Margins In Prostatectomy Specimens Research Articles

Oncologic outcomes in men with metastasis to the prostatic anterior fat pad lymph nodes: a multi-institution international study.

BackgroundThe presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population.MethodsData were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR).ResultsOf the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8–10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP.ConclusionsThere was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0070-1) contains supplementary material, which is available to authorized users.

Margin details matter: The prognostic significance of pseudocapsule invasion at the site of involved margin in prostatectomy specimens

BackgroundAn involved surgical margin at prostatectomy has long been associated with elevated risk of prostate cancer recurrence; however, not all patients with an involved margin will relapse, and thus details of the involved margin may provide an opportunity for risk subset stratification. The present investigation seeks to determine whether a difference exists in recurrence rates when the margin involvement is at a site of prostate pseudocapsule invasion vs. within the prostate parenchyma proper. MethodsPatients were retrospectively identified for inclusion by clinically localized disease and prostate-specific antigen (PSA) level of<30ng/ml at diagnosis, managed with prostatectomy alone and identified to have involvement of surgical margin(s). Exclusion criteria were: pT3b or pN1 disease, immediate/nonsalvage postoperative radiation or hormone therapy, or insufficient follow-up (<12mo). Pathology slides were reviewed by a pathologist blinded to outcome, for determination of pseudocapsule invasion at a site of margin involvement. Disease recurrence was defined as PSA level of≥0.2ng/ml and rising, per contemporary guidelines. Kaplan-Meier method was used for construction of disease control estimate confidence intervals; Cox Proportional Hazards Model was used to compare disease control across groups. ResultsBetween 2003 and 2010, 155 patients were identified for inclusion in the present study. The median age was 61 years, and all had clinical stage T1 and T2 disease (75% T1c). At diagnosis, the Gleason score was 6, 7, and 8–9 for 103 (66%), 42 (27%), and 10 (6%) patients, respectively, with median PSA level of 5.6ng/ml (85%≤10). For 149 patients with reviewable margin site data, 51 (34%) demonstrated involvement within or beyond the pseudocapsule. At a median follow-up of 68 months (range: 13–137), 62 patients had experienced PSA relapse. The estimated 5-year PSA relapse rates for patients with an involved margin at the site of pseudocapsule invasion vs. prostate parenchyma were 49% vs. 34%, respectively (P = 0.017; hazard ratio = 1.853). ConclusionsEarly PSA relapse rates are high for patients with involved surgical margin(s) without seminal vesicle or node involvement at prostatectomy; however, for patients who are followed without immediate adjuvant therapy, presence of tumor cells at the margin in a site of pseudocapsule invasion or penetration confers a higher risk of recurrence.

MP53-16 ONCOLOGIC OUTCOMES IN MEN WITH METASTASIS TO THE PROSTATIC ANTERIOR FAT PAD LYMPH NODES: A MULTI-INSTITUTION INTERNATIONAL STUDY

Background: The presence of lymph nodes (LN) within the prostatic anterior fat pad (PAFP) has been reported in several recent reports. These PAFP LNs rarely harbor metastatic disease, and the characteristics of patients with PAFP LN metastasis are not well-described in the literature. Our previous study suggested that metastatic disease to the PAFP LN was associated with less severe oncologic outcomes than those that involve the pelvic lymph node (PLN). Therefore, the objective of this study is to assess the oncologic outcome of prostate cancer (PCa) patients with PAFP LN metastasis in a larger patient population. Methods: Data were analyzed on 8800 patients from eleven international centers in three countries. Eighty-eight patients were found to have metastatic disease to the PAFP LNs (PAFP+) and 206 men had isolated metastasis to the pelvic LNs (PLN+). Clinicopathologic features were compared using ANOVA and Chi square tests. The Kaplan-Meier method was used to calculate the time to biochemical recurrence (BCR). Results: Of the eighty-eight patients with PAFP LN metastasis, sixty-three (71.6 %) were up-staged based on the pathologic analysis of PAFP and eight (9.1 %) had a low-risk disease. Patients with LNs present in the PAFP had a higher incidence of biopsy Gleason score (GS) 8–10, pathologic N1 disease, and positive surgical margin in prostatectomy specimens than those with no LNs detected in the PAFP. Men who were PAFP+ with or without PLN involvement had more aggressive pathologic features than those with PLN disease only. However, there was no significant difference in BCR-free survival regardless of adjuvant therapy. In 300 patients who underwent PAFP LN mapping, 65 LNs were detected. It was also found that 44 out of 65 (67.7 %) nodes were located in the middle portion of the PAFP. Conclusions: There was no significant difference in the rate of BCR between the PAFP LN+ and PLN+ groups. The PAFP likely represents a landing zone that is different from the PLNs for PCa metastasis. Therefore, the removal and pathologic analysis of PAFP should be adopted as a standard procedure in all patients undergoing radical prostatectomy.

