Length Of Positive Surgical Margin Research Articles

Risk classification system using the detailed positive surgical margin status for predicting biochemical recurrence after robot-assisted radical prostatectomy.

This study aimed to evaluate the risk classification system using the detailed positive surgical margin (PSM) status to predict biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). We retrospectively analyzed 427 patients who underwent RARP between January 2016 and March 2020. We investigated risk factors for BCR using univariate and multivariate Cox proportional hazard regression models. The biochemical recurrence-free survival (BRFS) rate was assessed using the Kaplan-Meier method. The median follow-up period was 43.4 months and 99 patients developed BCR. In the multivariate analysis, maximum PSM length>5.0mm and the International Society of Urological Pathology grade group (ISUP GG) at the PSM ≥3 were predictive factors for BCR in patients with a PSM. In the multivariate analysis, these factors were also independent predictive factors in the overall study population, including patients without a PSM. We classified the patients into four groups using these factors and found that the 1-year BRFS rates in the negative surgical margin (NSM) group, low-risk group (PSM and neither factor), intermediate-risk group (either factor), and high-risk group (both factors) were 94.9%, 94.5%, 83.1%, and 52.9%, respectively. The low-risk group showed similar BRFS to the NSM group (p=0.985), while the high-risk group had significantly worse BRFS than the other groups (p<0.001). Maximum PSM length>5.0mm and ISUP GG at the PSM ≥3 were independent predictive factors for BCR after RARP. Risk classification for BCR using these factors is considered to be useful and might help urologists decide on additional treatment after RARP.

The impact of positive surgical margin parameters and pathological stage on biochemical recurrence after radical prostatectomy: A systematic review and meta-analysis.

To systematically review and perform a meta-analysis on the predictive value of the primary Gleason grade (PGG) at the positive surgical margin (PSM), length of PSM, number of PSMs, and pathological stage of the primary tumor on biochemical recurrence (BCR) in patients with prostate cancer (PCa) after radical prostatectomy (RP). A systematic literature search was performed using electronic databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, from January 1, 2005, to October 1, 2023. The protocol was pre-registered in PROSPERO. Subgroup analyses were performed according to the different treatments and study outcomes. Pooled hazard ratios with 95% confidence intervals were extracted from multivariate analyses, and a fixed or random effect model was used to pool the estimates. Subgroup analyses were performed to explore the reasons for the heterogeneity. Thirty-one studies that included 50,028 patients with PCa were eligible for this meta-analysis. The results showed that, compared to PGG3, PGG4/5 was associated with a significantly increased risk of BCR. Compared with PSM ≤3 mm, PSM ≥3 mm was associated with a significantly increased risk of BCR. Compared with unifocal PSM, multifocal PSM (mF-PSM) was associated with a significantly increased risk of BCR. In addition, pT >2 was associated with a significantly increased risk of BCR compared to pT2. Notably, the findings were found to be reliable based on the sensitivity and subgroup analyses. PGG at the PSM, length of PSM, number of PSMs, and pathological stage of the primary tumor in patients with PCa were found to be associated with a significantly increased risk of BCR. Thus, patients with these factors should be treated differently in terms of receiving adjunct treatment and more frequent monitoring. Large-scale, well-designed prospective studies with longer follow-up periods are needed to validate the efficacy of these risk factors and their effects on patient responses to adjuvant and salvage therapies and other oncological outcomes.

Length and Gleason pattern at positive surgical margin after radical prostatectomy to assess risk of postoperative recurrence in localized prostate cancer.

359 Background: The prostatic apex is most popular location of positive surgical margin (PSM) at radical prostatectomy (RP) and the frequency of apex is reported to be about 20-40% of all positive cases. Prostatic apex is also reported to lack a well-defined capsule. Some recommendation suggest that reporting require location of a PSM, as well as length of PSM, though there are also reports that these classifications is inadequate in some patients. In addition, there is a lack of tumor grade at PSM in these recommendations. This study aims to investigate the impact of location, number, length, and tumor grade at PSM on biochemical recurrence (BCR) after RP. Methods: We retrospectively evaluated 1013 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant or adjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2019 criteria. PSM were subcategorized according to the length of PSM (≤ 5mm or &gt; 5mm), Gleason pattern (GP3 vs. GP4 or 5) at PSM, the number (single or multiple), and the location (apex-only or others). Results: The median patient age was 67 (range, 45–80) years. The median initial PSA was 6.8 ng/ml (0.4–82 ng/ml). The median follow-up period was 69 (0.7–135) months. Pathological T stage was in 73% of pT2 (n=733), 22% of pT3a (n=229), and 4% of pT3b (n=41). PSM was found in 377 cases. Length of margin is total and 5mm in median. PSM was found at apex-only in 187 cases (50%), and others showed other single location or multiple PSM. Single PSM is found in 293 cases (78%). GP3 at PSM was found in 130 cases, GP4 in 214, and GP5 in 33. GP3 at PSM tended to be more common in apex-only PSM. GP5, extra prostatic extension (EPE), seminal vesicle invasion, IDC-P, and PSM were significant in all the patients to predict BCR. Among the patients with PSM, multivariate analysis showed that length and GP at PSM were significantly strong factors and were stronger than location and number of PSM. The prognosis in pT2 patients with PSM were significantly subcategorized into 3 groups according to the length and GP at PSM (P&lt;0.001). Conclusions: We proposed the recurrence risk classification based on the length and the GP at PSM to predict BCR after radical prostatectomy. It is useful for prognosis prediction and high-risk group should be considered for adjuvant radiation and/or hormonal therapy in postoperative care.

