Guideline for optimization of surgical and pathological quality performance for radical prostatectomy in prostate cancer management: evidentiary base

Abstract

Background: The objective is to provide surgical and pathological guidelines for radical prostatectomy (RP) with or without concurrent pelvic lymph node dissection (PLND) to achieve optimal benefit for patients, with minimal risk of harm. Methods:For surgical questions, a literature search of MEDLINE, EMBASE and the Cochrane database was performed. A literature search for the pathological questions was not conducted since the protocol for invasive carcinomas of the prostate gland developed by the College of American Pathologists (CAP) was endorsed. Urologists and pathologists were consulted for their assessment of the surgical and pathological recommendations. Results:Limited high-quality evidence from 95 primary studies was available and, therefore, the expert panel developed recommendations on the basis of a consensus of the expert opinion of the working group and through a consultation with urologists and pathologists. In addition to the CAP protocol, some technical recommendations related to the handling and processing of the specimen were made. Conclusion:Radical prostatectomy is recommended for the surgical treatment of prostate cancer, depending on a patient's preoperative risk profile. The panel unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%, rates of rectal injury of <1% and blood transfusion rates of <10% in non-anemic patients. Standard PLND should be mandatory in high-risk patients, should be recommended for intermediate-risk patients and should be optional for low-risk patients. The quality and effectiveness of this treatment and of subsequent patient care depend on good management, effective communication and reporting between surgeons and pathologists working together as part of a multidisciplinary

The need for, and utilization of prostate-bed radiotherapy after radical prostatectomy for patients with prostate cancer in British Columbia

“…The positive margin rate (36%) in our study was similar to the population-based rate found in Ontario (which ranged from 0-53%). 11 It is difficult to compare these rates to studies that are not population-based, as there may be selection bias, however, the results are within the range of published series (18%-46%, with a mean of 31%) ( Table 2). A large population-based series from the Surveillance, Epidemiology and End Results (SEER) registry reported an overall margin positive rate of 21%.…”

“…39 The positive margin rate for pT2 patients in our series (of 30 %) exceeded the 20% threshold held by most Ontario urologists. 11 However, the positive margin rates for pathologic T2 patients in British Columbia are generally comparable to the range of regional rates seen in Ontario (16%-42%), 11 although they are higher than those seen in other jurisdictions ( Table 2). The positive margin rate in British Columbia in pT3 cases (57%) are also comparable to the range of regional rates seen in Ontario (42%-83%), 11 and within the ranges of rates reported in the literature (24%-80%).…”

“…11 However, the positive margin rates for pathologic T2 patients in British Columbia are generally comparable to the range of regional rates seen in Ontario (16%-42%), 11 although they are higher than those seen in other jurisdictions ( Table 2). The positive margin rate in British Columbia in pT3 cases (57%) are also comparable to the range of regional rates seen in Ontario (42%-83%), 11 and within the ranges of rates reported in the literature (24%-80%). [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] In comparison to the recent large SEER series, need for, and use of, post prostatectomy radiotherapy our margin positive rates exceed those reported for SEER (18% for pT2, and 44% for pT3).…”

“…9,10 Cancer Care Ontario's Surgical Oncology program recently reported on evidence-based quality indicators for radical prostatectomy (RP) in prostate cancer management. 11 The panel "unanimously determined that the goals for RP are to attain a positive margin rate of <25% for pT2 disease, a mortality rate of <1%." 11 Our objective was to describe the population-based utilization of RP and to examine the utilization rate of prostate-bed radiotherapy after RP, and factors predicting its use in British Columbia, in the first few years after the aforementioned randomized trials were published.…”

Intrinsic indicators for specimen degradation

“…Only more recently, evidence accumulated that biochemical degradation of tissues can be observed within hours or even minutes after tissue excision. [13][14][15][16] Although recent work has focused on developing protocols/guidelines for better tissue manipulation and developing anti-degradation reagents such as RNA stabilizers and protease inhibitor cocktails, 3,[17][18][19][20] no degradation measurement tool exists currently.…”