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Fiorello N, Di Benedetto A, Brizzi L, Mogorovich A, Summonti D, Silvestri G, Benvenuti S, Sepich CA. Impact of positive surgical margins (PSMs) after robotic prostatectomy on biochemical recurrence (BCR): Multicenter analysis. Urologia 2023; 90:647-652. [PMID: 37354007 DOI: 10.1177/03915603231183478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To study and analyze any correlations between positive surgical margins after RARP and biochemical recurrence. METHODS We enrolled 105 patients who underwent robot-assisted radical prostatectomy (RARP) from 2016-2020 with PSMs on final pathology, all performed or supervised by a senior surgeon in two tertiary referral center. Pathology has been described indicating also the area (apical, base, mediolateral, anterior, or multiple) and the extent of PSMs: focal (≤3 mm) or extensive (>3 mm). Cox univariable and multi-variable regression models were used to find the correlation between clinico-pathologic factors: age, local staging, PSA, grading, area, and size of PSMs). RESULTS We found a good correlation between PSA and grading and between PSA and local staging (T) (p < 0.001). There was no clear correlation between the PSM area with grading nor with T staging. There is a statistically significant correlation between extensive PSM and the worsening of grading and local staging (p < 0.001). BCR rate also has a strong correlation with the worsening of grading and local staging (T) (p < 0.001). A relevant fact is the difference between the BCR rate in the apical and base PSM (34.88%vs 62.5%; p < 0.001) which are the most frequent locations of PSMs. DISCUSSION PSMs remain a predictor of BCR but which may have controversial significance. The likelihood of BCR increases as grading or local staging gets worse. However, apical PSM is a relatively less powerful predictor of postoperative BCR. This can help to better select patients for subsequent RT, which still causes important side effects.
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Affiliation(s)
| | | | - Luca Brizzi
- UOC Urologia, Ospedale Santa Chiara, Trento, Italy
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Tissot S, Wynn J, Tran V, Farag M, Wong LM, Ng M. Re-defining 18 F-DCFPyl prostate-specific membrane antigen positron emission tomography detected local recurrence from radical prostatectomy histopathology. BJU Int 2023; 132:411-419. [PMID: 37216190 DOI: 10.1111/bju.16085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To assess topographic concordance between the histopathological features of patients' radical prostatectomy (RP) specimens and the location of the prostate-specific membrane antigen positron emission tomography (PSMA PET) local recurrences, qualitatively and quantitatively. PATIENTS AND METHODS Our cohort was selected from the 100 men who received a 18 F-DCFPyL PET scan in the IMPPORT trial (Australian New Zealand Clinical Trials Registry Number: ACTRN12618001530213), a prospective non-randomised study completed by GenesisCare Victoria. Eligibility included patients with a rising prostate-specific antigen (PSA) level (>0.2 ng/mL) after RP and PSMA PET detected local recurrence. Histopathological parameters collated included the location of tumour, extraprostatic extension (EPE), and positive margins. Criteria for the location and 'concordance' between histopathological features and local recurrences were pre-defined. RESULTS A total of 24 patients were eligible; the median age was 71 years, the median PSA level was 0.37 ng/mL, and the time between RP and PSMA PET was 2.6 years. In all, 15 patients had recurrences within the vesicourethral anastomotic region and nine within the lateral surgical margins. There was 100% concordance in the left-right plane between tumour location and local recurrence, with 79% of these lesions concordant three-dimensionally; across craniocaudal, left-right, and anterior-posterior planes. In all, 10 of the 16 (63%) patients with EPE and five of the nine patients with positive margins had three-dimensional concordance between their pathology and their local recurrence. In quantitative assessment, 17 of the 24 patients, had local recurrences that correlated with the location of their original tumour in the craniocaudal plane. CONCLUSION Local recurrence is highly concordant with the position of the tumour within the prostate. Predicting the location of local recurrence using the location of the EPE and positive margins is less helpful. Further investigation into this field, could impact surgical technique and salvage radiotherapy clinical target volume.
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Affiliation(s)
- Sophie Tissot
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jessica Wynn
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Vy Tran
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Matthew Farag
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Lih-Ming Wong
- Urology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Michael Ng
- GenesisCare, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
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Wang Y, Wu Y, Zhu M, Tian M, Liu L, Yin L. The Diagnostic Performance of Tumor Stage on MRI for Predicting Prostate Cancer-Positive Surgical Margins: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:2497. [PMID: 37568860 PMCID: PMC10417235 DOI: 10.3390/diagnostics13152497] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/17/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
PURPOSE Surgical margin status in radical prostatectomy (RP) specimens is an established predictive indicator for determining biochemical prostate cancer recurrence and disease progression. Predicting positive surgical margins (PSMs) is of utmost importance. We sought to perform a meta-analysis evaluating the diagnostic utility of a high clinical tumor stage (≥3) on magnetic resonance imaging (MRI) for predicting PSMs. METHOD A systematic search of the PubMed, Embase databases, and Cochrane Library was performed, covering the interval from 1 January 2000 to 31 December 2022, to identify relevant studies. The Quality Assessment of Diagnostic Accuracy Studies 2 method was used to evaluate the studies' quality. A hierarchical summary receiver operating characteristic plot was created depicting sensitivity and specificity data. Analyses of subgroups and meta-regression were used to investigate heterogeneity. RESULTS This meta-analysis comprised 13 studies with 3924 individuals in total. The pooled sensitivity and specificity values were 0.40 (95% CI, 0.32-0.49) and 0.75 (95% CI, 0.69-0.80), respectively, with an area under the receiver operating characteristic curve of 0.63 (95% CI, 0.59-0.67). The Higgins I2 statistics indicated moderate heterogeneity in sensitivity (I2 = 75.59%) and substantial heterogeneity in specificity (I2 = 86.77%). Area, prevalence of high Gleason scores (≥7), laparoscopic or robot-assisted techniques, field strength, functional technology, endorectal coil usage, and number of radiologists were significant factors responsible for heterogeneity (p ≤ 0.01). CONCLUSIONS T stage on MRI has moderate diagnostic accuracy for predicting PSMs. When determining the treatment modality, clinicians should consider the factors contributing to heterogeneity for this purpose.
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Affiliation(s)
- Yu Wang
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; (Y.W.); (L.L.)
- Institute of Radiation Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Ying Wu
- Department of Radiology, Affiliated Hospital of North Sichuan Medical College, Nanchong 637000, China;
| | - Meilin Zhu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai 200032, China;
| | - Maoheng Tian
- Department of Radiology, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China;
| | - Li Liu
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; (Y.W.); (L.L.)
- Institute of Radiation Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Longlin Yin
- Department of Radiology, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China; (Y.W.); (L.L.)
- Institute of Radiation Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
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Cho WJ, Pyo JS, Kim NY, Kang DW. Clinicopathological implications of histological mapping in radical prostatectomy specimens. Pathol Res Pract 2023; 243:154334. [PMID: 36796201 DOI: 10.1016/j.prp.2023.154334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The present study aims to elucidate the clinicopathological implications of histological mapping in radical prostatectomy specimens. METHODS This study included 76 prostatic cancers with histological mapping. The examined characteristics from the histological mappings were the largest tumor dimension, distance from the tumor core to resection margin, tumor dimension from the apex to base, tumor volume, tumor surface area, and proportion of the tumor. In addition, these histological parameters from the histological mapping were compared between patients with positive surgical margin (PSM) and negative surgical margin (NSM). RESULTS Patients with PSM were significantly correlated with a higher Gleason score and pT stage than those with NSM. Among the histological characteristics from mappings, there were significant correlations between PSM and the largest tumor dimension, tumor volume, tumor surface area, and proportion of tumor (P < 0.001, P < 0.001, P < 0.001, and P = 0.017, respectively). The distance from the tumor core to the resection margin was significantly longer with PSM than with NSM (P = 0.024). According to the linear regression test, the tumor volume, tumor surface area, and largest tumor dimension were significantly correlated with Gleason score and grade (P = 0.019, P = 0.036, and P = 0.016, respectively). There were no significant differences in the histological factors between the apical and non-apical involved subgroups. CONCLUSION Various clinicopathological characteristics assessed from the histological mappings, such as the tumor volume, tumor surface area, and proportion of the tumor, can be useful for interpreting PSM after radical prostatectomy.
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Affiliation(s)
- Won Jin Cho
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, the Republic of Korea
| | - Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, the Republic of Korea
| | - Nae Yu Kim
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, the Republic of Korea
| | - Dong-Wook Kang
- Department of Pathology, Chungnam National University Sejong Hospital, Sejong, the Republic of Korea; Department of Pathology, Chungnam National University School of Medicine, Daejeon, the Republic of Korea.
