1
|
Karwacki J, Łątkowska M, Jarocki M, Jaworski A, Szuba P, Poterek A, Lemiński A, Kaczmarek K, Hałoń A, Szydełko T, Małkiewicz B. The clinical meaning of lymphovascular invasion: preoperative predictors and postoperative implications in prostate cancer - a retrospective study. Front Oncol 2024; 14:1349536. [PMID: 38764583 PMCID: PMC11099271 DOI: 10.3389/fonc.2024.1349536] [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: 12/04/2023] [Accepted: 04/22/2024] [Indexed: 05/21/2024] Open
Abstract
Introduction Lymphovascular invasion (LVI) is a pivotal histopathological parameter in prostate cancer (PCa), holding significant prognostic implications. Our study pursued a dual objective: firstly, to identify preoperative factors associated with LVI, aiming to unveil markers facilitating the recognition of patients prone to LVI during postoperative examination; and secondly, to assess postoperative outcomes correlated with LVI. Methods We retrospectively analyzed 861 nonmetastatic PCa patients who underwent radical prostatectomy (RP), investigating preoperative factors and postoperative outcomes. Surgical specimens were processed following established guidelines. Statistical analyses utilized non-parametric tests to assess the association between LVI and both pre- and postoperative factors. Furthermore, logistic regression analyses were utilized to develop models aimed at identifying the most significant predictors of LVI and pN1 status, respectively. Results Numerous preoperative factors exhibited significant correlations with LVI, offering valuable clinical insights. Logistic regression identified magnetic resonance imaging (MRI)-based clinical tumor stage (cT) 3-4, biopsy Gleason Grading Group (GGG) 3-5, preoperative prostate specific antigen (PSA) ≥20 and percentage of positive biopsy cores (PPBC) ≥50% as the strongest preoperative predictors of LVI. Additionally, the study uncovered an association between LVI and postoperative outcomes, including postoperative PSA (p value <0.001), extracapsular extension (ECE) (<0.001), positive surgical margins (PSM) (<0.001), perineural invasion (PNI) (<0.001), pathological tumor stage (pT) (<0.001), pathological lymph node status (pN) (<0.001), postoperative GGG (<0.001), and operative time (0.023). Notably, the study revealed a novel and substantial association between LVI and an increased number of positive lymph nodes in pN+ patients in the univariate analysis (<0.001). Furthermore, we have found an association between LVI and pN1 status in the logistic regression analysis (odds ratio [OR] = 23.905; p <0.001). Conclusion Our findings underscore the pivotal role of LVI in influencing the prognosis of prostate cancer (PCa). The study acknowledges the challenges associated with preoperative LVI assessment and emphasizes the need for future research to unravel the factors associated with this histopathological finding. Significantly, our research stands out as the first, to the best of our knowledge, to reveal the association between LVI and the number of positive lymph nodes in pN+ patients.
Collapse
Affiliation(s)
- Jakub Karwacki
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | | | - Michał Jarocki
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Arkadiusz Jaworski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Przemysław Szuba
- Faculty of Economics in Opole, WSB University in Wroclaw, Wroclaw, Poland
| | - Adrian Poterek
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Artur Lemiński
- Department of General and Oncologic Urology, Independent Public Regional Hospital in Szczecin, Szczecin, Poland
- Department of Biochemical Sciences, Pomorenian Medical University, Szczecin, Poland
| | - Krystian Kaczmarek
- Department of General and Oncologic Urology, Independent Public Regional Hospital in Szczecin, Szczecin, Poland
| | - Agnieszka Hałoń
- Department of Clinical and Experimental Pathology, Wroclaw Medical University, Wroclaw, Poland
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| | - Bartosz Małkiewicz
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wrocław, Poland
| |
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
|
Di Mauro E, Di Bello F, Califano G, Morra S, Creta M, Celentano G, Abate M, Fraia A, Pezone G, Marino C, Cilio S, Capece M, La Rocca R, Imbimbo C, Longo N, Colla' Ruvolo C. Incidence and Predicting Factors of Histopathological Features at Robot-Assisted Radical Prostatectomy in the mpMRI Era: Results of a Single Tertiary Referral Center. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59030625. [PMID: 36984626 PMCID: PMC10057318 DOI: 10.3390/medicina59030625] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023]
Abstract
Background and Objectives: To describe the predictors of cribriform variant status and perineural invasion (PNI) in robot-assisted radical prostatectomy (RARP) histology. To define the rates of upgrading between biopsy specimens and final histology and their possible predictive factors in prostate cancer (PCa) patients undergoing RARP. Material and Methods: Within our institutional database, 265 PCa patients who underwent prostate biopsies and consecutive RARP at our center were enrolled (2018-2022). In the overall population, two independent multivariable logistic regression models (LRMs) predicting the presence of PNI or cribriform variant status at RARP were performed. In low- and intermediate-risk PCa patients according to D'Amico risk classification, three independent multivariable LRMs were fitted to predict upgrading. Results: Of all, 30.9% were low-risk, 18.9% were intermediate-risk and 50.2% were high-risk PCa patients. In the overall population, the rates of the cribriform variant and PNI at RARP were 55.8% and 71.1%, respectively. After multivariable LRMs predicting PNI, total tumor length in biopsy cores (>24 mm [OR: 2.37, p-value = 0.03], relative to <24 mm) was an independent predictor. After multivariable LRMs predicting cribriform variant status, PIRADS (3 [OR:15.37], 4 [OR: 13.57] or 5 [OR: 16.51] relative to PIRADS 2, all p = 0.01) and total tumor length in biopsy cores (>24 mm [OR: 2.47, p = 0.01], relative to <24 mm) were independent predicting factors. In low- and intermediate-risk PCa patients, the rate of upgrading was 74.4% and 78.0%, respectively. After multivariable LRMs predicting upgrading, PIRADS (PIRADS 3 [OR: 7.01], 4 [OR: 16.98] or 5 [OR: 20.96] relative to PIRADS 2, all p = 0.01) was an independent predicting factor. Conclusions: RARP represents a tailored and risk-adapted treatment strategy for PCa patients. The indication of RP progressively migrates to high-risk PCa after a pre-operative assessment. Specifically, the PIRADS score at mpMRI should guide the decision-making process of urologists for PCa patients.
