1
|
Pellegrino F, Falagario UG, Knipper S, Martini A, Akre O, Egevad L, Aly M, Moschovas MC, Bravi CA, Tran J, Heiniger Y, von Kempis A, Schaffar R, Carrieri G, Briganti A, Montorsi F, Rochat CH, Mottrie A, Ahlering TE, John H, Patel V, Graefen M, Wiklund P. Assessing the Impact of Positive Surgical Margins on Mortality in Patients Who Underwent Robotic Radical Prostatectomy: 20 Years' Report from the EAU Robotic Urology Section Scientific Working Group. Eur Urol Oncol 2024; 7:888-896. [PMID: 38155061 DOI: 10.1016/j.euo.2023.11.021] [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] [Received: 09/18/2023] [Revised: 10/25/2023] [Accepted: 11/23/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Positive surgical margins (PSMs) are frequent in patients undergoing radical prostatectomy (RP). The impact of PSMs on cancer-specific (CSM) and overall (OM) mortality has not yet been proved definitively. OBJECTIVE To evaluate whether the presence and the features of PSMs were associated with CSM and OM in patients who underwent robotic-assisted RP. DESIGN, SETTING, AND PARTICIPANTS A cohort of 8141 patients underwent robotic-assisted RP with >10 yr of follow-up. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cox multivariable analyses assessed the impact of margin status (positive vs negative) and PSM features (negative vs <3 mm vs >3 mm vs multifocal) on the risk of CSM, OM, and biochemical recurrence (BCR) after adjusting for potential confounders. We repeated our analyses after stratifying patients according to clinical (Cancer of the Prostate Risk Assessment [CAPRA] categories) and pathological characteristics (adverse: pT 3-4 and/or grade group [GG] 4-5 and/or pN1 and/or prostate-specific antigen [PSA] persistence). RESULTS AND LIMITATIONS PSMs were found in 1348 patients (16%). Among these, 48 (3.6%) patients had multifocal PSMs. Overall, 1550 men experienced BCR and 898 men died, including 130 for prostate cancer. At Cox multivariable analyses, PSMs were associated with CSM in patients with adverse clinical (Intermediate risk: hazard ratio [HR]: 1.71, p = 0.048; high risk: HR: 2.20, p = 0.009) and pathological (HR: 1.79, p = 0.005) characteristics. Only multifocal PSMs were associated with CSM and OM in the whole population (HR for CSM: 4.68, p < 0.001; HR for OM: 1.82, p = 0.037) and in patients with adverse clinical (intermediate risk: HR for CSM: 7.26, p = 0.006; high risk: HR for CSM: 9.26, p < 0.001; HR for OM: 2.97, p = 0.006) and pathological (HR for CSM: 9.50, p < 0.001; HR for OM: 2.59, p = 0.001) characteristics. Potential limitations include a selection bias and a lack of information on the Gleason score at PSM location. CONCLUSIONS We did not find an association between unifocal PSMs and mortality. Conversely, our results underscore the importance of avoiding multifocal PSMs in patients with adverse clinical (intermediate- and high-risk CAPRA score) and pathological (GG ≥4, pT ≥3, pN1, or PSA persistence) characteristics, to enhance overall survival and reduce CSM. PATIENT SUMMARY In this study, we evaluated whether the presence and the characteristics of positive surgical margins were associated with mortality in patients who underwent robotic-assisted radical prostatectomy. We found that the presence of positive surgical margins, particularly multifocal margins, was associated with mortality only in patients with adverse clinical and pathological characteristics.
Collapse
Affiliation(s)
- Francesco Pellegrino
- Department of Pelvic Cancer, Karolinska University Hospital, Solna, Sweden; Unit of Urology/Division of Oncology, Soldera Prostate Cancer Lab, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Ugo Giovanni Falagario
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, University of Foggia, Foggia, Italy.
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alberto Martini
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska institute, Stockholm, Sweden
| | - Markus Aly
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Departments of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Orlando, FL, USA; University of Central Florida (UCF), Orlando, FL, USA
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Joshua Tran
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Yasmin Heiniger
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Robin Schaffar
- Department of Urology, Clinique Générale Beaulieu, Geneva, Switzerland
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology, Soldera Prostate Cancer Lab, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, Soldera Prostate Cancer Lab, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Thomas E Ahlering
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Orlando, FL, USA; University of Central Florida (UCF), Orlando, FL, USA
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
2
|
John A, Lim A, Catterwell R, Selth L, O'Callaghan M. Length of positive surgical margins after radical prostatectomy: Does size matter? - A systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26:673-680. [PMID: 36859711 PMCID: PMC10638086 DOI: 10.1038/s41391-023-00654-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES The prognostic capacity of positive surgical margins (PSM) for biochemical recurrence (BCR) is unclear, with inconsistent findings across published studies. We aimed to systematically review and perform a meta-analysis exploring the impact of Positive surgical margin length on biochemical recurrence in men after radical prostatectomy. METHODS A search was conducted using the MEDLINE, Scopus, Embase and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of the studies was assessed using the Newcastle-Ottawa scale, and the protocol was registered in advance (PROSPERO: CRD42020195908). This meta-analysis included 16 studies with BCR as the primary outcome measure. RESULTS Studies used various dichotomised thresholds for PSM length. A subgroup meta-analysis was performed using the reported multivariable hazard ratio (Continuous, 3, and 1 mm PSM length). PSM length (continuous) was independently associated with an increased risk of BCR (7 studies, HR 1.04 (CI 1.02-1.05), I2 = 8% p < 0.05). PSM length greater than 3 mm conferred a higher risk of BCR compared to less than 3 mm (4 studies, HR 1.99 (1.54-2.58) I2 = 0%, p < 0.05). There was also an increased risk of BCR associated with PSM length of less than 1 mm compared to negative surgical margins (3 studies, HR 1.46 (1.05-2.04), I2 = 0%, P = 0.02). CONCLUSION PSM length is independently prognostic for BCR after radical prostatectomy. Further long-term studies are needed to estimate the impact on systemic progression.
Collapse
Affiliation(s)
- Athul John
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia.
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
| | - Alicia Lim
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Rick Catterwell
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Luke Selth
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute (FHMRI) and Freemasons Centre for Male Health and Wellbeing, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael O'Callaghan
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute (FHMRI) and Freemasons Centre for Male Health and Wellbeing, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Urology, Southern Adelaide Local Health Network, South Australia Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia, Australia
| |
Collapse
|
3
|
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.
Collapse
Affiliation(s)
| | | | - Luca Brizzi
- UOC Urologia, Ospedale Santa Chiara, Trento, Italy
| | | | | | | | | | | |
Collapse
|
4
|
Fan B, Zhang L, Wang Y, Dai Z, Pan H, Xie J, Wang H, Xin Z, Wang Y, Duan X, Luo J, Wang L, Liu Z. Value of three-dimensional visualization of preoperative prostatic magnetic resonance imaging based on measurements of anatomical structures in predicting positive surgical margin after radical prostatectomy. Front Endocrinol (Lausanne) 2023; 14:1228892. [PMID: 37859989 PMCID: PMC10582708 DOI: 10.3389/fendo.2023.1228892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/13/2023] [Indexed: 10/21/2023] Open
Abstract
Background Positive surgical margin (PSM) or apical positive surgical margin (APSM) is an established predictive factor of biochemical recurrence or disease progression in prostate cancer (PCa) patients after radical prostatectomy. Since there are limited usable magnetic resonance imaging (MRI)-based models, we sought to explore the role of three-dimensional (3D) visualization for preoperative MRI in the prediction of PSM or APSM. Methods From December 2016 to April 2022, 149 consecutive PCa patients who underwent radical prostatectomy were retrospectively selected from the Second Affiliated Hospital of Dalian Medical University. According to the presence of PSM or APSM, patients were divided into a PSM group (n=41) and a without PSM group (n=108) and into an APSM group (n=33) and a without APSM group (n=116). Twenty-one parameters, including prostate apical shape, PCa distance to the membranous urethra, and pubic angle, were measured on 3D visualization of MRI. The development of the nomogram models was built by the findings of multivariate logistic regression analysis for significant factors. Results To predict the probability of PSM, a longer PCa distance to the membranous urethra (OR=0.136, p=0.019) and the distance from the anterior peritoneum to the anterior border of the coccyx (work space AP, OR=0.240, p=0.030) were independent protective factors, while a type 3 prostate apical shape (OR=8.262, p=0.025) and larger pubic angle 2 (OR=5.303, p=0.029) were identified as independent risk factors. The nomogram model presented an area under the curve (AUC) of the receiver operating characteristic curve (ROC) of PSM of 0.777. In evaluating the incidence of APSM, we found that the distance to the membranous urethra (OR=0.135, p=0.014) was associated with a low risk of APSM, while larger pubic angle 1 (OR=4.666, p=0.043) was connected to a higher risk of APSM. The nomogram model showed that the AUC of APSM was 0.755. Conclusion As 3D visualization for preoperative MRI showed good performance in predicting PSM or APSM, the tool might be potentially valuable, which also needs to be validated by multicenter, large-scale, prospective studies.
Collapse
Affiliation(s)
- Bo Fan
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, the Liaoning Provincial Department of Science and Technology, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Liaoning Provincial Development and Reform Commission, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian Science and Technology Bureau, Dalian, Liaoning, China
| | - Luxin Zhang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, the Liaoning Provincial Department of Science and Technology, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Liaoning Provincial Development and Reform Commission, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian Science and Technology Bureau, Dalian, Liaoning, China
| | - Yuchao Wang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, the Liaoning Provincial Department of Science and Technology, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Liaoning Provincial Development and Reform Commission, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian Science and Technology Bureau, Dalian, Liaoning, China
| | - Zhihong Dai
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, the Liaoning Provincial Department of Science and Technology, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Liaoning Provincial Development and Reform Commission, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian Science and Technology Bureau, Dalian, Liaoning, China
| | - Heming Pan
- Department of Scientific Research, Dalian Neusoft University of Information, Dalian, Liaoning, China
| | - Jiaxin Xie
- Institute of Urology, Peking University, Beijing, China
| | - Hao Wang
- Department of Clinical Medicine, First Clinical School of Dalian Medical University, Dalian, Liaoning, China
| | - Zihan Xin
- Department of Clinical Medicine, First Clinical School of Dalian Medical University, Dalian, Liaoning, China
| | - Yutong Wang
- Department of Clinical Medicine, First Clinical School of Dalian Medical University, Dalian, Liaoning, China
| | - Xu Duan
- Department of Clinical Medicine, First Clinical School of Dalian Medical University, Dalian, Liaoning, China
| | - Jiawen Luo
- Department of Radiology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
| | - Liang Wang
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, the Liaoning Provincial Department of Science and Technology, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Liaoning Provincial Development and Reform Commission, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian Science and Technology Bureau, Dalian, Liaoning, China
| | - Zhiyu Liu
- Department of Urology, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning, China
- Liaoning Provincial Key Laboratory of Urological Digital Precision Diagnosis and Treatment, the Liaoning Provincial Department of Science and Technology, Dalian, Liaoning, China
- Liaoning Engineering Research Center of Integrated Precision Diagnosis and Treatment Technology for Urological Cancer, Liaoning Provincial Development and Reform Commission, Dalian, Liaoning, China
- Dalian Key Laboratory of Prostate Cancer Research, Dalian Science and Technology Bureau, Dalian, Liaoning, China
| |
Collapse
|
5
|
Beckmann KR, O'Callaghan ME, Vincent AD, Moretti KL, Brook NR. Clinical outcomes for men with positive surgical margins after radical prostatectomy-results from the South Australian Prostate Cancer Clinical Outcomes Collaborative community-based registry. Asian J Urol 2023; 10:502-511. [PMID: 38024435 PMCID: PMC10659979 DOI: 10.1016/j.ajur.2022.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 10/14/2022] Open
Abstract
Objective Positive surgical margins (PSMs) after radical prostatectomy (RP) indicate failure of surgery to completely clear cancer. PSMs confer an increased risk of biochemical recurrence (BCR), but how more robust outcomes are affected is unclear. This study investigated factors associated with PSMs following RP and determined their impact on clinical outcomes (BCR, second treatment [radiotherapy and/or androgen deprivation therapy], and prostate cancer-specific mortality [PCSM]). Methods The study cohort included men diagnosed with prostate cancer (pT2-3b/N0/M0) between January 1998 and June 2016 who underwent RP from the South Australian Prostate Cancer Clinical Outcomes Collaborative database. Factors associated with risk of PSMs were identified using Poisson regression. The impact of PSMs on clinical outcomes (BCR, second treatment, and PCSM) was assessed using competing risk regression. Results Of the 2827 eligible participants, 28% had PSMs-10% apical, 6% bladder neck, 17% posterolateral, and 5% at multiple locations. Median follow-up was 9.6 years with 81 deaths from prostate cancer recorded. Likelihood of PSM increased with higher pathological grade and pathological tumor stage, and greater tumour volume, but decreased with increasing surgeon volume (odds ratio [OR]: 0.93; 95% confidence interval [CI]: 0.88-0.98, per 100 previous prostatectomies). PSMs were associated with increased risk of BCR (adjusted sub-distribution hazard ratio [sHR] 2.5; 95% CI 2.1-3.1) and second treatment (sHR 2.9; 95% CI 2.4-3.5). Risk of BCR was increased similarly for each PSM location, but was higher for multiple margin sites. We found no association between PSMs and PCSM. Conclusion Our findings support previous research suggesting that PSMs are not independently associated with PCSM despite strong association with BCR. Reducing PSM rates remains an important objective, given the higher likelihood of secondary treatment with associated comorbidities.
