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Lee W, Lim B, Kyung YS, Kim CS. Impact of positive surgical margin on biochemical recurrence in localized prostate cancer. Prostate Int 2021; 9:151-156. [PMID: 34692588 PMCID: PMC8498720 DOI: 10.1016/j.prnil.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND We analyzed the relationship between biochemical recurrence (BCR) and the status of positive surgical margin (PSM) in patients with pT3a prostate cancer (PCa). MATERIALS AND METHODS Patients (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. RESULTS PSM 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. CONCLUSIONS Number (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.
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Affiliation(s)
- Wonchul Lee
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Yoon Soo Kyung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Celik S, Eker A, Bozkurt İH, Bolat D, Basmacı İ, Şefik E, Değirmenci T, Günlüsoy B. Factors affecting biochemical recurrence of prostate cancer after radical prostatectomy in patients with positive and negative surgical margin. Prostate Int 2020; 8:178-184. [PMID: 33425796 PMCID: PMC7767941 DOI: 10.1016/j.prnil.2020.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/12/2020] [Accepted: 08/30/2020] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the clinical and pathological predictive factors affecting biochemical recurrence (BCR) after radical prostatectomy (RP) in patients with positive and negative surgical margin (SM). Methods Patients who underwent RP were retrospectively reviewed for the study. Demographic, clinical, pathological and oncological data were evaluated. All data were compared between patients with positive SM and negative SM to detect factors associated with SM status. Later, patients were divided into two groups as BCR-negative and BCR-positive groups. Data were separately compared between BCR groups for all patients, SM-negative and SM-positive patients, respectively. Results A total of 254 patients with a mean age of 63.5 years and the mean prostate-specific antigen of 10.9 ng/ml were evaluated in the study. SM positivity was found to be an independent prognostic factor for BCR (p = 0.013, Odds Ratio (OR): 0.267, 95% Confidence Interval (CI): 0.094-0.755). In SM-positive patients, biopsy Gleason Score and International Society of Urological Pathology grade were found to be independent predictive factors for BCR (p < 0.05). However, only tumor to SM distance (TSMD) was found to be an independent risk factor for BCR (p = 0.024) in SM-negative patients. The predictive cutoff value of the TSMD was found to be 75 μm for BCR (100% sensitivity and 63.9% specificity) (AUC = 0.803, p = 0.024). Although all of 46 patients with >75 μm TSMD were recurrence free, 5 of 31 patients with <75 μm TSMD had BCR (p = 0.009; OR: 0.839 CI: 0.719-0.979). Conclusion High Gleason Score and International Society of Urological Pathology grade of biopsy were found to be associated with BCR in SM-positive patients. For SM-negative patients, only TSMD was found to be associated with BCR after RP.
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Affiliation(s)
- Serdar Celik
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey.,Dokuz Eylul University, Institute of Oncology, Department of Basic Oncology, Izmir, Turkey
| | - Anıl Eker
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
| | - İbrahim Halil Bozkurt
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
| | - Deniz Bolat
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
| | - İsmail Basmacı
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
| | - Ertuğrul Şefik
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
| | - Tansu Değirmenci
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
| | - Bülent Günlüsoy
- Health Science University, Izmir Bozyaka Training and Research Hospital, Urology Clinic, Izmir, Turkey
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Giannarini G, Crestani A, Valotto C. Close surgical margins after radical prostatectomy: how to make a complex story even more complex. BJU Int 2018; 122:528-530. [PMID: 30251471 DOI: 10.1111/bju.14359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Gianluca Giannarini
- Urology Unit, Academic Medical Centre 'Santa Maria della Misericordia', Udine, Italy
| | - Alessandro Crestani
- Urology Unit, Academic Medical Centre 'Santa Maria della Misericordia', Udine, Italy
| | - Claudio Valotto
- Urology Unit, Academic Medical Centre 'Santa Maria della Misericordia', Udine, Italy
