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John A, Lim A, Catterwell R, Selth L, O'Callaghan M. Length of positive surgical margins after radical prostatectomy: Does size matter? - A systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26:673-680. [PMID: 36859711 PMCID: PMC10638086 DOI: 10.1038/s41391-023-00654-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 01/19/2023] [Accepted: 01/31/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES The prognostic capacity of positive surgical margins (PSM) for biochemical recurrence (BCR) is unclear, with inconsistent findings across published studies. We aimed to systematically review and perform a meta-analysis exploring the impact of Positive surgical margin length on biochemical recurrence in men after radical prostatectomy. METHODS A search was conducted using the MEDLINE, Scopus, Embase and Cochrane databases according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of the studies was assessed using the Newcastle-Ottawa scale, and the protocol was registered in advance (PROSPERO: CRD42020195908). This meta-analysis included 16 studies with BCR as the primary outcome measure. RESULTS Studies used various dichotomised thresholds for PSM length. A subgroup meta-analysis was performed using the reported multivariable hazard ratio (Continuous, 3, and 1 mm PSM length). PSM length (continuous) was independently associated with an increased risk of BCR (7 studies, HR 1.04 (CI 1.02-1.05), I2 = 8% p < 0.05). PSM length greater than 3 mm conferred a higher risk of BCR compared to less than 3 mm (4 studies, HR 1.99 (1.54-2.58) I2 = 0%, p < 0.05). There was also an increased risk of BCR associated with PSM length of less than 1 mm compared to negative surgical margins (3 studies, HR 1.46 (1.05-2.04), I2 = 0%, P = 0.02). CONCLUSION PSM length is independently prognostic for BCR after radical prostatectomy. Further long-term studies are needed to estimate the impact on systemic progression.
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Affiliation(s)
- Athul John
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia.
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia.
| | - Alicia Lim
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Rick Catterwell
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Luke Selth
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute (FHMRI) and Freemasons Centre for Male Health and Wellbeing, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Michael O'Callaghan
- Adelaide Medical School, The University of Adelaide Faculty of Health and Medical, Sciences, Adelaide, South Australia, Australia
- Flinders Health and Medical Research Institute (FHMRI) and Freemasons Centre for Male Health and Wellbeing, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Urology, Southern Adelaide Local Health Network, South Australia Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia, Australia
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Fiorello N, Di Benedetto A, Brizzi L, Mogorovich A, Summonti D, Silvestri G, Benvenuti S, Sepich CA. Impact of positive surgical margins (PSMs) after robotic prostatectomy on biochemical recurrence (BCR): Multicenter analysis. Urologia 2023; 90:647-652. [PMID: 37354007 DOI: 10.1177/03915603231183478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
OBJECTIVE To study and analyze any correlations between positive surgical margins after RARP and biochemical recurrence. METHODS We enrolled 105 patients who underwent robot-assisted radical prostatectomy (RARP) from 2016-2020 with PSMs on final pathology, all performed or supervised by a senior surgeon in two tertiary referral center. Pathology has been described indicating also the area (apical, base, mediolateral, anterior, or multiple) and the extent of PSMs: focal (≤3 mm) or extensive (>3 mm). Cox univariable and multi-variable regression models were used to find the correlation between clinico-pathologic factors: age, local staging, PSA, grading, area, and size of PSMs). RESULTS We found a good correlation between PSA and grading and between PSA and local staging (T) (p < 0.001). There was no clear correlation between the PSM area with grading nor with T staging. There is a statistically significant correlation between extensive PSM and the worsening of grading and local staging (p < 0.001). BCR rate also has a strong correlation with the worsening of grading and local staging (T) (p < 0.001). A relevant fact is the difference between the BCR rate in the apical and base PSM (34.88%vs 62.5%; p < 0.001) which are the most frequent locations of PSMs. DISCUSSION PSMs remain a predictor of BCR but which may have controversial significance. The likelihood of BCR increases as grading or local staging gets worse. However, apical PSM is a relatively less powerful predictor of postoperative BCR. This can help to better select patients for subsequent RT, which still causes important side effects.