The Effect of Adverse Surgical Margins on the Risk of Biochemical Recurrence after Robotic-Assisted Radical Prostatectomy.

Positive surgical margins (PSM) after radical prostatectomy are associated with a greater risk of biochemical recurrence (BCR). However, not all PSM harbour the same prognosis for recurrence. We aim to determine the impact of different PSM characteristics and their coexistence on the risk of BCR. This retrospective study included 333 patients that underwent robotic-assisted radical prostatectomy for prostate cancer between 2015–2020 at a single institution. The effect of PSM and their adverse characteristics on the risk of BCR was assessed using Cox proportional hazard models. Kaplan–Meier was used to represent BCR-free survival stratified by margin status. With a median follow-up of 34.5 months, patients with PSM had a higher incidence of BCR, higher risk of relapse and lower BCR-free survival than negative margins (p < 0.001). We established as adverse characteristics: PSM length ≥ 3 mm, multifocality and Gleason at margin > 3. PSM ≥ 3 mm or multifocal PSM were associated with an increased risk for BCR compared to favourable margins (HR 3.50; 95% CI 2.05–5.95, p < 0.001 and HR 2.18; 95% CI 1.09–4.37, p = 0.028, respectively). The coexistence of these two adverse features in the PSM also conferred a higher risk for biochemical relapse and lower BCR-free survival. Adverse Gleason in the margin did not confer a higher risk for BCR than non-adverse margins in our models. We concluded that PSM are an independent predictor for BCR and that the presence of adverse characteristics, such as length and focality, and their coexistence in the PSM are associated with a greater risk of recurrence. Nevertheless, subclassifying PSM with adverse features did not enhance the model’s predictive performance in our cohort.

Impact of positive surgical margin length and Gleason grade at the margin on oncologic outcomes in patients with nonorgan-confined prostate cancer.

Positive surgical margins (PSM) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality and the Gleason grade at the PSM, on the oncologic outcomes in nonorgan-confined RP patients. Within a high-volume center database, we identified patients who harbored non-organ-confined (pT3) prostate cancer (PCa) at RP between 2010 and 2016. Only patients without lymph node invasion were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of PSM on biochemical recurrence (BCR), metastasis, and cancer-specific death after RP in patients without adjuvant radiotherapy. Overall, 3705 patients were identified. Of those, 27.2% (n = 1007) harbored PSM. At 96 months after RP, BCR-free, metastasis-free and cancer-specific survival was 41.6 versus 57.5%, 82.7 versus 88.6%, and 94.7 versus 98.5% for patients with versus without PSM (all p < 0.001). BCR-free, metastasis-free and cancer-specific survival rates at 96 months were 56.7 versus 26.5% (p < 0.001), 94.4 versus 67.4% (p < 0.001), and 100.0 versus 87.1% (p < 0.01) for Gleason pattern 3 versus ≥ 4 at the margin and 45.0 versus 27.8% (p < 0.01), 83.3 versus 82.3% (p = 0.2), and 95.2 versus 92.7% (p = 0.3) for <4 mm versus ≥4 mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (hazard ratio [HR]:1.53, p < 0.001) and cancer-specific death (HR:2.75, p = 0.02). In subgroups of patients with PSM only, Gleason ≥ 4 at the margin (HR:1.60, p < 0.01) and length of PSM (HR:1.02, p < 0.05) was an independent predictor of BCR. PSM represents an independent predictor for worse oncologic outcome in nonorgan-confined PCa at RP. Gleason ≥ 4 at the margin was associated with the development of BCR, metastasis, and with cancer-specific death after RP. Next to margin status, Gleason at the margin and its length carry important information that should be reported for the specimen.

