Location Of Positive Surgical Margins Research Articles

Evaluatoion of intraoperative histology during nerve-sparing radical prostatectomy

Background. Currently, for patients with localized PC, intact erectile function, and low risk of extracapsular extension radical prostatectomy (RP) with nerve-sparing (NS) technique is indicated. The proven method of intraoperative control for the presence of positive surgical margin is the study of fresh frozen sections.Aim. To evaluate the method of intraoperative histological examination (cito-histology) in NS RP.Materials and methods. A prospective clinical study was conducted to examine fresh frozen sections in laparoscopic NS RP. Between February of 2021 and May of 2022, 90 patients diagnosed with prostate cancer underwent laparoscopic NS RP performed by the same surgeon. The patients were divided into 2 groups: group A (n = 40) included patients who underwent laparoscopic NS RP and intraoperative histology; group B (control group) (n = 50) included patients who underwent standard laparoscopic NS RP. Rapid histological and final histological examinations of all removed samples were carried out at the City Clinical Hospital No. 1 named after N.I. Pirogov by one pathologist. The presence of tumor tissue in a stained resection margin was considered positive surgical margin.Results. Oncological processes in macrosamples obtained by intraoperative histology were observed in 32 (80 %) patients, of which primary positive surgical margin was found in 9 (22.5 %) patients. Conversion of (cito) positive surgical margin status into final negative surgical margin was observed in 4 (10 %) patients. Conversion of the surgical margin status of (cito) negative to positive was observed in 1 (2.5 %) patient due to the targeted examination of the area of interest, and not the entire surface of the prostate. Overall 2-year survival in groups A and B was 100 % and 96 %, respectively; cancer-specific 2-year survival was 100 % and 100 %, respectively. Depending on the pathological group, recurrence-free 2-year survival was: group A (pT2) – 90 %; group B (pT2) – 92 %, group A (pT3) – 91.3 %; group B (pT3) – 77.3 %.Conclusion. The proposed method of intraoperative histological examination allows to determine the presence and location of positive surgical margin, which indicates to the surgeon the necessity of additional tissue removal in the neurovascular bundle area, reduces the technical and economic burden on pathology department compared to other methods of rapid histological examination, and reduces contraindications to performing the NS technique in RP especially in the intermediate-risk group.

MP67-07 CAN WE PREDICT THE SITE OF POSITIVE SURGICAL MARGINS (PSM) BASED ON THE SITE OF THE INDEX LESION AT MULTIPARAMETRIC MRI? A TOPOGRAPHIC SINGLE CENTER STUDY

You have accessJournal of UrologyCME1 Apr 2023MP67-07 CAN WE PREDICT THE SITE OF POSITIVE SURGICAL MARGINS (PSM) BASED ON THE SITE OF THE INDEX LESION AT MULTIPARAMETRIC MRI? A TOPOGRAPHIC SINGLE CENTER STUDY Francesco Pellegrino, Giorgio Gandaglia, Armando Stabile, Elio Mazzone, Giuseppe Rosiello, Gabriele Sorce, Luigi Nocera, Simone Scuderi, Francesco Barletta, Riccardo Leni, Mario De Angelis, Antony Pellegrino, Pietro Scilipoti, Paolo Zaurito, Emanuele Zaffuto, R. Jeffrey karnes, Morgan Roupret, Francesco Montorsi, and Alberto Briganti Francesco PellegrinoFrancesco Pellegrino More articles by this author , Giorgio GandagliaGiorgio Gandaglia More articles by this author , Armando StabileArmando Stabile More articles by this author , Elio MazzoneElio Mazzone More articles by this author , Giuseppe RosielloGiuseppe Rosiello More articles by this author , Gabriele SorceGabriele Sorce More articles by this author , Luigi NoceraLuigi Nocera More articles by this author , Simone ScuderiSimone Scuderi More articles by this author , Francesco BarlettaFrancesco Barletta More articles by this author , Riccardo LeniRiccardo Leni More articles by this author , Mario De AngelisMario De Angelis More articles by this author , Antony PellegrinoAntony Pellegrino More articles by this author , Pietro ScilipotiPietro Scilipoti More articles by this author , Paolo ZauritoPaolo Zaurito More articles by this author , Emanuele ZaffutoEmanuele Zaffuto More articles by this author , R. Jeffrey karnesR. Jeffrey karnes More articles by this author , Morgan RoupretMorgan Roupret More articles by this author , Francesco MontorsiFrancesco Montorsi More articles by this author , and Alberto BrigantiAlberto Briganti More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003330.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The impact of multiparametric MRI on surgical approach during radical prostatectomy (RP) and on oncological outcomes after surgery is still controversial. We aimed at performing a detailed topographic description of the site of PSM according to the topographic location of IL at MRI. METHODS: Overall, 111 PCa patients undergoing MRI-targeted biopsy and bilateral nerve sparing RP at our centre between 2016 and 2022. All patients had PSM at final pathology. All patients had a single visible suspicious IL at MRI (PIRADS ≥3). We evaluated the site of PSM based on the IL location at MRI. IL and PSM location were categorized using the 3 regions scheme (Right vs Left vs Bilateral). We graphically described the site of PSM based on the IL using the alluvial plot. We evaluated whether the IL was correlated with the location of PSM (right vs left) using Pearson’s chi-square test. RESULTS: PIRADS score was 3, 4, and 5 in 22 (20%), 44 (40%), and 48 (40%) patients, respectively. Median IL volume was 1.3 cc. Overall, 10 (9%), 42 (38%) and 59 (53%) ILs were bilateral, on the left and right hemigland, respectively. Clinically significant PCa (defined as a Gleason score ≥7) was found in 93 (84%) patients at biopsy. At final pathology, extra capsular extension was found in 58 (52%) patients. Overall, 13 (12%), 41 (37%), and 57 (51%) patients had bilateral, left, and right PSM, respectively. The topographic distribution of the site of PSM according to the topographic location of the ROI is reported in Figure 1. The majority of PSMs were ipsilateral to the IL location. For instance, among the 59 patients with IL in the right emigland, 93% (n=55) had ipsilateral PSM, 3% (n=2) had contralateral PSM and 3% (n=2) had bilateral PSM. After excluding bilateral PSM, IL location was strongly associated with the site of PSM (p<0.001). CONCLUSIONS: Our analyses demonstrated that the majority of PSM are located on the same side of the MRI-visible lesion. A conservative nerve sparing RP approach could thus be safely considered to be performed on the contralateral side of IL at mpMRI. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e945 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Francesco Pellegrino More articles by this author Giorgio Gandaglia More articles by this author Armando Stabile More articles by this author Elio Mazzone More articles by this author Giuseppe Rosiello More articles by this author Gabriele Sorce More articles by this author Luigi Nocera More articles by this author Simone Scuderi More articles by this author Francesco Barletta More articles by this author Riccardo Leni More articles by this author Mario De Angelis More articles by this author Antony Pellegrino More articles by this author Pietro Scilipoti More articles by this author Paolo Zaurito More articles by this author Emanuele Zaffuto More articles by this author R. Jeffrey karnes More articles by this author Morgan Roupret More articles by this author Francesco Montorsi More articles by this author Alberto Briganti More articles by this author Expand All Advertisement PDF downloadLoading ...

