Presence and Number of Positive Surgical Margins after Radical Prostatectomy for Prostate Cancer: Effect on Oncological Outcome in a Population-Based Cohort

Richters, Anke; Derks, Joris; Fossion, L.; Kil, Paul; Verhoeven, Rob H.A.; Aarts, Mieke J.

doi:10.1159/000441012

Cited by 6 publications

(8 citation statements)

References 20 publications

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“…Indeed, in recent years, mpMRI of the prostate has shown to be an effective tool for identifying areas of suspicion that correlate with cancer upgrading and upstaging [22,23,24]. Moreover, it has recently been shown that mpMRI is an effective tool for both local staging and planning nerve-sparing surgery in patients undergoing RP [25,26,27]. …”

Section: Discussionmentioning

confidence: 99%

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

Porcaro

Siracusano²,

Luyk³

et al. 2016

Urol Int

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Objective: To identify clinical factors associated with prostate cancer (PCA) upgrading to higher patterns of the surgical specimen in low-risk PCA. Materials and Methods: We evaluated the records of 438 patients. The multinomial logistic regression model was used. Results: Low-risk PCA included 170 cases (38.8%) and tumor upgrading was detected in 111 patients (65.3%) of whom 72 (42.4%) had pathological Gleason patterns (pGP) = 3 + 4 and 39 (22.9%) pGP >3 + 4. Prostate-specific antigen (PSA) and proportion of positive cores (P+) were independent predictors of tumor upgrading to higher patterns. The main difference between upgraded cancers related to PSA and to P+ >0.20. The population was stratified into risk classes by PSA ≤5 μg/l and P+ ≤0.20 (class A), PSA >5 μg/l and P+ ≤0.20 (class B), PSA ≤5 μg/l and P+ >0.20 (class C) and PSA >5 μg/l and P+ 0.20 (class D). Upgrading rates to pGP >3 + 4 were extremely low in class A (5.1%), extremely high in D (53.8%). Conclusions: Low-risk PCA is a heterogeneous population with significant rates of undetected high-grade disease. Significant clinical predictors of upgrading to higher patterns include PSA and P+, which identify a very high-risk class that needs repeat biopsies in order to reclassify tumor grade.

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Section: Discussionmentioning

confidence: 99%

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

Porcaro

Siracusano²,

Luyk³

et al. 2016

Urol Int

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“…All 30 studies were retrospective in design, the time of publication ranged from 2006 to 2023, and the mean follow-up durations varied from 1.5 to 13 years. Among the studies, nine [9,12-19] , six [17,20-24] , 14 [12,17,20,23-33] and, 13 [23,26-28,30,33-40] studies evaluated the relationships between PGG, PSM length, number of PSMs, pathologic stage of the tumor, and BCR, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…14 [12,17,20,[23][24][25][26][27][28][29][30][31][32][33] and, 13 [23,[26][27][28]30,[33][34][35][36][37][38][39][40] studies evaluated the relationships between PGG, PSM length, number of PSMs, pathologic stage of the tumor, and BCR, respectively.…”

Section: Study Characteristics and Quality Assessmentsmentioning

confidence: 99%

The impact of positive surgical margin parameters and pathological stage on biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis

Guo,

Zhang,

Shao

et al. 2024

Preprint

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I ntroduction : To systematically review and perform a meta-analysis on the predictive value of the primary Gleason grade (PGG) at the positive surgical margin (PSM), length of PSM, number of PSMs, and pathological stage of the primary tumor on biochemical recurrence (BCR) in patients with prostate cancer (PCa) after radical prostatectomy (RP). Methods: A systematic literature search was performed using electronic databases, including PubMed, EMBASE, Cochrane Library, and Web of Science, from January 1, 2005, to October 1, 2023. The protocol was pre-registered in PROSPERO. Subgroup analyses were performed according to the different treatments and study outcomes. Pooled hazard ratios with 95% confidence intervals were extracted from multivariate analyses, and a fixed or random effect model was used to pool the estimates. Subgroup analyses were performed to explore the reasons for the heterogeneity. Results: Thirty studies that included 46,572 patients with PCa were eligible for this meta-analysis. The results showed that, compared to PGG3, PGG4/5 was associated with a significantly increased risk of BCR. Compared with PSM ≤3 mm, PSM ³3 mm was associated with a significantly increased risk of BCR. Compared with unifocal PSM, multifocal PSM (mF-PSM) was associated with a significantly increased risk of BCR. In addition, pT >2 was associated with a significantly increased risk of BCR compared to pT2. Notably, the findings were found to be reliable based on the sensitivity and subgroup analyses. Conclusions: PGG at the PSM, length of PSM, number of PSMs, and pathological stage of the primary tumor in patients with PCa were found to be associated with a significantly increased risk of BCR. Thus, patients with these factors should be treated differently in terms of receiving adjunct treatment and more frequent monitoring. Large-scale, well-designed prospective studies with longer follow-up periods are needed to validate the efficacy of these risk factors and their effects on patient responses to adjuvant and salvage therapies and other oncological outcomes.

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“…Second, our correct system was based on several ready predictors. Some novel biomarkers and factors such as IL6, TGFβ and positive surgical margins [24,25] were not included in the new correct system because of health care restrictions in China. Third, we have not tested the performance of the correct system in an external dataset.…”

Section: Discussionmentioning

confidence: 99%

Developing a Correct System to Evaluate the Accuracy of Gleason Score in Prostate Cancer of Chinese Population

Wang

Cheng²,

Li³

et al. 2016

Urol Int

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Introduction: A study was conducted to develop a new correct system to improve the overall rate of Gleason sum concordance between biopsy and final pathology. Materials and Methods: A total of 592 consecutive patients who had undergone transrectal ultrasound-guided prostate biopsy and radical prostatectomy were evaluated during the first stage. Age, PSA, PSA density (PSAD), biopsy cores, positive cores, prostate volume, positive core rate (PCR), core volume rate (CVR) and digital rectal examination findings were considered predictive factors. A multiple logistic regression analysis involving a backward elimination selection procedure and linear regression analysis involving a stepwise procedure were applied to select independent predictors. Results: Positive cores, PCR, CVR and PSAD were included in our assessing credibility model in the first stage. A significantly higher area under the receiver-operating curve was obtained in our model compared with CVR alone (0.641 vs. 0.517). In the second stage, patients with credibility of pre-operative Gleason score <0.388 were subjected to further evaluation. Compared with the 2 statuses, the rate of overall concordance was significantly increased (60.3 vs. 50.2%, p = 0.002). Conclusions: We developed a follow-up strategy based on the new and correct system, which represents an important consideration procedure when clinicians make decisions with regard to treatment plans.

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Presence and Number of Positive Surgical Margins after Radical Prostatectomy for Prostate Cancer: Effect on Oncological Outcome in a Population-Based Cohort

Cited by 6 publications

References 20 publications

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

The impact of positive surgical margin parameters and pathological stage on biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis

Developing a Correct System to Evaluate the Accuracy of Gleason Score in Prostate Cancer of Chinese Population

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