Collapse
Affiliation(s)
- Ernesto Di Mauro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Francesco Di Bello
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gianluigi Califano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Simone Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Massimiliano Creta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Giuseppe Celentano
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Marco Abate
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Agostino Fraia
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Gabriele Pezone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudio Marino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Simone Cilio
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Marco Capece
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Roberto La Rocca
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Ciro Imbimbo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Nicola Longo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| | - Claudia Colla' Ruvolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Via Sergio Pansini 5, 80131 Naples, Italy
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Kupski T, Małek M, Mor I. The association of a risk group with positive margin in the intraoperative and final pathology examination after robotic radical prostatectomy. Cent European J Urol 2022; 74:491-495. [PMID: 35083067 PMCID: PMC8771131 DOI: 10.5173/ceju.2021.0031] [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: 02/08/2021] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The aim of this study was to evaluate the risk of a positive margin in the intraoperative and final pathology depending on the risk group for biochemical recurrence in biopsy specimens after robot-assisted radical prostatectomy (RaRP) with sparing of the neurovascular bundles (NS). Material and methods The study was prospective and non-randomised. The intraoperative and final pathology examinations were performed in 65 consecutive patients treated with RaRP between 11.2019–08.2020. In the intraoperative examination, the site of the dissected neurovascular bundles and any suspicious places were examined. Patients were divided into 3 risk groups [according to the European Association of Urology (EAU) biochemical recurrence-risk stratification]. Due to the uncertain prognostic value of microscopic positive margins, 3 groups were identified: R0, Rmicro and R1. Results In the intraoperative examination, the distribution of risk groups in R0, Rmicro and R1 groups is similar (p = 0.132). In the postoperative study, the distribution of risk groups in each margin group is different, and is statistically significant (p <0.001). It has been shown that an increase in the risk group is an indicator of the occurrence of a positive margin in the final histopathological result regardless of the inclusion of Rmicro into R1 or into R0 by 2.68 and 6.52 times, respectively. Conclusions The preoperative risk group is an important factor for the occurrence of a positive margin, but only in the final examination and not in the intraoperative one. An intraoperative examination of the neurovascular bundles only is pointless and should be extended to the examination of the apex.
Collapse
Affiliation(s)
- Tomasz Kupski
- Mazovia Hospital Warsaw, Department of Urology, Warsaw, Poland
| | - Michał Małek
- Mazovia Hospital Warsaw, Department of Urology, Warsaw, Poland
| | - Igal Mor
- Mazovia Hospital Warsaw, Department of Urology, Warsaw, Poland
| |
Collapse
|
6
|
Revisiting extraprostatic extension based on invasion depth and number for new algorithm for substaging of pT3a prostate cancer. Sci Rep 2021; 11:13952. [PMID: 34230540 PMCID: PMC8260727 DOI: 10.1038/s41598-021-93340-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/21/2021] [Indexed: 12/09/2022] Open
Abstract
Extraprostatic extension (EPE) is a factor in determining pT3a stage in prostate cancer. However, the only distinction in EPE is whether it is focal or non-focal, causing diagnostic and prognostic ambiguity. We substaged pT3a malignancies using classification of EPE to improve personalized prognostication. We evaluated 465 radical prostatectomy specimens with a digital image analyzer by measuring the number, radial distance and two-dimensional square area of the EPE. The most significant cut-off value was proposed as an algorithm for the pT3a substaging system to predict biochemical recurrence (BCR). A combination of the radial distance and the number of EPEs predicted BCR the most effectively. The optimal cut-off criteria were 0.75 mm and 2 mm in radial distance and multifocal EPE (hazard ratio: 2.526, C-index 0.656). The pT3a was subdivided into pT3a1, < 0.75 mm and any number of EPEs; pT3a2, 0.75–2 mm and one EPE; and pT3a3, > 2 mm and any number of EPEs or 0.75–2 mm and ≥ 2 EPEs. This combined tier was highly significant in the prediction of BCR-free survival. The combination of radial distance and number of EPEs could be used to subdivide pT3a prostate cancer and may aid in the prediction of BCR.
Collapse
|
7
|
Kir G, Arikan EA, Seneldir H, Ankarali H, Oznergiz S, Olgun ZC, Yildirim A. Determining the cut-off values of tumor diameter, degree of extraprostatic extension, and extent of surgical margin positivity with regard to biochemical recurrence of prostate cancer after radical prostatectomy. Ann Diagn Pathol 2019; 44:151431. [PMID: 31837592 DOI: 10.1016/j.anndiagpath.2019.151431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/02/2019] [Accepted: 09/17/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The pre-biopsy (bx) prostate-specific antigen (PSA) level, tumor volume/diameter, degree of extraprostatic extension (EPE), and extent of surgical margin positivity have been shown to be significant prognostic parameters of biochemical recurrence (BCR) after radical prostatectomy. The present study assessed the cut-off values of the pre-bx PSA level, maximum tumor diameter, radial and circumferential distances of EPE, and circumferential length of surgical margin (SM) positivity with regard to BCR. MATERIAL AND METHODS The study included 445 radical prostatectomy specimens, and the cut-off values of all parameters were determined using receiver operating characteristic curve analysis. RESULTS An ISUP grade group ≥ 3, radial distance of EPE >1 mm, and circumferential length of SM positivity ≥2 mm were identified as independent predictors of BCR after radical prostatectomy. The parameters that showed statistical significance in univariate analysis, such as pre-bx PSA level ≥ 7.20 ng/mL, tumor diameter ≥ 19.5 mm, presence of seminal vesicle invasion, and circumferential distance of EPE >3 mm, did not have independent prognostic values for BCR. CONCLUSIONS An ISUP grade group ≥ 3, radial distance of EPE >1 mm, and circumferential length of SM positivity ≥2 mm are predictors of BCR. Our findings might have significance in risk classification and adjuvant therapy consideration among patients with localized prostate cancer.
Collapse
Affiliation(s)
- Gozde Kir
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey.
| | - Evsen Apaydin Arikan
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Hatice Seneldir
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Handan Ankarali
- Department of Biostatistics, Istanbul Medeniyet University, Istanbul, Turkey
| | - Seca Oznergiz
- Istanbul Medeniyet University, Faculty of Medicine, Istanbul, Turkey
| | - Zeynep Cagla Olgun
- Department of Pathology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Asif Yildirim
- Department of Urology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
8
|
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]
|
9
|
[Prostate pathology recommendations from the Uropathology working group of the Spanish Society of Pathology]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 52:167-177. [PMID: 31213258 DOI: 10.1016/j.patol.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 02/13/2019] [Accepted: 02/17/2019] [Indexed: 11/24/2022]
Abstract
These guidelines from the uropathology working group of the Spanish Society of Pathology (SEAP) are based on the European and ISUP 2015 recommendations and those of the College of American Pathologists, as well as the latest WHO 2016, TNM (AJCC) 2017 classifications. They include recommendations for specimen sampling, macro- and microscopic examination and immunohistochemistry. Gleason patterns are specified: Gleason pattern 3 includes hyperplastic, atrophic and microcystic glands, while pattern 4 includes all cribriform or glomeruloid glands. The Gleason score in prostatectomy specimens may change; if a tertiary pattern occurs in more than 5% of the tumour, it becomes a secondary pattern. In both biopsies and prostatectomy specimens, if the Gleason score is 7, the percentage of pattern 4 should be stated. Gleason scoring in tumor variants and special situations should also be specified. These recommendations should be adapted according to the resources available.