Collapse
Affiliation(s)
- Kerri R. Beckmann
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
- Translational Oncology and Urology Research, Division of Pharmaceutical and Cancer Studies, Kings College London, London, UK
| | - Michael E. O'Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia
| | - Andrew D. Vincent
- The Freemason's Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Kim L. Moretti
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Adelaide, Australia
- Discipline of Surgery, University of Adelaide, Adelaide, Australia
| | | |
Collapse
|
6
|
Panunzio A, Sorce G, Hoeh B, Hohenhorst L, Tappero S, Nimer N, Rajwa P, Tian Z, Terrone C, Chun FKH, Briganti A, Saad F, Shariat SF, Cerruto MA, Antonelli A, Karakiewicz PI. Effect of positive surgical margins at radical prostatectomy on cancer-specific mortality in high/very high-risk prostate cancer patients with Gleason Grade Group 4-5. Prostate 2023; 83:268-276. [PMID: 36336728 DOI: 10.1002/pros.24458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/18/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of positive surgical margins (PSM) on cancer specific mortality (CSM) in high/very high-risk (HR/VHR) prostate cancer (PCa) with aggressive Gleason Grade Group (GGG) is unknown. We tested PSM effect on CSM in this setting, in addition to testing of radiotherapy (RT) benefit in PSM patients. METHODS We relied on Surveillance, Epidemiology, and End Results database (2010-2015), focusing on HR/VHR patients with exclusive GGG 4-5 at radical prostatectomy (RP). Kaplan-Meier plots and multivariable Cox regression models tested the relationship between PSM and CSM. Moreover, the effect of RT on CSM was explored in PSM patients. RESULTS Of 3383 HR/VHR patients, 15.1% (n = 511) exhibited PSM. Patients with PSM harbored higher rates of GGG 5 (60.1% vs. 50.9%, p < 0.001), pathologic tumor stage T3a (69.1% vs. 45.2%, p < 0.001) and lymph node involvement (14.1% vs. 9.4%, p < 0.001), relative to patients without PSM. PSM rates decreased over time (2010-2015) from 16.0% to 13.6%. Seven-year CSM-free survival rates were 91.6% versus 95.7% in patients with and without PSM, respectively. In multivariable Cox regression models, PSM was an independent predictor of CSM (hazard ratio = 1.6, p = 0.040) even after adjustment for age, prostate specific antigen, pathologic tumor stage and lymph node status. Finally, in PSM patients, RT delivery did not reduce CSM in either univariable or multivariable Cox regression models. CONCLUSIONS In HR/VHR PCa patients with exclusive GGG 4-5, PSM at RP adversely affect survival. Moreover, RT has no protective effect on CSM. In consequence, lowest possible PSM rates are crucial in such patients.
Collapse
Affiliation(s)
- Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Nancy Nimer
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York City, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| |
Collapse
|
7
|
The Effect of Adverse Surgical Margins on the Risk of Biochemical Recurrence after Robotic-Assisted Radical Prostatectomy. Biomedicines 2022; 10:biomedicines10081911. [PMID: 36009458 PMCID: PMC9405399 DOI: 10.3390/biomedicines10081911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/25/2022] Open
Abstract
Positive surgical margins (PSM) after radical prostatectomy are associated with a greater risk of biochemical recurrence (BCR). However, not all PSM harbour the same prognosis for recurrence. We aim to determine the impact of different PSM characteristics and their coexistence on the risk of BCR. This retrospective study included 333 patients that underwent robotic-assisted radical prostatectomy for prostate cancer between 2015−2020 at a single institution. The effect of PSM and their adverse characteristics on the risk of BCR was assessed using Cox proportional hazard models. Kaplan−Meier was used to represent BCR-free survival stratified by margin status. With a median follow-up of 34.5 months, patients with PSM had a higher incidence of BCR, higher risk of relapse and lower BCR-free survival than negative margins (p < 0.001). We established as adverse characteristics: PSM length ≥ 3 mm, multifocality and Gleason at margin > 3. PSM ≥ 3 mm or multifocal PSM were associated with an increased risk for BCR compared to favourable margins (HR 3.50; 95% CI 2.05−5.95, p < 0.001 and HR 2.18; 95% CI 1.09−4.37, p = 0.028, respectively). The coexistence of these two adverse features in the PSM also conferred a higher risk for biochemical relapse and lower BCR-free survival. Adverse Gleason in the margin did not confer a higher risk for BCR than non-adverse margins in our models. We concluded that PSM are an independent predictor for BCR and that the presence of adverse characteristics, such as length and focality, and their coexistence in the PSM are associated with a greater risk of recurrence. Nevertheless, subclassifying PSM with adverse features did not enhance the model’s predictive performance in our cohort.
Collapse
|
8
|
Pavel AG, Stambouli D, Gener I, Preda A, Anton G, Baston C. Genetic variant located on chromosome 17p12 contributes to prostate cancer onset and biochemical recurrence. Sci Rep 2022; 12:4546. [PMID: 35296725 PMCID: PMC8927158 DOI: 10.1038/s41598-022-08472-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/07/2022] [Indexed: 12/24/2022] Open
Abstract
The genetic contribution to prostate cancer (PC) onset and clinical heterogeneity has an important impact on the disease stratification accuracy. Despite the fact that radical prostatectomy (RP) is an effective treatment for localized PC, a considerable number of individuals develop biochemical recurrence (BCR) following surgery. In the present study, we decided to investigate the significance of genetic variability in a homogeneous group of Romanian men and to determine if genotyping could provide information regarding the possible implications of rs4054823 susceptibility loci in PC progression and outcome. A total of 78 samples from both PC and benign prostatic hyperplasia (BPH) patients were genotyped. The genotype frequencies were examined to see if there was a link between the 17p12 SNP and PC disease. When compared to the BPH group, the PC group had a significantly higher frequency of the T risk variant (P = 0.0056) and TT genotype (P = 0.0164). Subsequent analysis revealed that the TT genotype had a significantly higher frequency among younger PC patients based on their age at diagnosis and that it was related with a greater probability of BCR (P = 0.02). According to our findings, the TT genotype appears to be a risk factor for early-onset PC and a potential predictor for BCR after RP.
Collapse
Affiliation(s)
- Anca Gabriela Pavel
- Molecular Genetics Department, Cytogenomic Medical Laboratory, Bucharest, Romania. .,The Romania Academy, "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania.
| | - Danae Stambouli
- Molecular Genetics Department, Cytogenomic Medical Laboratory, Bucharest, Romania
| | - Ismail Gener
- Department of Nephrology, Urology, Immunology and Immunology of Transplant, Dermatology, Allergology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Nephrology, Fundeni Clinical Institute, Bucharest, Romania
| | - Adrian Preda
- Center of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Gabriela Anton
- The Romania Academy, "Stefan S. Nicolau" Institute of Virology, Bucharest, Romania
| | - Catalin Baston
- Department of Nephrology, Urology, Immunology and Immunology of Transplant, Dermatology, Allergology, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Center of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| |
Collapse
|
9
|
Rocco B, Cimadamore A, Sarchi L, Bonetti LR, Bertoni L, Azzoni P, Assumma S, Turri F, Bozzini G, Eissa A, Micali S, Bianchi G, Maiorana A, Montironi R, Pellacani G, Sighinolfi MC. Current and future perspectives of digital microscopy with fluorescence confocal microscope for prostate tissue interpretation: a narrative review. Transl Androl Urol 2021; 10:1569-1580. [PMID: 33850791 PMCID: PMC8039586 DOI: 10.21037/tau-20-1237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/30/2020] [Indexed: 12/18/2022] Open
Abstract
Fluorescence confocal microscopy (FCM) is an optical imaging technique providing digital microscopical images of fresh tissue in a real time fashion, without conventional processing. FCM has been widely applied in several fields of dermatology, including the detection of basal cell carcinoma and of cutaneous inflammatory diseases. The aim of the paper is to provide an overview of FCM applications in the field of prostate tissue interpretation and prostate cancer (PCa) detection. A Literature search (PubMed & Web of Science) was performed to identify articles concerned with the clinical and surgical applications of FCM in prostatic and periprostatic tissues interpretation. Overall, six articles were identified. All articles investigated the level of agreement between FCM and conventional histopathological analysis (hematoxylin-eosin, HE) for the discrimination between normal and PCa tissues. An investigative article on prostate samples retrieved from radical prostatectomy (RP) specimens and an atlas of FCM digital images from the same series were found. Two prospective clinical trials, comparing FCM and HE, pointed out a "substantial" to "almost perfect" discriminative performance of FCM for the diagnosis of PCa on prostate biopsy core. Finally, two studies investigated the intra-operative role of FCM during RP for the control of surgical dissection. In this setting, FCM could be used to analyse samples retrieved from suspicious peri-prostatic areas; FCM has also been tested for an en-face evaluation of flat slices obtained from the systematic sampling of the posterolateral aspects of the prostate, in a NeuroSAFE-like approach. Generally, FCM provides digital microscopical images of fresh tissue in a real time fashion, without requiring conventional processing. Currently, available studies confirmed a high concordance with conventional pathology for the detection of PCa. Further studies are required to validate the technology, to evaluate ISUP score attribution and to implement the fields of application of FCM for the treatment of prostate diseases.