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.

Focal nodular enhancement on DCE MRI of the prostatectomy bed: radiologic-pathologic correlations and prognostic value.

To determine the concordance of dynamic contrast-enhanced (DCE) imaging findings with clinico-pathologic characteristics and their prognostic impact for predicting biochemical recurrence (BCR) in patients who underwent radical prostatectomy (RP) for prostate cancer. This retrospective study included patients who underwent MRI within 1 year after RP between November 2019 and October 2020. DCE findings and their concordance with the presence and location of positive surgical margin (PSM) were assessed using RP specimens. Kaplan-Meier and logistic regression analyses were used to evaluate the prognostic impact of DCE findings for BCR. Among the 272 men (mean age ± standard deviation, 66.6 ± 7.4 years), focal nodular enhancement was more frequently observed in those with PSM compared to those with negative margin (85.4% versus 14.6%; p < 0.001). The sites of focal nodular enhancement were 72.9% (35/48) concordant with the PSM locations. Focal nodular enhancement was associated with a higher Gleason score, higher preoperative PSA (≥ 10 ng/mL), higher Gleason grade at the surgical margin, and non-limited margin involvement (p = 0.002, 0.006, 0.032, and 0.001, respectively). In patients without BCR at the time of MRI, focal nodular enhancement was associated with a shorter time to BCR (p < 0.001) and a significant factor predicting 1-year BCR in both univariate (odds ratio = 8.4 [95% CI: 2.5-28.3]; p = 0.001) and multivariate (odds ratio = 5.49 [1.56-19.3]; p = 0.008) analyses. Focal nodular enhancement on post-prostatectomy MRI was associated with adverse clinico-pathologic characteristics of high risk for recurrence and can be a predictor for 1-year BCR in patients undergoing RP. • Focal nodular enhancement (PI-RR DCE score ≥ 4) was 72.9% (35/48) concordant with the site of positive resection margin by radiologic-histologic correlation. • Focal nodular enhancement (PI-RR DCE score ≥ 4) was associated with higher Gleason score ( ≥ 8), preoperative PSA ( > 10 ng/mL), and Gleason grade 4 or 5 at the surgical margin and non-limited margin involvement (p ≤ 0.032). • In patients without BCR at the time of MRI, focal nodular enhancement was a significant factor predicting 1-year BCR (odds ratio = 5.49; 95% CI: 1.56-19.3; p = 0.008).

Clinical outcomes of anterior prostate cancers treated with robotic assisted radical prostatectomy.