Do margin details matter? The prognostic significance of capsule invasion at the site of involved margin in prostatectomy specimens.

131 Background: An involved surgical margin at prostatectomy has long been associated with elevated risk of prostate cancer recurrence; however, not all patients with an involved margin will relapse, and thus details of the involved margin may provide an opportunity for risk subset stratification. The present investigation seeks to determine whether a difference exists in recurrence rates when the margin involvement is at a site of prostate capsule invasion versus within the prostate parenchyma proper. Methods: Patients were retrospectively identified for inclusion by clinically localized disease and PSA &lt;30 at diagnosis, managed with prostatectomy alone and identified to have involvement of surgical margin(s). Exclusion criteria were: pT3b or pN1 disease, immediate/non-salvage post-operative radiation or hormone therapy, or insufficient follow-up (&lt;12 months). Pathology slides were reviewed by a pathologist blinded to outcome, for determination of capsule invasion at a site of margin involvement. Disease recurrence was defined as PSA &gt;0.2 and rising, per contemporary guidelines. Kaplan-Meier method was employed for disease control estimates. Results: Between 2003 and 2010, 155 patients were identified for inclusion in the present study. The median age was 61 years, and all had cT1-2 disease (75% T1c). At diagnosis, the Gleason score was 6, 7, and 8-9 for 103 (66%), 42 (27%), and 10 (6%) patients, respectively, with median PSA 5.6 (85% &lt;10). For 149 patients with reviewable margin site data, 51 (34%) demonstrated involvement within or beyond the capsule. At a median follow-up of 68 months (range 13-137), 62 patients had experienced PSA relapse. The estimated 5-year PSA relapse rates for patients with an involved margin at the site of capsule invasion versus prostate parenchyma were 49% versus 34%, respectively (p=0.015). Conclusions: Early PSA relapse rates for all patients with involved surgical margin(s) but negative seminal vesicles and nodes at prostatectomy are high; however, for patients who are followed without immediate adjuvant therapy, presence of tumor cells at the margin in a site of capsule invasion or penetration confers a higher risk of recurrence.