Collapse
Affiliation(s)
- Bernardo Rocco
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Cimadamore
- Department of Pathology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Luca Sarchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Laura Bertoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Azzoni
- Department of Human Anatomy, University of Modena and Reggio Emilia, Modena, Italy
| | - Simone Assumma
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Filippo Turri
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Ahmed Eissa
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Salvatore Micali
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giampaolo Bianchi
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonino Maiorana
- Department of Pathology, University of Modena and Reggio Emilia, Modena, Italy
| | - Rodolfo Montironi
- Department of Pathology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | | |
Collapse
|
10
|
Martínez-Holguín E, Herranz-Amo F, Mayor de Castro J, Polanco-Pujol L, Hernández-Cavieres J, Subirá-Ríos D, Moralejo-Gárate M, Aragón-Chamizo J, Hernández-Fernández C. Comparison between laparoscopic and open prostatectomy: Oncological progression analysis. Actas Urol Esp 2021; 45:139-145. [PMID: 33160757 DOI: 10.1016/j.acuro.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION There are very few Spanish studies that compare oncological outcomes following radical prostatectomy (RP) based on surgical approach, and their methodology is not appropriate. OBJECTIVE To compare oncological outcomes in terms of surgical margins (SM) and biochemical recurrence (BR) between open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS Comparison of two cohorts (307 with ORP and 194 with LRP) between 2007-2015. Surgical margin status was defined as positive or negative, and BR as a PSA rise of >0.4 ng/ml after surgery. To compare the qualitative variables, we employed the Chi-squared test, and ANOVA was used for quantitative variables. We performed a multivariate analysis using logistic regression to evaluate the predictive factors of SM, and a multivariate analysis using Cox regression to evaluate the predictive factors of BR. RESULTS Gleason 7 (3+4) was determined in the surgical specimens of 43.5% of patients, and 31.7% had positive SM. The most frequent pathological stage was pT2c, on the 61.9% of the cases. No significant differences were found between both groups, except for extracapsular extension (p=0.001), more frequent in LRP. The median follow-up was 49 months. BR was seen in the 23% of patients, without significant differences between groups. In the multivariable analysis, only the D'Amico risk group behaved as an independent predictive factor of positive SM, and Gleason score and positive SM acted as independent predictive factors of BR. CONCLUSION The surgical approach did not influence SM status or BR.
Collapse
|
11
|
Liu CY, Chen YT, Su SH, Yu KJ, Chang YH, Lin PH, Shao IH, Kan HC, Chu YC, Huang LK, Chuang CK, Pang ST. Is immediate adjuvant radiotherapy necessary for men with positive surgical margin after robotic-assisted radical prostatectomy? FORMOSAN JOURNAL OF SURGERY 2021. [DOI: 10.4103/fjs.fjs_99_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
12
|
Nanda JS, Awadallah WN, Kohrt SE, Popovics P, Cates JMM, Mirosevich J, Clark PE, Giannico GA, Grabowska MM. Increased nuclear factor I/B expression in prostate cancer correlates with AR expression. Prostate 2020; 80:1058-1070. [PMID: 32692871 PMCID: PMC7434711 DOI: 10.1002/pros.24019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 04/17/2020] [Accepted: 05/11/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Most prostate cancers express androgen receptor (AR), and our previous studies have focused on identifying transcription factors that modify AR function. We have shown that nuclear factor I/B (NFIB) regulates AR activity in androgen-dependent prostate cancer cells in vitro. However, the status of NFIB in prostate cancer was unknown. METHODS We immunostained a tissue microarray including normal, hyperplastic, prostatic intraepithelial neoplasia, primary prostatic adenocarcinoma, and castration-resistant prostate cancer tissue samples for NFIB, AR, and synaptophysin, a marker of neuroendocrine differentiation. We interrogated publically available data sets in cBioPortal to correlate NFIB expression and AR and neuroendocrine prostate cancer (NEPCa) activity scores. We analyzed prostate cancer cell lines for NFIB expression via Western blot analysis and used nuclear and cytoplasmic fractionation to assess where NFIB is localized. We performed co-immunoprecipitation studies to determine if NFIB and AR interact. RESULTS NFIB increased in the nucleus and cytoplasm of prostate cancer samples versus matched normal controls, independent of Gleason score. Similarly, cytoplasmic AR and synaptophysin increased in primary prostate cancer. We observed strong NFIB staining in primary small cell prostate cancer. The ratio of cytoplasmic-to-nuclear NFIB staining was predictive of earlier biochemical recurrence in prostate cancer, once adjusted for tumor margin status. Cytoplasmic AR was an independent predictor of biochemical recurrence. There was no statistically significant difference between NFIB and synaptophysin expression in primary and castration-resistant prostate cancer, but cytoplasmic AR expression was increased in castration-resistant samples. In primary prostate cancer, nuclear NFIB expression correlated with cytoplasmic NFIB and nuclear AR, while cytoplasmic NFIB correlated with synaptophysin, and nuclear and cytoplasmic AR. In castration-resistant prostate cancer samples, NFIB expression correlated positively with an AR activity score, and negatively with the NEPCa score. In prostate cancer cell lines, NFIB exists in several isoforms. We observed NFIB predominantly in the nuclear fraction of prostate cancer cells with increased cytoplasmic expression seen in castration-resistant cell lines. We observed an interaction between AR and NFIB through co-immunoprecipitation experiments. CONCLUSION We have described the expression pattern of NFIB in primary and castration-resistant prostate cancer and its positive correlation with AR. We have also demonstrated AR interacts with NFIB.
Collapse
Affiliation(s)
- Jagpreet S. Nanda
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | | | - Sarah E. Kohrt
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH
| | - Petra Popovics
- Department of Urology, Case Western Reserve University, Cleveland, OH
| | - Justin M. M. Cates
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Janni Mirosevich
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Peter E. Clark
- Department of Urology, Levine Cancer Center/Atrium Health, Charlotte, NC
| | - Giovanna A. Giannico
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Magdalena M. Grabowska
- Department of Urology, Case Western Reserve University, Cleveland, OH
- Department of Pharmacology, Case Western Reserve University, Cleveland, OH
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH
- Address correspondence to: Magdalena M. Grabowska, 2123 Adelbert Road, Wood Research Tower; RTG00, Cleveland, OH 44106, Phone: 216-368-5736,
| |
Collapse
|
13
|
Lian Z, Zhang H, He Z, Ma S, Wang X, Liu R. Impact of positive surgical margin location and perineural invasion on biochemical recurrence in patients undergoing radical prostatectomy. World J Surg Oncol 2020; 18:201. [PMID: 32791998 PMCID: PMC7427290 DOI: 10.1186/s12957-020-01977-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/30/2020] [Indexed: 01/16/2023] Open
Abstract
Objective To estimate the prognostic value of positive surgical margins (PSM) location and perineural invasion (PNI) for biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP). Methods All men with prostate cancer (PCa) who received RP in the second hospital of Tianjin Medical University from 2014 to 2018 were retrospectively identified. All patients met the following criteria: no neoadjuvant or adjuvant treatment, absence of lymph node invasion, or distant metastasis confirmed by surgery or imaging. Comparisons were made between cases with only apex positive (AM), isolated nonapical positive (OM), multiple positive (MM), and negative surgical margins (NSM). Patients were also subdivided according to the Gleason score and pathological tumor stage for analysis. Results A total of 416 patients available for analysis, of which 132 (31.7%) were PSM, 43 were AM, 37 were OM, and 52 were MM at a median follow-up of 27 months. The PNI was in 30.5% of patients. BCR occurred in 22.6% of patients during follow-up. Both AM and MM were noticed to be independent predictors of BCR with a hazard ratio of 4.192 (95% CI 2.185–8.042; p < 0.001) and 2.758 (95% CI 1.559–4.880; p < 0.001), respectively, when compared to NSM. Though the correlation was significant in univariate analysis, PNI was not an independent risk factor for BCR (p = 0.369). Subgroup analyses suggested that MM was not particularly predictive for BCR in the Gleason score < 8. The hole Cox regression model for the C-index was 0.843 Conclusions PSM location was a significant independent predictor of BCR in PCa, especially in patients with AM or MM, while PNI is a non-independent risk factor. Compared with other locations, AM has a higher BCR risk.
Collapse
Affiliation(s)
- Zhenpeng Lian
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Hongtuan Zhang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Zhaowei He
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Shenfei Ma
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Xiaoming Wang
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| | - Ranlu Liu
- Department of Urology, Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China.
| |
Collapse
|
14
|
Zhang B, Zhou J, Wu S, Guo M, Zhang Y, Liu R. The impact of surgical margin status on prostate cancer-specific mortality after radical prostatectomy: a systematic review and meta-analysis. Clin Transl Oncol 2020; 22:2087-2096. [DOI: 10.1007/s12094-020-02358-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/28/2020] [Indexed: 12/21/2022]
|
15
|
Olde Heuvel J, de Wit-van der Veen BJ, Vyas KN, Tuch DS, Grootendorst MR, Stokkel MPM, Slump CH. Performance evaluation of Cerenkov luminescence imaging: a comparison of 68Ga with 18F. EJNMMI Phys 2019; 6:17. [PMID: 31650365 PMCID: PMC6813407 DOI: 10.1186/s40658-019-0255-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 09/27/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cerenkov Luminescence Imaging (CLI) is an emerging technology for intraoperative margin assessment. Previous research only evaluated radionuclide 18-Fluorine (18F); however, for future applications in prostate cancer, 68-Gallium (68Ga) seems more suitable, given its higher positron energy. Theoretical calculations predict that 68Ga should offer a higher signal-to-noise ratio than 18F; this is the first experimental confirmation. The aim of this study is to investigate the technical performance of CLI by comparing 68Ga to 18F. RESULTS The linearity of the system, detection limit, spatial resolution, and uniformity were determined with the LightPath imaging system. All experiments were conducted with clinically relevant activity levels in vitro, using dedicated phantoms. For both radionuclides, a linear relationship between the activity concentration and detected light yield was observed (R2 = 0.99). 68Ga showed approximately 22 times more detectable Cerenkov signal compared to 18F. The detectable activity concentration after a 120 s exposure time and 2 × 2 binning of 18F was 23.7 kBq/mL and 1.2 kBq/mL for 68Ga. The spatial resolution was 1.31 mm for 18F and 1.40 mm for 68Ga. The coefficient of variance of the uniformity phantom was 0.07 for the central field of view. CONCLUSION 68Ga was superior over 18F in terms of light yield and minimal detection limit. However, as could be expected, the resolution was 0.1 mm less for 68Ga. Given the clinical constraints of an acquisition time less than 120 s and a spatial resolution < 2 mm, CLI for intraoperative margin assessment using 68Ga could be feasible.