Impact of positive surgical margin status in predicting early biochemical recurrence after robot-assisted radical prostatectomy

We investigated the association between positive surgical margin (PSM) status and biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) to develop a prognostic factor-based risk stratification model for BCR. We analyzed the data of 483 patients who underwent RARP at our hospital between October 2010 and April 2019; 435 patients without neoadjuvant therapy were finally included. The BCR-free survival rate was determined using Kaplan-Meier analysis. Effects of the PSM status, including the number of PSMs, Gleason score (GS) at a PSM, and the maximum PSM length for BCR, were investigated using Cox regression analysis. BCR was confirmed after RARP in 61 patients (14.0%), and PSM was confirmed in 74 patients (17.0%); PSM was a significant predictor of BCR (p < 0.001). The median number of PSMs was 2 (1-6), and the median maximum length of PSM was 6.0 (2.0-17.0) mm. Multivariable analysis showed lymph node invasion (p < 0.001), GS of ≥ 7 at a PSM (p = 0.022) and a maximum PSM length of > 6.0mm (p = 0.003) were significant predictors of BCR. We classified the patients without lymph node invasion into good-, intermediate-, and poor-risk groups according to the other two risk factors (presence of 0, 1, and 2 factors, respectively) and rates of 1-year BCR-free survival (100.0, 72.7, and 48.1%, respectively). Higher GS at PSM and greater length of PSM were significant predictors of BCR after RARP, and console surgeons should be careful to prevent PSM during RARP.

Impact of positive surgical margin on biochemical recurrence in localized prostate cancer.

BackgroundWe analyzed the relationship between biochemical recurrence (BCR) and the status of positive surgical margin (PSM) in patients with pT3a prostate cancer (PCa).Materials and methodsPatients (n = 150) who underwent radical prostatectomy for pT3a PCa without nodal/distant metastasis were retrospectively reviewed between 2010 and 2013. The data regarding the status of PSM including the number, length, and margin Gleason score were collected. The predictors of BCR were analyzed using Cox regression hazard models. BCR-free survival was compared between the patients with negative surgical margin (NSM) and with PSM using Kaplan–Meier curves and log-rank tests.ResultsPSM was noted in 74 patients (49.3%). Seventy-six patients (50.7%) had NSM and 38 patients (25.3%) had single PSM. Twenty patients (13.3%) had two PSMs and 16 patients (10.7%) had ≥3 PSMs. In total patients, the multivariate analysis demonstrated that a pathological Gleason score of ≥8 was significantly associated with BCR [hazard ratio (HR), 2.173; 95% confidence interval (CI), 1.244–3.797; P = 0.038]. In patients with PSM, the number of PSM more than two was significantly associated with BCR (HR, 2.723; 95% CI, 1.256–5.902; P = 0.011). PSM length of ≥3 mm was also a significant predictive factor (HR, 1.024; 95% CI, 0.994–1.055, P = 0.042). Patients with the highest margin Gleason score of ≥4 had poorer BCR-free survival than those with that of 3/no surgical margin.ConclusionsNumber (more than one), length (≥3 mm), and higher margin Gleason score (≥4) of PSM were significantly associated with an increased likelihood of BCR in patients with pT3a PCa.

PD43-07 IMPACT OF POSITIVE SURGICAL MARGIN LENGTH AND GLEASON GRADE AT THE MARGIN ON ONCOLOGIC OUTCOMES IN PATIENTS WITH NON-ORGAN-CONFINED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II (PD43)1 Apr 2020PD43-07 IMPACT OF POSITIVE SURGICAL MARGIN LENGTH AND GLEASON GRADE AT THE MARGIN ON ONCOLOGIC OUTCOMES IN PATIENTS WITH NON-ORGAN-CONFINED PROSTATE CANCER Felix Preisser*, Alexander Heinze, Raisa Pompe, Felix Chun, Markus Graefen, Hartwig Huland, and Derya Tilki Felix Preisser*Felix Preisser* More articles by this author , Alexander HeinzeAlexander Heinze More articles by this author , Raisa PompeRaisa Pompe More articles by this author , Felix ChunFelix Chun More articles by this author , Markus GraefenMarkus Graefen More articles by this author , Hartwig HulandHartwig Huland More articles by this author , and Derya TilkiDerya Tilki More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000930.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Positive surgical margins (PSM) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality and the Gleason grade at the PSM, on the oncologic outcomes in non-organ-confined RP patients. METHODS: Within a high-volume center database we identified patients who harbored non-organ-confined (pT3) prostate cancer (PCa) at RP between 2010 and 2016. Only patients without lymph node invasion were included. Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of PSM on biochemical recurrence (BCR), metastasis and death after RP in patients without adjuvant radiotherapy. RESULTS: Overall, 3,706 patients were identified. Of those, 27.2% (n=1,008) harbored PSM. Patients with PSM had higher median PSA values (11.0 vs. 7.9ng/ml, p<0.001), higher proportion of primary Gleason ≥4 (56.0 vs. 38.7%, p<0.001) and more frequently harbored seminal vesicle invasion (45.9 vs. 22.0%, p<0.001). At 72 months after RP, BCR-free, metastasis-free and overall survival was 44.4 vs. 64.7%, 63.3 vs. 79.4% and 91.2 vs. 93.4% for patients with vs. without PSM (all p<0.001). BCR-free, metastasis-free and overall survival rates at 72 months were 49.3 vs. 32.7% (p=0.1), 60.9 vs. 76.5% (p=0.7) and 91.3 vs. 98.4% (p=0.3) for unifocal vs. multifocal PSM; 62.7 vs. 25.8% (p<0.001), 88.5 vs. 36.1% (p<0.001) and 98.4 vs. 83.7% (p<0.01) for Gleason pattern 3 vs. ≥4 at the margin and 48.4 vs. 37.3% (p=0.03), 63.6 vs. 63.1% (p=0.3) and 91.7 vs 93.9% (p=0.9) for <4mm vs. ≥4mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (Hazard ratio [HR]: 1.25, p<0.01) and overall survival (HR:1.94, p=0.02). In subgroups of patients with PSM only, length of PSM (HR: 1.03, p=0.03) and Gleason ≥4 at the margin (HR:1.76, p<0.01) represented independent predictors for BCR. CONCLUSIONS: PSM represents an independent predictor for worse oncologic outcome in non-organ-confined PCa at RP. Gleason ≥4 at the margin was an independent predictor for BCR and associated with development of metastasis and death after RP. Moreover, length of PSM was an independent predictor for BCR. Next to margin status, Gleason at the margin and its length carry important information that should be reported for the specimen. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e903-e903 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felix Preisser* More articles by this author Alexander Heinze More articles by this author Raisa Pompe More articles by this author Felix Chun More articles by this author Markus Graefen More articles by this author Hartwig Huland More articles by this author Derya Tilki More articles by this author Expand All Advertisement PDF downloadLoading ...