A prospective cohort study comparing peri- and postoperative outcomes for patients with predominantly anterior prostate cancer (APC) identified preoperatively against non-anterior prostate cancer (NAPC) treated via robotic-assisted radical prostatectomy (RARP). Of the 757 RARP's completed between January 2016 and April 2018, two comparative cohorts for anterior and an equivalent group of non-anterior prostate tumours each consisting of 152 patients were compared against each other. Data were collected on the following variables: patient age; operating consultant; preoperative PSA, ISUP grade, degree of nerve sparing; tumour staging; presence and location of positive surgical margins; PSA density, postoperative ISUP grade; treatment paradigm and postoperative PSA, erectile function, and continence outcomes with 2-year follow-up. APCs were found to have significantly lower ISUP grading postoperatively; increased diagnosis via active surveillance over new diagnosis; more frequently undertaken bilateral nerve-sparing and long-term poorer continence outcomes at 18 and 24 months postoperatively (p < 0.05). Pre- and post-op PSA levels, erectile function, PSA density, positive surgical margins (PSM), age and tumour staging showed no significant differences between the APC and NAPC cohorts (p > 0.05). The lower ISUP grading could indicate APC as overall being less aggressive than NAPC, whereas the poorer long-term continence outcomes require further investigating. The non-significant differences amongst tumour staging, PSA density, preoperative PSA levels and PSM rates suggest that APC may not be as significant as predicted in diagnostic evaluation. Overall, this study provides useful information on the growing literature of anterior prostate cancer. Being the largest comparative cohort study to date on APC post-RARP, these results indicate the true characteristics of anterior tumours and their functional outcomes to help improve education, patient expectations and management.

Preoperative Multiparametric Prostate Magnetic Resonance Imaging Structured Report Informs Risk for Positive Apical Surgical Margins During Radical Prostatectomy.

The prostatic apex is the most frequent location of positive surgical margin (PSM) after surgery. Data regarding the ability of multiparametric magnetic resonance imaging (mpMRI) to prospectively identify men at risk for apical PSMs (aPSMs) using a structured report are lacking. The aims of the study are to determine and to compare the rate of aPSM in men with versus without prospectively flagged at-risk prostate lesions during clinical mpMRI interpretation using whole-mount histopathology as the reference standard. This single-center, retrospective study of prospectively collected data included treatment-naive men with abnormal 3T mpMRI (PI-RADS v2 score ≥3) between January 2016 and December 2018 followed by surgery. During routine clinical interpretation, radiologists flagged prostate lesions abutting the apical most gland and/or encircling the distal most prostatic urethra using standardized language available as a "pick list" option in the structured report. Logistic regression was used to compare the rate of PSM in 2 groups (flagged vs nonflagged men). Propensity score covariate adjustment corrected for potential selection bias according to age, prostate-specific antigen (PSA), PSA density, grade group, and pT stage. The estimate was further adjusted by including surgeon as a covariate. A total of 428 men were included. A statistically significant higher proportion of aPSMs was noted in flagged (56% [51/91]) compared with nonflagged apical lesions (31% [105/337]; adjusted odds ratio, 2.5; 95% confidence interval, 1.6-4.1; P < 0.01). The difference in aPSM between both groups also varied according to the surgeon performing the RP. Prostate-specific antigen, PSA density, lesion size, apical location, Prostate Imaging Reporting & Data System score, grade group, pT stage, and surgeon's experience were associated with higher PSM rate. Biochemical recurrence, defined as PSA greater than 0.2 ng/mL on 2 measurements after RP, was significantly associated with PSM status (propensity score adjusted odds ratio, 3.1; 95% confidence interval, 1.8-5.3; P < 0.0001); however, patients flagged by radiologists did not have a significant difference in biochemical recurrence rates as compared with nonflagged patients ( P = 0.11). Standard language built into structured reports for mpMRI of the prostate helps identify preoperatively patients at risk for aPSM. Multiparametric MRI is able to identify patients at increased risk for aPSM, and this information can be conveyed in a structured report to urologists, facilitating patient counseling and treatment decisions.

The impact of the extent and location of positive surgical margins on the risk of biochemical recurrence following radical prostatectomy in men with Gleason 7 prostate cancers.

Positive surgical margins (PSM) after radical prostatectomy (RP) have been associated with increased risk of biochemical recurrence (BCR). This is heavily influenced by other clinicopathological factors. This study aims to assess the impact of the extent and location of PSM on BCR following RP for Gleason 7 carcinoma of the prostate (CaP). All men treated with RP between 2008 and 2017 in our region for localized or locally advanced Gleason 7 CaP, were included. Clinical (age, year, preoperative prostate specific antigen) and pathological (prostate weight, positive or negative surgical margins, International Society of Urological Pathology [ISUP] grade, T stage) data were collected. PSM were subcategorised according to Extent into favourable (unifocal and <3 mm in length) or unfavourable (multifocal or ≥3 mm in length), and Location into apical only or others. The outcome was the risk of BCR which was calculated with univariable and multivariable regression models and reported as hazard ratio (HR) with 95% confidence interval (CI). The cohort constituted of 1433 men. Majority had ISUP 2 (71.2%) or localized (62%) disease. Men with PSM (n = 506) were at greater risk of BCR when compared to those with negative margins (adjusted HR = 1.52, [CI: 1.14-2.04], p = .005). Similar observation was demonstrated for both PSM location subgroups. As for the PSM extent category, only men with unfavourable PSM demonstrated an increase in BCR risk over negative margin (adjusted HR = 1.67, [CI: 1.23-2.28], p = .001). Within this study settings, PSM were generally associated with increased BCR risk. This, however, was not demonstrated in favourable PSM extent cases. Observation rather than active treatment in these men should be considered.