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Fully Integrated Ultra-thin Intraoperative Micro-imager for Cancer Detection Using Upconverting Nanoparticles. Mol Imaging Biol 2023; 25:168-179. [PMID: 35312938 PMCID: PMC9970948 DOI: 10.1007/s11307-022-01710-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/09/2022] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Intraoperative detection and removal of microscopic residual disease (MRD) remain critical to the outcome of cancer surgeries. Today's minimally invasive surgical procedures require miniaturization and surgical integration of highly sensitive imagers to seamlessly integrate into the modern clinical workflow. However, current intraoperative imagers remain cumbersome and still heavily dependent on large lenses and rigid filters, precluding further miniaturization and integration into surgical tools. PROCEDURES We have successfully engineered a chip-scale intraoperative micro-imager array-without optical filters or lenses-integrated with lanthanide-based alloyed upconverting nanoparticles (aUCNPs) to achieve tissue imaging using a single micro-chip. This imaging platform is able to leverage the unique optical properties of aUCNPs (long luminescent lifetime, high-efficiency upconversion, no photobleaching) by utilizing a time-resolved imaging method to acquire images using a 36-by-80-pixel, 2.3 mm [Formula: see text] 4.8 mm silicon-based electronic imager micro-chip, that is, less than 100-µm thin. Each pixel incorporates a novel architecture enabling automated background measurement and cancellation. We have validated the performance, spatial resolution, and the background cancellation scheme of the imaging platform, using resolution test targets and mouse prostate tumor sample intratumorally injected with aUCNPs. To demonstrate the ability to image MRD, or tumor margins, we evaluated the imaging platform in visualizing a single-cell thin section of the injected prostate tumor sample. RESULTS Tested on USAF resolution targets, the imager is able to achieve a resolution of 71 µm. We have also demonstrated successful background cancellation, achieving a signal-to-background ratio of 8 when performing ex vivo imaging on aUCNP-injected prostate tumor sample, improved from originally 0.4. The performance of the imaging platform on single-cell layer sections was also evaluated and the sensor achieved a signal-to-background ratio of 4.3 in resolving cell clusters with sizes as low as 200 cells. CONCLUSION The imaging system proposed here is a scalable chip-scale ultra-thin alternative for bulky conventional intraoperative imagers. Its novel pixel architecture and background correction scheme enable visualization of microscopic-scale residual disease while remaining completely free of lenses and filters, achieving an ultra-miniaturized form factor-critical for intraoperative settings.
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Kim M, Yoo D, Pyo J, Cho W. Clinicopathological Significances of Positive Surgical Resection Margin after Radical Prostatectomy for Prostatic Cancers: A Meta-Analysis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091251. [PMID: 36143928 PMCID: PMC9500731 DOI: 10.3390/medicina58091251] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: This study aims to elucidate the positive rate and the clinicopathological significance of surgical margin after radical prostatectomy (RP) through a meta-analysis. Materials and Methods: This meta-analysis finally used 59 studies, including the information about the positive surgical margin (PSM) and those clinicopathological significances after RP. The subgroup analysis for the estimated rates of PSM was evaluated based on types of surgery, grade groups, and pathological tumor (pT) stages. We compared the clinicopathological correlations between positive and negative surgical margins (NSM). Results: The estimated PSM rate was 25.3% after RP (95% confidence interval [CI] 21.9-29.0%). The PSM rates were 26.0% (95% CI 21.5-31.1%) 28.0% (95% CI 20.2-37.5%) in robot-assisted RP and nerve-sparing RP, respectively. The PSM rate was significantly higher in high-grade groups than in low-grade groups. In addition, the higher pT stage subgroup had a high PSM rate compared to the lower pT stage subgroups. Patients with PSM showed significantly high PSA levels, frequent lymphovascular invasion, lymph node metastasis, and extraprostatic extension. Biochemical recurrences (BCRs) were 28.5% (95% CI 21.4-36.9%) and 11.8% (95% CI 8.1-16.9%) in PSM and NSM subgroups, respectively. Patients with PSM showed worse BCR-free survival than those with NSM (hazard ratio 2.368, 95% CI 2.043-2.744%). Conclusions: Our results showed that PSM was significantly correlated with worse clinicopathological characteristics and biochemical recurrence-free survival. Among the results in preoperative evaluations, grade group and tumor stage are useful for the prediction of PSM.
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Affiliation(s)
- Minseok Kim
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Korea
| | - Daeseon Yoo
- Department of Urology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea
| | - Jungsoo Pyo
- Department of Pathology, Uijeongbu Eulji University Hospital, Eulji University School of Medicine, Uijeongbu 11759, Korea
| | - Wonjin Cho
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Korea
- Correspondence: ; Tel.: +82-62-220-3210
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Chen J, Xie Q, Miao W, Fan J, Zhou X, Li M. CircPDHX promotes prostate cancer cell progression in vitro and tumor growth in vivo via miR-497-5p/ACSL1 axis. Biochem Biophys Res Commun 2022; 620:35-41. [DOI: 10.1016/j.bbrc.2022.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/20/2022] [Accepted: 06/05/2022] [Indexed: 12/01/2022]
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Lee W, Lim B, Kyung YS, Kim CS. Impact of positive surgical margin on biochemical recurrence in localized prostate cancer. Prostate Int 2021; 9:151-156. [PMID: 34692588 PMCID: PMC8498720 DOI: 10.1016/j.prnil.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We analyzed the relationship between biochemical recurrence (BCR) and the status of positive surgical margin (PSM) in patients with pT3a prostate cancer (PCa). MATERIALS AND METHODS Patients (n = 150) who underwent radical prostatectomy for pT3a PCa without nodal/distant metastasis were retrospectively reviewed between 2010 and 2013. The data regarding the status of PSM including the number, length, and margin Gleason score were collected. The predictors of BCR were analyzed using Cox regression hazard models. BCR-free survival was compared between the patients with negative surgical margin (NSM) and with PSM using Kaplan-Meier curves and log-rank tests. RESULTS PSM was noted in 74 patients (49.3%). Seventy-six patients (50.7%) had NSM and 38 patients (25.3%) had single PSM. Twenty patients (13.3%) had two PSMs and 16 patients (10.7%) had ≥3 PSMs. In total patients, the multivariate analysis demonstrated that a pathological Gleason score of ≥8 was significantly associated with BCR [hazard ratio (HR), 2.173; 95% confidence interval (CI), 1.244-3.797; P = 0.038]. In patients with PSM, the number of PSM more than two was significantly associated with BCR (HR, 2.723; 95% CI, 1.256-5.902; P = 0.011). PSM length of ≥3 mm was also a significant predictive factor (HR, 1.024; 95% CI, 0.994-1.055, P = 0.042). Patients with the highest margin Gleason score of ≥4 had poorer BCR-free survival than those with that of 3/no surgical margin. CONCLUSIONS Number (more than one), length (≥3 mm), and higher margin Gleason score (≥4) of PSM were significantly associated with an increased likelihood of BCR in patients with pT3a PCa.
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Affiliation(s)
- Wonchul Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoon Soo Kyung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Long-term Oncologic Impact of Positive Anterior and Posterior Surgical Margins After Radical Prostatectomy. Am J Clin Oncol 2021; 43:872-879. [PMID: 33002923 DOI: 10.1097/coc.0000000000000765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the impact of the anterior/posterior status of positive surgical margin (PSM) on long-term outcomes after radical prostatectomy for prostate cancer. PATIENTS AND METHODS We included 391 consecutive PSM patients after radical prostatectomy between 1993 and 2007 excluding cases with multiple location PSM or lack of anterior/posterior status data. The oncologic impact of anterior-PSM and posterior-PSM were examined by Kaplan-Meier analysis and the Cox proportional hazards model. RESULTS There were 115 cases (29.4%) with apex-PSM, 257 cases (65.7%) with peripheral PSM, and 19 cases (4.9%) with bladder neck PSM. Among the 257 peripheral PSM cases, 58 cases (22.6%) were with anterior-PSM, 174 cases (67.7%) were with posterior-PSM, and 25 cases (9.7%) were with both anterior and posterior PSM. Over a median follow-up of 12.6 years, patients with anterior-PSM, especially those with low to intermediate Gleason score (≤7), showed a biochemical recurrence (BCR) prognosis similar to those with apex-PSM. In contrast, patients with posterior-PSM showed significantly higher BCR risk on both univariate and multivariate analyses when compared with those with apex-PSM. No impact on metastasis-free survival or overall survival was observed. CONCLUSIONS In our study, we found that prostate cancer patients with anterior-PSM showed a more favorable BCR prognosis similar to those with apex-PSM when comparing to patients with posterior-PSM. Our study results may help physicians to choose different treatment options for patients diagnosed with different PSM status including considering further adjuvant treatment for patients with posterior-PSM.
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Mao Y, Li W, Hua B, Gu X, Pan W, Chen Q, Xu B, Lu C, Wang Z. Circular RNA_PDHX Promotes the Proliferation and Invasion of Prostate Cancer by Sponging MiR-378a-3p. Front Cell Dev Biol 2021; 8:602707. [PMID: 33634097 PMCID: PMC7901981 DOI: 10.3389/fcell.2020.602707] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022] Open
Abstract
The dysregulation of circular RNAs (circRNAs) is implicated in the pathogenesis of prostate cancer (PCa). However, the underlying mechanisms by which hsa_circ_0003768 (circPDHX) contributes to PCa remain elusive. The differentially expressed circRNAs between PCa and normal tissues were identified by Gene Expression Omnibus dataset. The association of circPDHX and miR-378a-3p expression with the clinicopathological parameters and prognosis in patients with PCa was analyzed by fluorescence in situ hybridization and The Cancer Genome Atlas dataset. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and Transwell assays as well as a xenograft tumor model were used to assess the role of circPDHX in PCa cells. circPDHX-specific binding with miR-378a-3p was validated by bioinformatic analysis, luciferase gene reporter, and RNA immunoprecipitation assays. As a result, we found that increased expression of circPDHX was associated with Gleason score (P = 0.001) and pathogenic T stage (P = 0.01) and acted as an independent prognostic factor of poor survival (P = 0.036) in patients with PCa. Knockdown of circPDHX inhibited cell proliferation and invasion in vitro and in vivo, but ectopic expression of circPDHX reversed these effects. Furthermore, circPDHX could sponge miR-378a-3p to promote cell proliferation, but miR-378a-3p counteracted circPDHX-induced cell proliferation and insulin-like growth factor 1 receptor (IGF1R) expression in PCa cells. In conclusion, our findings demonstrated that circPDHX facilitated the proliferation and invasion of PCa cells by sponging miR-378a-3p.
