Prostate-specific antigen failure despite pathologically organ-confined and margin-negative prostate cancer: the basis for an adjuvant therapy trial.

D’Amico, A.V.; Whittington, Richard; Malkowicz, S. Bruce; Schultz, Delray; Tomaszewski, John E.; Wein, Alan J.

doi:10.1200/jco.1997.15.4.1465

Cited by 50 publications

(18 citation statements)

References 27 publications

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“…7 Conversely, margin negative, extracapsular extension negative patients may have relapse rates as high as 40% at three years if other prognostic factors are unfavourable. 33 In fact, survival curves for margin positive patients are similar to those for extracapsular extension positive, margin negative patients. 3 5 6 Although in some studies margin status has been more important than extraprostatic extension of carcinoma in the prediction of recurrence, 1 2 13 other studies have found limited impact on survival adjusted for extraprostatic extension and seminal vesicle invasion, 5 and this is reflected in the AJCC staging system.…”

Section: Discussionmentioning

confidence: 89%

The influence of extent of surgical margin positivity on prostate specific antigen recurrence

Emerson

Koch²,

Jones

et al. 2005

J Clin Pathol

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Background: Positive surgical margins are an adverse prognostic factor in patients undergoing prostatectomy for prostate cancer. The extent of margin positivity varies and its influence on clinical outcome is uncertain. Aims: To evaluate the linear extent of margin positivity and the number and location of positive sites as prognostic indicators in a series of prostatectomy specimens evaluated with the whole mount technique. Methods: Eighty six consecutive margin positive prostatectomy specimens were evaluated, and all pathology data were collected prospectively. The linear extent of margin positivity was measured with an ocular micrometer and the total extent of all positive sites was summed. The total number of sites with positive margins and anatomical sites of the positive margins were analysed. Results: The linear extent of margin positivity ranged from 0.01 to 68 mm (mean, 6.8; median, 3.0) and was associated with prostate specific antigen (PSA) recurrence in univariate logistic regression (p = 0.031). In addition, the extent of margin positivity weakly correlated with preoperative PSA (p = 0.017) and tumour volume (p = 0.013), but not with age, prostate weight, Gleason score, pathological stage, or perineural invasion. The total number of positive sites was significantly higher in patients with PSA recurrence (p = 0.037). The location of the positive margin site was not associated with PSA recurrence. The extent of margin positivity correlated with PSA recurrence in univariate analysis, although it had only marginal predictive value when adjusted for Gleason score (p = 0.076). Conclusions: The extent of margin positivity correlates with PSA recurrence in univariate analysis, although it has no predictive value independent of Gleason score.

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Section: Discussionmentioning

confidence: 89%

The influence of extent of surgical margin positivity on prostate specific antigen recurrence

Emerson

Koch²,

Jones

et al. 2005

J Clin Pathol

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“…2 Identifying patients in whom primary curative therapy is likely to fail would be helpful for selecting those best suited for clinical trials of early systemic intervention, sparing men the morbidity associated with ineffective local therapy and/or predicting patient outcome. 2,3 To improve the preoperative prediction of patient stage groups have evaluated additional information available in initial prostate needle biopsies. Factors such as quantitative nuclear grade, 4 total percent cancer in biopsy cores (PosBx), 5 a combination of percent positive biopsy (greater than 50%), and the number of positive cores (NoPosBx) 6 -9 have been found to improve the prediction of pathological stage.…”

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confidence: 99%

The Percent of Biopsy Cores Positive for Cancer Is a Predictor of Advanced Pathological Stage and Poor Clinical Outcomes in Patients Treated With Radical Prostatectomy

et al. 2004

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Percent PosBx is associated with established pathological features, biochemical progression, distant metastases and overall death in patients who undergo RP for clinically localized disease. Percent PosBx should be included in preoperative predictive models for prognosticating outcomes after primary treatment and it may assist in selecting patients for inclusion in neoadjuvant and/or adjuvant therapy trials.

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“…Therefore, it is important to define successful adjuvant and salvage treatment strategies for postoperative patients who are at high risk for clinical failure. At present, there are no studies that clearly demonstrate a survival benefit for any type of post-prostatectomy therapy [3,5].…”

Section: Introductionmentioning

confidence: 99%

“…These patients are at high risk for subsequent biochemical and clinical recurrence. Even for patients who successfully undergo RP with negative pelvic lymph nodes and negative surgical margins, approximately 15%-40% of these patients will develop a biochemical recurrence within 3 years of RP depending on the pretreatment PSA (PSA > 10) and pathologic Gleason score (Gleason score >6) [3]. Overall, Pound et al [4] at Johns Hopkins have stated that "between 27% and 53% of men undergoing radical prostatectomy will have a detectable PSA elevation within 10 years following surgery."…”

Section: Introductionmentioning

confidence: 99%

PSA based review of adjuvant and salvage radiation therapy vs. observation in postoperative prostate cancer patients

et al. 2000

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SUMMARY Because of the uncertainties regarding the efficacy of postoperative radiation therapy for early prostate cancer, treatment strategies following radical prostatectomy include: (1) observation alone in high-risk patients, (2) adjuvant radiation therapy (PSA undetectable) in high-risk patients, or (3) salvage radiation therapy for biochemical and clinical recurrence. Fifty-two patients treated with postoperative radiation therapy in either an adjuvant setting (13) or for salvage (39) were retrospectively reviewed. The actuarial biochemical disease-free survival (bNED) rates following radiation therapy were calculated using the life-table method. Univariate and multi variate analyses were used to define the clinical factors that predict biochemical failure following postoperative radiation therapy. In addition, the bNED survival rate for 36 high-risk surgery patients who were simply observed following prostatectomy was determined. The 3-year bNED survival rate for the adjuvant radiation group was 85% compared with 27% for salvage radiation and 43% for the observation group. These results are statistically significant. Factors that predict biochemical failure following postoperative radiation therapy include preoperative PSA level, pre-radiation therapy PSA level, and seminal vesicle involvement. At our institutions, adjuvant radiation therapy was a superior strategy compared with either observation alone or salvage radiation therapy for high-risk postoperative prostate cancer patients.

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Prostate-specific antigen failure despite pathologically organ-confined and margin-negative prostate cancer: the basis for an adjuvant therapy trial.

Cited by 50 publications

References 27 publications

The influence of extent of surgical margin positivity on prostate specific antigen recurrence

The influence of extent of surgical margin positivity on prostate specific antigen recurrence

The Percent of Biopsy Cores Positive for Cancer Is a Predictor of Advanced Pathological Stage and Poor Clinical Outcomes in Patients Treated With Radical Prostatectomy

PSA based review of adjuvant and salvage radiation therapy vs. observation in postoperative prostate cancer patients

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