Collapse
|
10
|
Dataset for the reporting of prostate carcinoma in radical prostatectomy specimens: updated recommendations from the International Collaboration on Cancer Reporting. Virchows Arch 2019; 475:263-277. [DOI: 10.1007/s00428-019-02574-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/29/2019] [Accepted: 04/04/2019] [Indexed: 01/08/2023]
|
11
|
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
|
12
|
Long-term oncological outcomes of apical positive surgical margins at radical prostatectomy in the Shared Equal Access Regional Cancer Hospital cohort. Prostate Cancer Prostatic Dis 2016; 19:423-428. [DOI: 10.1038/pcan.2016.45] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/26/2016] [Accepted: 07/12/2016] [Indexed: 11/08/2022]
|
13
|
Cho SY, Choi YD. The Effect of Tumor-Prostate Ratio on Biochemical Recurrence after Radical Prostatectomy. World J Mens Health 2016; 34:123-8. [PMID: 27574595 PMCID: PMC4999485 DOI: 10.5534/wjmh.2016.34.2.123] [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: 06/25/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/04/2022] Open
Abstract
Purpose Prostate tumor volume calculated after surgery using pathologic tissue has been shown to be an independent risk factor for biochemical recurrence. Nonetheless, prostate size varies among individuals, regardless of the presence or absence of cancer. We assumed to be lower margin positive rate in the surgical operation, when the prostate volume is larger and the tumor lesion is same. Thus, we defined the tumor-prostate ratio in the ratio of tumor volume to prostate volume. In order to compensate the prostate tumor volume, the effect of tumor-prostate ratio on biochemical recurrence was examined. Materials and Methods This study included 251 patients who underwent open retropubic radical prostatectomy for prostate cancer in a single hospital. We analyzed the effects of tumor volume and tumor-prostate ratio, as well as the effects of known risk factors for biochemical recurrence, on the duration of disease-free survival. Results In the univariate analysis, the risk factors that significantly impacted disease-free survival time were found to be a prostate-specific antigen level ≥10 ng/mL, a tumor volume ≥5 mL, tumor-prostate ratio ≥10%, tumor capsular invasion, lymph node invasion, positive surgical margins, and seminal vesicle invasion. In the multivariate analysis performed to evaluate the risk factors found to be significant in the univariate analysis, positive surgical margins (hazard ratio=3.066) and a tumor density ≥10% (hazard ratio=1.991) were shown to be significant risk factors for biochemical recurrence. Conclusions Tumor-prostate ratio, rather than tumor volume, should be regarded as a significant risk factor for biochemical recurrence.
Collapse
Affiliation(s)
- Sung Yong Cho
- Department of Urology, Inje University College of Medicine, Busan, Korea
| | - Young Deuk Choi
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
14
|
Lee S, Kim KB, Jo JK, Ho JN, Oh JJ, Jeong SJ, Hong SK, Byun SS, Choe G, Lee SE. Prognostic Value of Focal Positive Surgical Margins After Radical Prostatectomy. Clin Genitourin Cancer 2016; 14:e313-9. [DOI: 10.1016/j.clgc.2015.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 12/16/2015] [Accepted: 12/16/2015] [Indexed: 10/22/2022]
|
15
|
Kang YJ, Abalajon MJ, Jang WS, Kwon JK, Yoon CY, Lee JY, Cho KS, Ham WS, Choi YD. Association of Anterior and Lateral Extraprostatic Extensions with Base-Positive Resection Margins in Prostate Cancer. PLoS One 2016; 11:e0158922. [PMID: 27391650 PMCID: PMC4938503 DOI: 10.1371/journal.pone.0158922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 06/23/2016] [Indexed: 12/01/2022] Open
Abstract
Introduction Positive surgical margins (PSM) detected in the radical prostatectomy specimen increase the risk of biochemical recurrence (BCR). Still, with formidable number of patients never experiencing BCR in their life, the reason for this inconsistency has been attributed to the artifacts and to the spontaneous regression of micrometastatic site. To investigate the origin of margin positive cancers, we have looked into the influence of extraprostatic extension location on the resection margin positive site and its implications on BCR risk. Materials & Methods The clinical information and follow-up data of 612 patients who had extraprostatic extension and positive surgical margin at the time of robot assisted radical prostatectomy (RARP) in the single center between 2005 and 2014 were modeled using Fine and Gray’s competing risk regression analysis for BCR. Extraprostatic extensions were divided into categories according to location as apex, base, anterior, posterior, lateral, and posterolateral. Extraprostatic extensions were defined as presence of tumor beyond the borders of the gland in the posterior and posterolateral regions. Tumor admixed with periprostatic fat was additionally considered as having extraprostatic extension if capsule was vague in the anterior, apex, and base regions. Positive surgical margins were defined as the presence of tumor cells at the inked margin on the inspection under microscopy. Association of these classifications with the site of PSM was evaluated by Cohen’s Kappa analysis for concordance and logistic regression for the odds of apical and base PSMs. Results Median follow-up duration was 36.5 months (interquartile range[IQR] 20.1–36.5). Apex involvement was found in 158 (25.8%) patients and base in 110 (18.0%) patients. PSMs generally were found to be associated with increased risk of BCR regardless of location, with BCR risk highest for base PSM (HR 1.94, 95% CI 1.40–2.68, p<0.001) after adjusting for age, initial prostate-specific antigen, pathologic Gleason score, and pathologic T stage in the multivariate model. Logistic regression for PSM site revealed no significant correlation of apex PSM with extraprostatic extension location, while base PSM was associated with increased odds of anterior (OR 2.513, 95% CI 1.425–4.430, p = 0.001) and lateral (OR 2.715, 95% CI 1.735–4.250, p<0.001) extraprostatic extension. Conclusion Extension into the extraprostatic tissue on some specific locations do not share the same recur risk due to the different anatomical structures surrounding the organ. Anterior and lateral EPEs are prone to leave PSM on the base of the prostate, probably because of the lack of anatomical barricades slowing down the direct invasion process. More study on the pattern of spread of the tumors found to have extraprostatic extension is suggested for optimal planning of the operation extent and of the adjuvant radiotherapy.
Collapse
Affiliation(s)
- Yong Jin Kang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Mark Joseph Abalajon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jong Kyou Kwon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Yong Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joo Yong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kang Su Cho
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
- * E-mail:
| |
Collapse
|
16
|
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
|
17
|
Fadul LC, da Silva MT, de Freitas LAR, Athanazio DA. Assessment of the circumferential margins, extraprostatic extension and Gleason score in radical prostatectomy specimens: Comparison of a partial embedding method with supplemental total inclusion of peripheral tissues. Pathol Res Pract 2016; 212:217-21. [PMID: 26774290 DOI: 10.1016/j.prp.2015.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Revised: 12/11/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Recent data suggest that up to 21% of positive circumferential margins (PCM) and 47% of extraprostatic extension (EPE) samples may be missed when partial embedding methods are employed. Kim and colleagues (2009) suggested that total inclusion of the periphery (3mm rim) of the prostate prevented the failure to detect PCM and EPE. DESIGN Radical prostatectomy specimen (n=148) slides were reviewed after adoption of a protocol that included a ∼3 mm rim of peripheral tissues. We evaluated whether the analysis of supplemental slides of prostate periphery changed margin status, presence of EPE, Gleason score and extent of PCM and EPE. RESULTS Partial sampling resulted in missing 29% of PCM and 20% of EPE without using data from the supplemental slides of prostate periphery. Changes from focal to extensive disease were found in 11/21 (52%) cases of positive circumferential margins and in 5/13 (38%) cases of extraprostatic extension. Changes in the Gleason score were uncommon. CONCLUSIONS These results indicate the importance of including all the prostate peripheral tissue for microscopic analysis when partial embedding methods are adopted.