Collapse
Affiliation(s)
- J Olde Heuvel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands. .,Robotics and Mechatronics , Technical Medical Centre, University of Twente, Enschede, The Netherlands.
| | | | - K N Vyas
- Lightpoint Medical Ltd, Misbourne Works, Waterside, Chesham, HP5 1PE, UK
| | - D S Tuch
- Lightpoint Medical Ltd, Misbourne Works, Waterside, Chesham, HP5 1PE, UK
| | - M R Grootendorst
- Lightpoint Medical Ltd, Misbourne Works, Waterside, Chesham, HP5 1PE, UK
| | - M P M Stokkel
- Department of Nuclear Medicine, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - C H Slump
- Robotics and Mechatronics , Technical Medical Centre, University of Twente, Enschede, The Netherlands
| |
Collapse
|
16
|
Koskas Y, Lannes F, Branger N, Giusiano S, Guibert N, Pignot G, Walz J, Rossi D, Bastide C. Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up. BMC Urol 2019; 19:37. [PMID: 31092240 PMCID: PMC6518701 DOI: 10.1186/s12894-019-0470-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 05/01/2019] [Indexed: 11/16/2022] Open
Abstract
Background To assess the prognostic value of the extent of positive surgical margins (PSM) following radical prostatectomy (RP) on biochemical recurrence (BR) with long-term follow-up. Methods This retrospective study analyzed 1275 RPs performed between January 1992 and December 2013 in two university centers in Marseille (France). The inclusion criteria were: follow-up > 24 months, undetectable postoperative prostate-specific antigen (PSA), no seminal vesicle (SV) invasion, no lymph node invasion confirmed by surgery (pN0) or imaging (pNx), and no neoadjuvant or adjuvant treatment. BR was defined by PSA level ≥ 0.2 ng/mL on two successive samples. We included 189 patients, divided into two groups: - Focal PSM (fPSM): single PSM (sPSM) ≤3 mm; - Extensive PSM (ePSM): sPSM with linear length > 3 mm or several margins regardless of the length. Results The median follow-up was 101 months (18–283) and the median age was 63 years (46–76). BR occurred in only 12.1% (14/115) of cases involving fPSM and in 54.1% (40/74) of cases involving ePSM. In the multivariate model, ePSM patients were significantly associated with increased BR compared to fPSM (hazard ratio [HR] = 6.11; 95% confidence interval [CI] = 3.25–11.49). The ePSM significantly decreased BR-free survival (p < 0.001) for every patient and every subgroup (pT2, pT3a, pG ≤6, and pG ≥7). The median BR time following RP was significantly shorter for ePSM patients than fPSM (57.2 vs. 89.2 months p < 0.001). Conclusion With a median 8-year follow-up, ePSM was strongly associated with BR compared to fPSM. Therefore, it seems legitimate to monitor patients with fPSM. In cases of ePSM, adjuvant treatment appears effective.
Collapse
Affiliation(s)
- Yoann Koskas
- Department of Urology, Hopital Nord, Chemin des Bourrely, 13015, Marseille, France.
| | - François Lannes
- Department of Urology, Hopital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Nicolas Branger
- Department of Urology, Hopital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Sophie Giusiano
- Department of Anatomic Pathology, Hôpital nord, Chemin des Bourrely, 13015, Marseille, France
| | - Nicolas Guibert
- Centre hospitalier universitaire de Lyon, Lyon, France.,Hopital Edouard Herriot, 69003, Lyon, France
| | - Géraldine Pignot
- Departement of urology, Institut Paoli-Calmettes, 13008, Marseille, France
| | - Jochen Walz
- Departement of urology, Institut Paoli-Calmettes, 13008, Marseille, France
| | - Dominique Rossi
- Department of Urology, Hopital Nord, Chemin des Bourrely, 13015, Marseille, France
| | - Cyrille Bastide
- Department of Urology, Hopital Nord, Chemin des Bourrely, 13015, Marseille, France
| |
Collapse
|
17
|
Martini A, Gandaglia G, Fossati N, Scuderi S, Bravi CA, Mazzone E, Stabile A, Scarcella S, Robesti D, Barletta F, Cucchiara V, Mirone V, Montorsi F, Briganti A. Defining Clinically Meaningful Positive Surgical Margins in Patients Undergoing Radical Prostatectomy for Localised Prostate Cancer. Eur Urol Oncol 2019; 4:42-48. [PMID: 31411971 DOI: 10.1016/j.euo.2019.03.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/27/2019] [Accepted: 03/12/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of positive surgical margins (PSMs) on the risk of metastases in prostate cancer (PCa) patients treated with radical prostatectomy (RP) is still debated. OBJECTIVE To identify PSM features associated with recurrence in a stage-by-stage analysis. DESIGN, SETTING, AND PARTICIPANTS A total of 1757 PCa patients treated with RP without neoadjuvant or adjuvant treatments between 2011 and 2017 were identified. Patients were stratified according to the presence of PSM and to margins characteristics in three groups: no versus favourable (single margin <3mm) versus unfavourable (≥3mm or multifocal margin) PSMs. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Predictors of biochemical recurrence (BCR) and clinical recurrence (CR) were assessed using semiparametric Cox proportional hazard models. RESULTS AND LIMITATIONS Overall, 285 (16%) patients had PSMs; 146 (51%) had a unifocal PSM, while 139 (49%) had a multifocal PSM. The median length of a PSM was 1mm. Overall, 120 (42%) versus 165 (58%) patients had favourable versus unfavourable PSMs. In patients with ≤pT3a and pathologic grade group ≤3 disease (n=1351), favourable (hazard ratio [HR]: 2.24; 95% confidence interval [CI]: 1.19-4.22) and unfavourable (HR: 2.68; 95% CI: 1.49-4.84) PSMs significantly increased the risk of BCR (p<0.01). However, they were not associated with CR (all p>0.05). Conversely, in patients with pT3b/4 and/or pathologic grade group 4-5 and/or pN1 (n=406), only an unfavourable PSM was associated with both BCR (HR: 2.96; 95% CI: 1.19-4.22) and CR (HR: 2.60; 95% CI: 1.07-6.30; all p≤0.04). CONCLUSIONS Although the presence of PSMs was associated with an increased risk of BCR in all stages, only men with adverse pathologic characteristics and an unfavourable PSM were at an increased risk of experiencing metastases as compared with their counterparts with no or a single margin shorter than 3mm. PATIENT SUMMARY In this study, we defined a new category of unfavourable positive surgical margins (namely, ≥3mm and/or multifocal), which confers a higher risk of developing metastasis in men with more aggressive pathologic features.
Collapse
Affiliation(s)
- Alberto Martini
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Carlo Andrea Bravi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elio Mazzone
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Armando Stabile
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Simone Scarcella
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniele Robesti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vito Cucchiara
- Department of Urology, Università Federico II, Naples, Italy
| | - Vincenzo Mirone
- Department of Urology, Università Federico II, Naples, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
18
|
Ikeda M, Amano N, Sakata Y, Honda T, Tachibana T, Hirano S, Yamashita H, Ishii J, Irie A. Gleason Pattern 5 is a Possible Pathologic Predictor for Biochemical Recurrence after Laparoscopic Radical
Prostatectomy. Asian Pac J Cancer Prev 2019; 20:783-788. [PMID: 30909685 PMCID: PMC6825777 DOI: 10.31557/apjcp.2019.20.3.783] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: Several prognostic factors for biochemical recurrence after radical prostatectomy have been reported, including initial prostate-specific antigen level, Gleason score, positive surgical margin, and seminal vesicle invasion. Here we investigate whether Gleason pattern 5 is a predictor for biochemical recurrence. Methods: This retrospective study included 168 patients who underwent laparoscopic radical prostatectomy from 2006 to 2015. The relationship between biochemical recurrence after laparoscopic radical prostatectomy and the presence of Gleason pattern 5, even as a tertiary pattern, was investigated. Biochemical recurrence was defined when the prostate-specific antigen level rose to >0.2 ng/ml after having decreased to <0.1 ng/ml following laparoscopic radical prostatectomy. Biochemical recurrence-free survival was estimated by the Kaplan-Meier method. Multivariate analysis was performed using a Cox proportional hazards regression model. Results: The median age was 66 years, median initial prostate-specific antigen level was 6.9 ng/ml, and median follow-up period was 47.3 months. Biochemical recurrence was recognized in 27 patients (16.1%) after laparoscopic radical prostatectomy, and 5-year biochemical recurrence-free survival was 78.6%. Gleason pattern 5 was noted in 5 patients as the primary pattern, in 10 as the secondary pattern, and in 5 as the tertiary pattern. According to multivariate analysis, presence of Gleason pattern 5 (HR = 4.75, p=0.001) and positive surgical margin (HR = 4.66, p=0.001) were independent predictive factors for biochemical recurrence-free survival. Conclusion: Gleason pattern 5 appears to be an important predictive factor for biochemical recurrence after laparoscopic radical prostatectomy.
Collapse
Affiliation(s)
- Masaomi Ikeda
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Noriyuki Amano
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Yusuke Sakata
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Tomotsugu Honda
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Takashi Tachibana
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Shuhei Hirano
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Hideyuki Yamashita
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Junichiro Ishii
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| | - Akira Irie
- Department of Urology, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
| |
Collapse
|
19
|
Panarello D, Compérat E, Seyde O, Colau A, Terrone C, Guillonneau B. Atlas of Ex Vivo Prostate Tissue and Cancer Images Using Confocal Laser Endomicroscopy: A Project for Intraoperative Positive Surgical Margin Detection During Radical Prostatectomy. Eur Urol Focus 2019; 6:941-958. [PMID: 30683530 DOI: 10.1016/j.euf.2019.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 12/18/2018] [Accepted: 01/08/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Confocal laser endomicroscopy (CLE) is an optical device that aims to image histological architecture and may be used to reduce positive surgical margins. The ability of CLE to describe prostatic and periprostatic tissues, and prostate cancer (PCa) is still an object of investigation. OBJECTIVE To create an atlas of ex vivo CLE images of prostatic and periprostatic tissues, and PCa in order to recognise different prostatic structures. DESIGN, SETTING, AND PARTICIPANTS From November 2017 to February 2018, 15 patients underwent radical prostatectomy for biopsy-proven PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Based on preoperative data and macroscopic examination, tumour location was assessed and confirmed on frozen sections. Prior to ex vivo CLE analysis, prostates were stained with fluorescein 10%. We used a GastroFlex probe to collect images of periprostatic tissue (adipose tissue, fibrous and connective tissues, vessels, nerve sheets, seminal vesicles, and urethra). Normal prostatic glands and tumour tissue according to the Gleason grade were analysed. Each PCa Gleason score was represented. RESULTS AND LIMITATIONS A total of 139 video clips and 237 pictures of prostatic and periprostatic tissues were collected. Among them, we selected 16 highly representative images. Adipose tissue, fibrous tissue, and connective tissue were supposable in all 15 specimens. PCa glands captured fluorescein in their cytoplasm, normal prostatic glands did not capture fluorescein, and glandular structures were easily recognisable. The principal limitation of this study is its ex vivo nature of the study. CONCLUSIONS Each CLE image was correlated with the corresponding haematoxylin/eosin/saffron definitive pathology image, allowing building of an atlas as a necessary tool to assess the diagnostic performance of CLE during radical prostatectomy in achieving negative surgical margins. PATIENT SUMMARY In this study, we aim to provide an atlas of images illustrating prostatic, periprostatic, and PCa tissues obtained using Cellvizio confocal laser endomicroscopy as a tool for further interpretation of intraoperative surgical margins during radical prostatectomy.