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Herforth C, Stroup SP, Chen Z, Howard LE, Freedland SJ, Moreira DM, Terris MK, Aronson WJ, Cooperberg MR, Amling CL, Kane CJ. Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database. BJU Int 2018; 122:592-598. [PMID: 29473992 DOI: 10.1111/bju.14178] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate biochemical recurrence (BCR) patterns amongst men undergoing radical prostatectomy (RP) with specimens having negative (NSM), positive (PSM), and close surgical margins (CSM) from the Shared Equal Access Regional Cancer Hospital (SEARCH) cohort, as PSM after RP are a significant predictor of biochemical failure and possible disease progression, with CSM representing a diagnostic challenge for surgeons. PATIENTS AND METHODS Men undergoing RP between 1988 and 2015 with known final pathological margin status were evaluated. The cohort was divided into three groups based on margin status; NSM, PSM, and CSM. CSM were defined by distance of tumour ≤1 mm from the surgical margin. BCR was defined as a prostate-specific antigen (PSA) level of >0.2 ng/mL, two values at 0.2 ng/mL, or secondary treatment for an elevated PSA level. Predictors of BCR, metastases, and mortality were analysed using Cox proportional hazard models. RESULTS Of 5515 men in the SEARCH database, 4337 (79%) men met criteria for inclusion in the analysis. Of these, 2063 (48%) had NSM, 1902 (44%) had PSM, and 372 (8%) had CSM. On multivariable analysis, relative to NSM, men with CSM had a higher risk of BCR (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.25-1.82; P < 0.001) but a decreased risk of BCR when compared to those men with PSM (HR 2.09, 95% CI 1.86-2.36; P < 0.001). Metastases, prostate cancer-specific mortality and all-cause mortality did not differ based on margin status alone. CONCLUSIONS Management of men with CSM is a diagnostic challenge, with a disease course that is not entirely benign. The evaluation of other known risk factors probably provides greater prognostic value for these men and may ultimately better select those who may benefit from adjuvant therapy.
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Affiliation(s)
- Christine Herforth
- Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA
| | - Sean P Stroup
- Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA.,Department of Urology, University of California, San Diego, CA, USA.,Section of Urologic Oncology, Moores UCSD Cancer Center, La Jolla, CA, USA
| | - Zinan Chen
- Duke University, Durham, NC, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | - Lauren E Howard
- Duke University, Durham, NC, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | - Stephen J Freedland
- Cedars-Sinai Medical Center, Los Angeles, CA, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | | | - Martha K Terris
- Duke University, Durham, NC, USA.,Veterans Affairs Durham Medical Center, Durham, NC, USA
| | - William J Aronson
- University of California, Los Angeles, CA, USA.,Veteran Affairs Los Angeles, Los Angeles, CA, USA
| | - Matthew R Cooperberg
- University of California, San Francisco, CA, USA.,Veterans Affairs San Francisco Medical Center, San Francisco, CA, USA
| | | | - Christopher J Kane
- Department of Urology, University of California, San Diego, CA, USA.,Section of Urologic Oncology, Moores UCSD Cancer Center, La Jolla, CA, USA.,Veterans Affairs San Diego Medical Center, La Jolla, CA, USA
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Grignon DJ. Prostate cancer reporting and staging: needle biopsy and radical prostatectomy specimens. Mod Pathol 2018; 31:S96-109. [PMID: 29297497 DOI: 10.1038/modpathol.2017.167] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/10/2017] [Accepted: 10/14/2017] [Indexed: 12/19/2022]
Abstract
Prostatic adenocarcinoma remains the most common cancer affecting men. A substantial majority of patients have the diagnosis made on thin needle biopsies, most often in the absence of a palpable abnormality. Treatment choices ranging from surveillance to radical prostatectomy or radiation therapy are largely driven by the pathologic findings in the biopsy specimen. The first part of this review focuses on important morphologic parameters in needle biopsy specimens that are not covered in the accompanying articles. This includes tumor quantification as well as other parameters such a extraprostatic extension, seminal vesicle invasion, perineural invasion, and lymphovascular invasion. For those men who undergo radical prostatectomy, pathologic stage and other parameters are critical in prognostication and in determining the appropriateness of adjuvant therapy. Staging parameters, including extraprostatic extension, seminal vesicle invasion, and lymph node status are discussed here. Surgical margin status is also an important parameter and definitions and reporting of this feature are detailed. Throughout the article the current reporting guidelines published by the College of American Pathologists and the International Collaboration on Cancer Reporting are highlighted.
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Affiliation(s)
- David J Grignon
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IUH Pathology Laboratory, Indianapolis, IN, USA
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