Collapse
Affiliation(s)
- Luiza Cavalcanti Fadul
- Hospital Universitário Professor Edgard Santos, Rua Augusto Viana sn, Canela, Salvador 40110060, Brazil
| | - Mariana Trindade da Silva
- Department of Pathology, Faculty of Medicine, Largo do Terreiro de Jesus s/n, Federal University of Bahia, 40025010 Salvador, Brazil
| | - Luiz Antonio Rodrigues de Freitas
- Hospital Universitário Professor Edgard Santos, Rua Augusto Viana sn, Canela, Salvador 40110060, Brazil; Department of Pathology, Faculty of Medicine, Largo do Terreiro de Jesus s/n, Federal University of Bahia, 40025010 Salvador, Brazil; Gonçalo Moniz Research Center, Rua Waldemar Falcão, 121, Oswaldo Cruz Foundation, 40296710 Salvador, Brazil; Imagepat, Pathology Laboratory, Rua Altino Serbeto de Barros 41810570, 119 Salvador, Brazil
| | - Daniel Abensur Athanazio
- Hospital Universitário Professor Edgard Santos, Rua Augusto Viana sn, Canela, Salvador 40110060, Brazil; Department of Pathology, Faculty of Medicine, Largo do Terreiro de Jesus s/n, Federal University of Bahia, 40025010 Salvador, Brazil; Gonçalo Moniz Research Center, Rua Waldemar Falcão, 121, Oswaldo Cruz Foundation, 40296710 Salvador, Brazil.
| |
Collapse
|
18
|
Richters A, Derks J, Fossion LMCL, Kil PJM, Verhoeven RHA, Aarts MJ. Presence and Number of Positive Surgical Margins after Radical Prostatectomy for Prostate Cancer: Effect on Oncological Outcome in a Population-Based Cohort. Urol Int 2015; 95:472-7. [PMID: 26523366 DOI: 10.1159/000441012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 09/09/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Additional insight in the occurrence and number of positive surgical margins (PSM) and the potential consequences is needed, since earlier studies show divergent results. This study aims at investigating the effect of the presence and number of PSM on oncological outcomes. METHODS Retrospective population-based cohort study including 648 consecutive prostate cancer patients who underwent RP in the Southern Netherlands in 2006-2008. The effect of PSM on risk of treatment failure, defined by either biochemical recurrence or necessity of any additional therapy (Cox regression), was evaluated. RESULTS PSM were observed in 39%; 11% had multiple PSM. Treatment failure was observed in 26% of all patients. Multivariably, the presence (hazard ratio 2.5) and number of PSM (hazard ratios: single 2.3; multiple 3.1) were independently associated with higher treatment failure rates, unlike location of PSM. CONCLUSIONS Treatment failure rates are high among patients with PSM, especially in those with multiple PSM. This needs to be taken into account when decisions are made on the applicability of the adjuvant and salvage therapy.
Collapse
Affiliation(s)
- Anke Richters
- Netherlands Cancer Registry/Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research, Utrecht, The Netherlands
| | | | | | | | | | | |
Collapse
|
19
|
Çelen İ, Müezzinoğlu T, Ataman OY, Bakırdere S, Korkmaz M, Neşe N, Şenol F, Lekili M. Selenium, nickel, and calcium levels in cancerous and non-cancerous prostate tissue samples and their relation with some parameters. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2015; 22:13070-13076. [PMID: 25925146 DOI: 10.1007/s11356-015-4555-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/16/2015] [Indexed: 06/04/2023]
Abstract
In the present study, tissue samples of patients with cancerous and non-cancerous prostate were analyzed for their Se, Ni, and Ca contents. Possible relationship between Se, Ni, and Ca concentrations and some parameters including preoperative prostate-specific antigen (PSA) levels, histopathological neurovascular invasion, extra-capsular extension, seminal vesicle invasion, positive surgical margins, PSA relapse after radical prostatectomy, and total Gleason scores were obtained. Inductively coupled plasma (ICP) optical emission spectrometry and ICP-mass spectrometry instruments were used for the determination of analytes interested. All the system parameters in digestion and measurement steps were optimized to obtain efficient digestion and sensitive measurements. There was no statistically meaningful difference observed in the concentration of selenium in cancerous and benign prostatic tissues (p = 0.347) while nickel levels in cancerous tissues were observed as significantly lower than benign tissues (p < 0.001). In addition, calcium concentration in cancerous tissue samples were found to be statistically lower than those in benign tissues (p < 0.001) with mean values of 657 and 1,431 mg/kg, respectively.
Collapse
Affiliation(s)
- İlker Çelen
- Denizli State Hospital, 20100, Denizli, Turkey,
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Pettenati C, Neuzillet Y, Radulescu C, Hervé JM, Molinié V, Lebret T. Positive surgical margins after radical prostatectomy: What should we care about? World J Urol 2015; 33:1973-8. [PMID: 25939539 DOI: 10.1007/s00345-015-1580-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/26/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Positive surgical margins (PSMs) after radical prostatectomy (RP) are a known factor associated with biochemical recurrence (BCR) and raise the issue of adjuvant treatment by radiotherapy versus salvage treatment at recurrence. To help this choice, our study aimed to analyze BCR-free survival and factors associated with BCR in patients with PSM and undetectable postoperative prostate-specific antigen (PSA). METHODS Between 2005 and 2008, 630 patients had RP for localized prostate cancer in our center. We included patients with PSM, uninvaded nods, undetectable postoperative PSA and no adjuvant treatment. The 5-year BCR-free survival was calculated using Kaplan-Meier method. Logistic regression models were used to determine the factors associated with BCR in univariate and multivariate analyses (Cox model). RESULTS The PSM rate was 32.7 % (n = 206 patients), and 110 patients corresponded to the inclusion criteria. The median follow-up was 72 months. The BCR rate was 30 % with a 5-year BCR-free survival of 83.9 %. The factors significantly associated with BCR were preoperative PSA, predominance and percentage of Gleason 4, tumor volume, PSM length and predominance of Gleason 4 at the margin. In the multivariate analysis, the remaining two significant factors were PSM length [OR 4.35, 95 % CI (1.011-1.421), p = 0.037] and tumor volume [OR 4.29, 95 % CI (1.011-1.483), p = 0.038]. CONCLUSION Over a 5-year follow-up, only one-third of patients experienced BCR. It might be reasonable to postpone adjuvant radiotherapy for patients with PSM and undetectable PSA after RP. Tumor volume and PSM length were associated with BCR and should be taken into account in the postoperative treatment management.