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Affiliation(s)
| | | | - Luca Brizzi
- UOC Urologia, Ospedale Santa Chiara, Trento, Italy
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Salles DC, Mendes AA, Han M, Partin AW, Trock BJ, Jing Y, Lotan TL. ERG Status at the Margin Is Associated With Biochemical Recurrence After Radical Prostatectomy With Positive Surgical Margins. Mod Pathol 2023; 36:100147. [PMID: 36828362 PMCID: PMC10442458 DOI: 10.1016/j.modpat.2023.100147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/22/2022] [Accepted: 02/16/2023] [Indexed: 02/24/2023]
Abstract
Positive surgical margins at radical prostatectomy are associated with an increased risk of biochemical recurrence (BCR). However, there is considerable variability in outcomes, suggesting that molecular biomarkers-when assessed specifically at the margin tumor tissue-may be useful to stratify prognosis in this group. We used a case-cohort design for the outcome of BCR, selecting 215 patients from a cohort of 813 patients undergoing prostatectomy treated at the Johns Hopkins from 2008 to 2017 with positive margins and available clinical data. Tissue microarrays were created from the tumor adjacent to the positive margin and stained for PTEN, ERG, and Ki-67. Cases were scored dichotomously (PTEN and ERG) or by the Ki-67 staining index using previously validated protocols. The analysis used Cox proportional hazards models weighted for the case-cohort design. Overall, 20% (37/185) of evaluable cases had PTEN loss and 38% (71/185) had ERG expression, and the median Ki-67 expression was 0.42%. In multivariable analysis adjusting for the CAPRA-S score, adjuvant radiation, and grade group at the positive margin, ERG-positive tumors were associated with a higher risk of BCR compared to those that were ERGnegative (hazard ratio [HR], 2.4; 95% CI, 1.2-4.9; P = .012) regardless of PTEN status at the margin, and adding ERG to clinicopathologic variables increased the concordance index from 0.827 to 0.847. PTEN loss was associated with an increased risk of BCR on univariable analysis (HR, 3.19; 95% CI, 1.72-5.92; P = .0002), but this association did not remain after adjusting for clinicopathologic variables (HR, 1.06; 95% CI, 0.49-2.29; P = .890). Thus, in the setting of prostate tumors with positive surgical margins after prostatectomy, ERG-positive tumors with or without PTEN loss at the positive margin are associated with a significantly higher risk of BCR after adjusting for clinicopathologic variables. If validated, ERG status may be helpful in decision-making surrounding adjuvant therapy after prostatectomy.
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Affiliation(s)
- Daniela C Salles
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Adrianna A Mendes
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Misop Han
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alan W Partin
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Bruce J Trock
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yuezhou Jing
- Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tamara L Lotan
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Park MY, Park KJ, Kim MH, Kim JK. Focal nodular enhancement on DCE MRI of the prostatectomy bed: radiologic-pathologic correlations and prognostic value. Eur Radiol 2023; 33:2985-2994. [PMID: 36350389 DOI: 10.1007/s00330-022-09241-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/01/2022] [Accepted: 10/13/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To determine the concordance of dynamic contrast-enhanced (DCE) imaging findings with clinico-pathologic characteristics and their prognostic impact for predicting biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) for prostate cancer. METHODS This retrospective study included patients who underwent MRI within 1 year after RP between November 2019 and October 2020. DCE findings and their concordance with the presence and location of positive surgical margin (PSM) were assessed using RP specimens. Kaplan-Meier and logistic regression analyses were used to evaluate the prognostic impact of DCE findings for BCR. RESULTS Among the 272 men (mean age ± standard deviation, 66.6 ± 7.4 years), focal nodular enhancement was more frequently observed in those with PSM compared to those with negative margin (85.4% versus 14.6%; p < 0.001). The sites of focal nodular enhancement were 72.9% (35/48) concordant with the PSM locations. Focal nodular enhancement was associated with a higher Gleason score, higher preoperative PSA (≥ 10 ng/mL), higher Gleason grade at the surgical margin, and non-limited margin involvement (p = 0.002, 0.006, 0.032, and 0.001, respectively). In patients without BCR at the time of MRI, focal nodular enhancement was associated with a shorter time to BCR (p < 0.001) and a significant factor predicting 1-year BCR in both univariate (odds ratio = 8.4 [95% CI: 2.5-28.3]; p = 0.001) and multivariate (odds ratio = 5.49 [1.56-19.3]; p = 0.008) analyses. CONCLUSIONS Focal nodular enhancement on post-prostatectomy MRI was associated with adverse clinico-pathologic characteristics of high risk for recurrence and can be a predictor for 1-year BCR in patients undergoing RP. KEY POINTS • Focal nodular enhancement (PI-RR DCE score ≥ 4) was 72.9% (35/48) concordant with the site of positive resection margin by radiologic-histologic correlation. • Focal nodular enhancement (PI-RR DCE score ≥ 4) was associated with higher Gleason score ( ≥ 8), preoperative PSA ( > 10 ng/mL), and Gleason grade 4 or 5 at the surgical margin and non-limited margin involvement (p ≤ 0.032). • In patients without BCR at the time of MRI, focal nodular enhancement was a significant factor predicting 1-year BCR (odds ratio = 5.49; 95% CI: 1.56-19.3; p = 0.008).
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Affiliation(s)
- Mi Yeon Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Kye Jin Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea.
