Impact of surgical margin status on prostate‐cancer‐specific mortality

Chalfin, Heather J.; Dinizo, Michael; Trock, Bruce J.; Feng, Zhaoyong; Partin, Alan W.; Walsh, Patrick C.; Humphreys, Elizabeth B.; Han, Misop

doi:10.1111/j.1464-410x.2012.11371.x

Cited by 91 publications

(64 citation statements)

References 31 publications

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“…After the multivariate regression analysis, positive surgical margin was the independent factor with greatest impact on BCR (3.4 OR, 1.97-5.99 CI 95%). This fact coincides with the results of most of the work in the literature [20][21][22][23]. A higher OR value does occur in our case, but it is likely to be due to our analysis involving high and very high-risk tumors.…”

Section: Discussionsupporting

confidence: 92%

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Aguilera¹,

Bañuelos²,

Dı́ez³

et al. 2015

CEJU

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Introduction High and very high-risk prostate cancers are tumors that display great variation in their progression, making their behaviour and consequent prognosis difficult to predict. We analyse preoperative and postoperative risk factors that could influence biochemical recurrence of these tumors. Material and methods We carried out univariate and multivariate analyses in an attempt to establish statistically significant preoperative (age, rectal examination, PSA, biopsy Gleason score, uni/bilateral tumor, affected cylinder percentage) and postoperative (pT stage, pN lymph node affectation, Gleason score, positive surgical margins, percentage of tumor affectation, perineural infiltration) risk factors, as well as their relationship with biochemical recurrence (PSA >0.2 ng/mL). Results We analysed 276 patients with high and very high-risk prostate cancer that were treated with laparoscopic radical prostatectomy (LRP) between 2003-2007, with a mean follow-up of 84 months. Incidence of biochemical recurrence is 37.3%. Preoperative factors with the greatest impact on recurrence are suspicious rectal exam (OR 2.2) and the bilateralism of the tumor in the biopsy (OR 1.8). Among the postoperative factors, the presence of a LRP positive surgical margins (OR 3.4) showed the greatest impact, followed by the first grade of the Gleason score (OR 3.3). Conclusions The factor with the greatest influence on biochemical recurrence when it comes to surgery and high and very high-risk prostate cancer is the presence of a positive margin, followed by the Gleason score. Preoperative factors (PSA, biopsy Gleason score, rectal examination, number of affected cylinders) offered no guidance concerning the incidence of BCR.

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Section: Discussionsupporting

confidence: 92%

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Aguilera¹,

Bañuelos²,

Dı́ez³

et al. 2015

CEJU

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“…In this study, the NCCN high-risk group and a Gleason score at surgery ≥8 were identified as the risk factors for BCR (Table 4). Several reports support these results, indicating that the advanced pathological features are likely to increase the risk of BCR for the patients with RM1 (5,6,22,23). Here, we ultimately focused on the uPSA value measured early after prostatectomy because a value >0.02 ng/ml was the most potent risk factor for disease recurrence (HR 13.10) compared with NCCN high-risk group (HR 2.05) and Gleason score ≥8 (HR 2.47).…”

Section: Discussionmentioning

confidence: 60%

Postoperative early ultrasensitive prostate-specific antigen identifies patients at risk for biochemical recurrence in margin positive prostate cancers: a single-center study