Collapse
Affiliation(s)
- Caroline Pettenati
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France.
| | - Yann Neuzillet
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Camelia Radulescu
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Jean-Marie Hervé
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| | - Vincent Molinié
- Department of Pathology, Fort de France University Hospital, Fort de France, France
| | - Thierry Lebret
- Department of Urology and Pathology, Hospital Foch, University of Versailles-Saint-Quentin-en-Yvelines (UVSQ), 40 rue Worth, 92151, Suresnes, France
| |
Collapse
|
21
|
Bryant RJ, Schmitt AJ, Roberts ISD, Gill PS, Browning L, Brewster SF, Hamdy FC, Verrill C. Variation between specialist uropatholgists in reporting extraprostatic extension after radical prostatectomy. J Clin Pathol 2015; 68:465-72. [DOI: 10.1136/jclinpath-2014-202661] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 02/26/2015] [Indexed: 11/04/2022]
Abstract
AbstractAimsExtraprostatic extension of prostate cancer in radical prostatectomy specimens significantly affects patient management. We evaluated the degree of interobserver variation between uropathologists at a tertiary referral teaching hospital in assessing the extraprostatic extension of prostate cancer in radical prostatectomy specimens.MethodsHistopathological data from a consecutive series of 293 radical prostatectomy specimens (January 2007–December 2012) were reviewed. A subset of 50 consecutive radical prostatectomy cases originally staged as tumours confined to the prostate (pT2) or tumours extending into periprostatic tissue (pT3a) during this period were reviewed by four specialist uropathologists.ResultsFive consultant histopathologists reported these specimens with significant differences in the reported stage (p=0.0164) between pathologists. Double-blind review by 4 uropathologists of 50 consecutive radical prostatectomy cases showed a lack of consensus in 16/50 (32%) cases (κ score 0.58, moderate agreement). A consensus meeting was held, but consensus could still not be reached in 9/16 cases.ConclusionsOur findings highlight variability in the reporting of pT stage in radical prostatectomy specimens even by specialist uropathologists. Assessment of extraprostatic extension has important implications for patient management and there is a need for more precise guidance.
Collapse
|
22
|
Leite KRM, Hartmann C, Reis ST, Viana N, Dall'Oglio MF, Sant'Anna AC, Nesrallah A, Nesrallah L, Antunes AA, Camara-Lopes LH, Srougi M. Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a. Int Braz J Urol 2014; 40:146-53. [PMID: 24856481 DOI: 10.1590/s1677-5538.ibju.2014.02.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 12/12/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Histological details of positive surgical margins in radical prostatectomy specimens have been related to outcome after surgery in rare studies recently published. Our objective is to assess whether the status of surgical margins, the extent and the Gleason score of positive margins, and the extent of the extraprostatic extension are predictive of biochemical recurrence post-radical prostatectomy. MATERIALS AND METHODS Three hundred sixty-five radical prostatectomy specimens were analyzed. The length of the positive surgical margin and extraprostatic extension and the Gleason score of the margin were recorded. Statistical analyses examined the predictive value of these variables for biochemical recurrence. RESULTS 236 patients were stage pT2R0, 58 pT2R1, 25 pT3R0 and 46 pT3R1. Biochemical recurrence occurred in 11%, 31%, 20% and 45.7% of pT2R0, pT2R1, pT3R0 and pT3R1, respectively. The extent of the positive surgical margins and the Gleason score of the positive surgical margins were not associated with biochemical recurrence in univariate analysis in a mean follow up period of 35.9 months. In multivariate analyses, only the status of the surgical margins and the global Gleason score were associated with biochemical recurrence, with a risk of recurrence of 3.1 for positive surgical margins and of 3.8 for a Gleason score > 7. CONCLUSION Positive surgical margin and the global Gleason score are significant risk factors for biochemical recurrence post-radical prostatectomy, regardless of the extent of the surgical margin, the extent of the extraprostatic extension, or the local Gleason score of the positive surgical margin or extraprostatic tissue. pT2R1 disease behaves as pT3R0 and should be treated similarly.
Collapse
Affiliation(s)
- Katia R M Leite
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School and Genoa Biotechnology, Sao Paulo, Brazil
| | | | - Sabrina T Reis
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Nayara Viana
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Marcos F Dall'Oglio
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Alexandre C Sant'Anna
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Adriano Nesrallah
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Luciano Nesrallah
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School and Genoa Biotechnology, Sao Paulo, Brazil
| | - Alberto A Antunes
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | | | - Miguel Srougi
- Laboratory of Medical Research, Urology - LIM 55, University of Sao Paulo Medical School, Sao Paulo, Brazil
| |
Collapse
|
23
|
Sooriakumaran P, Ploumidis A, Nyberg T, Olsson M, Akre O, Haendler L, Egevad L, Nilsson A, Carlsson S, Jonsson M, Adding C, Hosseini A, Steineck G, Wiklund P. The impact of length and location of positive margins in predicting biochemical recurrence after robot-assisted radical prostatectomy with a minimum follow-up of 5 years. BJU Int 2014; 115:106-13. [DOI: 10.1111/bju.12483] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Prasanna Sooriakumaran
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | | | - Tommy Nyberg
- Clinical Cancer Epidemiology; Department of Oncology-Pathology; Karolinska Institutet; Stockholm Sweden
| | - Mats Olsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Olof Akre
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
- Clinical Epidemiology Unit; Department of Medicine Solna; Karolinska Institutet; Stockholm Sweden
| | - Leif Haendler
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Lars Egevad
- Department of Pathology; Karolinska University Hospital; Stockholm Sweden
| | - Andreas Nilsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Stefan Carlsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Martin Jonsson
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Christofer Adding
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Abolfazl Hosseini
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| | - Gunnar Steineck
- Clinical Cancer Epidemiology; Department of Oncology-Pathology; Karolinska Institutet; Stockholm Sweden
| | - Peter Wiklund
- Department of Urology; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
24
|
Advanced imaging for the early diagnosis of local recurrence prostate cancer after radical prostatectomy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:827265. [PMID: 24757679 PMCID: PMC3971570 DOI: 10.1155/2014/827265] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/06/2014] [Indexed: 12/30/2022]
Abstract
Currently the diagnosis of local recurrence of prostate cancer (PCa) after radical prostatectomy (RT) is based on the onset of biochemical failure which is defined by two consecutive values of prostate-specific antigen (PSA) higher than 0.2 ng/mL. The aim of this paper was to review the current roles of advanced imaging in the detection of locoregional recurrence. A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of PET/CT in the restaging of PCa after RP; the second part is intended to provide the impact of multiparametric-MRI (mp-MRI) in the depiction of locoregional recurrence. Published data indicate an emerging role for mp-MRI in the depiction of locoregional recurrence, while the performance of PET/CT still remains unclear. Moreover Mp-MRI, thanks to functional techniques, allows to distinguish between residual glandular healthy tissue, scar/fibrotic tissue, granulation tissue, and tumour recurrence and it may also be able to assess the aggressiveness of nodule recurrence.
Collapse
|
25
|
Adamis S, Varkarakis IM. Defining prostate cancer risk after radical prostatectomy. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:496-504. [PMID: 24613741 DOI: 10.1016/j.ejso.2014.02.221] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 01/25/2014] [Accepted: 02/02/2014] [Indexed: 11/25/2022]
Abstract
Prostate cancer encompasses a wide spectrum of tumor phenotypes with differing prognoses and a part of these patients are at risk of experiencing tumor recurrence after initial treatment. This review discusses the parameters that determine PCa risk for failure after radical prostatectomy and also focuses on the ability of currently available post-treatment nomograms to predict treatment outcomes, and probability of treatment failure. The use of predictive nomograms may be therefore helpful in the complex decision making process.