Collapse
Affiliation(s)
- Daniele Panarello
- Service of Urology, Diaconesses-Croix St Simon Hospital, Sorbonne University, Paris, France; Department of Urology, San Martino Hospital, Genoa University, Genova, Italy
| | - Eva Compérat
- Service of Pathology, Tenon Hospital, HUEP, Sorbonne University, Paris, France
| | - Olivia Seyde
- Service of Pathology, Tenon Hospital, HUEP, Sorbonne University, Paris, France
| | - Alexandre Colau
- Service of Urology, Diaconesses-Croix St Simon Hospital, Sorbonne University, Paris, France
| | - Carlo Terrone
- Department of Urology, San Martino Hospital, Genoa University, Genova, Italy
| | - Bertrand Guillonneau
- Service of Urology, Diaconesses-Croix St Simon Hospital, Sorbonne University, Paris, France.
| |
Collapse
|
20
|
Keller EX, Bachofner J, Britschgi AJ, Saba K, Mortezavi A, Kaufmann B, Fankhauser CD, Wild P, Sulser T, Hermanns T, Eberli D, Poyet C. Prognostic value of unifocal and multifocal positive surgical margins in a large series of robot-assisted radical prostatectomy for prostate cancer. World J Urol 2018; 37:1837-1844. [PMID: 30519744 DOI: 10.1007/s00345-018-2578-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 11/26/2018] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To evaluate the prognostic value of positive surgical margins (PSM) focality for the prediction of biochemical recurrence (BCR) in patients undergoing robotic-assisted radical prostatectomy (RARP) for prostate cancer. METHODS All men with clinically localized prostate cancer undergoing RARP in our tertiary referral centre between May 2005 and August 2016 were retrospectively identified. Patients with neoadjuvant therapy were excluded. Comparisons were made between cases with negative surgical margins (NSM), unifocal PSM (uPSM), and multifocal PSM (mPSM). RESULTS From a total of 973 patients available for analysis, 315 (32%) had a PSM. In these patients, 190 had uPSM and 125 had mPSM. Focality of PSM was significantly associated with tumour stage and grade, preoperative PSA, and postoperative PSA persistence (all p < 0.001), but not with nerve sparing (NS) (p = 0.15). PSA persistence was found in 120 (12%) patients, resulting in 853 patients available for survival analyses with a median follow-up of 52 months. Both uPSM and mPSM were found to be independent predictors of BCR, conferring a hazard ratio of 1.9 (95% CI 1.3-3.0; p = 0.002) and 3.4 (95% CI 2.1-5.6; p < 0.001), respectively, when compared to NSM. In subgroup analyses, PSM was particularly predictive for BCR when patients underwent unilateral or bilateral NS (p ≤ 0.003). CONCLUSIONS Based on a large case series of RARP, we found PSM focality to be an independent predictor of BCR, with a 1.9- and 3.4-fold risk increase for BCR in case of uPSM and mPSM, respectively. PSM seems to be of particular prognostic relevance when NS has been performed.
Collapse
Affiliation(s)
- Etienne Xavier Keller
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Jacqueline Bachofner
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Anna Jelena Britschgi
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Karim Saba
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Ashkan Mortezavi
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Basil Kaufmann
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Christian D Fankhauser
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Peter Wild
- Institute of Surgical Pathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Tullio Sulser
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Daniel Eberli
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Cédric Poyet
- Department of Urology, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| |
Collapse
|
21
|
Croghan SM, Matanhelia DM, Foran AT, Galvin DJ. Oncological Outcomes of Open Radical Retropubic Prostatectomy in Ireland: A Single Surgeon's 5-Year Experience. Surg J (N Y) 2018; 4:e226-e234. [PMID: 30574556 PMCID: PMC6261740 DOI: 10.1055/s-0038-1675827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Accepted: 10/08/2018] [Indexed: 12/17/2022] Open
Abstract
Objectives There is a little published data on the outcomes of radical prostatectomy in the Irish context. We aimed to determine the 5-year oncological results of open radical retropubic prostatectomy (RRP) performed by a single surgeon following appointment. Methods A retrospective review of RRPs performed between 2011 and 2016 was conducted. Patient demographics, preoperative parameters (clinical stage on digital rectal exam, prostate-specific antigen (PSA) levels, biopsy Gleason's score and MRI [magnetic resonance imaging] findings), pathological variables (T-stage, Gleason's score, nodal status, and surgical margin status), and treatment decisions (lymphadenectomy or adjuvant radiotherapy) were recorded. Oncological outcome at last follow-up was ascertained. Results 265 patients underwent RRP between 2011 and 2016. Median age was 62 years (range: 41-74). Mean follow-up was 32.24 months (range: 8-72) months. Pathological disease stage was T2 in 170/265 (64.15%), T3a in 65/265 (24.53%), and T3b in 30/265 (11.32%). Final Gleason's score was upgraded from diagnostic biopsy in 16.35% (43/263) and downgraded in 27% (71/263). Pelvic lymph node dissection was performed in 44.25% (118/265) patients. A positive surgical margin (PSM) was seen in 26/170 (15.2%) patients with T2 disease and in 45/95 (47.37%) patients with T3 disease. Of the 265 patients, 238 (89.81%) were disease-free at last follow-up, of whom 24/238 (10.08%) had received adjuvant and 17/238 (7.14%) received salvage radiotherapy. Adjuvant/salvage treatment was ongoing in 19/265 (7.17%) of patients. Conclusion Good oncological outcomes of RRP in the Irish context are seen in this 5-year review, with the vast majority of patients experiencing biochemical-free survival at most recent follow-up.
Collapse
Affiliation(s)
- Stefanie M Croghan
- Department of Urology, The Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
| | | | - Ann T Foran
- Department of Urology, The Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
| | - David J Galvin
- Department of Urology, The Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland.,Department of Urology, St. Vincent's University Hospital, Elm Park, Dublin, Ireland.,Department of Urology, St. Vincent's Private Hospital, Elm Park, Dublin, Ireland
| |
Collapse
|
22
|
Ortelli L, Spitale A, Mazzucchelli L, Bordoni A. Quality indicators of clinical cancer care for prostate cancer: a population-based study in southern Switzerland. BMC Cancer 2018; 18:733. [PMID: 29996904 PMCID: PMC6042390 DOI: 10.1186/s12885-018-4604-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/18/2018] [Indexed: 12/31/2022] Open
Abstract
Background Quality of cancer care (QoCC) has become an important item for providers, regulators and purchasers of care worldwide. Aim of this study is to present the results of some evidence-based quality indicators (QI) for prostate cancer (PC) at the population-based level and to compare the outcomes with data available in the literature. Methods The study included all PC diagnosed on a three years period analysis (01.01.2011–31.12.2013) in the population of Canton Ticino (Southern Switzerland) extracted from the Ticino Cancer Registry database. 13 QI, approved through the validated Delphi methodology, were calculated using the “available case” approach: 2 for diagnosis, 4 for pathology, 6 for treatment and 1 for outcome. The selection of the computed QI was based on the availability of medical documentation. QI are presented as proportion (%) with the corresponding 95% confidence interval. Results 700 PC were detected during the three-year period 2011–2013: 78.3% of them were diagnosed through a prostatic biopsy and for 72.5% 8 or more biopsy cores were taken. 46.5% of the low risk PC patients underwent active surveillance, while 69.2% of high risk PC underwent a radical treatment (radical prostatectomy, radiotherapy or brachytherapy) and 73.5% of patients with metastatic PC were treated with hormonal therapy. The overall 30-day postoperative mortality was 0.5%. Conclusions Results emerging from this study on the QoCC for PC in Canton Ticino are encouraging: the choice of treatment modalities seems to respect the international guidelines and our results are comparable to the scarce number of available international studies. Additional national and international standardisation of the QI and further QI population-based studies are needed in order to get a real picture of the PC diagnostic-therapeutic process progress through the definition of thresholds of minimal standard of care. Electronic supplementary material The online version of this article (10.1186/s12885-018-4604-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Laura Ortelli
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland.
| | - Alessandra Spitale
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland
| | - Luca Mazzucchelli
- Clinical Pathology, Cantonal Institute of Pathology, 6600, Locarno, Switzerland
| | - Andrea Bordoni
- Ticino Cancer Registry, Cantonal Institute of Pathology, Via in Selva 24, 6600, Locarno, Switzerland
| |
Collapse
|
23
|
Exploring positive surgical margins after minimally invasive radical prostatectomy: Does body habitus really make a difference ? Prog Urol 2018; 28:434-441. [PMID: 29789234 DOI: 10.1016/j.purol.2018.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Positive surgical margins (PSMs) at radical prostatectomy (RP) are generally recognized as a surrogate of poor or difficult dissection of the prostatic gland. In open RP cohorts, obesity seems to be associated to an increased risk of PSMs, probably due to the technical challenge that obese men pose to surgical access. Minimally invasive RP has been claimed to possibly reduce PSM rate. Aim of the study was to explore the impact of obesity and body habitus on PSM risk and their localisation during laparoscopic and robotic-assisted RP. MATERIALS AND METHODS We reviewed 539 prospectively enrolled patients undergoing laparoscopic and robotic-assisted RP with pT2 prostate cancer. The outcome measured was rate of PSM according to the BMI and surgical approach (laparoscopic vs robotic-assisted). Patients were categorized in BMI<25kg/m2, BMI 25-29.9kg/m2 and BMI >30kg/m2 groups respectively and compared using Kruskall-Wallis or χ2 test, as appropriate. Uni- and multivariate logistic regression models were constructed to assess the impact of BMI and surgical technique on PSM risk. RESULTS Overall, 127 (24%) of men had PSMs detected at final specimen evaluation. Mean PSM length was 3.9±3.4mm, and 30 (6%) men presented significant margins ≥4mm. Analysing the rate of PSMs across BMI categories, no significant association between increased BMI and PSM was detected (all P>0.48). On uni- and multivariate logistic regression BMI was not a statistically significant risk factor for PSM (P=0.14), nor was the minimally invasive technique (laparoscopic vs robotic-assisted) (P=0.54). CONCLUSIONS In this study obese men do not appear to have a significant increase in risk of PSMs at RP compared to lean and overweight men when operated by a minimally invasive approach. The magnified vision and increased access to the pelvis allowed by a laparoscopic and robotic-assisted approach may be accountable for our findings. Larger studies are needed to validate our results. LEVEL OF PROOF 4.
Collapse
|
24
|
Orosco RK, Tapia VJ, Califano JA, Clary B, Cohen EEW, Kane C, Lippman SM, Messer K, Molinolo A, Murphy JD, Pang J, Sacco A, Tringale KR, Wallace A, Nguyen QT. Positive Surgical Margins in the 10 Most Common Solid Cancers. Sci Rep 2018; 8:5686. [PMID: 29632347 PMCID: PMC5890246 DOI: 10.1038/s41598-018-23403-5] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 03/05/2018] [Indexed: 01/01/2023] Open
Abstract
A positive surgical margin (PSM) following cancer resection oftentimes necessitates adjuvant treatments and carries significant financial and prognostic implications. We sought to compare PSM rates for the ten most common solid cancers in the United States, and to assess trends over time. Over 10 million patients were identified in the National Cancer Data Base from 1998–2012, and 6.5 million had surgical margin data. PSM rates were compared between two time periods, 1998–2002 and 2008–2012. PSM was positively correlated with tumor category and grade. Ovarian and prostate cancers had the highest PSM prevalence in women and men, respectively. The highest PSM rates for cancers affecting both genders were seen for oral cavity tumors. PSM rates for breast cancer and lung and bronchus cancer in both men and women declined over the study period. PSM increases were seen for bladder, colon and rectum, and kidney and renal pelvis cancers. This large-scale analysis appraises the magnitude of PSM in the United States in order to focus future efforts on improving oncologic surgical care with the goal of optimizing value and improving patient outcomes.