Hatano

Okusa

Ishizuya

et al. 2017

Japanese Journal of Clinical Oncology

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Objective: To identify predictors for biochemical recurrence among patients with positive surgical margins (RM1) after radical prostatectomy and to examine the effect of ultrasensitive prostatespecific antigen measured early after prostatectomy on biochemical recurrence. Methods: We identified 705 patients with prostate cancer who were treated with radical prostatectomy without preoperative hormonal therapy at our institution between 2000 and 2014. The patients with RM1 who had a postoperative prostate-specific antigen <0.2 ng/ml without lymph node metastasis were evaluated for biochemical recurrence-free survival. Survival rates were calculated using the Kaplan-Meier method. The Cox regression model was used for multivariate analysis. The prediction of biochemical recurrence was assessed using area under the curve of the receiver operating characteristic. Results: Among the 705 patients, 190 (27%) had RM1. Biochemical recurrence was evaluated in 164 patients, excluding 26 patients who underwent adjuvant therapy with or without lymph node metastasis. With a median follow-up of 55 months, the biochemical recurrence-free survival rate of the entire RM1 cohort was 78% at 2 years and 64% at 4 years. The multivariate analysis revealed that postoperative early ultrasensitive prostate-specific antigen >0.02 ng/ml was the significant risk factor for biochemical recurrence (hazard ratio 13.10). Meanwhile, the patients with postoperative early ultrasensitive prostate-specific antigen <0.01 ng/ml had a significantly lower risk for biochemical recurrence (hazard ratio 0.12). Area under the curve for the postoperative early ultrasensitive prostate-specific antigen value to predict biochemical recurrence was 0.789. Conclusions: The ultrasensitive prostate-specific antigen value measured early after prostatectomy was the potent predictor of biochemical recurrence among the patients with RM1.

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“…Wright et al reported in a study that the mortality risk due to prostate cancer was 1.7 times higher in patients with PCM than those without it (22). Chalfie et al suggested the adverse effect of PCM on survival in their study (23), but they also noted that this effect was relatively low when compared to Gleason score and pathological stage.…”

Section: Discussionmentioning

confidence: 98%

Relationship between Prostate Size and Positive Surgical Margin in the Open Radical Prostatectomy Surgery

Özyalvaçlı¹,

Kocaaslan²,

Yücetaş³

et al. 2016

Acta Med Anatol

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Introduction:Our study aims to reveal the correlation between positive surgical margins and prostate volume, thus determining a cutoff value for the prostate volume to predict PCM in patients with open radical prostatectomy.Methodology: In our study, a number of 450 patients who had undergone radical prostatectomy surgery at 2 centers within the last 5 years was evaluated. Age, total PSA, number of positive cores for prostate cancer, Gleason score, transfusion amount and prostate volume were all evaluated in the study. Evaluated all these parameters, 170 consecutive patients of whom data were available were included in the study Results: Stage T3 and PSA>10 ng/dL were statistically significant for positive surgical margins (p=0,002 and p<0,001, respectively). The number of positive cores and Gleason score from these biopsies was also statistically higher in those with positive surgical margins (p=0,002 and p<0,001, respectively). In the multivariate logistic regression analysis, the risk for PCM was found to be 2.67 times higher in patients with PSA>10 ng/dL (95% CI: 1.18 to 6.04; p = 0.018) and stage T3 increased the risk for PCM by 8.51 times (95% CI: 3.54 to 20.51, p = <0.001). When we performed AUROC analysis to determine the positivity of surgical margin in terms of prostate volume, we achieved a cutoff value of 34.5 with 55% sensitivity and 71% specificity (AUC: 0.646, 95% CI: 0.555 to 0.737, p = 0.002). Again, any value above 34.5 cc was found to statistically significantly increase the risk for PCM by 2.86 times (95% CI: 1.31 to 6.28; p = 0.009). Conclusion:We found that the prostate volume had an important role in positivity of surgical margins. It is likely that addition of prostate volume as well to nomograms used before surgery may be useful in improving of risk assessment in prostate cancer. Furthermore, evaluation of the prostate volume can be used as a prognostic factor for prostate cancer.Key Words: Radical Prostatectomy, Prostate Size, Surgical Margin Received: 05.03.2016 Accepted: 14.04.2016 doi: 10.5505/actamedica.2016 Abstract Introduction

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Impact of surgical margin status on prostate‐cancer‐specific mortality

Cited by 91 publications

References 31 publications

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Biochemical recurrence risk factors in surgically treated high and very high-risk prostate tumors

Postoperative early ultrasensitive prostate-specific antigen identifies patients at risk for biochemical recurrence in margin positive prostate cancers: a single-center study

Relationship between Prostate Size and Positive Surgical Margin in the Open Radical Prostatectomy Surgery

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