Collapse
Affiliation(s)
- S Adamis
- 2nd Department of Urology, University of Athens, Medical School, Sismanoglion Hospital, Athens, Greece.
| | - I M Varkarakis
- 2nd Department of Urology, University of Athens, Medical School, Sismanoglion Hospital, Athens, Greece
| |
Collapse
|
26
|
Lee JW, Ryu JH, Kim YB, Yang SO, Lee JK, Jung TY. Do positive surgical margins predict biochemical recurrence in all patients without adjuvant therapy after radical prostatectomy? Korean J Urol 2013; 54:510-5. [PMID: 23956825 PMCID: PMC3742902 DOI: 10.4111/kju.2013.54.8.510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 06/14/2013] [Indexed: 11/29/2022] Open
Abstract
Purpose The objective was to study whether positive surgical margins (PSMs) predict biochemical recurrence (BCR) in all patients without adjuvant therapy after radical prostatectomy (RP). Materials and Methods We retrospectively reviewed the medical records of patients who underwent RP for prostate cancer at Veterans Health Service Medical Center from 2005 to 2011. BCR was defined by a prostate-specific antigen (PSA) value ≥0.2 ng/mL. The clinicopathological factors of the PSM group were compared with those of the negative surgical margin (NSM) group, and the predictive impact of a PSM for BCR-free survival were evaluated. In addition, we analyzed the prognostic difference for BCR-free survival between solitary and multiple PSMs. Results A PSM was noted in 167 patients (45.5%). BCR was reported in 101 men in total (27.5%). The BCR-free survival rate of the PSM group was lower than that of the NSM group (p<0.001). In a multivariate analysis for the total patients, PSM was significantly associated with BCR-free survival (p<0.001). After stratification by pathological T stage, Gleason score (GS), and preoperative PSA value, PSM was significantly predictive for BCR-free survival in men with pT2 and/or GS ≤6 or 7 and/or a PSA value <10 or 10-20 ng/mL (all p<0.05). Multiple PSMs were more predictive of BCR-free survival than was a solitary PSM (p=0.001). Conclusions A PSM is a significant predictor of postoperative BCR in patients with pT2 and/or GS ≤7 and/or preoperative PSA <20 ng/mL. Multiple PSMs are considered a stronger prognostic factor for prediction of BCR than is a solitary PSM.
Collapse
Affiliation(s)
- Jun Woo Lee
- Department of Urology, Veterans Health Service Medical Center, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
27
|
Swanson GP, Lerner SP. Positive margins after radical prostatectomy: Implications for failure and role of adjuvant treatment. Urol Oncol 2013; 31:531-41. [DOI: 10.1016/j.urolonc.2011.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 05/20/2011] [Accepted: 06/13/2011] [Indexed: 11/29/2022]
|
28
|
Udo K, Cronin AM, Carlino LJ, Savage CJ, Maschino AC, Al-Ahmadie HA, Gopalan A, Tickoo SK, Scardino PT, Eastham JA, Reuter VE, Fine SW. Prognostic Impact of Subclassification of Radical Prostatectomy Positive Margins by Linear Extent and Gleason Grade. J Urol 2013; 189:1302-7. [DOI: 10.1016/j.juro.2012.10.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Kazuma Udo
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Angel M. Cronin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Lauren J. Carlino
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Caroline J. Savage
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Alexandra C. Maschino
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hikmat A. Al-Ahmadie
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Anuradha Gopalan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Satish K. Tickoo
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Peter T. Scardino
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, New York
- Department of Urology, Weill Medical College of Cornell University, New York, New York
| | - James A. Eastham
- Department of Surgery (Urology Service), Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor E. Reuter
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Samson W. Fine
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| |
Collapse
|
29
|
Fontenot PA, Mansour AM. Reporting positive surgical margins after radical prostatectomy: time for standardization. BJU Int 2013; 111:E290-9. [DOI: 10.1111/j.1464-410x.2012.11640.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philip A. Fontenot
- Department of Urology; University of Miami Miller School of Medicine; Miami; FL; USA
| | | |
Collapse
|
30
|
Kench JG, Delahunt B, Griffiths DF, Humphrey PA, McGowan T, Trpkov K, Varma M, Wheeler TM, Srigley JR. Dataset for reporting of prostate carcinoma in radical prostatectomy specimens: recommendations from the International Collaboration on Cancer Reporting. Histopathology 2012; 62:203-18. [DOI: 10.1111/his.12042] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Brett Delahunt
- Department of Pathology and Molecular Medicine; Wellington School of Medicine and Health Sciences; University of Otago; Wellington; New Zealand
| | | | - Peter A Humphrey
- Department of Pathology and Immunology; Washington University School of Medicine; St Louis; MO; USA
| | - Thomas McGowan
- Department of Radiation Oncology; Carlo Fidani Peel Regional Cancer Centre; Mississauga; ON; Canada
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine; University of Calgary and Calgary Laboratory Services; Alberta; Canada
| | - Murali Varma
- Department of Pathology; University Hospital of Wales; Cardiff; UK
| | - Thomas M Wheeler
- Department of Pathology & Immunology; Baylor College of Medicine; Houston; TX; USA
| | - John R Srigley
- Department of Pathology and Molecular Medicine; McMaster University; Hamilton; ON; Canada
| |
Collapse
|
31
|
Osunkoya AO, Grignon DJ. Practical issues and pitfalls in staging tumors of the genitourinary tract. Semin Diagn Pathol 2012; 29:154-66. [DOI: 10.1053/j.semdp.2011.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
32
|
Comparative analysis of multiparametric magnetic resonance and PET-CT in the management of local recurrence after radical prostatectomy for prostate cancer. Crit Rev Oncol Hematol 2012; 84:109-21. [PMID: 22401991 DOI: 10.1016/j.critrevonc.2012.01.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2011] [Revised: 01/19/2012] [Accepted: 01/25/2012] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Our aim was to assess whether multiparametric magnetic resonance and PET-CT can have a role in detecting local recurrence in patients with biochemical recurrence after radical prostatectomy. METHODS We reviewed the recent international literature by carrying out a PUBMED search. RESULTS We critically reviewed 11 recent original studies about the use of PET-CT and 5 recent studies about the use of multiparametric magnetic resonance. PET-CT has not shown significant results in terms of detection rate for local recurrence in patients with low level of PSA. Multiparametric magnetic resonance showed encouraging results to detect local recurrence in patients with low PSA and with small diameter lesions. CONCLUSIONS Currently, most important urological societies do not consider multiparametric magnetic resonance and PET-CT in the follow-up of patients with suspected local recurrence after radical prostatectomy. We can assert that multiparametric magnetic resonance seems to have excellent results in detecting local recurrence in patients submitted to radical prostatectomy and PSA<1.5 ng/ml.
