The impact on oncological outcomes after radical prostatectomy for prostate cancer of converting soft tissue margins at the apex and bladder neck from tumour‐positive to ‐negative

Abstract

Conversion of the soft tissue margin at the prostate apex and bladder neck from histologically positive to negative improved the BCRFS and DMFS after RP for prostate cancer; however, the benefit of conversion was not apparent in patients in the high-risk group.

Positive surgical margin during radical prostatectomy: overview of sampling methods for frozen sections and techniques for the secondary resection of the neurovascular bundles

“…This occurrence is consistent with the recent finding from Pak et al (the paper is not included in the present review as it considers only SM from the apical and basal periprostatic tissue without including the NVB area). In the paper, they failed to find benefits of FS analysis and incremental resection in high‐risk patients, concluding that tumour biology is the major determinant of disease recurrence . However, given the constrained value of FS analysis of limited areas, one could argue that systematic sampling of the prostate surface would lead to a higher detection of PSM and thus improve conversion to a negative SM status.…”

Real‐time assessment of surgical margins during radical prostatectomy: a novel approach that uses fluorescence confocal microscopy for the evaluation of peri‐prostatic soft tissue

“…Frozen-section approaches and the 'NeuroSAFE' technique have been developed for this purpose [1][2][3][4]. These require a fully equipped laboratory, a pathologist inside the institution and take overall >30 min to perform.…”

Editorial: Conversion to negative surgical margin after intraoperative frozen section – (un)necessary effort and relevance in 2019?

“…In these men, long‐term cancer outcomes are probably more related to risks of unsuspected metastatic disease rather than residual, microscopic cancer within the prostatic fossa. As suggested in this study , an initial PSM in high‐risk men, independent of ultimate NCSM, may be a surrogate for non‐localised disease and poorer outcomes; PSMs were found in 53% of men with pT3b. In low‐risk men, the issues are whether active surveillance is a more appropriate initial management strategy and that routine intraoperative frozen section analysis may not be worthwhile with a PSM rate of only 10%.…”

“…The study by Pak et al. , published in this issue of the BJUI , reported that specimens with initial PSMs were converted to NSMs upon permanent specimen evaluation (NCSM) in 4.9% of 2013 men undergoing RP. In this subgroup, the 5‐year BCR‐free survival (BCRFS) rates did not differ from those observed in National Comprehensive Cancer Network (NCCN) low‐ and intermediate‐risk patients with an initially NSM.…”

“…Although it is clearly desirable to completely remove the entire tumour at the time of surgery, and NSMs are a surrogate marker of adequate local excision, the devil is in the details. First, in this study , the authors only assessed SMs at the bladder neck and apex. Although the apex is one of the most frequent locations for PSMs, other and/or multiple sites of PSMs are possible and could have been missed.…”