| | - Mi-Hyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea
| | - Jeong Kon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-Gu, Seoul, 05505, Korea
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Cho WJ, Pyo JS, Kim NY, Kang DW. Clinicopathological implications of histological mapping in radical prostatectomy specimens. Pathol Res Pract 2023; 243:154334. [PMID: 36796201 DOI: 10.1016/j.prp.2023.154334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/15/2023] [Accepted: 01/21/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The present study aims to elucidate the clinicopathological implications of histological mapping in radical prostatectomy specimens. METHODS This study included 76 prostatic cancers with histological mapping. The examined characteristics from the histological mappings were the largest tumor dimension, distance from the tumor core to resection margin, tumor dimension from the apex to base, tumor volume, tumor surface area, and proportion of the tumor. In addition, these histological parameters from the histological mapping were compared between patients with positive surgical margin (PSM) and negative surgical margin (NSM). RESULTS Patients with PSM were significantly correlated with a higher Gleason score and pT stage than those with NSM. Among the histological characteristics from mappings, there were significant correlations between PSM and the largest tumor dimension, tumor volume, tumor surface area, and proportion of tumor (P < 0.001, P < 0.001, P < 0.001, and P = 0.017, respectively). The distance from the tumor core to the resection margin was significantly longer with PSM than with NSM (P = 0.024). According to the linear regression test, the tumor volume, tumor surface area, and largest tumor dimension were significantly correlated with Gleason score and grade (P = 0.019, P = 0.036, and P = 0.016, respectively). There were no significant differences in the histological factors between the apical and non-apical involved subgroups. CONCLUSION Various clinicopathological characteristics assessed from the histological mappings, such as the tumor volume, tumor surface area, and proportion of the tumor, can be useful for interpreting PSM after radical prostatectomy.
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Affiliation(s)
- Won Jin Cho
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, the Republic of Korea
| | - Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, the Republic of Korea
| | - Nae Yu Kim
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Gyeonggi-do, the Republic of Korea
| | - Dong-Wook Kang
- Department of Pathology, Chungnam National University Sejong Hospital, Sejong, the Republic of Korea; Department of Pathology, Chungnam National University School of Medicine, Daejeon, the Republic of Korea.
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Panunzio A, Sorce G, Hoeh B, Hohenhorst L, Tappero S, Nimer N, Rajwa P, Tian Z, Terrone C, Chun FKH, Briganti A, Saad F, Shariat SF, Cerruto MA, Antonelli A, Karakiewicz PI. Effect of positive surgical margins at radical prostatectomy on cancer-specific mortality in high/very high-risk prostate cancer patients with Gleason Grade Group 4-5. Prostate 2023; 83:268-276. [PMID: 36336728 DOI: 10.1002/pros.24458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/18/2022] [Accepted: 10/20/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND The effect of positive surgical margins (PSM) on cancer specific mortality (CSM) in high/very high-risk (HR/VHR) prostate cancer (PCa) with aggressive Gleason Grade Group (GGG) is unknown. We tested PSM effect on CSM in this setting, in addition to testing of radiotherapy (RT) benefit in PSM patients. METHODS We relied on Surveillance, Epidemiology, and End Results database (2010-2015), focusing on HR/VHR patients with exclusive GGG 4-5 at radical prostatectomy (RP). Kaplan-Meier plots and multivariable Cox regression models tested the relationship between PSM and CSM. Moreover, the effect of RT on CSM was explored in PSM patients. RESULTS Of 3383 HR/VHR patients, 15.1% (n = 511) exhibited PSM. Patients with PSM harbored higher rates of GGG 5 (60.1% vs. 50.9%, p < 0.001), pathologic tumor stage T3a (69.1% vs. 45.2%, p < 0.001) and lymph node involvement (14.1% vs. 9.4%, p < 0.001), relative to patients without PSM. PSM rates decreased over time (2010-2015) from 16.0% to 13.6%. Seven-year CSM-free survival rates were 91.6% versus 95.7% in patients with and without PSM, respectively. In multivariable Cox regression models, PSM was an independent predictor of CSM (hazard ratio = 1.6, p = 0.040) even after adjustment for age, prostate specific antigen, pathologic tumor stage and lymph node status. Finally, in PSM patients, RT delivery did not reduce CSM in either univariable or multivariable Cox regression models. CONCLUSIONS In HR/VHR PCa patients with exclusive GGG 4-5, PSM at RP adversely affect survival. Moreover, RT has no protective effect on CSM. In consequence, lowest possible PSM rates are crucial in such patients.
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Affiliation(s)
- Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Benedikt Hoeh
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Stefano Tappero
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Nancy Nimer
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Pawel Rajwa
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Department of Urology, IRCCS Policlinico San Martino, Genova, Italy
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Alberto Briganti
- Division of Experimental Oncology, Department of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Departments of Urology, Weill Cornell Medical College, New York City, New York, USA
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Division of Urology, Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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Kurose H, Ueda K, Ogasawara N, Chikui K, Nakiri M, Nishihara K, Matsuo M, Suekane S, Kusano H, Akiba J, Yano H, Igawa T. Impact of Gleason score of the tumor at the positive surgical margin as a prognostic factor. Mol Clin Oncol 2022; 16:82. [PMID: 35251633 PMCID: PMC8892462 DOI: 10.3892/mco.2022.2515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 10/27/2021] [Indexed: 11/19/2022] Open
Abstract
Although numerous studies have reported that a positive surgical margin (PSM) is the most important predictive factor for biochemical recurrence (BCR) of prostate cancer (PCa), only a small number of studies have evaluated the predictive value of the Gleason score (GS) of the tumor at the margin in radical prostatectomy (RP). The present study aimed to investigate the preoperative factors that predict PSM and the significant predictive factors for BCR in cases with PSM. In addition, it was examined whether documenting the GS of the tumor at the margin in pathological reports is useful as a predictive factor for BCR. Data of 241 patients with PCa who underwent RP at Kurume University Hospital (Kurume, Japan) between January 2007 and December 2011 were retrospectively reviewed. The median follow-up period was 72 months and 122 patients had at least one PSM. The time to BCR was significantly shorter in patients with PSM than in those with a negative surgical margin. Multivariate analysis demonstrated that >10 ng/ml prostate-specific antigen at diagnosis (P=0.024) and >25% positive core at biopsy (P=0.041) were independent prognostic preoperative factors for PSM. The GS of the tumor at the margin was equal, lower and higher than those of the main tumor in 74 (60.7%), 16 (13.1%) and 32 (26.2%) RPs, respectively. The BCR rates were 35.7, 55.1 and 82.1% in patients whose GS of the tumor at the margin was 6, 7 and 8-10, respectively (P=0.0017). The GS of the tumor at the PSM (P=0.038) and anatomic location of the PSM (P=0.04) were identified as independent prognostic preoperative factors for BCR, whereas the GS of the main tumor and margin length were not. These results suggest that documenting the GS at the margin in pathological reports is useful as a predictive factor for BCR.