Collapse
|
33
|
Vrang ML, Røder MA, Vainer B, Christensen IJ, Gruschy L, Brasso K, Iversen P. First danish single-institution experience with radical prostatectomy: impact of surgical margins on biochemical outcome. ACTA ACUST UNITED AC 2012; 46:172-9. [DOI: 10.3109/00365599.2011.644860] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Ben Vainer
- Urology Research Unit, Department of Pathology
| | - Ib Jarle Christensen
- The Finsen Laboratory, Rigshospitalet, Faculty of Health and Medical Sciences,
University of Copenhagen, Denmark
| | | | | | | |
Collapse
|
34
|
Yip PY, Kench JG, Rasiah KK, Benito RP, Lee CS, Stricker PD, Henshall SM, Sutherland RL, Horvath LG. Low AZGP1 expression predicts for recurrence in margin-positive, localized prostate cancer. Prostate 2011; 71:1638-45. [PMID: 21432866 DOI: 10.1002/pros.21381] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 02/17/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Men with positive margins after radical prostatectomy (RP) for localized prostate cancer (PC) have a 40-50% biochemical relapse rate at 5 years. Adjuvant radiotherapy improves biochemical progression-free and overall survival in men with positive margins, but is associated with increased toxicity. There is an urgent need to identify new prognostic markers to define the group of patients who would benefit from multimodality therapy. METHODS Nuclear β-catenin, membranous secreted frizzled-related protein 4 (sFRP4), zinc-alpha 2-glycoprotein (AZGP1), and macrophage inhibitory cytokine-1 (MIC-1) have previously been identified as molecular markers of outcome in localized PC. From these published studies, we identified a subset of patients with positive margins. The aim of this study was to assess the association between these four molecular markers and outcome in men with margin-positive, localized PC. RESULTS We identified 186 men with positive margins from 330 men with localized PC; 53% had preoperative PSA >10 ng/ml, 72% extraprostatic extension (EPE), 24% seminal vesicles involvement (SVI), and 57% RP Gleason score ≥ 7. AZGP1 (P = 0.009), membranous sFRP4 (P = 0.03) and MIC-1 (P = 0.04) expression predicted for biochemical relapse on univariate analysis. Only absent/low AZGP1 expression (P = 0.01) was an independent predictor of recurrence in margin-positive, localized PC when modeled with preoperative PSA (P = 0.2), EPE (P = 0.2), SVI (P = 0.4), Gleason score ≥ 7 (P = 0.5) and adjuvant treatment (P = 0.4). Furthermore, there was an association between absent/low AZGP1 expression and clinical recurrence (P = 0.007). CONCLUSIONS AZGP1 is a potential molecular marker for biochemical relapse in men with margin-positive, localized PC. Routine assessment of this biomarker may lead to better selection of patients who will benefit from post-RP radiotherapy.
Collapse
Affiliation(s)
- Po Yee Yip
- Department of Medical Oncology, Sydney Cancer Centre, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Savdie R, Horvath LG, Benito RP, Rasiah KK, Haynes AM, Chatfield M, Stricker PD, Turner JJ, Delprado W, Henshall SM, Sutherland RL, Kench JG. High Gleason grade carcinoma at a positive surgical margin predicts biochemical failure after radical prostatectomy and may guide adjuvant radiotherapy. BJU Int 2011; 109:1794-800. [PMID: 21992536 DOI: 10.1111/j.1464-410x.2011.10572.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
UNLABELLED Study Type - Prognosis (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Only 30-35% of patients with positive surgical margins after radical prostatectomy develop recurrent disease. Adjuvant radiotherapy reduces the rate of biochemical relapse or metastasis and improves overall survival after radical prostatectomy. Various pathological factors, such as location and extent of positive margins, have been proposed as possible prognostic factors in men with margin-positive prostate cancer, however, the recent International Society of Urological Pathology consensus meeting in Boston noted that there is limited data on the significance of Gleason grade of the carcinoma at a positive margin. The present study shows that the presence of high grade prostate cancer, i.e. Gleason pattern 4 or 5, at a positive surgical margin is an independent predictor of biochemical recurrence after radical prostatectomy. Moreover, patients with lower grade carcinoma at the margin have a similar prognosis to men with negative margins. Hence, assessment of Gleason grade at the site of positive margin may aid optimal selection of patients for adjuvant radiotherapy. OBJECTIVE • To establish predictors of biochemical recurrence by analysing the pathological characteristics of positive surgical margins (PSMs), including Gleason grade of the carcinoma at the involved margin. PATIENTS AND METHODS • Clinicopathological and outcome data on 940 patients who underwent radical prostatectomy (RP) between 1997 and 2003 were collected. • Of these, 285 (30.3%) patients with PSMs were identified for pathological review, including assessment of location of margin, linear extent, number of PSMs, plane of margin and Gleason grade (3 vs 4 or 5) at the margin. RESULTS • At a median follow-up of 82 months, the biochemical recurrence rate of the PSM cohort was 29%. • On univariate analysis, the presence of Gleason grade 4 or 5 at the margin (34.4% of cases) was significantly associated with biochemical recurrence (hazard ratio [HR] 2.80, 95% confidence interval [CI]= 1.82-4.32, P < 0.001) compared with the presence of Gleason grade 3. • Linear extent of margin involvement was also associated with recurrence (P= 0.009). • Single vs multiple margin involvement, location, and plane of the involved margin were not significant predictors of recurrence. • On multivariate analysis, Gleason grade 4 or 5 at the margin remained an independent predictor of recurrence (HR 2.14, 95% CI = 1.29-4.03, P= 0.003). CONCLUSION • The Gleason grade at the site of a PSM identifies patients at increased risk of biochemical recurrence and should aid stratification of patients for adjuvant radiation therapy.
Collapse
Affiliation(s)
- Richard Savdie
- Cancer Research Program, Garvan Institute of Medical Research, NSW, Australia
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Prognostic factors in prostate cancer. Key elements in structured histopathology reporting of radical prostatectomy specimens. Pathology 2011; 43:410-9. [DOI: 10.1097/pat.0b013e328348a6b3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
37
|
Frequency of positive surgical margin at prostatectomy and its effect on patient outcome. Prostate Cancer 2011; 2011:673021. [PMID: 22110996 PMCID: PMC3200270 DOI: 10.1155/2011/673021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/27/2011] [Indexed: 11/17/2022] Open
Abstract
A positive surgical margin at prostatectomy is defined as tumor cells touching the inked edge of the specimen. This finding is reported in 8.8% to 42% of cases (median about 20%) in various studies. It is one of the main determinants of eventual biochemical (PSA) failure, generally associated with a doubled or tripled risk of failure. The effect of a positive margin on outcome can be modified by stage or grade and the length, number and location of positive margins, as well as by technical operative approach and duration of operator experience. This paper tabulates data from the past decade of studies on margin status.
Collapse
|
38
|
Berney DM, Montironi R, Egevad L. Pathology in prostate research: optimizing the pathological data. Acta Oncol 2011; 50 Suppl 1:49-52. [PMID: 21604940 DOI: 10.3109/0284186x.2010.525223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pathology remains the gold standard for the diagnosis and local staging and grading of prostate cancer. However, as in any discipline, there are variations in national standards and protocols leading to possible significant intra-observer variations. This can significantly impact on the data supplied to clinical trials. Diagnostic and grading criteria. Error rates in the diagnosis of prostate cancer have improved but the possibility that diagnostic error may be discovered has to be addressed in any research series. Major changes in Gleason grading have occurred in the past 40 years and this may lead to suboptimal application of grades in research cohorts, falsely raising the prognostic power of new biomarkers. Tumor measurements and staging criteria. Further information that may provide additional prognostic information include various measures of tumor extent and peri-neural invasion in biopsy specimens. Standardization of measures of tumor extent is necessary to give more useful assessments of prognosis. In radical prostatectomy specimens there are a number of other staging measurements which might be applied, including tumor volume, margin status, extra-capsular extension and nodal positivity though many of these variables are interdependent. Conclusion. Appropriate utilization of such pathological material will produce improved cohorts in which it will be possible to test new biomarkers with increased rigor.