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Affiliation(s)
- Yuanshen Mao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenfeng Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bao Hua
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Gu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weixin Pan
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qi Chen
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Lu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Wang L, Liu Y, Liu H, Tian H, Wang Y, Zhang G, Lei Y, Xue L, Zheng B, Fan T, Zheng Y, Tan F, Xue Q, Gao S, Li C, He J. The therapeutic significance of the novel photodynamic material TPE-IQ-2O in tumors. Aging (Albany NY) 2020; 13:1383-1409. [PMID: 33472175 PMCID: PMC7835032 DOI: 10.18632/aging.202355] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
Combination therapies based on photodynamic therapy (PDT) have received much attention in various cancers due to their strong therapeutic effects. Here, we aimed to explore the safety and effectiveness of a new mitochondria-targeting photodynamic material, TPE-IQ-2O, in combination therapies (combined with surgery or immunotherapy). The safety and effectiveness of TPE-IQ-2O PDT were verified with cytotoxicity evaluation in vitro and a zebrafish xenograft model in vivo, respectively. The effectiveness of TPE-IQ-2O PDT combined with surgery or immune checkpoint inhibitors (ICIs) was verified in tumor-bearing mice. Small animal in vivo imaging, immunohistochemistry, and flow cytometry were used to determine the underlying mechanism. TPE-IQ-2O PDT can not only reduce tumor recurrence in surgical treatment but also effectively improve the response to ICIs in immunotherapy without obvious toxicity. It was also found to ameliorate the immunosuppressive tumor microenvironment and promote the antitumor immunity induced by ICIs by increasing CD8+ tumor-infiltrating lymphocyte accumulation. Thus, TPE-IQ-2O PDT is a safe and effective antitumor therapy that can be combined with surgery or immunotherapy.
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Affiliation(s)
- Liyu Wang
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yu Liu
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hengchang Liu
- Department of Colorectal Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - He Tian
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yalong Wang
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Guochao Zhang
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuanyuan Lei
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Bo Zheng
- Department of Pathology, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Tao Fan
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yujia Zheng
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Chunxiang Li
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Prostate Carcinoma Grade and Length But Not Cribriform Architecture at Positive Surgical Margins Are Predictive for Biochemical Recurrence After Radical Prostatectomy. Am J Surg Pathol 2019; 44:191-197. [DOI: 10.1097/pas.0000000000001384] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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13
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Evren I, Hacıislamoğlu A, Ekşi M, Yavuzsan AH, Baytekin F, Çolakoğlu Y, Canoğlu D, Tugcu V. The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy. Int Braz J Urol 2019; 45:45-53. [PMID: 30325603 PMCID: PMC6442133 DOI: 10.1590/s1677-5538.ibju.2017.0702] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 06/11/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular extension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic. MATERIALS AND METHODS We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the patients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were included in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated. RESULTS The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recurrence (p = 0.03). CONCLUSION Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.
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Affiliation(s)
- Ismail Evren
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Hacıislamoğlu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mithat Ekşi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Abdullah Hizir Yavuzsan
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Firat Baytekin
- Department of Pathology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yunus Çolakoğlu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Didem Canoğlu
- Department of Pathology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Bianchi L, Schiavina R, Borghesi M, Casablanca C, Chessa F, Mineo Bianchi F, Pultrone C, Vagnoni V, Ercolino A, Dababneh H, Fiorentino M, Brunocilla E. Patterns of positive surgical margins after open radical prostatectomy and their association with clinical recurrence. MINERVA UROL NEFROL 2019; 72:464-473. [PMID: 31144486 DOI: 10.23736/s0393-2249.19.03269-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We report long-term oncologic outcomes in patients with positive surgical margins (PSMs) at radical prostatectomy (RP) and the oncologic impact of different scenarios of PSMs presentation. METHODS We selected 494 men with at least 3 years follow-up after surgery. PSMs patterns were recorded as: burden (focal vs. multifocal), site (apical-anterior vs. posterolateral vs. base-bladder neck vs. multiple) and side (unilateral vs. bilateral). Kaplan-Meier curves depicted the clinical recurrence-free survival (CR-FS) rates at 10-year in the overall population, after biochemical recurrence and according to different PSMs patterns. Multivariate Cox-regression analysis was performed to predict CR. RESULTS Overall, PSMs sites were apical-anterior, postero-lateral, base-bladder neck and multiple in 19.8%, 23.7%, 3.4% and 43.8%, respectively. Out of 494 patients, 278 (56.3%) had a focal margin, while 216 (43.7%) had a multifocal margin. In 268 (54.3%) and 87 (17.6%) men, PSMs were unilateral and bilateral, respectively. Median follow-up was 93 months. No significant differences were found in CR-FS rates after stratifying according to burden and site of PSMs. Men with unilateral PSMs experienced significant higher CR-FS rates compared to those with bilateral PSMs (87.1% vs. 71.3% at 10 years, P<0.001). At multivariate Cox regression Gleason score 8-10 (HR: 2.53, Confidence Interval [CI]: 1.01-6.33; P=0.04), pathologic stage pT3b-pT4 (HR 3.02, CI: 1.60-7.85; P=0.02) and adjuvant radiotherapy (HR: 0.30, CI: 0.11-0-86; P=0.02) were independent predictors of CR. CONCLUSIONS Men with bilateral PSMs had higher risk to experience CR, suggesting that the different patterns of PSMs, should be considered during patients counseling to guide postoperative treatments. Retrospective nature of the study and restricted number of patients included consist of main limitations.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy - .,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy -
| | - Riccardo Schiavina
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Marco Borghesi
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Carlo Casablanca
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Francesco Chessa
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | | | - Cristian Pultrone
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Valerio Vagnoni
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Amelio Ercolino
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Hussam Dababneh
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
| | - Michelangelo Fiorentino
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), F. Addarii Institute of Oncology and Transplant Pathology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, S. Orsola-Malpighi Hospital, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Bologna, Italy
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15
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Grivas N, de Bruin D, Barwari K, van Muilekom E, Tillier C, van Leeuwen PJ, Wit E, Kroese W, van der Poel H. Ultrasensitive prostate-specific antigen level as a predictor of biochemical progression after robot-assisted radical prostatectomy: Towards risk adapted follow-up. J Clin Lab Anal 2018; 33:e22693. [PMID: 30365194 DOI: 10.1002/jcla.22693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/18/2018] [Accepted: 09/21/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Ultrasensitive prostate-specific antigen (USPSA) is useful for stratifying patients according to their USPSA-based risk. Aim of our study was to determine the usefulness of USPSA as predictor of biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). METHODS This retrospective study included 213 prostate cancer patients who had a postoperative USPSA between 0.01 and 0.2 ng/mL and at least 2 years of follow-up. We developed predictive models for BCR with PSA ≥0.2 and ≥0.5 ng/mL. RESULTS A total of 103 patients (48.3%) had BCR at a median follow-up of 13.3 months. Higher postoperative USPSA (odds ratio [OR] = 4.73, P < 0.01), bilateral positive surgical margin in both sides (OR = 1.32, P = 0.044), higher average PSA rise (OR = 1.67, P = 0.031), ISUP grade group ≥3 (OR = 1.48, P = 0.003), and shorter interval since RARP (OR = 0.58, P < 0.001) were independent predictors of BCR with PSA ≥0.2 ng/mL. Higher postoperative USPSA (OR = 3.85, P < 0.01), bilateral positive surgical margin (OR = 1.34, P = 0.011), ISUP grade group ≥3 (OR = 1.5, P = 0.002), and shorter interval since RARP (OR = 0.61, P = 0.001) were independent predictors of BCR with PSA ≥0.5 ng/mL. The areas under the curve for the first and second model were 0.865 and 0.834, respectively. CONCLUSION Ultrasensitive PSA after RARP is a useful prognostic indicator of BCR which could guide postoperative risk stratification and layout follow-up scheduling.