PD64-09 COMPARATIVE EVALUATION OF ONCOLOGIC OUTCOMES ACCORDING TO THE ANATOMIC LOCATION OF SURGICAL MARGIN POSITIVITY AFTER PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy VI (PD64)1 Sep 2021PD64-09 COMPARATIVE EVALUATION OF ONCOLOGIC OUTCOMES ACCORDING TO THE ANATOMIC LOCATION OF SURGICAL MARGIN POSITIVITY AFTER PARTIAL NEPHRECTOMY Alp T. Beksac, Soodong Kim, Umberto Carbonara, Margaret Meagher, Alessandro Tafuri, Mahmoud Abou Zeinab, Louis Lenfant, Alessandro Antonelli, Riccardo Autorino, Ithaar Derweesh, and Jihad Kaouk Alp T. BeksacAlp T. Beksac More articles by this author , Soodong KimSoodong Kim More articles by this author , Umberto CarbonaraUmberto Carbonara More articles by this author , Margaret MeagherMargaret Meagher More articles by this author , Alessandro TafuriAlessandro Tafuri More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Louis LenfantLouis Lenfant More articles by this author , Alessandro AntonelliAlessandro Antonelli More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Ithaar DerweeshIthaar Derweesh More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002108.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to assess if the anatomical location of positive surgical margins (PSM) can affect the oncological outcomes following partial nephrectomy (PN). METHODS: From a multi-institutional dataset, we performed a retrospective analysis of 115 patients who were found to have PSM following PN. Surgeries were performed between from January 2010 to May 2020. Patients with benign pathology, less than 6 months follow up, baseline metastatic disease, bilateral tumors, familial renal cell carcinoma, and pathological node positive disease were excluded from analysis. Patients with PSM were stratified into two groups according to the anatomical location (parenchymal invasion, sinus fat invasion). Due to uneven sample size a 1:2 matched pair analysis was performed (by cT stage) to limit confounding effect of stage on recurrence. Demographics, clinical and tumor characteristics, and poncological outcomes were compared using Chi-square, Fisher’s exact, Mann-Whitney U, and student’s t tests. Kaplan-Meier analysis performed to analyze recurrence free survival (RFS). RESULTS: Overall 84 patients were included in analysis (56 parenchymal vs. 28 sinus). Median follow-up was 25 months (IQR 11-41). Baseline characteristics were comparable between the two groups. Pathological tumor size was comparable. In the parenchymal group, more patients had multifocal PSM, whereas more patients had pT3a upstaging in the sinus group. Local recurrence rate was higher in the sinus group (17.9% vs. 10.9%, p=0.377), however this association did not reach statistical significance. Distant recurrence rate was comparable as well (5.5% vs. 7.1%, p=0.76). Kaplan-Meier analysis did not show any difference in terms of RFS (p=0.68). CONCLUSIONS: At 25 months follow up, the location of positive surgical margin did not alter distance recurrence rates following PN. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e1147-e1148 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Alp T. Beksac More articles by this author Soodong Kim More articles by this author Umberto Carbonara More articles by this author Margaret Meagher More articles by this author Alessandro Tafuri More articles by this author Mahmoud Abou Zeinab More articles by this author Louis Lenfant More articles by this author Alessandro Antonelli More articles by this author Riccardo Autorino More articles by this author Ithaar Derweesh More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement Loading ...

Impact of Nerve-Sparing Status on Positive Surgical Margin Location and Biochemical Recurrence in Patients with Prostate Cancer Post Radical Prostatectomy.

This study was designed to assess the relationship between nerve-sparing (NS) status, positive surgical margin (PSM) location, and biochemical recurrence (BCR) based on a multicenter, radical prostatectomy (RP) database. We retrospectively reviewed data from 726 patients who underwent RP without any neoadjuvant or adjuvant treatment between 2010 and 2014. We statistically assessed the impact of NS sides on PSM location and BCR. PSM rates were 21.9% in the 726 patients studied, 13.2% in patients with ≤pT2, and 46.8% in patients with ≥pT3. Regarding PSM locations, the anterior-apex (AA) was the most common site for PSM (43.3%). After adjusting for confounding factors, bilateral nerve sparing (BNS) had a significantly higher odds ratio of PSM than the absence of NS did (odds ratio [OR] 3.04, 95% confidence interval [CI] 1.85-4.99). In the UNS RP in patients with ≤pT2, non-AA PSM on the non-NS side was significantly higher than that on the NS side (92.9% vs. 45.5%, p = 0.009). In all patients, 5.8% experienced BCR during a median follow-up of 43.5 months. PSM was significantly associated with BCR-free survival in patients with ≤pT2 (p = 0.013), but not in patients with ≥pT3 (p = 0.185). Non-AA PSM at the non-NS side was an independent risk factor for BCR (hazard ratio [HR] 2.56, 95% confidence interval [CI] 1.12-5.85), whereas AA PSMs, including NS/non-NS sides and non-AA PSM at the NS side, were not associated with BCR-free survival. Avoidance of non-AA PSM on the non-NS side may be rather important for maintaining BCR-free survival after RP.

