Abstract
Simple SummaryProstate 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.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.
Highlights
Introduction iationsProstate cancer is the second most common noncutaneous malignancy in men with 1,414,259 new cases worldwide in 2020, and represents the fifth most common cause of cancer death in men [1,2]
MORofinMargin prostatectomy depending on a variety of factors, including the stage ofspecimens the disease, the surgical techThe frequency of positive in prostatectomy ranges from 6–38%, depending a variety of factors,ofincluding the stage of the disease, the surgical technique nique used on and the experience the surgeon
Results from multi-institutional randomized trials have shown that there is a benefit of radiotherapy compared with active surveillance after prostatectomy regarding biochemical recurrence-free survival in patients with positive margins, though the overall survival is not improved [41]
Summary
The prostate is partially enveloped by a capsule, consisting of a layer of smooth muscle bundles mainly arranged in a transverse plane, and collagen fibers, usually concentrated as a thin line at the external border [10,11]. Apex and base will be subsequently sectioned in a contact with the surface of the prostate is not considered as a positive margin The presence of neoplastic cells close but not in in its capsule is dissected incomplete, there is increased difficulty in recognizing the presence of contact with the surface of the prostate is not considered as a positive margin contact with the surfaceand of the prostate is not ascautery a positive margin extraprostatic extension positive. In the anterior surface of the prostate, the gland is surrounded by a fibromuscular stroma and its capsule is incomplete, there is increased difficulty in recognizing the presence of extraprostatic extension and positive MOR [19]. Cautery artifact incells neoplastic cells in contact indicate the area ofthe margin infiltration.
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