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Affiliation(s)
- Hirofumi Kurose
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Kosuke Ueda
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Naoyuki Ogasawara
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Katsuaki Chikui
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Makoto Nakiri
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Kiyoaki Nishihara
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Mitsunori Matsuo
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Shigetaka Suekane
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Hironori Kusano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Jun Akiba
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
| | - Tsukasa Igawa
- Department of Urology, Kurume University School of Medicine, Kurume, Fukuoka 830‑0011, Japan
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Radical or Not-So-Radical Prostatectomy: Do Surgical Margins Matter? Cancers (Basel) 2021; 14:cancers14010013. [PMID: 35008178 PMCID: PMC8749855 DOI: 10.3390/cancers14010013] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary Prostate cancer is the second most common noncutaneous malignancy in men. Prostatectomy is a commonly used treatment modality for selected patients. The prostate’s ill-defined borders and its vicinity with vital structures complicate the wide excision of the organ, resulting in positive margins of resection. Neoplastic infiltration of margins of resection in prostatectomy specimens affects patients’ prognosis. The surgical technique and surgeons’ expertise affect the incidence of margin positivity. The location and the extent of positive margins diversify the risk of recurrence, with basal infiltration and multifocal foci of positive margins behaving more aggressively. Pathologists are encouraged to thoroughly report the status of margins of resection, as they provide important information for patients’ prognosis and enable the clinician to decide upon the most appropriate subsequent therapeutic steps. Abstract Prostate cancer is the second most common malignancy in men, and prostatectomy is the treatment of choice for most patients with at least low risk of progression. The presence of positive margins in the radical prostatectomy specimen is considered an adverse pathologic feature, and may prompt additional therapeutic intervention in the patients. The absence of a distinct capsule around the prostate and intraoperative manipulations that aim to minimize postoperative adverse effects, complicate its wide removal. Proper handling of the specimen during the gross processing is essential for accurate determination of the status of margins or resection. Positive margins, defined as the presence of neoplastic glands in the highlighted-with-ink margin of resection, range from 6–38%. The surgical technique, surgeon’s expertise and tumor (i.e., grade and stage) and patients’ (i.e., BMI) characteristics affect the rate of margin positivity. Extensive or multifocal and nonanterior/nonapical positive margins are linked with higher recurrence rates, especially in organ-confined disease, underscoring the need for treating these patients more aggressively. In summary, detailed description of the status of the margins should be performed in every pathology report to determine patients’ prognosis and the most appropriate therapeutic plan.
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Remmers S, Hollemans E, Nieboer D, Luiting HB, van Leenders GJLH, Helleman J, Roobol MJ. Improving the prediction of biochemical recurrence after radical prostatectomy with the addition of detailed pathology of the positive surgical margin and cribriform growth. Ann Diagn Pathol 2021; 56:151842. [PMID: 34717190 DOI: 10.1016/j.anndiagpath.2021.151842] [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: 08/16/2021] [Revised: 09/08/2021] [Accepted: 10/14/2021] [Indexed: 11/15/2022]
Abstract
The risk on biochemical recurrence (BCR) after radical prostatectomy (RP) is usually estimated using PSA and pathological stage and grading including the presence of positive surgical margins (PSM). Objective was to investigate whether the presence of cribriform growth in the primary tumor, Grade Group (GG) at the PSM, and length of the PSM have added value in the prognostication. We analyzed data of 835 patients initially treated with RP between 2000 and 2017. Cox regression models were developed to compare the baseline model (PSA, pT-stage, pN-stage, GG at RP, and presence of PSM) with an extended model (adding the presence of cribriform growth, length and GG at the PSM) using the likelihood ratio test. Discrimination was assessed at internal validation by the time-dependent area under the receiver operating characteristic curve (AUC) at 3- and 5-year. A total of 224 men experienced BCR. Median follow-up for men without BCR was 50.4 months (interquartile range, IQR 11.9-95.5). The extended model had a significant better fit, χ2(4) = 31.0, p < 0.001 than the baseline model. The AUC of the 3- and 5-year extended model was 0.85 (95% CI 0.81-0.88) compared to 0.83 (95% CI 0.79-0.87) for the baseline model. Importantly, the presence of cribriform growth in the primary tumor, and GG ≥ 2 at PSM were associated with a higher risk on BCR. In conclusion, the addition of pathological variables improved the prediction of the risk on BCR after RP slightly. However, the clinical implications of this model are important.
