Positive Surgical Margins After Radical Prostatectomy: A Systematic Review and Contemporary Update

Yossepowitch, Ofer; Briganti, Alberto; Eastham, James A.; Epstein, Jonathan I.; Graefen, Markus; Montironi, Rodolfo; Touijer, Karim

doi:10.1016/j.eururo.2013.07.039

Cited by 336 publications

(295 citation statements)

References 74 publications

Supporting

Mentioning

261

Contrasting

Unclassified

Order By: Relevance

“…However, in 6.5 -32% of radical prostatectomy surgeries a positive surgical margin is found. 3 This has been consistent across the surgical approaches for radical prostatectomy (open vs. laparoscopic vs. robotic assisted laparoscopic). 3,9 Some risks that can increase the likelihood of a positive surgical margin include pathologic stage (pT2 and higher), preoperative PSA level, tumor volume, increased BMI, and surgeon experience.…”

Section: Discussionsupporting

confidence: 54%

“…3 This has been consistent across the surgical approaches for radical prostatectomy (open vs. laparoscopic vs. robotic assisted laparoscopic). 3,9 Some risks that can increase the likelihood of a positive surgical margin include pathologic stage (pT2 and higher), preoperative PSA level, tumor volume, increased BMI, and surgeon experience. 3,9,10 Positive surgical margins following radical prostatectomy are known to be an unfavorable prognostic factor in prostate cancer.…”

Section: Discussionsupporting

confidence: 54%

“…3,9 Some risks that can increase the likelihood of a positive surgical margin include pathologic stage (pT2 and higher), preoperative PSA level, tumor volume, increased BMI, and surgeon experience. 3,9,10 Positive surgical margins following radical prostatectomy are known to be an unfavorable prognostic factor in prostate cancer. PSMs are associated with an increase in biochemical recurrence and local disease recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…8 However, 6.5 -32% of radical prostatectomy surgeries have a positive surgical margin (PSM). 3 PSM's are associated with an increased risk for biochemical recurrence (BCR) which is indicated by a PSA level greater than 0.2 ng/mL. However, the percentage of men that will actually have a BCR who had positive surgical margins post operatively is relatively low, ranging from 16.6-40%.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Positive Surgical Margin after Radical Prostatectomy: Effect on Oncologic Outcomes

Choi¹,

Hill²,

Deem³

2016

WVMJ

View full text Add to dashboard Cite

Objective: A treatment dilemma exists when finding positive surgical margins after radical prostatectomy. Our aim is to better understand the effect of positive surgical margins (PSM) on biochemical recurrence and differences between delayed vs immediate treatment after radical prostatectomy.Materials and Methods: Records for patients who underwent radical prostatectomy for prostate cancer from 2000-2010 were identified and analyzed in our local registry.Results: 468 patients underwent radical prostatectomy. 56 subjects were found to have a PSM (12%). 51 patients chose surveillance. With a mean follow-up of 61 months, 38 patients (75%) remained cancer free. Overall, 13 patients developed biochemical recurrence (PSA > 0.2). 6 patients underwent salvage external beam radiation (XRT) and continue to do well. Conclusion:Despite positive surgical margins, 75% of men remained cancer free at 5 years with no adjuvant radiation. Undergoing salvage XRT when biochemical recurrence occurs offers patients an opportunity to avoid radiation and have acceptable outcomes.3

show abstract

Section: Discussionsupporting

confidence: 54%

Section: Discussionsupporting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Positive Surgical Margin after Radical Prostatectomy: Effect on Oncologic Outcomes

Choi¹,

Hill²,

Deem³

2016

WVMJ

View full text Add to dashboard Cite

show abstract

“…18,37,42,43,49 The outcome of positive surgical margin status is a complex one, with its clinical impact increasingly scrutinized. 50 A recent randomized controlled trial did not show a beneficial effect of MRI+DWI 33 on surgical margins. There were a number of potential limitations to the trial that diluted the ability to detect a difference in surgical margin status between groups, including: limited power; specified criteria for deciding how to modify the surgical plan based on imaging (including a wider excision at sites of tumour) was not part of the study design; limitations of the surgical technique associated with robotic surgery, including the lack of a specified surgical protocol for various types of imaging findings; and the protocol detailing communication between the radiologist and the urologist could be improved.…”

Section: Discussionmentioning

confidence: 96%

Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline

Salerno

Finelli

Morash

et al. 2016

CUAJ

View full text Add to dashboard Cite

Introduction: The utility of T2-weighted magnetic resonance imaging (MRI) in the local staging of prostate cancer is controversial. Due to the success of multiparametric MRI in cancer localization, there is renewed interested in MRI (± functional sequences) for local staging. Guidance on pre-treatment local staging of prostate cancer by MRI was developed using systematic review methodology and expert consultation. Methods: MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and other databases were searched to identify studies comparing: (1) MRI staging vs. radical prostatectomy staging on diagnostic accuracy outcomes; and (2) MRI staging vs. routine clinical staging on clinical and patient outcomes. Studies meeting inclusion criteria were synthesized by outcome and sensitivity/ specificity analysis by tumour location was performed. Evidence quality of included studies was assessed and considered in recommendation formulation. Results: The literature search identified 2510 citations; 62 studies were included. Analysis of MRI ≥1.5 T plus endorectal coil (ER) (± functional sequences) in the detection of extraprostatic extension or seminal vesicle invasion showed modest sensitivities (≥50%) and excellent specificities (>85%) among patients scheduled for radical prostatectomy. MRI upstaging was shown in 20/21 studies, with large variation in correctness (11-85%). Scarcity of clinical and patient outcomes among studies limited synthesis and evaluation. Quality assessment found non-trivial biases. Conclusions: Modest imaging performance was shown for MRI (1.5 T + ER and 3 T ± ER) ± functional sequences in regards to sensitivity. Limitations in study design, reporting of clinical and patient outcomes, and the heterogeneous use of MRI tempered the strength of the recommendations.

show abstract

Optimizing Outcomes During Laparoscopic and Robot‐assisted Radical Prostatectomy

Ryn

Rosen

Bessède

et al. 2018

Smith's Textbook of Endourology

View full text Add to dashboard Cite

Positive Surgical Margins After Radical Prostatectomy: A Systematic Review and Contemporary Update

Cited by 336 publications

References 74 publications

Positive Surgical Margin after Radical Prostatectomy: Effect on Oncologic Outcomes

Positive Surgical Margin after Radical Prostatectomy: Effect on Oncologic Outcomes

Multiparametric magnetic resonance imaging for pre-treatment local staging of prostate cancer: A Cancer Care Ontario clinical practice guideline

Optimizing Outcomes During Laparoscopic and Robot‐assisted Radical Prostatectomy

Contact Info

Product

Resources

About