Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact?

Connolly, Sheelah; O’Toole, Gary; O’Malley, Kiaran; Manecksha, Rustom P.; O'Brien, Anne; Mulvin, D.; Quinlan, David M.

doi:10.1080/00365590310017334

Cited by 21 publications

(6 citation statements)

References 29 publications

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“…Biochemical or clinical recurrence or progression and prostate cancer-specific mortality clearly are the most relevant outcome measures. In addition, however, spread of carcinoma beyond the confines of the prostate (EPE), 12 a large tumor volume, 13 the presence of high Gleason grades, and positive margins 14 have been associated with an increased risk of progressive disease after radical prostatectomy. Indeed, some investigators believe that tumors that do not exhibit any of these features lack the ability to progress during a patient's lifespan and, thus, are ''clinically insignificant.…”

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confidence: 99%

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

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Clinically localized prostate cancer is associated with a wide variation in biologic behavior, and men with the less aggressive form of the disease may never develop symptoms. There has been a rise in prostate cancer incidence in countries in which the blood test for prostatic-specific antigen (PSA) is common, and concerns have been expressed that this may be because of the increased detection of indolent disease, subjecting these men to unnecessary treatment and associated side effects. For the current review, the authors conducted a systematic evaluation of the literature regarding the outcomes of men who were diagnosed on the basis of a small volume of cancer in prostatic biopsies. The results indicated that, despite differences in study design and reporting, a significant proportion of patients with microfocal cancer, regardless of how it was defined, had adverse pathologic findings and a significant risk of PSA recurrence after undergoing radical prostatectomy. Biochemical and clinical recurrences also were observed after radiotherapy or watchful waiting. The authors concluded that patients with microfocal carcinoma on biopsy should be advised that their disease is not necessarily ''insignificant'' and should be counseled accordingly. Cancer 2008; 112:971-81.

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confidence: 99%

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Harnden

Naylor

Shelley

et al. 2008

Cancer

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“…10-11 The impact of an isolated apical PSM on progression is controversial. Several authors have reported a higher BCR rate in men with apical PSMs 12-14 while others have not identified any adverse prognostic significance for isolated apical PSMs. 15-17 Pettus et al reported a higher risk of BCR for patients with a PSM with a similar risk of recurrence for patients with an isolated apical PSM as compared to a PSM at another site or multiple PSMs.…”

Section: Commentmentioning

confidence: 98%

Ethnic Variation in Pelvimetric Measures and Its Impact on Positive Surgical Margins at Radical Prostatectomy

Bodman

Matikainen²,

Yunis³

et al. 2010

Urology

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Objectives We sought to evaluate the ethnic variation in pelvimetry and its impact as a predictor of positive surgical margins (PSM) at radical prostatectomy (RP). Methods Preoperative MRI was performed in 482 Caucasian and 103 African-American (AA) men undergoing RP without prior treatment from 07/03-01/05 and 11/01-06/07, respectively. We measured bony and soft tissue dimensions on MRI to evaluate the pelvic inlet, midplane, prostate size and apical depth. Analysis of covariance was performed to determine the effect of ethnicity on the midpelvic area (MPA). We performed multivariate logistic regression analysis for prediction of overall and site-specific PSM. Results AA men had a significantly steeper symphysis pubis angle (median 43.1° vs 41.3°, respectively, p=0.001) and smaller MPA (median 78.5 vs 83.9 cm2, respectively, p=0.004). Ethnicity and BMI were found to have a significant effect on MPA. Apical depth of the prostate was identified as a significant independent predictor of apical PSM with a more pronounced effect in AA men. Pelvimetric measures were not a significant predictor of other sites of PSM. Conclusions AA men have a significantly smaller MPA and steeper symphysis angle. The adverse impact of a deep pelvis, as measured by the apical prostatic depth, on apical PSM was found to be greater in AA men. Evaluation of pelvic dimensions and prostate parameters in preoperative MRI imaging may add to our understanding of their impact on surgical outcomes.

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“…with a special expertise in prostate cancer. For some time patient selection has been deemed the most important factor in RRP outcome [16] . Our experience reflects a less selected patient population.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Experience with an Anatomical Anterograde Approach to Radical Prostatectomy: Results in Terms of Positive Margin Rate

Sciarra¹,

Gentile²,

Matteis³

et al. 2008

Urol Int

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Purpose: To evaluate the effect of an anterograde approach to radical retropubic prostatectomy (RRP) in terms of positive surgical margins (SM+). Methods: 323 untreated patients underwent anterograde RRP for clinically localized prostate adenocarcinoma. Spearman coefficients, logistic univariate and multivariate analysis were used. Results: The incidence of SM+ was 14.9% and, in particular, this was 4.5% for apical, 9.0% for lateral, 0.9% for other sites, and 2.8% for multiple SM+. Upon univariate analysis, prostate-specific antigen (PSA; r = 0.2073, p = 0.0002), pathological stage (r = 0.3777, p < 0.0001), and seminal vesicle invasion (r = 0.1453, p = 0.0089) were found to be significantly associated with SM+. Upon multivariate analysis, only PSA (p = 0.0090) and pathological stage (p < 0.0001) were significantly and independently associated with SM+ occurrence. Conclusion: In our experience, the anterograde approach to RRP is associated with low SM+ rates.

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Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact?

Abstract: All patients with a positive surgical margin, including those with a solitary apical margin alone, are at significantly increased risk of biochemical failure.

Cited by 21 publications

References 29 publications

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

The clinical management of patients with a small volume of prostatic cancer on biopsy: What are the risks of progression?

Ethnic Variation in Pelvimetric Measures and Its Impact on Positive Surgical Margins at Radical Prostatectomy

Long-Term Experience with an Anatomical Anterograde Approach to Radical Prostatectomy: Results in Terms of Positive Margin Rate

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