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Affiliation(s)
- Nikolaos Grivas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Kurdo Barwari
- Department of Urology, VU University Medical Centre, Amsterdam, The Netherlands
| | - Erik van Muilekom
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Corinne Tillier
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Esther Wit
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Henk van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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16
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Zhang L, Wu B, Zha Z, Zhao H, Yuan J, Jiang Y, Yang W. Surgical margin status and its impact on prostate cancer prognosis after radical prostatectomy: a meta-analysis. World J Urol 2018; 36:1803-1815. [PMID: 29766319 PMCID: PMC6208659 DOI: 10.1007/s00345-018-2333-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/08/2018] [Indexed: 12/18/2022] Open
Abstract
Background and purpose Positive surgical margins (PSMs) correlate with adverse outcomes in numerous solid tumours. However, the prognostic value of PSMs in prostate cancer (PCa) patients who underwent radical prostatectomy remains unclear. Herein, we performed a meta-analysis to evaluate the association between PSMs and the prognostic value for biochemical recurrence-free survival (BRFS), cancer-specific survival (CSS), overall survival (OS), cancer-specific mortality (CSM) and overall mortality (OM) in PCa patients. Materials and methods According to the PRISMA statement, online databases PubMed, EMBASE and Web of Science were searched to identify relevant studies published prior to February 2018. The hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated to evaluate the relationship between PSMs and PCa. Results Ultimately, 32 cohort studies that met the eligibility criteria and involved 141,222 patients (51–65,633 per study) were included in this meta-analysis. The results showed that PSMs were significantly predictive of poorer BRFS (HR = 1.35, 95% CI 1.28–1.48, p < 0.001), CSS (HR = 1.49, 95% CI 1.16–1.90, p = 0.001) and OS (HR = 1.11, 95% CI 1.02–1.20, p = 0.014). In addition, PSMs were significantly associated with higher risk of CSM (HR = 1.23, 95% CI 1.16–1.30, p < 0.001) and OM (HR = 1.09, 95% CI 1.02–1.16, p = 0.009) in patients with PCa. Conclusions Our study suggests that the presence of a histopathologic PSM is associated with the clinical outcomes BRFS, CSS, OS, CSM and OM in patients with PCa, and PSMs could serve as a poor prognostic factor for patients with PCa. Electronic supplementary material The online version of this article (10.1007/s00345-018-2333-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lijin Zhang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Bin Wu
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China.
| | - Zhenlei Zha
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Hu Zhao
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Jun Yuan
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Yuefang Jiang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
| | - Wei Yang
- Department of Urology, Affiliated Jiang-yin Hospital of the Southeast University Medical College, 163 Shou-shan Road, Jiangyin, 214400, Jiangsu, People's Republic of China
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17
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Yang R, Cao K, Han T, Zhang YF, Zhang GT, Xu LF, Lian HB, Li XG, Guo HQ. Perineural invasion status, Gleason score and number of positive cores in biopsy pathology are predictors of positive surgical margin following laparoscopic radical prostatectomy. Asian J Androl 2018; 19:468-472. [PMID: 27004537 PMCID: PMC5507095 DOI: 10.4103/1008-682x.173444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This study was designed to define possible preoperative predictors of positive surgical margin after laparoscopic radical prostatectomy. We retrospectively analyzed the records of 296 patients with prostate cancer diagnosed by prostate biopsy, and eventually treated with laparoscopic radical prostatectomy. The prognostic impact of age, prostate volume, preoperative prostate-specific antigen, biopsy Gleason score, maximum percentage tumor per core, number of positive cores, biopsy perineural invasion, capsule invasion on imaging, and tumor laterality on surgical margin was assessed. The overall positive surgical margin rate was 29.1%. Gleason score, number of positive cores, perineural invasion, tumor laterality in the biopsy specimen, and prostate volume significantly correlated with risk of positive surgical margin by univariate analysis (P < 0.05). Gleason score (odds ratio [OR] = 2.286, 95% confidence interval [95% CI] = 1.431–3.653, P = 0.001), perineural invasion (OR = 4.961, 95% CI = 2.656–9.270, P < 0.001), and number of positive cores (OR = 4.403, 95% CI = 1.878–10.325, P = 0.001) were independent predictors of positive surgical margin at the multivariable logistic regression analysis. Patients with perineural invasion, higher biopsy Gleason scores and/or a large number of positive cores in biopsy pathology had more possibility of capsule invasion. The positive surgical margin rate in patients with capsule invasion (49.5%) was much higher than that with localized disease (17.8%). In contrast, prostate volume showed a protective effect against positive surgical margin (OR = 0.572, 95% CI = 0.346–0.945, P = 0.029). Gleason score, perineural invasion, and number of positive cores in the biopsy specimen were preoperative independent predictors of positive surgical margin after laparoscopic radical prostatectomy while prostate volume was a protective factor against positive surgical margin.
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Affiliation(s)
- Rong Yang
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Kai Cao
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Tao Han
- Department of Urology, Nanjing Children's Hospital, Nanjing 210008, China
| | - Yi-Feng Zhang
- Department of Pathology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Gu-Tian Zhang
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Lin-Feng Xu
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Hui-Bo Lian
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Xiao-Gong Li
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
| | - Hong-Qian Guo
- Department of Urology, Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing 210008, China
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18
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Herforth C, Stroup SP, Chen Z, Howard LE, Freedland SJ, Moreira DM, Terris MK, Aronson WJ, Cooperberg MR, Amling CL, Kane CJ. Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int 2018; 122:592-598. [PMID: 29473992 DOI: 10.1111/bju.14178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate biochemical recurrence (BCR) patterns amongst men undergoing radical prostatectomy (RP) with specimens having negative (NSM), positive (PSM), and close surgical margins (CSM) from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort, as PSM after RP are a significant predictor of biochemical failure and possible disease progression, with CSM representing a diagnostic challenge for surgeons. PATIENTS AND METHODS Men undergoing RP between 1988 and 2015 with known final pathological margin status were evaluated. The cohort was divided into three groups based on margin status; NSM, PSM, and CSM. CSM were defined by distance of tumour ≤1 mm from the surgical margin. BCR was defined as a prostate-specific antigen (PSA) level of >0.2 ng/mL, two values at 0.2 ng/mL, or secondary treatment for an elevated PSA level. Predictors of BCR, metastases, and mortality were analysed using Cox proportional hazard models. RESULTS Of 5515 men in the SEARCH database, 4337 (79%) men met criteria for inclusion in the analysis. Of these, 2063 (48%) had NSM, 1902 (44%) had PSM, and 372 (8%) had CSM. On multivariable analysis, relative to NSM, men with CSM had a higher risk of BCR (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.25-1.82; P < 0.001) but a decreased risk of BCR when compared to those men with PSM (HR 2.09, 95% CI 1.86-2.36; P < 0.001). Metastases, prostate cancer-specific mortality and all-cause mortality did not differ based on margin status alone. CONCLUSIONS Management of men with CSM is a diagnostic challenge, with a disease course that is not entirely benign. The evaluation of other known risk factors probably provides greater prognostic value for these men and may ultimately better select those who may benefit from adjuvant therapy.
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Affiliation(s)
- Christine Herforth
- Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Sean P Stroup
- Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA.,Department of Urology, University of California, San Diego, CA, USA.,Section of Urologic Oncology, Moores UCSD Cancer Center, La Jolla, CA, USA
| | - Zinan Chen
- Duke University, Durham, NC, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | - Lauren E Howard
- Duke University, Durham, NC, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | - Stephen J Freedland
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | | | - Martha K Terris
- Duke University, Durham, NC, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | - William J Aronson
- University of California, Los Angeles, CA, USA.,Veteran Affairs Los Angeles, Los Angeles, CA, USA
| | - Matthew R Cooperberg
- University of California, San Francisco, CA, USA.,Veterans Affairs San Francisco Medical Center, San Francisco, CA, USA
| | | | - Christopher J Kane
- Department of Urology, University of California, San Diego, CA, USA.,Section of Urologic Oncology, Moores UCSD Cancer Center, La Jolla, CA, USA.,Veterans Affairs San Diego Medical Center, La Jolla, CA, USA
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19
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Impact du score de Gleason sur la survie sans récidive biologique après prostatectomie totale pour cancer avec marges chirurgicales positives. Prog Urol 2017; 27:467-473. [DOI: 10.1016/j.purol.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/26/2017] [Accepted: 05/05/2017] [Indexed: 11/24/2022]
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20
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Seo WI, Kang PM, Yoon JH, Kim W, Chung JI. Correlation between postoperative prostate-specific antigen and biochemical recurrence in positive surgical margin patients: Single surgeon series. Prostate Int 2017; 5:53-58. [PMID: 28593167 PMCID: PMC5448727 DOI: 10.1016/j.prnil.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 02/14/2017] [Accepted: 02/15/2017] [Indexed: 11/16/2022] Open
Abstract
Background To evaluate the relationship between postoperative prostate-specific antigen (PSA) levels and biochemical recurrence (BCR) after radical prostatectomy, especially in patients with positive surgical margins (PSMs). Materials and methods A total of 144 patients who underwent radical prostatectomies performed by a single surgeon without any neoadjuvant or adjuvant treatment were analyzed. Differences in clinicopathological factors were compared by surgical margin status, and the relationship between postoperative PSA level and BCR in patients with PSMs was evaluated. Results Fifty of the 144 patients (34.7%) had PSMs. Of these, 74% experienced BCR. The negative surgical margins and PSMs groups differed significantly in terms of PSA level at diagnosis, clinical T stage, and risk group by the cancer of the prostate risk assessment score (P = 0.002, P = 0.002, and P = 0.004, respectively). Also, the nadir PSA level, tumor volume, and BCR rate differed between the two groups (P = 0.007, P = 0.015, and P = 0.005, respectively) On Kaplan–Meier analysis, BCR-free survival was better in the negative surgical margins than the PSMs group (64.1 vs. 55.4 months, log-rank test, P = 0.011). BCR-free survival did not differ significantly in PSMs patients according to whether PSA level was or was not detectable at 1 month postoperatively. However, BCR-free survival improved when the nadir PSA level was undetectable (compared to detectable) in PSMs patients (64.3 vs. 26.1 months, log-rank test, P < 0.001). In PSMs patients belonging to the high risk group by cancer of the prostate risk assessment score, BCR-free survival was significantly better when the PSA level attained the nadir within 3 months, compared to > 6 months, postoperatively (64.2 vs. 29.5 months, log-rank test, P = 0.022). Conclusion If PSA is detectable in PSMs patients until 1 month after operation, cautious observation may be possible. If the nadir is attained within 3 months postoperatively in high-risk patients with PSMs, better BCR-free survival may be expected.