Collapse
Affiliation(s)
- Ryan K Orosco
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, CA, USA
| | - Viridiana J Tapia
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, CA, USA
| | - Joseph A Califano
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, CA, USA.,Department of Surgery, University of California, San Diego, CA, USA.,Moores Cancer Center, University of California, San Diego, CA, USA
| | - Bryan Clary
- Department of Surgery, University of California, San Diego, CA, USA
| | - Ezra E W Cohen
- Moores Cancer Center, University of California, San Diego, CA, USA.,Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, CA, USA
| | - Christopher Kane
- Moores Cancer Center, University of California, San Diego, CA, USA.,Department of Urology, University of California, San Diego, CA, USA
| | - Scott M Lippman
- Moores Cancer Center, University of California, San Diego, CA, USA.,Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, CA, USA
| | - Karen Messer
- Moores Cancer Center, University of California, San Diego, CA, USA
| | - Alfredo Molinolo
- Moores Cancer Center, University of California, San Diego, CA, USA
| | - James D Murphy
- Department of Radiation Medicine and Applied Sciences, San Diego, CA, USA
| | - John Pang
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, CA, USA
| | - Assuntina Sacco
- Moores Cancer Center, University of California, San Diego, CA, USA.,Department of Medicine, Division of Hematology-Oncology, University of California, San Diego, CA, USA
| | - Kathryn R Tringale
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, CA, USA
| | - Anne Wallace
- Department of Surgery, University of California, San Diego, CA, USA.,Moores Cancer Center, University of California, San Diego, CA, USA
| | - Quyen T Nguyen
- Division of Otolaryngology, Head and Neck Surgery, University of California, San Diego, CA, USA. .,Department of Surgery, University of California, San Diego, CA, USA. .,Department of Pharmacology, University of California, San Diego, CA, USA. .,Moores Cancer Center, University of California, San Diego, CA, USA.
| |
Collapse
|
25
|
Wrong to be Right: Margin Laterality is an Independent Predictor of Biochemical Failure After Radical Prostatectomy. Am J Clin Oncol 2017; 41:1-5. [PMID: 26237192 DOI: 10.1097/coc.0000000000000216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To examine the impact of positive surgical margin (PSM) laterality on failure after radical prostatectomy (RP). A PSM can influence local recurrence and outcomes after salvage radiation. Unlike intrinsic risk factors, a PSM is caused by intervention and thus iatrogenic failures may be elucidated by analyzing margin laterality as surgical approach is itself lateralized. PATIENTS AND METHODS We reviewed 226 RP patients between 1991 and 2013 with PSM. Data includes operation type, pre/postoperative PSA, surgical pathology, and margin type (location, focality, laterality). The median follow-up was 47 months. Biochemical recurrence after RP was defined as PSA≥0.1 ng/mL or 2 consecutive rises above nadir. Ninety-two patients received salvage radiation therapy (SRT). Failure after SRT was defined as any PSA≥0.2 ng/mL or greater than presalvage. Kaplan-Meier and Cox multivariate analyses compared relapse rates. RESULTS The majority of PSM were iatrogenic (58%). Laterality was associated with differences in median relapse: right 20 versus left 51 versus bilateral 14 months (P<0.01). Preoperative PSA, T-stage, Gleason grade, and laterality were associated with biochemical progression on univariate and multivariate analyses. Right-sided margins were more likely to progress than left (hazard ratio, 1.67; P=0.04). More right-sided margins were referred for SRT (55% right vs. 23% left vs. 22% bilateral), but were equally salvaged. Only T-stage and pre-SRT PSA independently influenced SRT success. CONCLUSIONS Most PSM are iatrogenic, with right-sided more likely to progress (and sooner) than left sided. Margin laterality is a heretofore unrecognized independent predictor of biochemical relapse and hints at the need to modify the traditional unilateral surgical technique.
Collapse
|
26
|
Bellangino M, Verrill C, Leslie T, Bell RW, Hamdy FC, Lamb AD. Systematic Review of Studies Reporting Positive Surgical Margins After Bladder Neck Sparing Radical Prostatectomy. Curr Urol Rep 2017; 18:99. [PMID: 29116405 PMCID: PMC5676800 DOI: 10.1007/s11934-017-0745-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE OF REVIEW Bladder neck preservation (BNP) during radical prostatectomy (RP) has been proposed as a method to improve early recovery of urinary continence after radical prostatectomy. However, there is concern over a possible increase in the risk of positive surgical margins and prostate cancer recurrence rate. A recent systematic review and meta-analysis reported improved early recovery and overall long-term urinary continence without compromising oncologic control. The aim of our study was to perform a critical review of the literature to assess the impact on bladder neck and base margins after bladder neck sparing radical prostatectomy. EVIDENCE ACQUISITION We carried out a systematic review of the literature using Pubmed, Scopus and Cochrane library databases in May 2017 using medical subject headings and free-text protocol according to PRISMA guidelines. We used the following search terms: bladder neck preservation, prostate cancer, radical prostatectomy and surgical margins. Studies focusing on positive surgical margins (PSM) in bladder neck sparing RP pertinent to the objective of this review were included. EVIDENCE SYNTHESIS Overall, we found 15 relevant studies reporting overall and site-specific positive surgical margins rate after bladder neck sparing radical prostatectomy. This included two RCTs, seven prospective comparative studies, two retrospective comparative studies and four case series. All studies were published between 1993 and 2015 with sample sizes ranging between 50 and 1067. Surgical approaches included open, laparoscopic and robot-assisted radical prostatectomy. The overall and base-specific PSM rates ranged between 7-36% and 0-16.3%, respectively. Mean base PSM was 4.9% in those patients where bladder neck sparing was performed, but only 1.85% in those without sparing. Bladder neck preservation during radical prostatectomy may increase base-positive margins. Further studies are needed to better investigate the impact of this technique on oncological outcomes. A future paradigm could include modification of intended approach to bladder neck dissection when anterior base lesions are identified on pre-operative MRI.
Collapse
Affiliation(s)
- Mariangela Bellangino
- Department of Urology, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Clare Verrill
- Department of Pathology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tom Leslie
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Richard W. Bell
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Freddie C. Hamdy
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D. Lamb
- Department of Urology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
27
|
Sachdeva A, Veeratterapillay R, Voysey A, Kelly K, Johnson MI, Aning J, Soomro NA. Positive surgical margins and biochemical recurrence following minimally-invasive radical prostatectomy - An analysis of outcomes from a UK tertiary referral centre. BMC Urol 2017; 17:91. [PMID: 28969608 PMCID: PMC5625596 DOI: 10.1186/s12894-017-0262-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/24/2017] [Indexed: 12/05/2022] Open
Abstract
Background Positive surgical margins are a strong prognostic marker of disease outcome following radical prostatectomy, though prior evidence is largely from a PSA-screened population. We therefore aim to evaluate the biochemical recurrence in men with positive surgical margins (PSM) after minimally-invasive radical prostatectomy (MIRP) in a UK tertiary centre. Methods Retrospective study of men undergoing laparoscopic or robotic-assisted radical prostatectomy between 2002 and 2014. Men with positive surgical margins (PSM) were identified and their biochemical recurrence (BCR) rate compared with men without PSM. The primary outcome measures were BCR rates and time to BCR. Cox regression was used to estimate adjusted hazard ratios for biochemical recurrence rate (BCR), accounting for potential confounders. Results Five hundred ninety-two men were included for analysis. Pre-operative D’Amico risk stratification showed 37.5%, 53.3% and 9.3% of patients in the low, intermediate and high-risk groups, respectively. On final pathological analysis, the proportion of patients with local staging pT2, pT3a and pT3b was 68.8%, 25.2% and 6.1% respectively. Overall positive margin rate was 30.6%. On multivariate analysis, the only pre-operative factor associated with PSM was age >65years. Patients with PSM were more likely to have higher tumour volume and more advanced pathological local stage. The BCR rate was 10.7% in margin-positive patients and 5.1% in margin-negative patients, at median 4.4-year follow-up. Upon multivariate analysis, high pre-operative PSA and high Gleason group were the only significant predictors of BCR (P<0.05). Conclusions In comparison to patients with negative surgical margins, those with PSM do not translate into worse medium-term oncological outcomes in the majority of cases amongst our cohort. We found that high pre-operative PSA and high Gleason group were the only significant predictors of BCR. Electronic supplementary material The online version of this article (10.1186/s12894-017-0262-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ashwin Sachdeva
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Rajan Veeratterapillay
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Antonia Voysey
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Katherine Kelly
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Mark I Johnson
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Jonathan Aning
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Naeem A Soomro
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK. .,Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
| |
Collapse
|
28
|
Lipman D, Pieters BR, De Reijke TM. Improving postoperative radiotherapy following radical prostatectomy. Expert Rev Anticancer Ther 2017; 17:925-937. [PMID: 28787182 DOI: 10.1080/14737140.2017.1364994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Prostate cancer has one of the highest incidences in the world, with good curative treatment options like radiotherapy and radical prostatectomy. Unfortunately, about 30% of the patients initially treated with curative intent will develop a recurrence and need adjuvant treatment. Five randomized trials covered the role of postoperative radiotherapy after radical prostatectomy, but there is still a lot of debate about which patients should receive postoperative radiotherapy. Areas covered: This review will give an overview on the available literature concerning post-operative radiotherapy following radical prostatectomy with an emphasis on the five randomized trials. Also, new imaging techniques like prostate-specific membrane antigen positron emission tomography (PSMA-PET) and multiparametric magnetic resonance imaging (mp-MRI) and the development of biomarkers like genomic classifiers will be discussed in the search for an improved selection of patients who will benefit from postoperative radiotherapy following radical prostatectomy. With new treatment techniques like Intensity Modulated Radiotherapy, toxicity profiles will be kept low. Expert commentary: Patients with biochemical recurrence following radical prostatectomy with an early rise in prostate-specific antigen (PSA) will benefit most from postoperative radiotherapy. In this way, patients with only high risk pathological features can avoid unnecessary treatment and toxicity, and early intervention in progressing patients would not compromise the outcome.
Collapse
Affiliation(s)
- D Lipman
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - B R Pieters
- a Department of Radiation Oncology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| | - Theo M De Reijke
- b Department of Urology , Academic Medical Center/University of Amsterdam , Amsterdam , The Netherlands
| |
Collapse
|
29
|
Tallman JE, Packiam VT, Wroblewski KE, Paner GP, Eggener SE. Influence of pathologist experience on positive surgical margins following radical prostatectomy. Urol Oncol 2017; 35:461.e1-461.e6. [PMID: 28302349 DOI: 10.1016/j.urolonc.2017.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 01/10/2017] [Accepted: 02/13/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. METHODS We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. RESULTS Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score≥7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all P<0.05). Univariate logistic regression showed that surgeon experience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all P<0.05). Multivariable regression analysis confirmed that decreased surgeon experience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). CONCLUSIONS Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist.
Collapse
Affiliation(s)
- Jacob E Tallman
- Pritzker School of Medicine, The University of Chicago, Chicago, IL.
| | - Vignesh T Packiam
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| | | | - Gladell P Paner
- Department of Pathology, The University of Chicago Medicine, Chicago, IL
| | - Scott E Eggener
- Department of Surgery, The University of Chicago Medicine, Chicago, IL
| |
Collapse
|
30
|
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.
