Metrics details. To assess the prognostic value of the extent of positive surgical margins PSM following radical prostatectomy RP on biochemical recurrence BR with long-term follow-up. This retrospective study analyzed RPs performed between January and December in two university centers in Marseille France. We included patients, divided into two groups:. BR occurred in only
I don't think everyone agrees, but at least one published report says that the chance of recurrence Please ur sex partner greater with multiple positive margins. Privacy Statement. Do you stratify patients based on whether their PSA falls to an undetectable level and then rises, or whether the PSA never becomes undetectable? It is worth noting an increasing proportion of patients being offered surgery Positive margins prostate cancer high-risk disease. But what if a positive margin truly means that there's still cancer in the area?
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And it is patients like this who form the majority of men who have a positive surgical margin after surgery in America today. We would be able to offer you more detailed guidance there, but we are going to need some more detailed information from you too. But you have to understand that these patients were carefully selected for surgery, and Pattaya pussy thumbs data marfins not reflect outcomes for all T2 and T3 patients or for all surgeons. The problem we doing that is that unfortunately you are overtreating cancrr significant number of those patients. Limiting processed foods and red meats can help ward off cancer risk. Often, the amount of soft tissue around the prostate is minimal, sometimes less than a millimeter. News and information provided on this site should not be used for diagnosing or treating any health problem or disease. Theoretically when a higher Gleason score is found at the PSM, a more aggressive tumor remains in the patient with potentially higher rates of BCR. In this review we will consider the definition and significance of a PSM, the pathologic characteristics that influence the significance of the margin, recent surgical and imaging techniques that may reduce the rates of PSM and management of PSM when they are encountered. In this situation, I will often remove a few extra millimeters of tissue around the prostate and try to save some or most of the nerve tissue. The ability to detect PSA at very low levels has led many to conclude that a preferable strategy would be to offer early salvage treatment when patients have low but detectable PSA rather than adjuvant Positive margins prostate cancer. A few remaining prostate cancer cells may not produce enough PSA to become detectable at first. Meet teens in your area article has been cited by other articles in PMC. Posts: Joined: May Assessing the tissue How should a tissue Positive margins prostate cancer Poeitive handled in order to accurately determine if there is a positive surgical margin?
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- Seminal vesicles, Vasa Deferentia and pre-prostatic fat free of tumour.
- So that we are very clear, a positive surgical margin is an area on the edge of the prostate specimen, after surgical removal, that stains positive for prostate cancer cells when it is tested in the pathology laboratory.
- For some men, what they hope will be the end of their prostate cancer story turns out to be just an early chapter: with the radical prostatectomy complete, they head home from the hospital believing they have been cured, only to learn that some cancer may have been left behind.
Extensive positive surgical margins PSM at radical prostatectomy is strongly associated with an increased risk of biochemical recurrence BCR , according to new study findings published in BMC Urology. To minimize confounding, no patient had pT3b or pT4, detectable postoperative PSA, seminal vesicle or lymph node invasion, or neoadjuvant or adjuvant treatment. BCR-free survival at 5 years was Metastatic recurrence developed in 1 patient, and no patient died from prostate cancer.
While it is still unclear what the best treatment is for patients with PSMs, our data may provide beneficial information regarding how to best proceed, particularly for patients with fPSM. With regard to patients with ePSM, the authors noted, it remains unclear whether early treatment could be beneficial. Nevertheless, in these cases we believe it essential that the final therapeutic decision integrate the other prognostic factors Gleason, preoperative PSA, pT and life expectancy in order to treat these patients as well as possible.
Study limitations included the retrospective design and the absence of data on PSM Gleason score. The investigators also did not take into account tumor volume and surgeon experience. Extent of positive surgical margins following radical prostatectomy: impact on biochemical recurrence with long-term follow-up.
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Real-time transrectal ultrasound guidance during laparoscopic radical prostatectomy: Impact on surgical margins. Figure 7: Whole-mount technique Whole-mount technique This slide shows a whole-mount slice of a prostate gland. Bob, I found this to be a wonderful article. This is a word I hope I'll grow to love!! Any final comments? Is a laparoscopic prostatectomy better than a robotic prostatectomy or vice versa?
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Metrics details. To assess the prognostic value of the extent of positive surgical margins PSM following radical prostatectomy RP on biochemical recurrence BR with long-term follow-up. This retrospective study analyzed RPs performed between January and December in two university centers in Marseille France.