Impact of positive surgical margin length and Gleason grade at the margin on biochemical recurrence in patients with organ-confined prostate cancer.

Positive surgical margins (PSMs) represent a poor prognostic factor at radical prostatectomy (RP). To investigate the impact of PSM, its length, the focality, and the PSM Gleason, on biochemical recurrence (BCR) in organ-confined RP patients. Within a high-volume center database, we identified patients who harbored organ-confined (pathologic stage T2 disease) prostate cancer (PCa) at RP (2010-2016). Kaplan-Meier analyses and multivariable Cox regression models were used to test the effect of the PSM on the BCR risk. Overall, 8770 patients were identified. Of those, 6.6% (n = 579) harbored PSM. BCR-free survival at 72 months after RP was 77.7% vs 89.0% for patients with vs without PSM (P < .001). BCR-free survival rates at 72 months were 77.4% vs 73.6% (P = .1) for unifocal vs multifocal PSM, 77.2% vs 71.8% (P = .03) for Gleason pattern 3 vs ≥4 at the margin and 88.4% vs 66.3% (P < .001) for <3 vs ≥3 mm length of margin. In multivariable Cox models PSM was an independent predictor for BCR (hazard ratio [HR] = 2.40, P < .001). However, in subgroups with PSM, only ≥3 mm PSM represented an independent predictor (HR = 1.93, P = .04), while focality and Gleason at the margin were no significant predictors. PSM represents an independent predictor for BCR in organ-confined PCa at RP. Moreover, Gleason ≥4 at the margin and ≥3 mm PSM length were associated with worse BCR-free survival. Closer surveillance of patients with organ-confined PCa at RP and PSM can help to identify those who qualify for early salvage radiotherapy.

The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy.

ABSTRACTObjective:Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular extension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic.Materials and Methods:We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the patients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were included in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated.Results:The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recurrence (p = 0.03).Conclusion:Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.

Exploring positive surgical margins after minimally invasive radical prostatectomy: Does body habitus really make a difference ?

Positive surgical margins (PSMs) at radical prostatectomy (RP) are generally recognized as a surrogate of poor or difficult dissection of the prostatic gland. In open RP cohorts, obesity seems to be associated to an increased risk of PSMs, probably due to the technical challenge that obese men pose to surgical access. Minimally invasive RP has been claimed to possibly reduce PSM rate. Aim of the study was to explore the impact of obesity and body habitus on PSM risk and their localisation during laparoscopic and robotic-assisted RP. We reviewed 539 prospectively enrolled patients undergoing laparoscopic and robotic-assisted RP with pT2 prostate cancer. The outcome measured was rate of PSM according to the BMI and surgical approach (laparoscopic vs robotic-assisted). Patients were categorized in BMI<25kg/m2, BMI 25-29.9kg/m2 and BMI >30kg/m2 groups respectively and compared using Kruskall-Wallis or χ2 test, as appropriate. Uni- and multivariate logistic regression models were constructed to assess the impact of BMI and surgical technique on PSM risk. Overall, 127 (24%) of men had PSMs detected at final specimen evaluation. Mean PSM length was 3.9±3.4mm, and 30 (6%) men presented significant margins ≥4mm. Analysing the rate of PSMs across BMI categories, no significant association between increased BMI and PSM was detected (all P>0.48). On uni- and multivariate logistic regression BMI was not a statistically significant risk factor for PSM (P=0.14), nor was the minimally invasive technique (laparoscopic vs robotic-assisted) (P=0.54). In this study obese men do not appear to have a significant increase in risk of PSMs at RP compared to lean and overweight men when operated by a minimally invasive approach. The magnified vision and increased access to the pelvis allowed by a laparoscopic and robotic-assisted approach may be accountable for our findings. Larger studies are needed to validate our results. 4.