Evaluating Incidence, Location, and Predictors of Positive Surgical Margin Among Chinese Men Undergoing Robot-Assisted Radical Prostatectomy.

PurposeTo evaluate the incidence and locations of positive surgical margin (PSM) among Chinese men undergoing RARP and identify the preoperative predictors for PSM.MethodsWe retrospectively identified 393 patients who underwent RARP according to inclusion criteria by single surgeon in our hospital. PSM was defined as the presence of cancer adjacent to inked surface of the specimen and categorized into four groups based on locations: apex, posterolateral, base, and multifocal. Logistic regression analysis was performed to identify the predictors of overall and location-specific PSM.ResultsThe overall PSM rate was 133/393 (34%). The PSM rates for pT2, pT3, and pT4 stage were 63/278 (23%), 50/89 (56%), and 20/26 (77%), respectively. The estimated rates for apical, posterolateral, basal, and multifocal PSM were 8%, 4%, 7%, and 14%, respectively. In univariate analysis, overall PSM related to tPSA, f/tPSA, percentage of positive needles, and Gleason score. Multifocal PSM correlated with smoking history, drinking history, tPSA, f/tPSA, percentage of positive needles, and Gleason score. In multivariate analysis, percentage of positive needles reminded the only independent predictor for overall (OR = 10.5, 95% CI: 2.58–44.4) and basal PSM (OR = 24.0, 95% CI: 3.22–179.4). The f/tPSA (OR = 2.59, 95% CI: 2.18–5.71) and percentage of positive needles (OR = 31.0, 95% CI: 3.17–303) were independent risk factors for multifocal PSM.ConclusionThe multifocal sites were the most common location of positive surgical margin, followed by apical and basal sites among Chinese patients undergoing RARP. The percentage of positive needles was an independent predictor for overall, basal, and multifocal PSM.

Impact of positive surgical margin location and perineural invasion on biochemical recurrence in patients undergoing radical prostatectomy

ObjectiveTo estimate the prognostic value of positive surgical margins (PSM) location and perineural invasion (PNI) for biochemical recurrence (BCR) in patients undergoing radical prostatectomy (RP).MethodsAll men with prostate cancer (PCa) who received RP in the second hospital of Tianjin Medical University from 2014 to 2018 were retrospectively identified. All patients met the following criteria: no neoadjuvant or adjuvant treatment, absence of lymph node invasion, or distant metastasis confirmed by surgery or imaging. Comparisons were made between cases with only apex positive (AM), isolated nonapical positive (OM), multiple positive (MM), and negative surgical margins (NSM). Patients were also subdivided according to the Gleason score and pathological tumor stage for analysis.ResultsA total of 416 patients available for analysis, of which 132 (31.7%) were PSM, 43 were AM, 37 were OM, and 52 were MM at a median follow-up of 27 months. The PNI was in 30.5% of patients. BCR occurred in 22.6% of patients during follow-up. Both AM and MM were noticed to be independent predictors of BCR with a hazard ratio of 4.192 (95% CI 2.185–8.042; p < 0.001) and 2.758 (95% CI 1.559–4.880; p < 0.001), respectively, when compared to NSM. Though the correlation was significant in univariate analysis, PNI was not an independent risk factor for BCR (p = 0.369). Subgroup analyses suggested that MM was not particularly predictive for BCR in the Gleason score < 8. The hole Cox regression model for the C-index was 0.843ConclusionsPSM location was a significant independent predictor of BCR in PCa, especially in patients with AM or MM, while PNI is a non-independent risk factor. Compared with other locations, AM has a higher BCR risk.

Obese men undergoing radical prostatectomy: Is robotic or retropubic better to limit positive surgical margins? Results from SEARCH.

To evaluate the association between obesity and positive surgical margins in patients undergoing retropubic radical prostatectomy versus robotic-assisted laparoscopic prostatectomy. We retrospectively reviewed the data of 3141 men undergoing retropubic radical prostatectomy and 1625 undergoing robotic-assisted laparoscopic prostatectomy between 1988 and 2017 at eight Veterans Health Administration hospitals. The positive surgical margin location (peripheral, apical, bladder neck, overall) was determined from pathology reports. We adjusted for age, race, prostate-specific antigen, surgery year, prostate weight, pathological grade group, extracapsular extension, seminal vesicle invasion, hospital surgical volume and surgical method (in analyses not stratified by surgical method). Interactions between body mass index and surgical approach were tested. Among all patients, higher body mass index was associated with increased odds of overall, peripheral and apical positive surgical margins (OR 1.02-1.03, P≤0.02). Although not statistically significant, there was a trend between higher body mass index and increased odds of bladder neck positive surgical margins (OR 1.03, P=0.09). Interactions between body mass index and surgical method were significant for peripheral positive surgical margins only (P=0.024). Specifically, there was an association between body mass index and peripheral positive surgical margins among men undergoing retropubic radical prostatectomy (OR 1.04, P<0.001), but not robotic-assisted laparoscopic prostatectomy (OR 1.00, P=0.98). Limitations include lacking individual surgeon data and lacking central pathology review. In this multicenter cohort, higher body mass index was associated with increased odds of positive surgical margins at all locations except the bladder neck. Furthermore, there was a significant association between obesity and peripheral positive surgical margins in men undergoing retropubic radical prostatectomy, but not robotic-assisted laparoscopic prostatectomy. Long-term clinical significance requires further study.