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Affiliation(s)
- Won Ik Seo
- Department of Urology, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Pil Moon Kang
- Department of Urology, Kosin University Gospel Hospital, Busan, South Korea
| | - Jang Ho Yoon
- Department of Urology, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Wansuk Kim
- Department of Urology, Busan Paik Hospital, Inje University, Busan, South Korea
| | - Jae Il Chung
- Department of Urology, Busan Paik Hospital, Inje University, Busan, South Korea
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21
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Ceylan C, Tonyali S, Keles I. Impact of positive surgical margin on biochemical recurrence following radical prostatectomy in locally advanced prostate cancer. Kaohsiung J Med Sci 2016; 32:514-517. [PMID: 27742035 DOI: 10.1016/j.kjms.2016.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/26/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022] Open
Abstract
This study aimed to determine the effect of surgical margin positivity on biochemical recurrence (BCR) in patients with locally advanced prostate cancer (PCa) who underwent radical retropubic prostatectomy (RRP). The medical records of all patients with locally advanced PCa that underwent RRP were retrospectively reviewed. Patient demographics, digital rectal examination findings, prostate biopsy Gleason score, prostate volume, pre- and post-treatment prostate-specific antigen (PSA) levels, definitive pathology Gleason score, surgical margin status, seminal vesicle invasion, perineural invasion, absence or presence of BCR, and the time to BCR were analyzed. The study included 130 patients. The final pathologic examination showed that seven (5.4%) patients had T3a disease and 123 (94.6%) had T3b disease. In all, 93 (71.5%) patients had a positive surgical margin [SM(+)], whereas 37 (28.5%) patients had a negative surgical margin [SM(-)]. Among the seven patients with pT3a disease, four (57.1%) had SM(+), whereas 89 (72.4%) of the 123 patients with pT3b disease had SM(-). BCR occurred in 11.8% (11 of 93) of patients with SM(+) and in 45.9% (17 of 37) of those with SM(-) (p < 0.001). Multivariate logistic regression analysis showed that SM(+) was the only significant predictor of BCR following RRP (relative risk, 0.163; 95% confidence interval (0.062-0.433); p < 0.001). SM(+) in RRP specimens is not always indicative of BCR in patients with locally advanced PCa. RRP should be considered an effective treatment choice for selected patients with locally advanced PCa, despite the associated high SM(+) rate.
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Affiliation(s)
- Cavit Ceylan
- Department of Urology, Clinic of Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - Senol Tonyali
- Department of Urology, Clinic of Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey.
| | - Ibrahim Keles
- Department of Urology, Afyon Kocatepe University, Faculty of Medicine, Afyon, Turkey
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22
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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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Lay AH, Wang X, Morgan MSC, Kapur P, Liu H, Roehrborn CG, Cadeddu JA. Detecting positive surgical margins: utilisation of light-reflectance spectroscopy onex vivoprostate specimens. BJU Int 2016; 118:885-889. [DOI: 10.1111/bju.13503] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Aaron H. Lay
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Xinlong Wang
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
| | - Monica S. C. Morgan
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Payal Kapur
- Department of Pathology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Hanli Liu
- Department of Bioengineering; University of Texas at Arlington; Arlington TX USA
| | - Claus G. Roehrborn
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
| | - Jeffrey A. Cadeddu
- Department of Urology; University of Texas Southwestern Medical Center; Dallas TX USA
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Ün S, Türk H, Koca O, Divrik RT, Zorlu F. Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy. Turk J Urol 2015; 41:61-6. [PMID: 26328203 DOI: 10.5152/tud.2015.65624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/10/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was conducted to research the factors determining biochemical recurrence (BCR) in low-risk localized prostate cancer patients who underwent radical prostatectomy (RP). MATERIALS AND METHODS We retrospectively analyzed the data of 504 patients who had undergone RP between 2003 and 2013 at our clinic. One hundred and fifty-two patients who underwent RP for low-risk prostate cancer were included in the study. RESULTS The mean follow-up period for patients was 58.7 (21-229) months. The mean age of the patients was 63.7±7.2 years (49-79). The mean prostate specific antigen (PSA) value was 5.25±4.22 ng/mL (3.58-9.45). The BCR rate after the operation was 25% (38/152). In the univariate analysis, recurrence determining factors were shown to include extracapsular involvement (ECI) (p=0.004), capsular invasion (CI) (p=0.001), age (p=0.014), and tumor size (p=0.006). However, only CI was found to be significant in multivariate analysis (p=0.001). CONCLUSION Capsular invasion is an independent risk factor in low-risk prostate cancer patients who underwent RP for BCR.
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Affiliation(s)
- Sıtkı Ün
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hakan Türk
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Osman Koca
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Rauf Taner Divrik
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ferruh Zorlu
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
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Whalen MJ, Shapiro EY, Rothberg MB, Turk AT, Woldu SL, Roy Choudhury A, Patel T, Badani KK. Close surgical margins after radical prostatectomy mimic biochemical recurrence rates of positive margins. Urol Oncol 2015; 33:494.e9-494.e14. [PMID: 26259665 DOI: 10.1016/j.urolonc.2015.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/07/2015] [Accepted: 07/09/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The significance of a "close" but negative surgical margin after radical prostatectomy (RP) is controversial. We evaluated the effect of a close surgical margin (CSM) on biochemical recurrence (BCR) compared to a negative margin after RP. MATERIALS AND METHODS Pathologic records of men who underwent RP from 2005-2011 were retrospectively reviewed. Margin status was classified as "positive" (PSM), "negative" (NSM), or "close" (<1mm from margin). BCR was defined as 2 consecutive postoperative prostate specific antigen measurements >0.2ng/ml. Probability of BCR was estimated using the Kaplan-Meier method and stratified by margin status. Univariable and multivariable Cox proportional hazards models were used to determine whether close margin status was associated with an increased rate of BCR. RESULTS A total of 609 consecutive patients underwent RP (93% robotic) and had complete pathologic data. A total of 126 (20.7%) had PSM, 453 (74.4%) had NSM, and 30 (4.9%) had CSM (mean<0.44mm). The 3-year BCR-free survival for patients with CSM was similar to those with PSM (70.4% vs. 74.5%, log rank P = 0.66) and significantly worse than those with NSM (90%, log rank P<0.001). On multivariable regression, positive margin status (HR = 3.26, P<0.001) was significantly associated with a higher risk of BCR, along with close margins (HR = 2.7, P = 0.04). CONCLUSIONS BCR for patients with CSM at RP is tantamount to PSM patients. CSM <1mm should be explicitly noted on pathology reports. Patients with this finding should be followed up closely and offered adjuvant therapy.
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Affiliation(s)
- Michael J Whalen
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY.
| | - Edan Y Shapiro
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Michael B Rothberg
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Andrew T Turk
- Department of Pathology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Solomon L Woldu
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY
| | - Arindam Roy Choudhury
- Department of Biostatistics, Columbia University, Mailman School of Public Health, New York, NY
| | - Trushar Patel
- Department of Urology, Morsani College of Medicine, University of South Florida, Tampa, FL
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY
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26
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Sooriakumaran P, Ploumidis A, Nyberg T, Olsson M, Akre O, Haendler L, Egevad L, Nilsson A, Carlsson S, Jonsson M, Adding C, Hosseini A, Steineck G, Wiklund P. The impact of length and location of positive margins in predicting biochemical recurrence after robot-assisted radical prostatectomy with a minimum follow-up of 5 years. BJU Int 2014; 115:106-13. [DOI: 10.1111/bju.12483] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Prasanna Sooriakumaran
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | | | - Tommy Nyberg
- Clinical Cancer Epidemiology; Department of Oncology-Pathology; Karolinska Institutet; Stockholm Sweden
| | - Mats Olsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Olof Akre
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institutet; Stockholm Sweden
| | - Leif Haendler
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Lars Egevad
- Department of Pathology; Karolinska University Hospital; Stockholm Sweden
| | - Andreas Nilsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Stefan Carlsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Martin Jonsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Christofer Adding
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Abolfazl Hosseini
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Gunnar Steineck
- Clinical Cancer Epidemiology; Department of Oncology-Pathology; Karolinska Institutet; Stockholm Sweden
| | - Peter Wiklund
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
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27
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Effect of positive surgical margins on biochemical failure, biochemical recurrence-free survival, and overall survival after radical prostatectomy: Median long-term results. Kaohsiung J Med Sci 2014; 30:510-4. [DOI: 10.1016/j.kjms.2014.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 01/23/2014] [Accepted: 02/05/2014] [Indexed: 11/19/2022] Open
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Servoll E, Vlatkovic L, Sæter T, Nesland JM, Axcrona U, Waaler G, Axcrona K. The length of a positive surgical margin is of prognostic significance in patients with clinically localized prostate cancer treated with radical prostatectomy. Urol Int 2014; 93:289-95. [PMID: 25170745 DOI: 10.1159/000362342] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Accepted: 03/18/2014] [Indexed: 11/19/2022]
Abstract
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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Affiliation(s)
- Einar Servoll
- Section of Urology, Sørlandet County Hospital, Arendal, Norway
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29
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Tozawa K, Yasui T, Umemoto Y, Mizuno K, Okada A, Kawai N, Takahashi S, Kohri K. Pitfalls of robot-assisted radical prostatectomy: A comparison of positive surgical margins between robotic and laparoscopic surgery. Int J Urol 2014; 21:976-9. [DOI: 10.1111/iju.12492] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 04/13/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Keiichi Tozawa
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Takahiro Yasui
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Yukihiro Umemoto
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Kentaro Mizuno
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Atsushi Okada
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Noriyasu Kawai
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Satoru Takahashi
- Department of Experimental Pathology and Tumor Biology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Kenjiro Kohri
- Department of Nephro-urology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
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Adamis S, Varkarakis IM. Defining prostate cancer risk after radical prostatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:496-504. [PMID: 24613741 DOI: 10.1016/j.ejso.2014.02.221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 01/25/2014] [Accepted: 02/02/2014] [Indexed: 11/25/2022]
Abstract
Prostate cancer encompasses a wide spectrum of tumor phenotypes with differing prognoses and a part of these patients are at risk of experiencing tumor recurrence after initial treatment. This review discusses the parameters that determine PCa risk for failure after radical prostatectomy and also focuses on the ability of currently available post-treatment nomograms to predict treatment outcomes, and probability of treatment failure. The use of predictive nomograms may be therefore helpful in the complex decision making process.
