.421), p = 0.037] and tumor volume [OR 4.29, 95 % CI (1.011-1.483), p = 0.038]. CONCLUSION Over a 5-year follow-up, only one-third of patients experienced BCR. It might be reasonable to postpone adjuvant radiotherapy for patients with PSM and undetectable PSA after RP. Tumor volume and PSM length were associated with BCR and should be taken into account in the postoperative treatment management.
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Affiliation(s)
- Caroline Pettenati
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
| | - Yann Neuzillet
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Camelia Radulescu
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Jean-Marie Hervé
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Vincent Molinié
- Department of Pathology, Fort de France University Hospital, Fort de France, France
| | - Thierry Lebret
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
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Dev HS, Wiklund P, Patel V, Parashar D, Palmer K, Nyberg T, Skarecky D, Neal DE, Ahlering T, Sooriakumaran P. Surgical margin length and location affect recurrence rates after robotic prostatectomy. Urol Oncol 2015; 33:109.e7-13. [DOI: 10.1016/j.urolonc.2014.11.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 11/09/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
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Gandaglia G, Trinh QD. Models of assessment of comparative outcomes of robot-assisted surgery: best evidence regarding the superiority or inferiority of robot-assisted radical prostatectomy. Urol Clin North Am 2014; 41:597-606. [PMID: 25306171 DOI: 10.1016/j.ucl.2014.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The widespread dissemination of robot-assisted radical prostatectomy (RARP) occurred despite the absence of high-level evidence supporting its safety and efficacy in patients with clinically localized prostate cancer. This study aims at systematically evaluating the models adopted in scientific reports assessing the comparative effectiveness of RARP versus open radical prostatectomy (ORP). Although several retrospective observational studies have assessed the comparative effectiveness of RARP and ORP, currently no published randomized data are available to comprehensively evaluate this issue. Furthermore, well-designed prospective investigations are needed to ultimately assess the benefits of RARP compared with other treatment modalities in patients with clinically localized prostate cancer.
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Affiliation(s)
- Giorgio Gandaglia
- Division of Oncology, Unit of Urology, Urological Research Institute, San Raffaele Scientific Institute, IRCCS Ospedale San Raffaele, Vita-Salute San Raffaele University, Via Olgettina 57, Milan 20132, Italy.
| | - Quoc-Dien Trinh
- Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Harvard Medical School, 45 Francis St, ASB II-3, Boston, MA 02115, USA
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