Collapse
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
| |
Collapse
|
31
|
Tatsugami K, Yoshioka K, Shiroki R, Eto M, Yoshino Y, Tozawa K, Fukasawa S, Fujisawa M, Takenaka A, Nasu Y, Kashiwagi A, Gotoh M, Terachi T. Reality of nerve sparing and surgical margins in surgeons’ early experience with robot-assisted radical prostatectomy in Japan. Int J Urol 2017; 24:191-196. [DOI: 10.1111/iju.13281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/24/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Katsunori Tatsugami
- Department of Urology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | | | - Ryoichi Shiroki
- Department of Urology; Fujita Health University School of Medicine; Aichi Japan
| | - Masatoshi Eto
- Department of Urology; Graduate School of Medical Sciences; Kyushu University; Fukuoka Japan
| | - Yasushi Yoshino
- Department of Urology; Nagoya University Graduate School of Medicine; Aichi Japan
| | - Keiichi Tozawa
- Department of Nephro-Urology; Nagoya City University Graduate School of Medical Sciences; Aichi Japan
| | | | - Masato Fujisawa
- Division of Urology; Department of Surgery Related; Kobe University Graduate School of Medicine; Hyogo Japan
| | - Atsushi Takenaka
- Division of Urology; Department of Surgery; Tottori University Faculty of Medicine; Tottori Japan
| | - Yasutomo Nasu
- Department of Urology; Okayama University Graduate School of Medicine; Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Akira Kashiwagi
- Department of Urology; Teine Keijinkai Medical Center; Hokkaido Japan
| | - Momokazu Gotoh
- Department of Urology; Nagoya University Graduate School of Medicine; Aichi Japan
| | - Toshiro Terachi
- Department of Urology; Tokai University School of Medicine; Kanagawa Japan
| | | |
Collapse
|
32
|
Hatano K, Okusa T, Ishizuya Y, Nakai Y, Nakayama M, Kakimoto KI, Nishimura K. Postoperative early ultrasensitive prostate-specific antigen identifies patients at risk for biochemical recurrence in margin positive prostate cancers: a single-center study. Jpn J Clin Oncol 2017; 47:74-79. [DOI: 10.1093/jjco/hyw150] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 09/02/2016] [Accepted: 09/30/2016] [Indexed: 11/12/2022] Open
Affiliation(s)
- Koji Hatano
- Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Takuya Okusa
- Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yu Ishizuya
- Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Yasutomo Nakai
- Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Masashi Nakayama
- Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Ken-ichi Kakimoto
- Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| | - Kazuo Nishimura
- Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan
| |
Collapse
|
33
|
Bruce HM, Stricker PD, Gupta R, Savdie RR, Haynes AM, Mahon KL, Lin HM, Kench JG, Horvath LG. Loss of AZGP1 as a Superior Predictor of Relapse in Margin-Positive Localized Prostate Cancer. Prostate 2016; 76:1491-1500. [PMID: 27473574 DOI: 10.1002/pros.23233] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 06/21/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Positive surgical margins (PSMs) in localized prostate cancer (PC) confer a two- to three-fold increased risk of biochemical relapse (BR). Absent/weak AZGP1 expression and Gleason grade ≥4 at the margin are each independent predictors of BR in patients with PSMs. Our study aimed to determine whether the biomarkers AZGP1 expression and Gleason grade at the site of a PSM are significant independent markers of biochemical and clinical relapse (CR) when modeled together and whether one of these biomarkers may be superior in its capacity to predict outcome. METHODS A cohort of 275 consecutive patients with margin-positive localized PC following surgery were assessed for Gleason grade and AZGP1 expression at the PSM. BR-free survival was the primary end-point, while CR-free survival and PC-specific death were secondary endpoints. Kaplan-Meier Analysis and Cox Proportional Hazards Modeling were performed. RESULTS Absent AZGP1 expression was significantly associated with increased risk of BR (P = 0.001) and PC-specific death (P = 0.02). Gleason grade ≥4 at PSM was associated with BR (P = 0.02), CR (P = 0.003), and PC-specific death (P = 0.004). On multivariable analysis, absent AZGP1 expression remained an independent predictor of BR (HR 2.4, 95%CI 1.5-3.9, P < 0.001) when modeled with Gleason grade at margin (HR 1.3, 95%CI 0.9-1.9, P = 0.16), preoperative PSA (P = 0.002), seminal vesicle involvement (P = 0.002), extraprostatic extension (P = 0.001), Gleason score (P = 0.01), adjuvant treatment (P = 0.75), linear length of the involved margin (P = 0.001) and margin number (P = 0.09). CONCLUSION Absent AZGP1 expression is an independent predictor of BR in margin-positive localized PC and is associated with increased PC-specific mortality in a Phase II study. Absent AZGP1 expression was superior to Gleason grade at PSM in predicting relapse and should be incorporated into subsequent clinical trials of post-operative radiotherapy in men with margin-positive PC. Prostate 76:1491-1500, 2016. © 2016 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Hannah M Bruce
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
| | - Phillip D Stricker
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- University of New South Wales, Kensington, New South Wales, Australia
- Department of Urology, St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - Ruta Gupta
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Richard R Savdie
- Department of Urology, St Vincent's Clinic, Darlinghurst, New South Wales, Australia
| | - Anne-Maree Haynes
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
| | - Kate L Mahon
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Hui-Ming Lin
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
| | - James G Kench
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
- University of Sydney, Camperdown, New South Wales, Australia
| | - Lisa G Horvath
- Division of Cancer Research, Garvan Institute of Medical Research/The Kinghorn Cancer Centre, Darlinghurst, New South Wales, Australia.
- University of Sydney, Camperdown, New South Wales, Australia.
- Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia.
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.
| |
Collapse
|
34
|
Miyamoto H. Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought? Int J Urol 2016; 24:25-31. [PMID: 27862367 DOI: 10.1111/iju.13247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/05/2016] [Indexed: 12/18/2022]
Abstract
Despite significant advances in patient selection as well as surgical technique over the past few decades, it is still not uncommon for patients with urological malignancy and positive surgical margins to be observed. Meanwhile, intraoperative pathology consultation with frozen section assessment, which generally provides useful information for the optimal procedure, has been widely utilized for the assessment of surgical margins during urological surgeries. Thus, it remains unanswered whether intraoperative frozen section assessment has an impact on final surgical margin status as well as long-term oncological outcomes. The present review summarizes and discusses available data assessing the utility of frozen section assessment of the surgical margins during urological surgeries, such as radical prostatectomy, partial nephrectomy and radical cystectomy. The current findings suggest that select patients might benefit from the routine frozen section assessment.
Collapse
Affiliation(s)
- Hiroshi Miyamoto
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
35
|
Sooriakumaran P, Dev HS, Skarecky D, Ahlering T. The importance of surgical margins in prostate cancer. J Surg Oncol 2016; 113:310-5. [DOI: 10.1002/jso.24109] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 11/14/2015] [Indexed: 11/07/2022]
Affiliation(s)
| | - Harveer S. Dev
- Department of Urology; University of Cambridge; Cambridge United Kingdom
| | - Douglas Skarecky
- Department of Urology; University of California; Irvine California
| | - Thomas Ahlering
- Department of Urology; University of California; Irvine California
| |
Collapse
|
36
|
Impact of surgeon-defined capsular incision during radical prostatectomy on biochemical recurrence rates. World J Urol 2016; 34:1547-1553. [DOI: 10.1007/s00345-016-1805-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/09/2016] [Indexed: 10/22/2022] Open
|
37
|
Abdollah F, Moschini M, Sood A, Sammon J, Dalela D, Hsu L, Beyer B, Haese A, Graefen M, Gandaglia G, Montorsi F, Briganti A, Menon M. When Should a Positive Surgical Margin Ring a Bell? An Analysis of a Multi-Institutional Robot-Assisted Laparoscopic Radical Prostatectomy Database. J Endourol 2016; 30:201-7. [DOI: 10.1089/end.2015.0465] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Firas Abdollah
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Marco Moschini
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Akshay Sood
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Jesse Sammon
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Deepansh Dalela
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Linda Hsu
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| | - Burkhard Beyer
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Giorgio Gandaglia
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Mani Menon
- Vattikuti Urology Institute and VUI Center for Outcomes Research Analytics and Evaluation, Henry Ford Health System, Detroit, Michigan
| |
Collapse
|
38
|
Suardi N, Dell׳Oglio P, Gallina A, Gandaglia G, Buffi N, Moschini M, Fossati N, Lughezzani G, Karakiewicz PI, Freschi M, Lucianò R, Shariat SF, Guazzoni G, Gaboardi F, Montorsi F, Briganti A. Evaluation of positive surgical margins in patients undergoing robot-assisted and open radical prostatectomy according to preoperative risk groups. Urol Oncol 2016; 34:57.e1-7. [DOI: 10.1016/j.urolonc.2015.08.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
|
39
|
Bessede T, Patard JJ. Words of Wisdom. Re: The Use of Early Postoperative Prostate-specific Antigen to Stratify Risk in Patients with Positive Surgical Margins After Radical Prostatectomy. Eur Urol 2016; 69:372. [PMID: 26758520 DOI: 10.1016/j.eururo.2015.10.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Thomas Bessede
- Department of Urology, Bicetre Hospital, Université Paris-Sud, Le Kremlin-Bicetre, France.
| | - Jean-Jacques Patard
- Department of Urology, Bicetre Hospital, Université Paris-Sud, Le Kremlin-Bicetre, France
| |
Collapse
|
40
|
Schade GR, Wright JL, Lin DW. Prognostic Significance of Positive Surgical Margins and Other Implications of Pathology Report. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00033-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
41
|
Long-Term Oncologic Outcome of an Initial Series of Laparoscopic Radical Prostatectomy for Clinically Localized Prostate Cancer After a Median Follow-up of 10 Years. Clin Genitourin Cancer 2015; 14:290-7. [PMID: 26710661 DOI: 10.1016/j.clgc.2015.11.006] [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: 07/27/2015] [Revised: 10/22/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION When laparoscopic radical prostatectomy (LRP) was introduced as a novel treatment option for prostate cancer, it had to compete with the established open techniques. The short- and intermediate-term oncologic and functional outcomes were encouraging and comparable to those with retropubic radical prostatectomy. However, the long-term oncologic safety for LRP has yet to be fully elucidated. We evaluated the long-term oncologic outcomes of an initial series of patients who had undergone LRP. PATIENTS AND METHODS An initial unselected and consecutive series of 100 patients who had undergone LRP for clinically localized prostate cancer from 1999 to 2001 was identified. The pre-, intra-, and postoperative data were collected. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value of ≥ 0.2 ng/mL. The outcome measures were cancer control (CC), BCR-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS The mean patient age was 64 ± 7 years, and the mean preoperative PSA level was 9.6 ± 8.3 ng/mL. Of the 100 patients, 79 (79%) had stage pT2 and 15 (15%) had stage pT3 disease. Positive surgical margins were found in 25 patients (25%; 16.4% for pT2 and 40% for pT3). The median follow-up time was 126 months (range, 60-176 months). The 5-year CC rate was 82%. The estimated 10-year BCRFS was 83% and 80% for patients with stage pT2 and pT3 tumors, respectively. The median time to BCR was 52 months (range, 6-144 months). The estimated 10-year CSS and OS was 98% and 93%, respectively. CONCLUSION Our long-term follow-up data from an initial unselected patient cohort have indicated that LRP offers excellent long-term oncologic control for patients with localized prostate cancer.
