The Significance of Positive Surgical Margin in Areas of Capsular Incision in Otherwise Organ Confined Disease at Radical Prostatectomy

Chuang, Ai Ying; Nielsen, Matthew E.; Hernandez, David J.; Walsh, Patrick C.; Epstein, Jonathan I.

doi:10.1016/j.juro.2007.05.159

Cited by 88 publications

(80 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, Chuang et al 32 showed single intraprostatic incision into tumor to have a higher associated recurrence rate when compared with organ-confined or focal extraprostatic extension, margin-negative disease. This recurrence rate was, however, lower than that for patients with non-focal, extraprostatic extension, margin-positive tumor, but was instead accompanied by a risk of progression comparable to those with a positive margin in an area of focal extraprostatic extension.…”

Section: Intraprostatic ('Capsular') Incision and Surgical Marginsmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

et al. 2011

View full text Add to dashboard Cite

The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed that tumor extending close to the 'capsular' margin, yet not to it, should be reported as a negative margin, and that locations of positive margins should be indicated as either posterior, posterolateral, lateral, anterior at the prostatic apex, mid-prostate or base. Other items of consensus included specifying the extent of any positive margin as millimeters of involvement; tumor in skeletal muscle at the apical perpendicular margin section, in the absence of accompanying benign glands, to be considered organ confined; and that proximal and distal margins be uniformly referred to as bladder neck and prostatic apex, respectively. Grading of tumor at positive margins was to be left to the discretion of the reporting pathologists. There was no consensus as to how the surgical margin should be regarded when tumor is present at the inked edge of the tissue, in the absence of transected benign glands at the apical margin. Pathologists also did not achieve agreement on the reporting approach to benign prostatic glands at an inked surgical margin in which no carcinoma is present.

show abstract

Section: Intraprostatic ('Capsular') Incision and Surgical Marginsmentioning

confidence: 99%

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

et al. 2011

View full text Add to dashboard Cite

show abstract

“…This finding is of clinical importance, since it has been shown that patients with intraprostatic positive surgical margins have a recurrence rate significantly higher than patients with organ confined tumors and negative margins, and equivalent to cases with positive margins and focal EPE (16,17). In fact, all the 30 patients that we reclassified as margin positive underwent biochemical recurrence after surgery.…”

Section: Patients Without Recurrencementioning

confidence: 61%

Pathologic Reassessment of Prostate Cancer Surgical Specimens Before Molecular Retrospective Studies

Fromont

Validire²,

Prapotnich³

et al. 2011

Clinical Cancer Research

View full text Add to dashboard Cite

Purpose: The retrospective use of prostate cancer tissue is crucial to design tumor marker prognostic studies. We hypothesize that comparison between recent and more historical cases could introduce biases due to stage and grade migration upon time.Design: We reviewed 544 margin-free specimens from patients treated for clinically localized prostate cancer by radical prostatectomy between 2000 and 2005. One hundred and ninty-two patients that underwent biochemical recurrence after surgery were matched with 352 patients without progression, according to pretreatment prostate specific antigen, Gleason score, pathologic stage, and follow-up duration (at least 36 months).

show abstract

“…10,[15][16][17][18][19][20] Suggested PSM cutoff points have ranged from 1 15 to 3 mm 10,16,17,20 to 6 18 to 10 mm 19 . Of note from our study is the finding that patients with a total PSM length X0.1 mm (non-focal), had a significantly higher risk of BCF (51.5%) than patients with total PSM length o0.1 mm (focal) (10.0%).…”

Section: Focal and Non-focal Epe And Subtypes Of Epementioning

confidence: 99%

“…First, the CAP has suggested that EPE be subdivided into focal and nonfocal types as multiple studies have indicated that focal EPE is associated with a better prognosis. [8][9][10][11] It remains unresolved, however, as to which of the many definitions for EPE focality should be incorporated into the decision-making algorithm on adjuvant radiotherapy. Second, the histological criteria for diagnosis of EPE has been expanded from tumor in fat to include tumor at the level of fat, neurovascular bundle involvement, bulging nodule and tumor beyond the normal confines of the prostate.…”

Section: Introductionmentioning

confidence: 99%

“…The CAP has recommended measuring the total linear length of PSM in mm as this provides additional prognostic information that may aid in this decision-making process. Several studies have found that patients with focal/short PSM possess a better prognosis than patients with non-focal/longer PSM, 10,[15][16][17][18][19][20] though definitions for PSM focality are highly variable with no consensus.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The clinical significance of in-depth pathological assessment of extraprostatic extension and margin status in radical prostatectomies for prostate cancer

Chan

Garcı́a

Chin

et al. 2011

Prostate Cancer Prostatic Dis

View full text Add to dashboard Cite

Despite recent Level 1 evidence on the benefits of adjuvant radiotherapy for locally advanced prostate cancer (PCa), the timing and decision to administer adjuvant radiotherapy post-radical prostatectomy (post-RP) remains debatable, particularly for patients with focal extraprostatic extension (EPE) and/or focal positive surgical margins (PSMs). In this study, we assess the utility of detailed pathological assessment of EPE and PSM, as this may influence the criteria for instituting adjuvant radiotherapy. A total of 148 RP cases (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001) were identified retrospectively as having EPE and/or PSM. All slides were re-reviewed, incorporating recent proposals by the Collage of American Pathologists (CAP) for the reporting of EPE and PSM, and correlated with clinical data. Both EPE and PSM were found to be independent predictors of biochemical failure (BCF); however, only EPE was associated with metastasis and death. BCF was also more likely to be associated with cases that had non-focal EPE than focal EPE. Similarly, non-focal PSM cases had a significantly higher risk of BCF than focal cases. Our study confirms the value of detailed pathological assessment of EPE and PSM post-RP. The results support the concept of selective adjuvant radiotherapy in patients with EPE and PSM, based on focality and extent.

show abstract

The Significance of Positive Surgical Margin in Areas of Capsular Incision in Otherwise Organ Confined Disease at Radical Prostatectomy

Cited by 88 publications

References 14 publications

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins

Pathologic Reassessment of Prostate Cancer Surgical Specimens Before Molecular Retrospective Studies

The clinical significance of in-depth pathological assessment of extraprostatic extension and margin status in radical prostatectomies for prostate cancer

Contact Info

Product

Resources

About