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Affiliation(s)
- S Adamis
- 2nd Department of Urology, University of Athens, Medical School, Sismanoglion Hospital, Athens, Greece.
| | - I M Varkarakis
- 2nd Department of Urology, University of Athens, Medical School, Sismanoglion Hospital, Athens, Greece
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31
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Ploussard G, Drouin SJ, Rode J, Allory Y, Vordos D, Hoznek A, Abbou CC, de la Taille A, Salomon L. Location, extent, and multifocality of positive surgical margins for biochemical recurrence prediction after radical prostatectomy. World J Urol 2014; 32:1393-400. [DOI: 10.1007/s00345-014-1243-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 01/13/2014] [Indexed: 10/25/2022] Open
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32
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Wilt TJ. Management of low risk and low PSA prostate cancer: long term results from the prostate cancer intervention versus observation trial. Recent Results Cancer Res 2014; 202:149-169. [PMID: 24531789 DOI: 10.1007/978-3-642-45195-9_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Management of localized prostate cancer is controversial due in part to the lack of randomized controlled trial information in men diagnosed with prostate specific antigen (PSA) testing. Men with low risk or low PSA (<10 ng/ml) prostate cancer comprise up to 70 % of men currently diagnosed. Evidence suggests an excellent long-term prognosis with observation though nearly 90 % are treated with surgery (radical prostatectomy), external beam radiation, or brachytherapy. Results from the Prostate cancer Intervention Versus Observation Trial (PIVOT) provide high quality Level 1 evidence that observation compared to surgery results in similar long-term overall and prostate cancer survival, prevention of bone metastases and avoidance of surgery related harms. Combined with emerging evidence from screening, natural history, decision analysis and cost-effectiveness modeling studies, these data demonstrate that observation is the preferred treatment option for men with low risk and possibly low PSA prostate cancer. Recommending against PSA testing or, in men who still desire testing, raising thresholds of PSA values used to define abnormal, lengthening intervals between PSA tests and discontinuing testing in men with a life expectancy less than 15 years will reduce diagnostic and treatment related harms without adversely impacting overall or disease specific mortality and morbidity.
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Affiliation(s)
- Timothy J Wilt
- Minneapolis VA Center for Chronic Diseases Outcomes Research, 1 Veterans Drive (111-0), Minneapolis, MN, 55417, USA,
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33
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Cormier L, Bastide C, Beuzeboc P, Fromont G, Hennequin C, Mongiat-Artus P, Peyromaure M, Ploussard G, Renard-Penna R, Richaud P, Rozet F, Soulié M, Salomon L. [Prostate cancer surgical margin: review by the CCAFU (Oncology Committee of the French Association of Urology)]. Prog Urol 2013; 24:334-45. [PMID: 24821555 DOI: 10.1016/j.purol.2013.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 10/27/2013] [Accepted: 11/11/2013] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Literature showed the impact of surgical margin status on prognosis after radical prostatectomy (mostly on biochemical survival). Margin status is an easy self-evaluation of surgical practice to assess. The aim of this paper was to define what a positive surgical margin (PSM) is and how to prevent the occurrence, to precise the impact on survival and how to treat. METHOD A literature analysis with Pubmed has been performed to 2012, furthermore conclusions of the main congresses with selection committee and review publication have also been studied. RESULTS PSM is defined as "tumor cells touching the ink on the specimen edge". The most frequent reported incidence is between 15 to 20%. Margin status remains one of the major criteria to determine the need of adjuvant radiotherapy after surgery. Quality of life is not or only lightly modified by radiotherapy with the current techniques. Adjuvant radiotherapy improves biological survival but is synonymous with overtreatment in many times. Salvage radiotherapy has to be quickly performed after Prostate Specific Antigen (PSA) relapse (PSA<1 ng/mL even<0.5 ng/mL). CONCLUSION This literature review did not allow to suggest superiority of one surgical technique over another. In the same way, the kind of dissection i.e. bladder neck or neurovascular bundle preservation does no clearly modify PSM rate. However, it seems logical to "customize" dissection according to prostate cancer characteristics (D'Amico criteria for instance) guided with multiparametric MRI. Intrafascial dissection has to be applied only to low risk. Lastly, the debate between adjuvant or salvage radiotherapy is always ongoing.
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Affiliation(s)
- L Cormier
- Sous-comité « prostate » du CCAFU, hôpital du Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France.
| | - C Bastide
- Sous-comité « prostate » du CCAFU, CHU de Marseille, 13015 Marseille, France.
| | - P Beuzeboc
- Sous-comité « prostate » du CCAFU, institut Curie, 75248 Paris, France.
| | - G Fromont
- Sous-comité « prostate » du CCAFU, CHU de Tours, 37044 Tours, France.
| | - C Hennequin
- Sous-comité « prostate » du CCAFU, CHU Saint-Louis, 75475 Paris, France.
| | - P Mongiat-Artus
- Sous-comité « prostate » du CCAFU, CHU Saint-Louis, 75475 Paris, France.
| | - M Peyromaure
- Sous-comité « prostate » du CCAFU, CHU de Cochin, 75014 Cochin, France.
| | - G Ploussard
- Sous-comité « prostate » du CCAFU, CHU Saint-Louis, 75475 Paris, France.
| | - R Renard-Penna
- Sous-comité « prostate » du CCAFU, CHU La Pitié, 75013 Paris, France.
| | - P Richaud
- Sous-comité « prostate » du CCAFU, institut Bergonié, 33076 Bordeaux, France.
| | - F Rozet
- Sous-comité « prostate » du CCAFU, institut Monstsouris, 75014 Paris, France.
| | - M Soulié
- Sous-comité « prostate » du CCAFU, CHU de Toulouse, 31403 Toulouse, France.
| | - L Salomon
- Sous-comité « prostate » du CCAFU, CHU Mondor, 94010 Paris, France.
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Lee JW, Ryu JH, Kim YB, Yang SO, Lee JK, Jung TY. Do positive surgical margins predict biochemical recurrence in all patients without adjuvant therapy after radical prostatectomy? Korean J Urol 2013; 54:510-5. [PMID: 23956825 PMCID: PMC3742902 DOI: 10.4111/kju.2013.54.8.510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/14/2013] [Indexed: 11/29/2022] Open
Abstract
Purpose The objective was to study whether positive surgical margins (PSMs) predict biochemical recurrence (BCR) in all patients without adjuvant therapy after radical prostatectomy (RP). Materials and Methods We retrospectively reviewed the medical records of patients who underwent RP for prostate cancer at Veterans Health Service Medical Center from 2005 to 2011. BCR was defined by a prostate-specific antigen (PSA) value ≥0.2 ng/mL. The clinicopathological factors of the PSM group were compared with those of the negative surgical margin (NSM) group, and the predictive impact of a PSM for BCR-free survival were evaluated. In addition, we analyzed the prognostic difference for BCR-free survival between solitary and multiple PSMs. Results A PSM was noted in 167 patients (45.5%). BCR was reported in 101 men in total (27.5%). The BCR-free survival rate of the PSM group was lower than that of the NSM group (p<0.001). In a multivariate analysis for the total patients, PSM was significantly associated with BCR-free survival (p<0.001). After stratification by pathological T stage, Gleason score (GS), and preoperative PSA value, PSM was significantly predictive for BCR-free survival in men with pT2 and/or GS ≤6 or 7 and/or a PSA value <10 or 10-20 ng/mL (all p<0.05). Multiple PSMs were more predictive of BCR-free survival than was a solitary PSM (p=0.001). Conclusions A PSM is a significant predictor of postoperative BCR in patients with pT2 and/or GS ≤7 and/or preoperative PSA <20 ng/mL. Multiple PSMs are considered a stronger prognostic factor for prediction of BCR than is a solitary PSM.