Factors Affecting Surgical Margin Positivity after Radical Prostatectomy in the Turkish Population: A Multicenter Study of the Urooncology Association

Background: The prediction of positive surgical margins (SM) after radical prostatectomy (RP) is important for planning the surgical modality and adjuvant therapy in patients with prostate cancer (PCa). Objectives: To investigate factors affecting SM positivity in patients diagnosed with PCa who underwent RP using the PCa database of the Urooncology Association (Turkey). Methods: Patients who underwent RP due to clinically T1c–T3 PCa and who had detailed SM data for the RP specimen were included in the study. Pathological data of 12 core transrectal ultrasound prostate biopsies and RP were evaluated. Patients were divided into 2 groups (SM positive and SM negative) according to SM status after RP. Data were compared between the groups. Factors affecting SM positivity, the number of positive SM sites, and the location of positive SM were separately evaluated with regression models. Results: A total of 2,643 patients from 6 different centers (median age: 63 years) with a prostate-specific antigen (PSA) level of 7.3 ng/mL were investigated in the study. BMI, PSA, biopsy Gleason score (GS), and perineural invasion (PNI) were found to be independent predictive factors for SM positivity and the number of positive SM locations, respectively (p < 0.05). According to the positive SM location, PSA was found to be associated with positive SM in apex, anterior prostate, and bladder neck locations. Also, according to posterolateral SM status, PNI and nerve-sparing RP (nsRP) rates were 21.3 and 44% for patients with negative posterolateral SM, and rates were 35.4 and 50.6% for patients with positive posterolateral SM, respectively (p < 0.05). In patients who underwent nsRP, positive SM was present in 22.2% of patients who did not have PNI on prostate biopsy, whereas positive SM was present in 40.6% of patients with PNI (p < 0.001). Similarly, 10.9% of patients without PNI had positive posterolateral SM, whereas 17.3% of patients with PNI had positive posterolateral SM (p = 0.031). Conclusions: BMI, PSA, biopsy GS, and biopsy PNI positivity were found to be predictive factors affecting SM positivity. The most important factors affecting posterolateral positive SM were biopsy PNI and nsRP, indicating that the nsRP approach may cause positive SM in the posterolateral margin of the prostate (neurovascular bundle location) in patients with positive PNI on biopsy.

Risk of recurrence in patients with positive surgical margin at apex only versus other locations after radical prostatectomy.

124 Background: Some reported that positive surgical margin at radical prostatectomy (RP) was a prognostic factor of clinical recurrence and prostate cancer death, and others showed that was not necessarily true. The prostatic apex is most popular location of positive surgical margin at 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 and to be hardly retracted during operation. In this study, we evaluated the effect of positive surgical margin at apex-only on prognosis after RP in a large cohort. Methods: We retrospectively evaluated 1019 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. The operative approach (open, laparoscopic, or robotic) was decided by each institution. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014 criteria. Recurrence following RP was defined according to AUA guidelines. Results: The median patient age was 67 (range, 45–80) years. The median initial PSA was 6.8 ng/ml (range, 0.4–82 ng/ml). The median follow-up period was 69 (range, 0.7–135) months. Pathological T stage was in 72.5% of pT2 (n = 739), 23.4% of pT3a (n = 238), and 4.1% of pT3b (n = 42). There were 163 Grade Group (GG) 1 cases, 502 GG 2, 217 GG 3, 39 GG 4, and 98 GG 5 cases. 372 cases had positive surgical margin. Details were 201 (54%) apex only, 57 (15%) anterior, 43 (12%) posterior, 76 (20%) lateral, 40 (11%) bladder. Some patients showed multiple positive surgical margin. The patients with positive surgical margin at apex-only showed significantly better prognosis than other locations (P = 0.0001). This result was confirmed in each operative approach (open; P = 0.008, laparoscopic; P = 0.001, robotic; P = 0.01). Conclusions: Among surgical margin positive patients after RP, those at prostatic apex-only showed lower biochemical recurrence than other locations regardless of operative approach. Physician should follow such a patient carefully without adjuvant therapy.