Collapse
Affiliation(s)
- Daniel M Berney
- Department of Molecular Oncology and Imaging, Institute of Cancer, Queen Mary University of London, London, UK.
| | | | | |
Collapse
|
39
|
Cao D, Humphrey PA, Gao F, Tao Y, Kibel AS. Ability of Linear Length of Positive Margin in Radical Prostatectomy Specimens to Predict Biochemical Recurrence. Urology 2011; 77:1409-14. [DOI: 10.1016/j.urology.2010.10.059] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 09/21/2010] [Accepted: 10/03/2010] [Indexed: 11/16/2022]
|
40
|
Tan PH, Cheng L, Srigley JR, Griffiths D, Humphrey PA, van der Kwast TH, Montironi R, Wheeler TM, Delahunt B, Egevad L, Epstein JI. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins. Mod Pathol 2011; 24:48-57. [PMID: 20729812 DOI: 10.1038/modpathol.2010.155] [Citation(s) in RCA: 166] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.
Collapse
Affiliation(s)
- Puay Hoon Tan
- Department of Pathology, Singapore General Hospital, Singapore, Singapore.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Biochemical Recurrence After Radical Prostatectomy: Multiplicative Interaction Between Surgical Margin Status and Pathological Stage. J Urol 2010; 184:1341-6. [DOI: 10.1016/j.juro.2010.06.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Indexed: 11/22/2022]
|
42
|
The Gleason Score of Tumor at the Margin in Radical Prostatectomy is Predictive of Biochemical Recurrence. Am J Surg Pathol 2010; 34:994-1001. [DOI: 10.1097/pas.0b013e3181e103bf] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
43
|
Davidson DD, Koch MO, Lin H, Jones TD, Biermann K, Cheng L. Does the size matter?: Prostate weight does not predict PSA recurrence after radical prostatectomy. Am J Clin Pathol 2010; 133:662-8. [PMID: 20231620 DOI: 10.1309/ajcpphgxdi94sgac] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Previous studies suggest that low prostate weight is a significant negative prognostic factor for prostate cancer. In the current study, the data for 431 men who underwent radical retropubic prostatectomy between 1990 and 1998 were analyzed for association between prostate weight and various clinical and pathologic parameters. These included age, preoperative prostate-specific antigen (PSA) level, PSA recurrence, pathologic stage, Gleason grade, extraprostatic extension, positive surgical margins, tumor volume, associated high-grade prostatic intraepithelial neoplasia, perineural invasion, and lymph node metastasis. Potential associations were probed by using Cox regression model analysis. A significant positive correlation was found between prostate weight and increasing patient age or increasing preoperative PSA level. There was no significant independent association between prostate weight and any of the other variables examined. No association was found between prostate weight and PSA recurrence. Although increasing prostate weight correlates with increased patient age and higher preoperative PSA level, it does not independently predict postoperative cancer recurrence.
Collapse
|
44
|
van Oort IM, Bruins HM, Kiemeney LALM, Knipscheer BC, Witjes JA, Hulsbergen-van de Kaa CA. The length of positive surgical margins correlates with biochemical recurrence after radical prostatectomy. Histopathology 2010; 56:464-71. [DOI: 10.1111/j.1365-2559.2010.03497.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
45
|
Fleshner NE, Evans A, Chadwick K, Lawrentschuk N, Zlotta A. Clinical significance of the positive surgical margin based upon location, grade, and stage. Urol Oncol 2010; 28:197-204. [DOI: 10.1016/j.urolonc.2009.08.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
46
|
Cookson MS, Chang SS. Margin control in open radical prostatectomy: What are the real outcomes? Urol Oncol 2010; 28:205-9. [DOI: 10.1016/j.urolonc.2009.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
47
|
Sæther T, Sørlien LT, Viset T, Lydersen S, Angelsen A. Are positive surgical margins in radical prostatectomy specimens an independent prognostic marker? ACTA ACUST UNITED AC 2009; 42:514-21. [DOI: 10.1080/00365590802299585] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Thorstein Sæther
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars Tjugum Sørlien
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Stian Lydersen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anders Angelsen
- Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Urology, St Olav's Hospital, University Hospital of Trondheim, Trondheim, Norway
| |
Collapse
|
48
|
Bong GW, Ritenour CW, Osunkoya AO, Smith MT, Keane TE. Evaluation of modern pathological criteria for positive margins in radical prostatectomy specimens and their use for predicting biochemical recurrence. BJU Int 2009; 103:327-31. [DOI: 10.1111/j.1464-410x.2008.08075.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
49
|
Montironi R, Cheng L, Mazzucchelli R, Lopez-Beltran A. PATHOLOGICAL DEFINITION AND DIFFICULTIES IN ASSESSING POSITIVE MARGINS IN RADICAL PROSTATECTOMY SPECIMENS. BJU Int 2009; 103:286-8. [DOI: 10.1111/j.1464-410x.2008.08006.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
50
|
Yossepowitch O, Bjartell A, Eastham JA, Graefen M, Guillonneau BD, Karakiewicz PI, Montironi R, Montorsi F. Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol 2008; 55:87-99. [PMID: 18838211 DOI: 10.1016/j.eururo.2008.09.051] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 09/23/2008] [Indexed: 11/28/2022]
Abstract
CONTEXT This review focuses on positive surgical margins (PSM) in radical prostatectomy (RP). OBJECTIVE To address the etiology, incidence, and oncologic impact of PSM and discuss technical points to help surgeons minimize their positive margin rate. An evidence-based approach to assist clinicians in counseling patients with a PSM is provided. EVIDENCE ACQUISITION A literature search in English was performed using the National Library of Medicine database and the following key words: prostate cancer, surgical margins, and radical prostatectomy. Seven hundred sixty-eight references were scrutinized, and 73 were selected for rigorous review based on their pertinence, study size, and overall contribution to the field. EVIDENCE SYNTHESIS In contemporary series, PSM are reported in 11-38% of patients undergoing RP. Although variability exists in the pathologic interpretation of surgical margins, PSM are associated with an increased hazard of biochemical recurrence (BCR) and local disease recurrence as well as the need for secondary cancer treatment. A posterolateral PSM appears to confer the greatest risk of recurrence, whereas the prognostic significance of positive apical margins remains controversial. The role of preoperative imaging and intraoperative frozen section analysis are being investigated to reduce margin positivity rates. Level-1 evidence indicates that adjuvant radiotherapy (RT) in men with PSM reduces BCR rates and clinical progression and possibly improves overall survival (OS). CONCLUSIONS PSM in RP specimens are uniformly considered an adverse outcome. Regardless of approach (open or laparoscopic), attention to surgical detail is essential to minimize rates. For patients with a PSM destined to experience a cancer recurrence, RT is the only established treatment with curative potential. A randomized trial in patients with PSM comparing immediate postoperative RT to salvage RT is critically needed before definitive recommendations can be made.
Collapse
|