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

Abstract

ObjectiveTo examine the association between histopathological factors of extraprostatic prostate cancer and outcome. Patients and MethodsPatients with extraprostatic extension (EPE) without positive margins, seminal vesicle or lymph node involvement were analysed from a consecutive radical prostatectomy cohort of 1136 (2002-2006) for: (i) distance of EPE from the margin; (ii) Gleason score of the EPE; and (iii) extent of EPE. Log-rank, Kaplan-Meier, and Cox regression analyses were performed. ResultsThe study included 194 pT3a, pN0, R0 patients with a median follow-up of 5.4 years, with 37 (19%) patients experiencing biochemical relapse (BCR). On univariable analysis, patients with a Gleason score of ≥8 in the extraprostatic portion showed increased incidence of BCR compared with those with Gleason scores of ≤7 (P = 0.03). The proximity of the EPE to the margin (0.01-7.5 mm) did not correlate with BCR. On multivariable analysis, the extent of EPE, the Gleason score of the dominant nodule or of the EPE portion did not correlate with BCR. ConclusionData from this study using current International Society of Urological Pathology Gleason scoring and EPE criteria indicate that close proximity of EPE to the margin is not associated with recurrence. Gleason score ≥8 within EPE is associated with an increased BCR risk on univariable analysis, but larger studies are required to confirm whether extensive Gleason pattern 4 in an EPE indicates increased risk in an otherwise overall Gleason score 7 cancer.

Radical prostatectomy and the effect of close surgical margins: results from the Shared Equal Access Regional Cancer Hospital (SEARCH) database

“…Subsequent studies further examined the clinical implication of CSM and found no correlation between these margins and disease recurrence, suggesting that CSM should be pathologically described as ‘negative’ and that postoperative management should not be influenced by tumour proximity to the margin . The results of these studies contributed to current International Society of Urological Pathology (ISUP) guidelines, which state that tumour extending close to the capsular margin should be documented as a NSM .…”

“…The natural history of CSM remains unknown. Whilst a few studies have examined the correlation between the surgical margin length and PSA recurrence; the results have been conflicting . Furthermore, to the best of our knowledge, no study has examined the relationship between CSM and more definitive endpoints such as metastases, disease‐specific and overall survival.…”

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

“…Recently, the importance of the mGS of PSM as a predictive factor for BCR has been also described by some physicians [ 12 , 32 ]. Kates et al.…”

Prostate cancer reporting and staging: needle biopsy and radical prostatectomy specimens

“…83 A detailed study of the distance of the extraprostatic tumor to the adjacent margin did not find this to impact outcome. 84 A special situation arises when tumor is at the margin in combination with benign glands. Published data indicates that positive margins at a site of 'intraprostatic incision' or 'capsular incision' is associated with a higher risk of failure than positive surgical margins in a pT2 tumor.…”