Risk of biochemical recurrence based on extent and location of positive surgical margins after robot-assisted laparoscopic radical prostatectomy

BackgroundThere are no published studies on the simultaneous effect of extent and location of positive surgical margins (PSMs) on biochemical recurrence (BCR) after robot-assisted laparoscopic prostatectomy (RALP). The aim was to report the incidence, extent, and location of PSMs over the inclusion period as well as the rates of BCR and cancer-related mortality, and determine if BCR is associated with PSM extent and/or location.MethodsRetrospective review of 530 consecutive patients who underwent RALP between 2003 and 2012. Kaplan-Meier (KM) survival analyses and Cox regressions were performed to determine variables associated with BCR.ResultsFor the 530 operated patients, evaluated at a median of 92 months (IQR, 87–99), PSMs were observed in 156 (29%), of which 24% were focal. Out of 172 PSMs, 126 (73%) were focal and 46 (27%) were extensive. The KM survival using BCR as endpoint was 0.81 (CI, 0.78–0.85) at 5 years and was 0.67 (CI, 0.61–0.72) at 10 years; and using cancer-related mortality as endpoint was 0.99 (CI, 0.99–1.00) at 5 years and 0.95 (CI, 0.92–0.98) at 10 years. Multi-variable analysis revealed the strongest predictors of BCR to be Gleason score ≥ 8 (HR = 7.97; CI, 4.38–14.51) and 4 + 3 (HR = 3.88; CI, 2.12–7.07), lymph nodes invasion (HR = 3.42; CI, 1.70–6.91), pT stage 3b or 4 (HR = 3.07; CI, 1.93–4.90), and extensive apical PSMs (HR = 2.62; CI, 1.40–4.90) but not focal apical PSMs (HR = 0.86; CI, 0.49–1.50; p = 0.586).ConclusionExtensive apical PSMs significantly increased the risk of BCR, independently from pT stage, Gleason score and lymph nodes invasion, while focal apical PSMs had no significant effect on BCR.

Incidence and location of positive surgical margin among open, laparoscopic and robot-assisted radical prostatectomy in prostate cancer patients: a single institutional analysis.

To evaluate the positive surgical margin rates and locations in radical prostatectomy among three surgical approaches, including open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy. We retrospectively reviewed clinical outcomes at our institution of 450 patients who received radical prostatectomy. Multiple surgeons were involved in the three approaches, and a single pathologist conducted the histopathological diagnoses. Positive surgical margin rates and locations among the three approaches were statistically assessed, and the risk factors of positive surgical margin were analyzed. This study included 127, 136 and 187 patients in the open radical prostatectomy, laparoscopic radical prostatectomy and robot-assisted radical prostatectomy groups, respectively. The positive surgical margin rates were 27.6% (open radical prostatectomy), 18.4% (laparoscopic radical prostatectomy) and 13.4% (robot-assisted radical prostatectomy). In propensity score-matched analyses, the positive surgical margin rate in the robot-assisted radical prostatectomy was significantly lower than that in the open radical prostatectomy, whereas there was no significant difference in the positive surgical margin rates between robot-assisted radical prostatectomy and laparoscopic radical prostatectomy. In the multivariable analysis, PSA level at diagnosis and surgical approach (open radical prostatectomy vs robot-assisted radical prostatectomy) were independent risk factors for positive surgical margin. The apex was the most common location of positive surgical margin in the open radical prostatectomy and laparoscopic radical prostatectomy groups, whereas the bladder neck was the most common location in the robot-assisted radical prostatectomy group. The significant difference of positive surgical margin locations continued after the propensity score adjustment. Robot-assisted radical prostatectomy may potentially achieve the lowest positive surgical margin rate among three surgical approaches. The bladder neck was the most common location of positive surgical margin in robot-assisted radical prostatectomy and apex in open radical prostatectomy and laparoscopic radical prostatectomy. Although robot-assisted radical prostatectomy may contribute to the reduction of positive surgical margin, dissection of the bladder neck requires careful attention to avoid positive surgical margins.

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 ...

PD30-09 A COMPARISON OF THE INCIDENCE AND LOCATION OF POSITIVE SURGICAL MARGIN AMONG OPEN, LAPAROSCOPIC, AND ROBOT-ASSISTED RADICAL PROSTATECTOMIES: A SINGLE INSTITUTIONAL ANALYSIS