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Affiliation(s)
- Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands.
| | - Eva Hollemans
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands; Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Henk B Luiting
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Jozien Helleman
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, the Netherlands
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10
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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]
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11
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John A, O'Callaghan M, Catterwell R, Selth L. Does Gleason score of positive surgical margin after radical prostatectomy affect biochemical recurrence and oncological outcomes? Protocol for systematic review. BMJ Open 2020; 10:e034612. [PMID: 32209629 PMCID: PMC7199942 DOI: 10.1136/bmjopen-2019-034612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Positive surgical margins (PSM) in cancer patients are commonly associated with worse prognosis and a higher risk of secondary treatment. However, the relevance of this parameter in prostate cancer patients undergoing radical prostatectomy (RP) remains controversial, given the inconsistencies in its ability to predict biochemical recurrence (BCR) and oncological outcomes. Hence, further assessment of the utility of surgical margins for prostate cancer prognosis is required to predict these outcomes more accurately. Over the last decade, studies have used the Gleason score (GS) of positive margins to predict outcomes. Herein, the authors aim to conduct a systematic review investigating the role of GS of PSM after radical prostatectomy in predicting BCR and oncological outcomes. METHODS AND ANALYSIS We will perform a search using MEDLINE, EMBASE, SCOPUS and COCHRANE databases. The review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will screen titles and abstracts to select articles appropriate for full-text review. Studies discussing GS of PSM after RP will be included. Given the change in reporting of GS, only articles from 2005 to 2019 will be included. The quality of the studies chosen will be assessed using the Newcastle Ottawa tool for non-randomised and Cochrane risk of bias for randomised control studies. We will adopt the grading of recommendations, assessment, development and evaluation framework to comment on quality of cumulative evidence. The primary outcome measure will be time to BCR. Secondary outcome measures include secondary treatment, disease-specific survival, disease progression-free and overall mortality at follow-up period. We aim to perform a meta-analysis if the level of heterogeneity is acceptable (I2 <50%). ETHICS AND DISSEMINATION The review does not require ethics approval as it is a review of published literature. The findings of the review will be submitted for peer-reviewed publications and presented at scientific meetings. PROSPERO REGISTRATION NUMBER CRD42019131800.
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Affiliation(s)
- Athul John
- School of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide local healthcare network, Adelaide, South Australia, Australia
| | - Michael O'Callaghan
- School of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Urology, South Australia Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia, Australia
- Flinders centre for innovation in Cancer, Flinders Unviersity, Adelaide, South Australia, Australia
| | - Rick Catterwell
- School of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
- Urology, Central Adelaide local healthcare network, Adelaide, South Australia, Australia
| | - Luke Selth
- School of Medicine, The University of Adelaide Faculty of Health and Medical Sciences, Adelaide, South Australia, Australia
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12
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Lysenko I, Mori K, Mostafaei H, Enikeev DV, Karakiewicz PI, Briganti A, Quhal F, Janisch F, Shariat SF. Prognostic Value of Gleason Score at Positive Surgical Margin in Prostate Cancer: A Systematic Review and Meta-analysis. Clin Genitourin Cancer 2020; 18:e517-e522. [PMID: 32229268 DOI: 10.1016/j.clgc.2020.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/13/2020] [Accepted: 02/17/2020] [Indexed: 10/24/2022]
Abstract
The individual clinical significance of a positive surgical margin (PSM) after radical prostatectomy has remained controversial. Studies have suggested that the Gleason grade (GG) at the PSM could improve predictive accuracy and decision making. Our objective was to systematically review the reported data to determine the effect of the GG at the PSM on the prognosis after radical prostatectomy. A systematic review was conducted by searching MEDLINE/PubMed for studies reported by June 2019 in accordance with the Preferred Reporting Items for Systematic Review statement. The keywords used included prostate cancer, radical prostatectomy, positive surgical margin, Gleason score, and/or Gleason grade. After a systematic literature review, 10 studies were included, comprising 14,108 patients, of whom 2454 (17.4%) had a PSM and 428 (14%) eventually experienced biochemical recurrence (BCR) within a median follow-up of 18 to 156 months. Data on neoadjuvant or adjuvant therapy were not estimable. In a meta-analysis, GG4 at PSM was significantly associated with BCR compared with GG3 (pooled hazard ratio, 1.87; 95% confidence interval, 1.53-2.28; z = 6.16). The Cochrane Q test (χ2 = 5.88; P = .318) and I2 test (I2 = 15.0%) showed that no significant heterogeneity was present. GG4 at a PSM is a feature of biologically and clinically aggressive prostate cancer that is associated with a significant increase risk of BCR. GG at PSM should be recorded in each pathological report. Given this adverse prognostic value patients with GG4 at the PSM should be considered for multimodal therapy such as radiotherapy.