MP46-14 LOOKING BEYOND CANCER DETECTION: IS TEMPLATE BIOPSY BETTER THAN TRUS BIOPSY IN PLANNING NERVE SPARING ROBOTIC RADICAL PROSTATECTOMY IN THE MULTIPARAMETRIC MRI ERA?

You have accessJournal of UrologyProstate Cancer: Detection & Screening IV1 Apr 2018MP46-14 LOOKING BEYOND CANCER DETECTION: IS TEMPLATE BIOPSY BETTER THAN TRUS BIOPSY IN PLANNING NERVE SPARING ROBOTIC RADICAL PROSTATECTOMY IN THE MULTIPARAMETRIC MRI ERA? Dimitrios Moschonas, Edward Bass, Pavlos Pavlakis, Murthy Kusuma, Stylianos Chintzoglou, Krishnaji Patil, Christopher Eden, Matthew Perry, and Stephen Langley Dimitrios MoschonasDimitrios Moschonas More articles by this author , Edward BassEdward Bass More articles by this author , Pavlos PavlakisPavlos Pavlakis More articles by this author , Murthy KusumaMurthy Kusuma More articles by this author , Stylianos ChintzoglouStylianos Chintzoglou More articles by this author , Krishnaji PatilKrishnaji Patil More articles by this author , Christopher EdenChristopher Eden More articles by this author , Matthew PerryMatthew Perry More articles by this author , and Stephen LangleyStephen Langley More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1473AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Surgical decision-making at radical prostatectomy is of vital importance to maximizing biochemical disease-free survival as well as quality of life. Accurate characterisation of a patient′s tumour at diagnosis is thus paramount. Whilst the bulk of existing data has focused on cancer detection, little has been done in regard to whether biopsy strategies have demonstrable effect on surgical outcome. Our aim was to assess the impact of biopsy method on nerve sparing robotic assisted radical prostatectomy (RARP) and positive surgical margin (PSM) rates. METHODS We analysed our prospectively collected data of consecutive patients who underwent primary RARP following a diagnosis of CaP at a single referral centre between October 2010 and June 2017. All patients underwent multiparametric MRI (mpMRI) and either transrectal ultrasound guided (TRUS) or template transperineal biopsy. Data included presenting PSA (pPSA); patient age; clinical and radiological T stage; biopsy type and Gleason grade; D′Amico risk classification; whole-mount Gleason grade, prostate and tumour volumes; PSM status, site and length. PSM status was compared between groups. RESULTS 771 patients were included in the study, with 343 (44.5%) having undergone TRUS and 428 (55.6%) template biopsies. Median age was 66 [IQR 60-69] and median pPSA 7.2 [IQR 5.3-10.7]. Nerve sparing procedures were performed in 273 (79.6%) men following mpMRI and TRUS and 330 (77.1%) following mpMRI and template. PSM rates were significantly higher in the mpMRI and TRUS groups than in the mpMRI and template groups (p=0.005). Subgroup analysis demonstrated advantage of mpMRI and template in D′Amico high (p=0.04) and intermediate (p=0.04) risk groups. CONCLUSIONS MpMRI and template biopsy are superior to the combination of mpMRI and TRUS in surgical planning leading to better pathologic margin outcomes for patients. Targeted biopsy strategies beyond cancer detection, confidently support clinical decision making of nerve sparing prostatectomy approach © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e611-e612 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Dimitrios Moschonas More articles by this author Edward Bass More articles by this author Pavlos Pavlakis More articles by this author Murthy Kusuma More articles by this author Stylianos Chintzoglou More articles by this author Krishnaji Patil More articles by this author Christopher Eden More articles by this author Matthew Perry More articles by this author Stephen Langley More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Positive margin length and highest Gleason grade of tumor at the margin predict for biochemical recurrence after radical prostatectomy in patients with organ-confined prostate cancer.