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Affiliation(s)
- Jun Woo Lee
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
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35
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Rouanne M, Rode J, Campeggi A, Allory Y, Vordos D, Hoznek A, Abbou CC, De La Taille A, Salomon L. Long-term impact of positive surgical margins on biochemical recurrence after radical prostatectomy: ten years of follow-up. Scand J Urol 2013; 48:131-7. [PMID: 23883410 DOI: 10.3109/21681805.2013.813067] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Positive surgical margins (PSMs) in men undergoing radical prostatectomy (RP) for prostate cancer are associated with an increased risk of biochemical recurrence. This study evaluated the long-term (>10 year) impact of PSMs on biochemical recurrence after RP in adjuvant treatment-naïve pT2-pT4 N0 men and determined predictors of prostate-specific antigen (PSA) failure. MATERIAL AND METHODS The institutional registry of 1276 patients who underwent RP at Henri Mondor Hospital from 1988 to 2001 was reviewed, identifying 403 patients with regular follow-up at the time of analysis. The study included 108 patients with PSMs who did not receive neoadjuvant or adjuvant therapy before PSA relapse. Median follow-up was 12.2 years. PSA failure was defined by a PSA rising by more than 0.2 ng/ml and biochemical recurrence-free survival (RFS) was estimated using the Kaplan-Meier method. Cox proportional hazard regression models were used to analyse clinicopathological variables associated with biochemical recurrence. RESULTS Biochemical recurrence 10 years after RP was 33.5% for patients regardless of the margin status. The 10-year biochemical RFS was 73% in men with negative margins compared to 49% in the case of PSM (p < 0.001). In multivariate analysis, margin status was a significantly predictive for PSA failure (hazard ratio 1.46, p = 0.04). After stratification by pathological stage, margin status was significantly predictive for biochemical RFS in pT2 (p < 0.001) and pT3a (p < 0.001), whereas the impact of PSM did not reach significance in pT3b (p = 0.16). CONCLUSIONS After 10-year follow-up, PSMs remain an independent risk factor of biochemical RFS after RP with less relevant impact in pT3b disease. Randomized prospective trials are needed to determine the place of adjuvant versus delayed radiotherapy.
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Billis A, Meirelles LL, Freitas LLL, Magna LA, Reis LO, Ferreira U. Influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression following radical prostatectomy. Int Braz J Urol 2013; 38:175-84. [PMID: 22555042 DOI: 10.1590/s1677-55382012000200005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2011] [Indexed: 11/22/2022] Open
Abstract
PURPOSE The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification. MATERIALS AND METHODS A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal) and in more than 1 quadrant or section (Group 2, diffuse); and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal) and in more than 2 quadrants or sections (Group 2, diffuse). The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors. RESULTS Extraprostatic extension was found in 129/360 (35.8%) patients, 39/129 (30.2%) in Group 1 and 90/129 (69.8%) in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2) had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4%) patients, 81/160 (50.6%) patients in Group 1 and 79/160 (49.4%) patients in Group 2. Patients with diffuse positive surgical margins (Group 2) had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. CONCLUSION Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant predictors of shorter time to biochemical progression following radical prostatectomy.
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Affiliation(s)
- Athanase Billis
- Department of Pathology, School of Medicine, University of Campinas-Unicamp, Brazil.
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Prise en charge de la pièce de prostatectomie radicale. Résultats de la conférence de consensus de la Société internationale d’uropathologie (ISUP). Ann Pathol 2013; 33:155-61. [DOI: 10.1016/j.annpat.2013.04.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/08/2013] [Indexed: 11/21/2022]
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38
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Fontenot PA, Mansour AM. Reporting positive surgical margins after radical prostatectomy: time for standardization. BJU Int 2013; 111:E290-9. [DOI: 10.1111/j.1464-410x.2012.11640.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philip A. Fontenot
- Department of Urology; University of Miami Miller School of Medicine; Miami; FL; USA
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Indications for postoperative radiotherapy in patients with prostate cancer after surgery with positive surgical margins. Contemp Oncol (Pozn) 2013; 17:383-8. [PMID: 24592127 PMCID: PMC3934049 DOI: 10.5114/wo.2013.37217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 02/15/2013] [Accepted: 02/20/2013] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY Prostate cancer is the second most prevalent cancer among men in Poland. The main methods of radical treatment are radical prostatectomy and radiotherapy. In patients who have been correctly qualified for surgery, a positive surgical margin is always an unexpected and undesirable factor. The aim of this prospective study was to evaluate the incidence of positive margins in more than 100 consecutive patients with prostate cancer undergoing radical prostatectomy. MATERIAL AND METHODS The study included 114 patients aged 44-78 years (mean 61.5 years) who underwent surgery for prostate cancer in stage cT1-3N0/M0 (according to the TNM staging system) in the years 2010-2011 in the Clinical Department of Oncological Urology in the Center of Oncology in Bydgoszcz. RESULTS The presence of positive surgical margins was found in 45 (39.47%) patients, and in 20 (17.54%) margins were assessed as close (1-2 mm). Among the patients with positive surgical margins about 22% had biochemical recurrence. Among patients with negative surgical margins 13% of pT2c and 12.5% of pT3a had biochemical recurrence. Patients with positive surgical margins, along with patients diagnosed with tumor extending beyond the prostate (pT3a) or invading seminal vesicles (pT3b), are at an increased risk of recurrence and progression, reaching up to 30-50% over 10 years. The risk is 2-4 times higher than in patients without positive operating margins.
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The impact of solitary and multiple positive surgical margins on hard clinical end points in 1712 adjuvant treatment-naive pT2-4 N0 radical prostatectomy patients. Eur Urol 2012; 64:19-25. [PMID: 22901983 DOI: 10.1016/j.eururo.2012.08.002] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 08/01/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Positive surgical margins (PSMs) increase the risk of biochemical recurrence (BCR) after radical prostatectomy (RP), but their impact on hard clinical end points is a topic of ongoing discussion. OBJECTIVE To evaluate the influence of solitary PSMs (sPSMs) and multiple PSMs (mPSMs) on important clinical end points. DESIGN, SETTING, AND PARTICIPANTS Data from 1712 patients from the Centre Hospitalier Universitaire de Québec with pT2-4 N0 prostate cancer (PCa) and undetectable prostate-specific antigen after RP were analyzed. INTERVENTION RP without neoadjuvant or adjuvant treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Kaplan-Meier analysis estimated survival functions, and Cox proportional hazards models addressed predictors of clinical end points. RESULTS AND LIMITATIONS Median follow-up was 74.9 mo. A total of 1121 patients (65.5%) were margin-negative, 281 patients (16.4%) had sPSMs, and 310 patients (18.1%) had mPSMs. A total of 280 patients (16.4%) experienced BCR, and 197 patients (11.5%) were treated with salvage radiotherapy (SRT). Sixty-eight patients (4.0%) received definitive androgen deprivation therapy, 19 patients (1.1%) developed metastatic disease, and 15 patients (0.9%) had castration-resistant PCa (CRPC). Thirteen patients (0.8%) died from PCa, and 194 patients (11.3%) died from other causes. Ten-year Kaplan-Meier estimates for BCR-free survival were 82% for margin-negative patients, 72% for patients with sPSMs, and 59% for patients with mPSMs (p<0.0001). Time to metastatic disease, CRPC, PCa-specific mortality (PCSM), or all-cause mortality did not differ significantly among the three groups (p=0.991, p=0.988, p=0.889, and p=0.218, respectively). On multivariable analysis, sPSMs and mPSMs were associated with BCR (hazard ratio [HR]: 1.711; p=0.001 and HR: 2.075; p<0.0001), but sPSMs and mPSMs could not predict metastatic disease (p=0.705 and p=0.242), CRPC (p=0.705 and p=0.224), PCSM (p=0.972 and p=0.260), or all-cause death (p=0.102 and p=0.067). The major limitation was the retrospective design. CONCLUSIONS In a cohort of patients who received early SRT in 70% of cases upon BCR, sPSMs and mPSMs predicted BCR but not long-term clinical end points. Adjuvant radiotherapy for margin-positive patients might not be justified, as only a minority of patients progressed to end points other than BCR. PCSM was exceeded 15-fold by competing risk mortality.
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Wilt TJ, Brawer MK, Jones KM, Barry MJ, Aronson WJ, Fox S, Gingrich JR, Wei JT, Gilhooly P, Grob BM, Nsouli I, Iyer P, Cartagena R, Snider G, Roehrborn C, Sharifi R, Blank W, Pandya P, Andriole GL, Culkin D, Wheeler T. Radical prostatectomy versus observation for localized prostate cancer. N Engl J Med 2012; 367:203-13. [PMID: 22808955 PMCID: PMC3429335 DOI: 10.1056/nejmoa1113162] [Citation(s) in RCA: 1301] [Impact Index Per Article: 108.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The effectiveness of surgery versus observation for men with localized prostate cancer detected by means of prostate-specific antigen (PSA) testing is not known. METHODS From November 1994 through January 2002, we randomly assigned 731 men with localized prostate cancer (mean age, 67 years; median PSA value, 7.8 ng per milliliter) to radical prostatectomy or observation and followed them through January 2010. The primary outcome was all-cause mortality; the secondary outcome was prostate-cancer mortality. RESULTS During the median follow-up of 10.0 years, 171 of 364 men (47.0%) assigned to radical prostatectomy died, as compared with 183 of 367 (49.9%) assigned to observation (hazard ratio, 0.88; 95% confidence interval [CI], 0.71 to 1.08; P=0.22; absolute risk reduction, 2.9 percentage points). Among men assigned to radical prostatectomy, 21 (5.8%) died from prostate cancer or treatment, as compared with 31 men (8.4%) assigned to observation (hazard ratio, 0.63; 95% CI, 0.36 to 1.09; P=0.09; absolute risk reduction, 2.6 percentage points). The effect of treatment on all-cause and prostate-cancer mortality did not differ according to age, race, coexisting conditions, self-reported performance status, or histologic features of the tumor. Radical prostatectomy was associated with reduced all-cause mortality among men with a PSA value greater than 10 ng per milliliter (P=0.04 for interaction) and possibly among those with intermediate-risk or high-risk tumors (P=0.07 for interaction). Adverse events within 30 days after surgery occurred in 21.4% of men, including one death. CONCLUSIONS Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not significantly reduce all-cause or prostate-cancer mortality, as compared with observation, through at least 12 years of follow-up. Absolute differences were less than 3 percentage points. (Funded by the Department of Veterans Affairs Cooperative Studies Program and others; PIVOT ClinicalTrials.gov number, NCT00007644.).