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Affiliation(s)
- Ivan Lysenko
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria; Department of Urology, Jikei University School of Medicine, Tokyo, Japan
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Vienna, Austria; Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Dmitry V Enikeev
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Alberto Briganti
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fahad Quhal
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Florian Janisch
- Department of Urology, Medical University of Vienna, Vienna, Austria; King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria; Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia; Department of Urology, Weill Cornell Medical College, New York, NY; Department of Urology, University of Texas Southwestern Medical School, Dallas, TX; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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13
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A Comprehensive Analysis of the Association Between Gleason Score at a Positive Surgical Margin and the Risk of Biochemical Recurrence After Radical Prostatectomy. Am J Surg Pathol 2020; 43:369-373. [PMID: 30557174 DOI: 10.1097/pas.0000000000001204] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Our objective was to identify the best of the existing definitions of Gleason score (GS) at a positive surgical margin (PSM) by validating them in our radical prostatectomy cohort. We analyzed 251 patients who had mixed (3+4, 3+5, 4+3 or 5+3) pathologic GS and PSM. We used 5 definitions to record GS at a PSM. Univariate and multivariate analyses were used to study the association between each definition and the risk of biochemical recurrence (BCR). We also tested the prognostic value of multivariate models including established predictors and each of the studied definitions of GS at a PSM. GS 3+3 was seen at a PSM in 57.4% of the cases and was more common in patients with lower overall GS. Over a median follow-up of 4.0 years 89 patients (35.5%) developed BCR. All of the definitions of GS at a PSM were independent predictors of the BCR-free survival. Most of them also improved the prognostic value of the multivariate models when added to the established parameters. The degree of improvement was similar for the most complex definition (full GS at a PSM) and the easiest to record binary definition (presence of Gleason 4/5 pattern at a PSM). We conclude that compared with the other possible options of reporting GS at a PSM, the presence of Gleason 4/5 pattern may be the most practical definition. It is at least as predictive as other definitions, may be the easiest to record and is the best studied of the existing alternatives.
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14
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Prostate Carcinoma Grade and Length But Not Cribriform Architecture at Positive Surgical Margins Are Predictive for Biochemical Recurrence After Radical Prostatectomy. Am J Surg Pathol 2019; 44:191-197. [DOI: 10.1097/pas.0000000000001384] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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15
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Management of patients with high-risk and advanced prostate cancer in the Middle East: resource-stratified consensus recommendations. World J Urol 2019; 38:681-693. [PMID: 31297628 PMCID: PMC7064460 DOI: 10.1007/s00345-019-02872-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/04/2019] [Indexed: 12/24/2022] Open
Abstract
Purpose Prostate cancer care in the Middle East is highly variable and access to specialist multidisciplinary management is limited. Academic tertiary referral centers offer cutting-edge diagnosis and treatment; however, in many parts of the region, patients are managed by non-specialists with limited resources. Due to many factors including lack of awareness and lack of prostate-specific antigen (PSA) screening, a high percentage of men present with locally advanced and metastatic prostate cancer at diagnosis. The aim of these recommendations is to assist clinicians in managing patients with different levels of access to diagnostic and treatment modalities. Methods The first Advanced Prostate Cancer Consensus Conference (APCCC) satellite meeting for the Middle East was held in Beirut, Lebanon, November 2017. During this meeting a consortium of urologists, medical oncologists, radiation oncologist and imaging specialists practicing in Lebanon, Syria, Iraq, Kuwait and Saudi Arabia voted on a selection of consensus questions. An additional workshop to formulate resource-stratified consensus recommendations was held in March 2019. Results Variations in practice based on available resources have been proposed to form resource-stratified recommendations for imaging at diagnosis, initial management of localized prostate cancer requiring therapy, treatment of castration-sensitive/naïve advanced prostate cancer and treatment of castration-resistant prostate cancer. Conclusion This is the first regional consensus on prostate cancer management from the Middle East. The following recommendations will be useful to urologists and oncologists practicing in all areas with limited access to specialist multi-disciplinary teams, diagnostic modalities and treatment resources. Electronic supplementary material The online version of this article (10.1007/s00345-019-02872-x) contains supplementary material, which is available to authorized users.
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16
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Hoey C, Liu SK. Circulating blood miRNAs for prostate cancer risk stratification: miRroring the underlying tumor biology with liquid biopsies. Res Rep Urol 2019; 11:29-42. [PMID: 30881943 PMCID: PMC6398395 DOI: 10.2147/rru.s165625] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Current risk stratification methods for prostate cancer – although they have seen marked improvements over the past decades – are far from perfect. Despite the significant utility of prostate-specific antigen as a biomarker to monitor for disease recurrence, it cannot predict which tumors will recur or recommend the best treatment for patients. Similarly, although biopsies are imperative for diagnosis and staging, they are saddled with limitations and risks. We must move toward a noninvasive biomarker that has predictive and prognostic efficacy. We therefore review the current literature on circulating miRNA biomarkers, apply their use to two significant clinical problems (ie, how limitations of prostate biopsies can impact diagnosis and treatment management, and the need to tailor treatment for a clinically heterogeneous disease), and evaluate how circulating miRNAs have inherent properties that make them ideal liquid biomarkers. We also outline current gaps in knowledge that must be addressed before they can be implemented into routine clinical practice. With further research on their function and validation of their biomarker utility in large prospective cohorts, circulating miRNAs will likely prove to be the liquid biopsies of tomorrow.