To evaluate the pathologic features after radical prostatectomy to determine if the length of positive surgical margin (PSM) and the highest Gleason grade within the tumor at the PSM could risk stratify patients for biochemical recurrence (BCR). We performed a retrospective, matched, cohort study to identify patients with pathologically organ-confined (pT2) tumors and negative nodes (pN0/Nx), receiving no adjuvant therapy. Specimens underwent single pathologist review. BCR-free survival was estimated using the Kaplan-Meier method and compared between subgroups using two-sided log-rank test. Using Classification and Regression Tree analysis (CART), we identified an optimal cutoff for the PSM length which differentiated risk for BCR. Cox proportional hazards regression models were fit to assess the association between variables and BCR-free survival. Two-hundred PSM patients were matched to 200 patients with negative surgical margins (NSM). Median follow-up was 64 months. 5 year BCR-free survival was 90% (95% CI 84-97%) in the NSM group and 70% (95% CI 63-79%) in the PSM group. There was an increased risk of BCR with any PSM. Multivariable analysis demonstrated an association with length of PSM ( > 1 mm vs. ≤ 1 mm, HR 2.29; 95% CI 1.2-4.5) and having a highest Gleason grade of the cancer focus at the margin ≥ 4 (HR 6.8; 95% CI 1.6-29). We demonstrated that patients with pathologic T2 tumors with PSM > 1 mm or a Gleason grade of tumor focus at the margin ≥ 4 are at elevated risk for BCR. However, this study suggests that patients with pT2 tumors with positive surgical margins have a relatively low risk of biochemical recurrence and adjuvant radiation may be over treating this sub population. The subsets at greatest risk for BCR may benefit from more frequent PSA monitoring to direct salvage therapies.

Influence du score de Gleason des marges chirurgicales de prostatectomie totale sur la récidive biologique

The aim of this study was to assess the impact of the aggressiveness of cancer cells at the level of positive surgical margins (PSM) on the biochemical recurrence rate (BRR) by studying the Gleason score (GS) at this level. We included all radical prostatectomy (RP) procedures performed from January 2007 to November 2011. All of the RP specimens with PSM were reviewed to determine the GS at the level of PSM. We compared the GS at PSM with BRR. A total of 658 RP were analysed, among which 16% had PSM. From the 101 patients with PSM included, 32% had biochemical recurrence (BR) with a median follow-up of 38 months. GS at PSM was significantly associated with earlier BR (P=0.008). Univariate analysis showed that GS at PSM (P=0.013), initial PSA (P<0.0001), pathologic GS (P<0.001), length of PSM (P=0.013), and seminal vesicle invasion (P<0.0001) were predictors of BR. Multivariate analysis confirmed that PSA greater than 10ng/mL and length of PSM greater than 3mm were independent prognostic factors for BR, but GS at the level of PSM was not. GS at PSM was not confirmed as an independent risk factor for BR. Initial PSA greater than 10ng/mL and length of PSM greater than 3mm were the sole independent predictors for BR. 4.

MP93-13 EXPLORING POSITIVE SURGICAL MARGINS AFTER MINIMALLY INVASIVE RADICAL PROSTATECTOMY: DOES BODY HABITUS REALLY MAKE A DIFFERENCE?

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VII1 Apr 2017MP93-13 EXPLORING POSITIVE SURGICAL MARGINS AFTER MINIMALLY INVASIVE RADICAL PROSTATECTOMY: DOES BODY HABITUS REALLY MAKE A DIFFERENCE? Simone Albisinni, Julien Grosman, Fouad Aoun, Thierry Quackels, Alexandre Peltier, Roland van Velthoven, and Thierry Roumeguére Simone AlbisinniSimone Albisinni More articles by this author , Julien GrosmanJulien Grosman More articles by this author , Fouad AounFouad Aoun More articles by this author , Thierry QuackelsThierry Quackels More articles by this author , Alexandre PeltierAlexandre Peltier More articles by this author , Roland van VelthovenRoland van Velthoven More articles by this author , and Thierry RoumeguéreThierry Roumeguére More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2895AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Positive surgical margins (PSMs) at radical prostatectomy (RP) are generally recognized as a surrogate of poor or difficult dissection of the prostatic gland. In open RP cohorts, obesity seems to be associated to an increased risk of PSMs, probably due to the technical challenge that obese men pose to surgical access. Minimally invasive RP has been claimed to possibly reduce PSM rate. Aim of the study was to explore the impact of obesity and body habitus on PSM risk and their localisation during laparoscopic and robotic-assisted RP. METHODS We reviewed 539 prospectively enrolled patients undergoing laparoscopic and robotic-assisted RP with pT2 prostate cancer. The outcome measured was rate of PSM according to the BMI and surgical approach (laparoscopic vs robotic-assisted). BMI groups were compared using Kruskall-wallis or ?2 test, as appropriate. Uni- and multivariate logistic regression models were constructed to assess the impact of BMI and surgical technique on PSM risk. RESULTS Overall, 127 (24%) of men had PSMs detected at final specimen evaluation. Mean PSM length was 3.9±3.4mm, and 30 (6%) men presented significant margins ≥4mm. Analysing the rate of PSMs across BMI categories, no significant association between increased BMI and PSM was detected (all p>0.48)(table 1). On uni- and multivariate logistic regression BMI was not a statistically significant risk factor for PSM (p=0.14), nor was the minimally invasive technique (laparoscopic vs robotic-assisted) (p=0.54). CONCLUSIONS In this study obese men do not appear to have a significant increase in risk of PSMs at RP compared to lean and overweight men when operated by a minimally invasive approach. The magnified vision and increased access to the pelvis allowed by a laparoscopic and robotic-assisted approach may be accountable for our findings. Larger studies are needed to validate our results. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1241-e1242 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Simone Albisinni More articles by this author Julien Grosman More articles by this author Fouad Aoun More articles by this author Thierry Quackels More articles by this author Alexandre Peltier More articles by this author Roland van Velthoven More articles by this author Thierry Roumeguére More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