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Affiliation(s)
- Timothy J Wilt
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs (VA) Health Care System, and Section of General Medicine, University of Minnesota School of Medicine, Minneapolis, USA.
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Gaztañaga M, Crook JM. Permanent seed brachytherapy for locally recurrent prostate cancer after radical prostatectomy: a case report and review of the literature. Brachytherapy 2012; 12:338-42. [PMID: 22748289 DOI: 10.1016/j.brachy.2012.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/19/2012] [Accepted: 04/20/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the management of a patient with locally recurrent prostate cancer in the prostate bed, 10 years after a radical prostatectomy. METHODS AND MATERIALS A 71-year-old man had a radical prostatectomy for a Gleason 7 clinical T2a carcinoma of the prostate in 2000. Final pathologic stage was pT3a pN0. Postoperatively his prostate-specific antigen was undetectable, but by 2008 it was 1.0ng/mL and in 2011 it reached to 1.43ng/mL. He was referred for consideration of salvage radiotherapy. Staging workup was negative but transrectal ultrasound revealed a 15cc recurrence in the prostate bed. A combination of external beam radiation therapy (4600/23/4.5 weeks to the pelvis) and a brachytherapy boost (115Gy) was selected for definitive management. Androgen ablation was not used. RESULTS The treatment was well tolerated. The brachytherapy boost was planned in a similar fashion to a de novo implant for an intact prostate. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. Acute toxicity was minimal. Six months after brachytherapy, the prostate-specific antigen had fallen from 1.43 to 0.05ng/mL. CONCLUSIONS Dose escalation with combined external beam and brachytherapy may be feasible if recurrent disease can be visualized using transrectal ultrasound and encompassed in an implanted volume. Although longer followup and a larger series of patients are required to demonstrate safety and efficacy, consideration should be given this approach.
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Affiliation(s)
- Miren Gaztañaga
- Department of Radiation Oncology, British Columbia Cancer Agency, Center for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada
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[Diagnostics of radical prostatectomy specimens. Results of the 2009 consensus conference of the International Society of Urological Pathology]. DER PATHOLOGE 2012; 33:337-44. [PMID: 22552640 DOI: 10.1007/s00292-012-1587-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The 2009 consensus conference of the International Society of Urological Pathology (ISUP) made recommendations for standardization of handling and staging of radical prostatectomy specimens. The conference topics were preparation of specimens, the T2 subclassification, prostate cancer volume, extraprostatic tumor extent, lymphovascular invasion, seminal vesicle infiltration, lymph node metastases and surgical margins. This review article presents the essential results and recommendations of this conference.
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Vrang ML, Røder MA, Vainer B, Christensen IJ, Gruschy L, Brasso K, Iversen P. First danish single-institution experience with radical prostatectomy: impact of surgical margins on biochemical outcome. ACTA ACUST UNITED AC 2012; 46:172-9. [DOI: 10.3109/00365599.2011.644860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Ben Vainer
- Urology Research Unit, Department of Pathology
| | - Ib Jarle Christensen
- The Finsen Laboratory, Rigshospitalet, Faculty of Health and Medical Sciences,
University of Copenhagen, Denmark
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The role of adjuvant hormonal treatment after surgery for localized high-risk prostate cancer: results of a matched multiinstitutional analysis. Adv Urol 2012; 2012:612707. [PMID: 22400018 PMCID: PMC3286887 DOI: 10.1155/2012/612707] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 10/26/2011] [Accepted: 11/12/2011] [Indexed: 11/18/2022] Open
Abstract
Introduction. To assess the role of adjuvant androgen deprivation therapy (ADT) in high-risk prostate cancer patients (PCa) after surgery.
Materials and Methods. The analysis case matched 172 high-risk PCa patients with positive section margins or non-organ confined disease and negative lymph nodes to receive adjuvant ADT (group 1, n = 86) or no adjuvant ADT (group 2, n = 86). Results. Only 11.6% of the patients died, 2.3% PCa related. Estimated 5–10-year clinical progression-free survival was 96.9% (94.3%) for group 1 and 73.7% (67.0%) for group 2, respectively. Subgroup analysis identified men with T2/T3a tumors at low-risk and T3b margins positive disease at higher risk for progression. Conclusion. Patients with T2/T3a tumors are at low-risk for metastatic disease and cancer-related death and do not need adjuvant ADT. We identified men with T3b margin positive disease at highest risk for clinical progression. These patients benefit from immediate adjuvant ADT.
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Corcoran NM, Hovens CM, Metcalfe C, Hong MK, Pedersen J, Casey RG, Peters J, Harewood L, Goldenberg SL, Costello AJ, Gleave ME. Positive surgical margins are a risk factor for significant biochemical recurrence only in intermediate-risk disease. BJU Int 2012; 110:821-7. [DOI: 10.1111/j.1464-410x.2011.10868.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Santos PB, Graça B, Lourenço M, Coelho MF, Ribeiro F, Fonseca J, Cardoso AP, Varregoso J, Ferrito F, Gomes FC. Impact of positive surgical margins on biochemical relapse after radical retropubic prostatectomy (RRP). Cent European J Urol 2011; 64:223-8. [PMID: 24578898 PMCID: PMC3921750 DOI: 10.5173/ceju.2011.04.art7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 09/07/2011] [Accepted: 09/12/2011] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION RP (radical prostatectomy) technique continues the major treatment option for men with potential cure and life expectancy exceeding 10 years. The aim of the study is to assess the impact of PSM on BR (biochemical relapse), to identify PSM risk factors, to clarify the factors involved in BR in the absence of PSM. MATERIAL AND METHODS Consultation of 171 medical-records from patients submitted to RRP (radical retropubic prostatectomy) between January/2000-December/2005. Mean-age: 64 yr. Mean - PSA (positive surgical margin): 11.88 ng/ml. Clinical staging: 67.8% cT1, 32.2% cT2. GS: ≤6 (66.1%), =7 (21.1%), 8-10 (12.3%). PS: pT0 1.2%, pT2 50.3%, pT3a 36.3%, pT3b 12.9%, pT4 0.6%. pathological Gleason score: ≤6 39.2%, =7 40.9%, 8-10 19.3%. RB definition was PSA ≥0.2 ng/ml. Adjusted Odds-Ratios with 95% confidence intervals (CI) were estimated through univariate logistic regression. RESULTS There were PSM in 46 specimens, 28 had single PSM and 18 multiple PSM (≥2). BR occurred in 57 patients (33.3%), with an average time after surgery of 23.5 months - 26 patients had PSM and 31 had not. Statistical significant results for BR in variables PSA, PS and PSM. Quadruples if PSM (p <0.0001), triples in single PSM (p = 0.01) and is 6x higher in multiple PSM (p = 0.001). Regarding factors that influence the presence of PSM, only PS ≥pT3a reach statistical significance (p <0.0001). Patients with BR but without PSM (54.38%), variables statistically significant were: initial PSA >10, (p = 0.029) and pathological Gleason score ≥8 with a risk nearly 4x higher than pathological Gleason score ≤6 (p = 0.027). CONCLUSIONS Statistical risk analysis concluded that the presence of PSM in RRP is strongly influenced by PS ≥pT3a. The presence of PSM and their number increase significantly the risk of BR compared to other factors. In the absence of PSM, the factors that seem to be crucial and with greater impact on BR are initial PSA>10 and pathological Gleason score ≥8.
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Affiliation(s)
- Pedro Bargão Santos
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Bruno Graça
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Miguel Lourenço
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | | | - Fernando Ribeiro
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Júlio Fonseca
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - A Pepe Cardoso
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - João Varregoso
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
| | - Fernando Ferrito
- Department of Urology, Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal
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Usefulness of postoperative nadir prostate-specific antigen value by ultrasensitive assay as a predictor of prostate-specific antigen relapse for pathological T3 or positive surgical margins after radical prostatectomy for prostate cancer. Int Urol Nephrol 2011; 44:479-85. [DOI: 10.1007/s11255-011-0044-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
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Boorjian SA, Tollefson MK, Rangel LJ, Bergstralh EJ, Karnes RJ. Clinicopathological predictors of systemic progression and prostate cancer mortality in patients with a positive surgical margin at radical prostatectomy. Prostate Cancer Prostatic Dis 2011; 15:56-62. [DOI: 10.1038/pcan.2011.36] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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