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Affiliation(s)
- Christianne Hoey
- Biological Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada, .,Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada,
| | - Stanley K Liu
- Biological Sciences, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada, .,Department of Medical Biophysics, University of Toronto, Toronto, ON M5G 1L7, Canada, .,Department of Radiation Oncology, University of Toronto, Toronto, ON M5S 3E2, Canada,
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17
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Rates of Positive Surgical Margins and Their Effect on Cancer-specific Mortality at Radical Prostatectomy for Patients With Clinically Localized Prostate Cancer. Clin Genitourin Cancer 2019; 17:e130-e139. [DOI: 10.1016/j.clgc.2018.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/24/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022]
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18
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Susperregui J, Pierry C, Bonhomme B, Pasticier G, Bernhard JC, Capon G, Bensadoun H, Ballanger P, Ferrière JM, Robert G. Influence du score de Gleason des marges chirurgicales de prostatectomie totale sur la récidive biologique. Prog Urol 2017; 27:632-639. [PMID: 28869168 DOI: 10.1016/j.purol.2017.07.239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/10/2017] [Accepted: 07/20/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The aim of this study was to assess the impact of the aggressiveness of cancer cells at the level of positive surgical margins (PSM) on the biochemical recurrence rate (BRR) by studying the Gleason score (GS) at this level. METHODS We included all radical prostatectomy (RP) procedures performed from January 2007 to November 2011. All of the RP specimens with PSM were reviewed to determine the GS at the level of PSM. We compared the GS at PSM with BRR. RESULTS A total of 658 RP were analysed, among which 16% had PSM. From the 101 patients with PSM included, 32% had biochemical recurrence (BR) with a median follow-up of 38 months. GS at PSM was significantly associated with earlier BR (P=0.008). Univariate analysis showed that GS at PSM (P=0.013), initial PSA (P<0.0001), pathologic GS (P<0.001), length of PSM (P=0.013), and seminal vesicle invasion (P<0.0001) were predictors of BR. Multivariate analysis confirmed that PSA greater than 10ng/mL and length of PSM greater than 3mm were independent prognostic factors for BR, but GS at the level of PSM was not. CONCLUSION GS at PSM was not confirmed as an independent risk factor for BR. Initial PSA greater than 10ng/mL and length of PSM greater than 3mm were the sole independent predictors for BR. LEVEL OF PROOF 4.
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Affiliation(s)
- J Susperregui
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France.
| | - C Pierry
- Service d'anatomopathologie, centre hospitalier universitaire de Bordeaux, France
| | - B Bonhomme
- Service d'anatomopathologie, centre hospitalier universitaire de Bordeaux, France
| | - G Pasticier
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - J-C Bernhard
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
| | - G Capon
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - H Bensadoun
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France
| | - P Ballanger
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
| | - J-M Ferrière
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
| | - G Robert
- Service d'urologie, centre hospitalier universitaire de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Université de Bordeaux, France
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19
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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
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20
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Abstract
Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.
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Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - D Böhmer
- Klinik für Radioonkologie und Strahlentherapie, Charité Campus Benjamin Franklin, Berlin, Deutschland
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21
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Moschini M, Sharma V, Gandaglia G, Dell'Oglio P, Fossati N, Zaffuto E, Montorsi F, Briganti A, Karnes RJ. Long-term utility of adjuvant hormonal and radiation therapy for patients with seminal vesicle invasion at radical prostatectomy. BJU Int 2016; 120:69-75. [PMID: 27753192 DOI: 10.1111/bju.13683] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To investigate the long-term utility of adjuvant therapy after radical prostatectomy (RP) for prostate cancer with seminal vesicle invasion (SVI; pT3b), as the published data are conflicting. PATIENTS AND METHODS Patients with SVI during RP and pelvic lymph node dissection at two major referral centres from 1986 to 2014 were included. Kaplan-Meier analyses and multivariable Cox regressions were used to determine if adjuvant radiotherapy (aRT) and adjuvant hormonal therapy (aHT) were predictors of biochemical recurrence (BCR), cancer-specific mortality (CSM) and overall mortality (OM). Subset analyses were performed for pN0 patients and pN+ patients. RESULTS Overall, 3 279 patients with prostate cancer and SVI were included with a median follow-up of 148 months. Considering the whole SVI population, 1 387 (42%) received no adjuvant therapy, 1 179 (36%) received aHT, 461 (14.1%) received aRT, while 252 (7.7%) received both aHT and aRT. The 10-year BCR, CSM, and OM rates were 64%, 14%, and 27%, respectively. In the overall population, aRT and aHT were predictors of BCR, CSM and OM (all P < 0.04). When only pT3bN0 patients were considered, aHT was a significant multivariate predictor of BCR [hazard ratio (HR) 0.50, P < 0.001), CSM (HR 0.62, P = 0.01) and OM (HR 0.75, P = 0.004). Conversely, aRT was not associated with survival outcomes (all P > 0.05). When only the subgroup pT3bN+ was considered, the use of aRT was related to an improvement in CSM (HR 0.65, P = 0.03) and OM (HR 0.78, P = 0.03). CONCLUSIONS aHT + aRT seems to be effective in pT3b patients. However, when stratified according to the presence of nodal metastases, aHT remains effective only in the node-negative subgroup, while aRT remains effective only in the node-positive subgroup. Further data including prospective trials are warranted to study the utility of adjuvant therapies in this setting.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA.,Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Paolo Dell'Oglio
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Emanuele Zaffuto
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI, Milan, Italy
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22
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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
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23
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Adeniran AJ, Humphrey PA. Morphologic Updates in Prostate Pathology. Surg Pathol Clin 2015; 8:539-60. [PMID: 26612214 DOI: 10.1016/j.path.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] [Indexed: 10/22/2022]
Abstract
In the past several years, modifications have been made to the original Gleason system with resultant therapeutic and prognostic implications. Several morphologic variants of prostatic adenocarcinoma have also been described. Prostate pathology has also evolved over the years with the discovery and utility of new immunohistochemical stains. The topics discussed in this update include the Gleason grading system, prognostic grade grouping, variants of prostatic adenocarcinoma, and the application of immunohistochemistry to prostate pathology.
