Influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression following radical prostatectomy

Abstract

The amount of extraprostatic extension (EPE) and positive surgical margins (PSM) has prognostic importance in most studies (1-10).However, during the International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens held in Boston during the 98th meeting of the United States and Canadian Academy Vol. 38 (2): 175-184; March -April, 2012 Purpose: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the infl uence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantifi cation. Materials and Methods: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratifi ed into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal) and in more than 1 quadrant or section (Group 2, diffuse); and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal) and in more than 2 quadrants or sections (Group 2, diffuse). The Kaplan-Meier productlimit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify signifi cant predictors. Results: Extraprostatic extension was found in 129/360 (35.8%) patients, 39/129 (30.2%) in Group 1 and 90/129 (69.8%) in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2) had a signifi cant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4%) patients, 81/160 (50.6%) patients in Group 1 and 79/160 (49.4%) patients in Group 2. Patients with diffuse positive surgical margins (Group 2) had a signifi cant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. Conclusion: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are signifi cant predictors of shorter time to biochemical progression following radical prostatectomy.

Assessment of the circumferential margins, extraprostatic extension and Gleason score in radical prostatectomy specimens: Comparison of a partial embedding method with supplemental total inclusion of peripheral tissues

“…After supplemental sections meeting, Billis and colleagues tested the influence of focal (defined as presence in up to two quadrants as focal) and extensive margins in a series of 360 prostatectomies, and biochemical recurrence was found in 38% of focal cases and 61% of cases with extensive margins. The extent of positive margins proved to be an independent risk factor for recurrence in that study [3]. A similar discussion has been taking place for extraprostatic extension.…”

“…After the consensus meeting, Billis and colleagues tested the influence of focal (defined as presence in up to one quadrant as focal) and extraprostatic extension in a series of 360 prostatectomies, and biochemical recurrence occurred in 26% of focal cases and 72% of cases with diffuse extraprostatic extension. Diffuse extraprostatic extension was not an independent predictor of disease progression when adjusted for other [3].…”

Extraprostatic extension (EPE) of prostatic carcinoma: is its proximity to the surgical margin or Gleason score important?

“…Billis et al. , using a slightly different semiquantitation method for EPE, have reported similar findings on univariable analysis including patients with positive surgical margins. However, positive surgical margins emerged as the most important prognostic factor on multivariable analysis in their cohort .…”

Multi-parametric magnetic resonance imaging as a management decision tool

“…However, mpMRI is unable to detect focal ECE, though focal ECE is associated with good prognosis and is unlikely to be of clinical significance (42,43). This study also determined that mpMRI accurately localized established ECE to the specific prostate zone on final pathology, however the sensitivity for detection is lowest at the apex (30%) compared to the base (70.4%) owing to the anatomical ambiguity and the loss of fat planes at the apex (44).…”