S&T-60 THE INFLUENCE OF LENGTH, GRADE, AND LOCATION OF POSITIVE SURGICAL MARGIN (PSM) ON BIOCHEMICAL RECURRENCE IN ORGAN CONFINED PROSTATE CANCER

You have accessJournal of UrologyScience & Technology Posters1 Apr 2016S&T-60 THE INFLUENCE OF LENGTH, GRADE, AND LOCATION OF POSITIVE SURGICAL MARGIN (PSM) ON BIOCHEMICAL RECURRENCE IN ORGAN CONFINED PROSTATE CANCER Chanwoo Lee, Aram Kim, Myong Kim, Myung-Chan Park, Jaeyoon Jung, Hyun-Jung Go, Yang-Soon Park, Yong Mee Cho, In Gab Jeong, Cheryn Song, Jun-Hyuk Hong, Choung-Soo Kim, and Hanjong Ahn Chanwoo LeeChanwoo Lee More articles by this author , Aram KimAram Kim More articles by this author , Myong KimMyong Kim More articles by this author , Myung-Chan ParkMyung-Chan Park More articles by this author , Jaeyoon JungJaeyoon Jung More articles by this author , Hyun-Jung GoHyun-Jung Go More articles by this author , Yang-Soon ParkYang-Soon Park More articles by this author , Yong Mee ChoYong Mee Cho More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Cheryn SongCheryn Song More articles by this author , Jun-Hyuk HongJun-Hyuk Hong More articles by this author , Choung-Soo KimChoung-Soo Kim More articles by this author , and Hanjong AhnHanjong Ahn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2889AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The oncological significance of pathological variables associated with positive surgical margin (PSM) after radical prostatectomy (RP), including location, involved length and grade, is still under debate. We intended to evaluate the influence of PSM-associated pathological variables on biochemical recurrence (BCR). METHODS Data from 1,236 patients who underwent RP and were confirmed pathologically with organ confined (=pT2) prostate cancer was reviewed. The prognostic significance of pathologic Gleason score (GS), percentage tumor volume (PTV), and aforementioned length, grade and location of PSM on BCR were analyzed utilizing Cox regression analysis. RESULTS PSMs were observed in 215 (17.4%) prostatectomy specimens and median length of PSM is 2mm (IQR: 1-5). Among them, 110 margins (51.2%) were grade 3 and 53 margins (24.6%) were grade 4 or 5. Grade of 52 cases were unreported at pathological outcome. Location of PSM was reported in all patients, 87 margins (40.4%) were only at apex lesion, 77 margins (35.8%) were at both apex and other lesion, and 51 margins (23.7%) were not at apex lesion. Biochemical recurrence occurred in 120 (9.7%) patients, in median follow up of 49 months (IQR: 32-61), and the estimated 5-year BCR-free survival was 89.5%. On multivariable analysis, pathologic GS (=8; HR = 2.19, p=0.019) and presence of PSMs (HR= 2.62, p=0.005) were independent prognostic factors for BCR. However, involved length (p range: 0.207-0.678), and tumor grade at surgical margin (p range: 0.179-0.203) did not affected BCR. The location of PSM was the only pathologic variable associated with PSM affecting the BCR (single apical lesion, HR = 1.96, p > 0.05; multiple lesions including apex; HR = 2.83, p = 0.012; non-apical lesion; HR = 3.01, p = 0.003; compared to negative surgical margin). CONCLUSIONS Among the variables associated with PSM, non-apical PSM was significantly associated with biochemical recurrence in pT2 prostate cancer, while the length and grade of PSM did not affect BCR. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e333 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Chanwoo Lee More articles by this author Aram Kim More articles by this author Myong Kim More articles by this author Myung-Chan Park More articles by this author Jaeyoon Jung More articles by this author Hyun-Jung Go More articles by this author Yang-Soon Park More articles by this author Yong Mee Cho More articles by this author In Gab Jeong More articles by this author Cheryn Song More articles by this author Jun-Hyuk Hong More articles by this author Choung-Soo Kim More articles by this author Hanjong Ahn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Influence of pathological factors on oncological outcomes after robot-assisted radical prostatectomy for localized prostate cancer: Results of a prospective study