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Affiliation(s)
- Adebowale J Adeniran
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, LH 108, New Haven, CT 06520, USA.
| | - Peter A Humphrey
- Department of Pathology, Yale University School of Medicine, 310 Cedar Street, LH 108, New Haven, CT 06520, USA
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24
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Kates M, Sopko NA, Han M, Partin AW, Epstein JI. Importance of Reporting the Gleason Score at the Positive Surgical Margin Site: Analysis of 4,082 Consecutive Radical Prostatectomy Cases. J Urol 2015; 195:337-42. [PMID: 26264998 DOI: 10.1016/j.juro.2015.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Since 2010 pathologists at our institution have routinely been documenting the Gleason score at the margin and length of the positive surgical margin after prostatectomy. In this study we evaluate how the Gleason score and positive surgical margin length correlate with the grade and adverse pathological characteristics of the final specimen, and whether the positive surgical margin Gleason score affects the risk of early biochemical recurrence. MATERIALS AND METHODS A total of 4,082 consecutive patients undergoing radical prostatectomy and pelvic lymph node dissection between 2010 and 2014 for localized prostate cancer were included in the study, of whom 405 had a Gleason score of 7 or greater of the primary nodule and a positive surgical margin with the length and Gleason score recorded at the margin. Concordance rates between the Gleason score at the margin and the final pathological specimen were compared. Logistic regression models were used to predict the risk of unfavorable pathology. Cox proportional hazards models controlling for Gleason score, preoperative prostate specific antigen, pathological stage and adjuvant radiation were used to predict biochemical recurrence, and Kaplan-Meier estimates of recurrence-free survival were calculated by Gleason score. RESULTS Among patients with positive margins biochemical recurrence was identified in 22% (vs 5.6% without positive margins), metastases in 3% (vs 0.5%) and adjuvant radiation in 30% (vs 4.1%). Mean followup was 22 months (range 12 to 48). The Gleason score at the positive surgical margin was the same as the final pathology specimen in 44% of patients, and a lower Gleason score in 56% of patients. A shorter positive surgical margin was independently associated with a lower Gleason score at the margin (p=0.02). Kaplan-Meier estimates demonstrated improved freedom from biochemical recurrence among patients with a lower Gleason score at the margin. In multivariate Cox models having a lower grade margin was associated with a decreased risk of biochemical recurrence (HR 0.50, OR 0.25-0.97). CONCLUSIONS A lower Gleason score at the positive surgical margin is independently associated with a shorter margin length and a decreased risk of early biochemical recurrence. Thus, the Gleason score at the margin should be documented.
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Affiliation(s)
- Max Kates
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland.
| | - Nikolai A Sopko
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Misop Han
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Alan W Partin
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathan I Epstein
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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25
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Faria EF, Chapin BF, Muller RL, Machado RD, Reis RB, Matin SF. Radical Prostatectomy for Locally Advanced Prostate Cancer: Current Status. Urology 2015; 86:10-5. [DOI: 10.1016/j.urology.2015.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
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26
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Santoni M, Scarpelli M, Mazzucchelli R, Lopez-Beltran A, Cheng L, Epstein JI, Cascinu S, Briganti A, Catto JW, Montorsi F, Montironi R. Current Histopathologic and Molecular Characterisations of Prostate Cancer: Towards Individualised Prognosis and Therapies. Eur Urol 2015; 69:186-90. [PMID: 26070514 DOI: 10.1016/j.eururo.2015.05.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 05/25/2015] [Indexed: 12/12/2022]
Abstract
Data on TMPRSS2-ERG and AR-V7 may pave the way for personalised therapy for prostate cancer (PCa) patients. Comprehensive molecular profiling can help identify multiple PCa subtypes and driving alterations. Translating these findings into clinical practice is still challenging.
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Affiliation(s)
- Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Marina Scarpelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | - Roberta Mazzucchelli
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy
| | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan I Epstein
- Departments of Pathology, Urology, and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Stefano Cascinu
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Alberto Briganti
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - James W Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Francesco Montorsi
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, Italy.
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