Collapse
|
42
|
Aguilera A, Bañuelos B, Díez J, Alonso-Dorrego JM, Cisneros J, Peña J. Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors. Cent European J Urol 2015; 68:302-7. [PMID: 26568870 PMCID: PMC4643694 DOI: 10.5173/ceju.2015.485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 10/23/2014] [Accepted: 05/25/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction High and very high-risk prostate cancers are tumors that display great variation in their progression, making their behaviour and consequent prognosis difficult to predict. We analyse preoperative and postoperative risk factors that could influence biochemical recurrence of these tumors. Material and methods We carried out univariate and multivariate analyses in an attempt to establish statistically significant preoperative (age, rectal examination, PSA, biopsy Gleason score, uni/bilateral tumor, affected cylinder percentage) and postoperative (pT stage, pN lymph node affectation, Gleason score, positive surgical margins, percentage of tumor affectation, perineural infiltration) risk factors, as well as their relationship with biochemical recurrence (PSA >0.2 ng/mL). Results We analysed 276 patients with high and very high-risk prostate cancer that were treated with laparoscopic radical prostatectomy (LRP) between 2003-2007, with a mean follow-up of 84 months. Incidence of biochemical recurrence is 37.3%. Preoperative factors with the greatest impact on recurrence are suspicious rectal exam (OR 2.2) and the bilateralism of the tumor in the biopsy (OR 1.8). Among the postoperative factors, the presence of a LRP positive surgical margins (OR 3.4) showed the greatest impact, followed by the first grade of the Gleason score (OR 3.3). Conclusions The factor with the greatest influence on biochemical recurrence when it comes to surgery and high and very high-risk prostate cancer is the presence of a positive margin, followed by the Gleason score. Preoperative factors (PSA, biopsy Gleason score, rectal examination, number of affected cylinders) offered no guidance concerning the incidence of BCR.
Collapse
Affiliation(s)
- Alfredo Aguilera
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Beatriz Bañuelos
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Jesús Díez
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Jesus Cisneros
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| | - Javier Peña
- Department of Urology, Hospital Universitario La Paz, Madrid, Spain
| |
Collapse
|
43
|
[Analysis and prognostic factors of the specimen of radical prostatectomy in prostate cancer]. Prog Urol 2015; 25:999-1009. [PMID: 26519964 DOI: 10.1016/j.purol.2015.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Handling and pathologic analysis of radical prostatectomy specimens are crucial to confirm the diagnosis of prostate cancer and evaluate prognostic criteria. MATERIAL AND METHODS A systematic review of the scientific literature was performed in the Medline database (PubMed), using different associations of the following keywords: prostate cancer; prostatectomy; specimen; handling; pathology; tumor staging; Gleason score; surgical margin; prognosis; frozen section; lymph node; biomarkers. A particular search was done on specimen management and characterization of tissue prognostic factors. RESULTS Handling of both radical prostatectomy specimen and lymph node dissection is standardized according to international criteria. Although the main histoprognostic factors are still Gleason score, pathologic staging and margin status, these criteria have been refined these last 10 years, allowing to improve the prediction of relapse after surgical treatment. CONCLUSION The standardization of handling and pathology reporting of radical prostatectomy specimens will be mandatory for treatment uniformization according to risk stratification in prostate cancer and personalization of therapeutic approaches.
Collapse
|
44
|
Salomon L, Ploussard G, Hennequin C, Richaud P, Soulié M. Traitements complémentaires de la chirurgie du cancer de la prostate et chirurgie de la récidive. Prog Urol 2015; 25:1086-107. [DOI: 10.1016/j.purol.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
|
45
|
Gandaglia G, Cozzarini C, Mottrie A, Bossi A, Fossati N, Montorsi F, Briganti A. The Role of Radiotherapy After Radical Prostatectomy in Patients with Prostate Cancer. Curr Oncol Rep 2015; 17:53. [DOI: 10.1007/s11912-015-0478-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
46
|
Hashimoto T, Yoshioka K, Horiguchi Y, Inoue R, Yoshio O, Nakashima J, Tachibana M. Clinical effect of a positive surgical margin without extraprostatic extension after robot-assisted radical prostatectomy. Urol Oncol 2015; 33:503.e1-6. [PMID: 26277617 DOI: 10.1016/j.urolonc.2015.07.009] [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: 03/24/2015] [Revised: 06/28/2015] [Accepted: 07/11/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the effect of positive surgical margin (PSM) without extraprostatic extension after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS We retrospectively reviewed 837 patients who underwent RARP for clinically localized prostate cancer without neoadjuvant endocrine therapy. The pT2+category lesions were defined according to World Health Organization classification. The actuarial probabilities of biochemical recurrence-free survival (BCR-FS) were determined using Kaplan-Meier analysis. Univariate and multivariate Cox proportional hazards regression analyses were also used to identify independent predictors for BCR. RESULTS Of the 837 patients, 102 (12.2%) experienced BCR during the follow-up period. The BCR-FS rate was significantly higher in patients with pT2+category tumors than in those with pT3a category tumors, and significantly lower in patients with pT2+category tumors than that in those with pT2 category tumors without PSM. The BCR-FS rate of patients with pT2+category tumors was significantly higher than that with pT3a category tumors with PSM but not significantly different from that with pT3a category tumors without PSM. In a multivariate analysis, the pathological T category considering pT2+category was one of independent predictive factors for BCR. CONCLUSIONS This study support the hypothesis that the pT2+category disease is associated with a significantly increased risk of BCR in patients with organ-confined prostate cancer after RARP. As PSM can be avoided in some cases, urologists should continually seek to improve their operative skills and to reduce the rate of PSM, especially in patients with organ-confined prostate cancer.
Collapse
Affiliation(s)
| | | | | | - Rie Inoue
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Ohno Yoshio
- Department of Urology, Tokyo Medical University, Tokyo, Japan
| | - Jun Nakashima
- Department of Urology, Tokyo Medical University, Tokyo, Japan
| | | |
Collapse
|
47
|
Alvin LWX, Gee SH, Hong HH, Christopher CWS, Henry HSS, Weber LKO, Hoon TP, Shiong LL. Oncological outcomes following robotic-assisted radical prostatectomy in a multiracial Asian population. J Robot Surg 2015; 9:201-9. [PMID: 26531200 DOI: 10.1007/s11701-015-0516-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/02/2015] [Indexed: 11/26/2022]
Abstract
This study evaluates the oncological outcomes of RARP in a multiracial Asian population from a single institution. All suitable patients from 1st January 2003-30th June 2013 were identified from a prospectively maintained cancer registry. Peri-operative and oncological outcomes were analysed. Significance was defined as p < 0.05. There were n = 725 patients identified with a mean follow-up duration 28 months. The mean operative time, EBL and LOS were 186 min, 215 ml and 3 days, respectively. The pathological stage was pT2 in 68.6% (n = 497/725), pT3 in 31.3% (n = 227/725) and n = 1 patient with pT4 disease. The pathological Gleason scores (GS) were 6 in 27.9% (n = 202/725), GS 7 in 63.6% (n = 461/725) and GS ≥ 8 in 8.0 % (n = 58/725). The node positivity rate was 5.8% (n = 21/360). The positive margin rates were 31.0% (n = 154/497) and 70.9% (n = 161/227) for pT2 and pT3, respectively, and decreasing PSM rates are observed with surgical maturity. The biochemical recurrence rates were 9.7% (n = 48/497) and 34.2% (n = 78/228) for pT2 and pT3/T4, respectively. On multivariate analysis, independent predictors of BCR were pathological T stage and pathological Gleason score. Post-operatively, 78.5% (n = 569/725) of patients had no complications and 17.7% (n = 128/725) had minor (Clavien grade I-II) complications. This series, representing the largest from Southeast Asia, suggests that RARP can be a safe and oncologically feasible treatment for localised prostate cancer in an institution with moderate workload.
Collapse
Affiliation(s)
- Low Wei Xiang Alvin
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore.
| | - Sim Hong Gee
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Huang Hong Hong
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Cheng Wai Sam Christopher
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Ho Sien Sun Henry
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Lau Kam On Weber
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore
| | - Tan Puay Hoon
- Department of Pathology, Singapore General Hospital, Singapore, 169856, Singapore
| | - Lee Lui Shiong
- Department of Urology, Singapore General Hospital, Level 5, The Academia, 20 College Road, Singapore, 169856, Singapore.
| |
Collapse
|
48
|
Mithal P, Howard LE, Aronson WJ, Terris MK, Cooperberg MR, Kane CJ, Amling C, Freedland SJ. Positive surgical margins in radical prostatectomy patients do not predict long-term oncological outcomes: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort. BJU Int 2015; 117:244-8. [PMID: 26010160 DOI: 10.1111/bju.13181] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the impact of positive surgical margins (PSMs) on long-term outcomes after radical prostatectomy (RP), including metastasis, castrate-resistant prostate cancer (CRPC), and prostate cancer-specific mortality (PCSM). PATIENTS AND METHODS Retrospective study of 4,051 men in the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort treated by RP from 1988 to 2013. Proportional hazard models were used to estimate hazard ratios (HRs) of PSMs in predicting biochemical recurrence (BCR), CRPC, metastases, and PCSM. To determine if PSMs were more predictive in certain patients, analyses were stratified by pathological Gleason score, stage, and preoperative prostate-specific antigen (PSA) level. RESULTS The median (interquartile range) follow-up was 6.6 (3.2-10.6) years and 1 127 patients had >10 years of follow-up. During this time, 302 (32%) men had BCR, 112 (3%) developed CRPC, 144 (4%) developed metastases, and 83 (2%) died from prostate cancer. There were 1,600 (40%) men with PSMs. In unadjusted models, PSMs were significantly associated with all adverse outcomes: BCR, CRPC, metastases and PCSM (all P ≤ 0.001). After adjusting for demographic and pathological characteristics, PSMs were associated with increased risk of only BCR (HR 1.98, P < 0.001), and not CRPC, metastases, or PCSM (HR ≤1.29, P > 0.18). Similar results were seen when stratified by pathological Gleason score, stage, or PSA level, and when patients who underwent adjuvant radiotherapy were excluded. CONCLUSIONS PSMs after RP are not an independent risk factor for CRPC, metastasis, or PCSM overall or within any subset. In the absence of other high-risk features, PSMs alone may not be an indication for adjuvant radiotherapy.
Collapse
Affiliation(s)
- Prabhakar Mithal
- Department of Urology, University of Rochester Medical Center, Rochester, NY, USA
| | - Lauren E Howard
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, USA.,Division of Urology, Veterans Affairs Medical Center, Durham, NC, USA
| | - William J Aronson
- Urology Section, Department of Surgery, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Urology, UCLA School of Medicine, Los Angeles, CA, USA
| | - Martha K Terris
- Section of Urology, Veterans Affairs Medical Center, Augusta, GA, USA.,Section of Urology, Medical College of Georgia, Augusta, GA, USA
| | - Matthew R Cooperberg
- Department of Urology, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Christopher J Kane
- Urology Department, University of California San Diego Health System, San Diego, CA, USA
| | - Christopher Amling
- Division of Urology, Department of Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Stephen J Freedland
- Division of Urology, Veterans Affairs Medical Center, Durham, NC, USA.,Division of Urology, Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| |
Collapse
|
49
|
Gözen AS, Akin Y, Ates M, Hruza M, Rassweiler J. Impact of laparoscopic radical prostatectomy on clinical T3 prostate cancer: experience of a single centre with long-term follow-up. BJU Int 2015; 116:102-8. [DOI: 10.1111/bju.12710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Ali S. Gözen
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Yigit Akin
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Mutlu Ates
- Department of Urology; Memorial Antalya Hospital; Antalya Turkey
| | - Marcel Hruza
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| | - Jens Rassweiler
- Department of Urology; SLK-Klinikum Heilbronn; University of Heidelberg; Heilbronn Germany
| |
Collapse
|
50
|
Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status. Wideochir Inne Tech Maloinwazyjne 2014; 9:362-70. [PMID: 25337159 PMCID: PMC4198659 DOI: 10.5114/wiitm.2014.45085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/12/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Preservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved. AIM To evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy. MATERIAL AND METHODS A retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated. RESULTS The distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins. CONCLUSIONS CONCLUSIONS Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases.
Collapse
|