PurposeTo assess the prognostic significance of lymphovascular invasion (LVI), maximum tumor diameter (MTD), high-grade prostatic intraepithelial neoplasia, perineural invasion, and length of positive surgical margins after robot-assisted radical prostatectomy (RARP). MethodsA single-institution prospective analysis of all patients who underwent RARP for localized prostate cancer was performed between January 2005 and June 2013. The primary end point was biochemical recurrence-free survival (BRFS). BRFS was estimated using the Kaplan-Meier method and compared to that from the log-rank test. Cox׳s proportional hazards regression univariate and multivariate analyses were performed to define the prognostic factors. ResultsOverall, 742 men were included. After a median follow-up of 31.4 months, biochemical recurrence occurred in 80 patients (10.8%). BRFS was 93%, 87%, and 80.7% at 1, 3, and 5 years, respectively. Progression to local recurrence occurred in 49 patients (6.6%). During the follow-up period, 3 patients experienced progression to metastatic disease and were treated with hormonotherapy. No patient died of disease during the study period. In multivariate analyses, Gleason score was the strongest predictor of BRFS (hazard ratio [HR] = 3.4; P<0.001). There were 3 other predictive factors of BRFS were LVI (HR = 7.64; P = 0.005), MTD (HR = 4.04; P =0.009), and margin length≥3mm (HR = 1.25; P = 0.04). ConclusionIn the era of serum prostate-specific antigen testing maturity in conjunction with a single approach to extirpation of the prostate gland by RARP, LVI, MTD, and positive surgical margins≥3mm are prognostic factors associated with BRFS after RARP. Consideration could be given to incorporate them in the pathology report of the radical prostatectomy specimens and they could assist physicians in clinical decision making.

Positive surgical margins after radical prostatectomy: What should we care about?

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). 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). 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]. 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.

Surgical margin length and location affect recurrence rates after robotic prostatectomy

BackgroundRobotic-assisted laparoscopic radical prostatectomy is a current standard treatment for localized prostate cancer, with treatment failure defined by biochemical recurrence (BCR). Open radical prostatectomy series have identified the presence of a positive surgical margin (PSM) as a predictor of long-term recurrence, a measure that is affected by the surgeon׳s skill. We evaluate the effect of PSM parameters on BCR rates from robotic-assisted laparoscopic radical prostatectomy, across 3 high-volume institutions. MethodsDe-identifiable clinicopathological and histopathological data were prospectively collected for 4,001 patients with at least 3 years of follow-up. Kaplan-Meier plots and 3 statistical models were used to evaluate the effect of margin parameters on BCR, via crude rates, traditional multivariable Cox regression, and a propensity-adjusted Cox regression model. ResultsOverall, 37% of men with a PSM developed BCR compared with 10% of men with negative margins (hazard ratio [HR] = 1.81, 95% CI: 1.47–2.22). Length ≥3mm or a multifocal positive margin was associated with a higher risk of BCR compared with negative margin cases. On multivariable Cox regression analysis of the positive margin cohort, only apical margins significantly predicted BCR relative to basal margins (HR = 2.03, 95% CI: 1.01–4.09), whereas there was no significant difference in BCR rates for posterolateral margins relative to basal margins (HR = 1.62, 95% CI: 0.84–3.11). Propensity-adjusted modeling confirmed a greater effect of apical compared with posterolateral PSM. ConclusionsA PSM length ≥3mm is predictive of BCR, as is to a lesser extent multiple positive margins. In contrast to open prostatectomy series, posterolateral margins carry a smaller risk of BCR compared with apical margins.

The Length of a Positive Surgical Margin Is of Prognostic Significance in Patients with Clinically Localized Prostate Cancer Treated with Radical Prostatectomy

Objective: To establish predictors of clinical failure in patients operated with radical prostatectomy (RP) for clinically localized prostate cancer (PC) by analyzing the pathological characteristics of positive surgical margins (PSM). Patients and Methods: The RP specimens of 303 consecutive patients operated with RP between 1985 and 2009 were reviewed. PSM were analyzed with regard to the PSM length, location and multifocality and the Gleason score (GS) at the PSM. Results: Of the 163 patients with PSM, 79 (48%) progressed to clinical failure compared to 30 (22%) in the negative-margin-status group. In univariate analysis, a GS at the PSM ≥4 + 3 = 7 (p = 0. 013) and a PSM length >3.0 mm (p < 0.005) were significantly associated with higher clinical failure rates compared to a GS at the PSM ≤3 + 4 = 7 and ≤3.0 mm in extent, respectively. A linear extent of the PSM ≤3.0 mm appeared to have the same clinical outcome as in the group with a negative margin status. In multivariate analysis, a PSM length >3.0 mm remained an independent predictor of clinical failure. Conclusions: PSM length is an independent predictor of clinical failure following RP.