1482 FACTORS FOR PREDICTION OF GLEASON SCORE UPGRADING AFTER RADICAL PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Detection & Screening (II)1 Apr 20131482 FACTORS FOR PREDICTION OF GLEASON SCORE UPGRADING AFTER RADICAL PROSTATECTOMY Ching-Wei Yang, Tzu-Ping Lin, Yi-Hsiu Huang, Hsiao-Jen Chung, Junne-Yih Kuo, William Huang, Howard Wu, Yen-Hwa Chang, Alex Lin, and Kuang-Kuo Chen Ching-Wei YangChing-Wei Yang Taipei, Taiwan More articles by this author , Tzu-Ping LinTzu-Ping Lin Taipei, Taiwan More articles by this author , Yi-Hsiu HuangYi-Hsiu Huang Taipei, Taiwan More articles by this author , Hsiao-Jen ChungHsiao-Jen Chung Taipei, Taiwan More articles by this author , Junne-Yih KuoJunne-Yih Kuo Taipei, Taiwan More articles by this author , William HuangWilliam Huang Taipei, Taiwan More articles by this author , Howard WuHoward Wu Taipei, Taiwan More articles by this author , Yen-Hwa ChangYen-Hwa Chang Taipei, Taiwan More articles by this author , Alex LinAlex Lin Taipei, Taiwan More articles by this author , and Kuang-Kuo ChenKuang-Kuo Chen Taipei, Taiwan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2947AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Gleason score upgrading after radical prostatectomy existed in a significant portion of patients who were diagnosed prostate cancer by needle biopsy and may has untoward effect regarding treatment outcomes. We identified clinical and pathological parameters that predict pathological upgrading in this population. METHODS A total of 324 patients who underwent biopsy and radical prostatectomy between March 2000 and September 2011 were included in the study. Clinical Gleason score upgrading was defined as higher Gleason score sum in prostatectomy than in needle biopsy specimen pathologically. Pretreatment characteristics were analyzed to identify predictors of pathological upgrading. Upgrading significance was established in cases that were and were not upgrade. RESULTS A total of 125 patients (38 %) had upgraded and 199 patients (62 %) had non-upgraded Gleason score postoperatively. Preoperative serum prostate specific antigen (PSA) greater than 12ng/ml (p = 0.008) and prostate specific antigen density (PSAD) greater than 0.35 (p = 0.04) was associated with pathological upgrading. Prostate specific antigen, prostate volume, biopsy number, biopsy cores, positive biopsy side, number of positive cores, highest tumor percentage of positive cores, interval to surgery, methods of operation and different operators were not associated with upgrading. Higher PSAD, number of positive cores and tumor percentage of positive cores were associated with pathologically extraprostatic extension or positive surgical margin while Gleason score upgrading were not significant difference associated with extraprostatic extension or positive surgical margin in prostatectomy specimens. CONCLUSIONS Higher serum PSA and PSAD predict clinically significant upgrading in prostate cancer patients who were treated with radical prostatectomy. These parameters should be considered in the pretreatment risk assessment and counseling of prostate cancer patients. Table 1. Pre-RP predictors in upgrading and non-upgrading groups Predictors Upgrading (N=105) Non-upgrading (N=93) P value Mean age (y/o) 68 65 0.012 PSA (ng/ml) 14 11 0.280 Prostate volume (ml) 34 37 0.201 PSA density (ng/ml2) 0.46 0.36 0.128 Mean max% Ca in any core 49 36 0.007 Mean days from Biopsy to RP 55 61 0.117 Number of biopsies 1.1 1.1 0.930 Mean No. of biopsy cores 9.2 8.9 0.504 Mean No. of positive cores 2.8 1.9 0.004 Bx Primary GS 3.0 3.2 0.031 Bx Secondary GS 3.0 3.1 0.967 Bx GS sum 6.0 6.3 0.678 T test & Mann-Whitney test Table 2. Multivariate logistic regression analysis of Gleason Score upgrading after RP Predictors OR 95% CI P value PSA <>12 ng/ml 4.323 1.704 ∼10.967 0.002 PSA density > 0.35 ng/ml2 2.539 1.193∼5.406 0.016 Max Ca > 20% in any core 1.649 0.760∼3.578 0.206 Biopsy positive >2 cores 1.971 0.904∼4.296 0.088 T test & Mann-Whitney test © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e607-e608 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ching-Wei Yang Taipei, Taiwan More articles by this author Tzu-Ping Lin Taipei, Taiwan More articles by this author Yi-Hsiu Huang Taipei, Taiwan More articles by this author Hsiao-Jen Chung Taipei, Taiwan More articles by this author Junne-Yih Kuo Taipei, Taiwan More articles by this author William Huang Taipei, Taiwan More articles by this author Howard Wu Taipei, Taiwan More articles by this author Yen-Hwa Chang Taipei, Taiwan More articles by this author Alex Lin Taipei, Taiwan More articles by this author Kuang-Kuo Chen Taipei, Taiwan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...