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy II1 Apr 2016PD30-09 A COMPARISON OF THE INCIDENCE AND LOCATION OF POSITIVE SURGICAL MARGIN AMONG OPEN, LAPAROSCOPIC, AND ROBOT-ASSISTED RADICAL PROSTATECTOMIES: A SINGLE INSTITUTIONAL ANALYSIS Atsushi Koizumi, Shintaro Narita, Taketoshi Nara, Koichiro Takayama, Kazuyuki Numakura, Hiroshi Tsuruta, Atsushi Maeno, Mitsuru Saito, Takamitsu Inoue, Shigeru Satoh, and Tomonori Habuchi Atsushi KoizumiAtsushi Koizumi More articles by this author , Shintaro NaritaShintaro Narita More articles by this author , Taketoshi NaraTaketoshi Nara More articles by this author , Koichiro TakayamaKoichiro Takayama More articles by this author , Kazuyuki NumakuraKazuyuki Numakura More articles by this author , Hiroshi TsurutaHiroshi Tsuruta More articles by this author , Atsushi MaenoAtsushi Maeno More articles by this author , Mitsuru SaitoMitsuru Saito More articles by this author , Takamitsu InoueTakamitsu Inoue More articles by this author , Shigeru SatohShigeru Satoh More articles by this author , and Tomonori HabuchiTomonori Habuchi More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.540AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES A positive surgical margin (PSM) after radical prostatectomy (RP) is associated with adverse oncological outcomes in patients with prostate cancer (PCa). Therefore, a negative surgical margin is one of the critical trifecta to be achieved during RP. Here, we investigate the differences in PSM rates and locations after RP among three operative procedures at a single institution. METHODS We retrospectively reviewed 478 patients who underwent RP without any neoadjuvant therapy at our institution between April 2004 and September 2015. All pathological diagnoses of RP specimens were evaluated by a single pathologist. We statistically compared PSM rates and locations after RP among three operative procedures, including open RP (ORP), laparoscopic RP (LRP), and robot assisted LRP (RALP), according to the International Society of Urological Pathology consensus conference on handling and staging of RP specimens. RESULTS The total numbers of patients in each group were 180 (37.3%) in ORP, 149 (30.8%) in LRP, and 154 (31.9%) in RALP. PSM rates in all patients were 23.5% (42/180), 17.6% (26/148), and 13.9% (21/151), respectively (P = 0.078). PSM rates after RALP were significantly lower than those after ORP (P = 0.028). In patients with stage =pT2 disease, PSM rates were the lowest for RALP (9.8%), intermediate for LRP (14.3%), and highest for ORP (14.4%). Among the patients treated with RALP, the PSMs were located in the apex (28.6%), in the lateral/posterolateral (28.6%) and bladder neck (42.9%). The most common site of PSM in patients treated with ORP and LRP was at the apex (45.2% and 48.0%, respectively). The rate of PSM in the bladder neck was higher in patients treated with RALP than in those treated with ORP and LRP (P < 0.001 and P = 0.087, respectively). CONCLUSIONS PSM rates were the lowest in patients with PCa treated with RALP compared with those treated with ORP and LRP (in all patients and in those with stage =pT2 disease). However, the bladder neck was the most common location of PSM in patients treated with RALP. Although RALP is a promising standard technique for local therapy in PCa, even from the point of margin status, it is necessary to pay attention to avoid a PSM, in particular, at the bladder neck. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e715 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Atsushi Koizumi More articles by this author Shintaro Narita More articles by this author Taketoshi Nara More articles by this author Koichiro Takayama More articles by this author Kazuyuki Numakura More articles by this author Hiroshi Tsuruta More articles by this author Atsushi Maeno More articles by this author Mitsuru Saito More articles by this author Takamitsu Inoue More articles by this author Shigeru Satoh More articles by this author Tomonori Habuchi More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Significant reduction in positive surgical margin rate after laparoscopic radical prostatectomy by application of the modified surgical margin recommendations of the 2009 International Society of Urological Pathology consensus.

To verify retrospectively the margin status and analyse the location and characteristics of positive surgical margins (PSMs) in patients undergoing radical prostatectomy (RP), by a central pathology review, based on the consensus conference 2009 updated margin criteria from the International Society of Urological Pathology (ISUP). The detailed PSM characteristics of 441 patients who underwent laparoscopic RP (LRP) between 1999 and 2007 were centrally reviewed with regard to location, number, Gleason score at the PSM and tumour width. Predictors of PSMs and the impact of several PSM characteristics on clinical outcomes were examined. Patient characteristics were compared using the chi-squared test. Differences in recurrence-free survival (RFS) rates were analysed using the log-rank test and presented as Kaplan-Meier survival curves. Univariable and multivariable Cox regression analysis for the prediction of RFS was performed. Central pathology review using the updated PSM definition according to ISUP 2009, resulted in reclassification of a substantial number of patients with PSMs (n = 113, 26.6%) as R0. Several PSM characteristics with a higher risk of biochemical recurrence (BCR) were identified as the strongest independent predictors of RFS: pathological stage; Gleason score; and the presence of multiple PSMs (hazard ratio [HR] 1.78; 95% confidence interval [CI] 1.08-2.96; P = 0.025). Further analysis replacing the location of PSM by the width categories of PSM showed that a PSM >3 mm was an independent predictor of RFS (HR 1.72; 95% CI 1.08-2.72; P = 0.022). The impact of PSMs after LRP for prostate cancer remains unclear. PSMs in the present cohort of patients undergoing LRP had different characteristics and conferred different risks of BCR. A better understanding of PSM characteristics and a careful standardized pathological evaluation is needed to adequately counsel patients with respect to prognosis and adjuvant therapy after LRP.

Presence and Number of Positive Surgical Margins after Radical Prostatectomy for Prostate Cancer: Effect on Oncological Outcome in a Population-Based Cohort

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.