We included patients, divided into two groups:. BR occurred in only Therefore, it seems legitimate to monitor patients with fPSM.
In cases of ePSM, adjuvant treatment appears effective. The presence of positive surgical margins PSM following radical prostatectomy RP is a worrying for surgeons and patients alike as it represents an independent biochemical recurrence BR risk factor [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. A PSM means incomplete cancer resection and may lead to additional treatment, such as either adjuvant radiotherapy AR or chemical or surgical castration.
These remedial treatments display side effects and affect patient quality of life [ 12 ]. However, despite the evidence that AR significantly reduces the BR risk in locally-advanced cancers [ 12 ], the optimal approach concerning PSM remains unclear.
Moreover, there is generally no evaluation of PSM characteristics size, number, location, and focality regarding these additional therapeutic decisions. This can be explained by the observation that there is no consensus yet taking into account these factors for the therapeutic decision.
One reason could be the lack of standardization of anatomopathological reports regarding PSM description, and thus a potential lack of information that could be detrimental to the therapeutic decision-making process. The College of American Pathologists recommends referring to the Gleason score of the margin [ 13 ]. Nevertheless, there are still no clear recommendations, especially regarding how to act depending on the PSM length and number extent.
Lake et al. In another recent study based on a median month follow-up, Lee et al. Similarly, Maxeiner et al. We also sought to determine the influence of other BR prognostic factors, such as PSM location within the prostate. From January to December , a total of patients underwent RP for prostate cancer in two university centers in Marseille France.
Each intervention was conducted by experienced surgeons. The anatomopathological examination of all surgical specimens was performed according to the Stanford technique [ 17 ] up to , and then as recommended by the ISUP from onwards [ 3 ]. A centralized reading of the slides was performed by the same pathologist. Positive margins were defined as the presence of cancerous tissue in contact with the inked surface of the prostatectomy specimen.
Healthy tissue margins were considered negative margins. Additionally, the weight and volume of the prostate were listed. All statistical analyses were performed using the statistical software R Version 2. Survival curves were plotted according to the Kaplan-Meier method. Overall, patients exhibiting PSM who met the inclusion criteria were included in the study.
No differences regarding Gleason score, pT stage, or surgical technique were observed between the two subgroups. Lymph node dissection was performed on patients The most often-performed RP technique was open RP patients, BR was observed in only 54 patients In the fPSM group, 14 Kaplan-Meier curves showing biochemical recurrence BR -free survival following.
In both cases, the correlations were found to be not significantly different from 1. Anterior and bladder-neck PSMs were significantly less frequent, with 1. In this multicenter study with an 8-year median follow-up, we demonstrated that men with ePSM following prostatectomy were significantly more likely to develop BR than those with fPSM. Other studies in the literature specifically analyzed the prognostic value of the PSM extent following prostatectomy for patients followed-up for prostate cancer.
Sooriakumaran et al. This study excluded patients who had neoadjuvant or adjuvant treatment, yet did include pT3b patients. This a potential confounding factor. For this reason we have deliberately excluded all potential confounders of RB. Therefore, we intentionally excluded patients with locally-advanced disease lymph node or seminal vesicle invasion in order to better select patients whose BR was most likely to be linked to PSM.
For patients with locally-advanced disease, BR is most likely a reflection of micro-metastatic systemic disease, meaning the PSM status in these cases would have a very limited influence on BR [ 19 , 20 ].
All in all, for patients with lymph node or seminal vesicle invasion, the prognosis does not really seem related to PSM changes, but rather to the existence of micro-metastases responsible for the systemic spread of the disease.
This is why we excluded these patients from our study. Moreover, even if this hypothesis proved inaccurate, the postoperative measures would be the same. With or without PSM, it is still recommended to perform adjuvant therapy in patients classified as pT3b and pT4 [ 12 ]. It is therefore of little interest to focus on patients with locally-advanced disease in a study of PSM, as long as the results do not impact or only slightly impact the measures to be taken.
Regarding the length of the PSM, other studies have analyzed the effect, though often their populations were not selected to eliminate potential confounder BR factors.
Only very few authors have investigated a population equally absent of BR confounders. Also, in terms of limits, the Gleason score of the PSM could have been analyzed in order to reveal any possible link with BR. However, within the Marseille centers involved in our study, the Gleason score is either barely or not at all analyzed on PCMs. Nevertheless, in agreement with a recent review, the impact of the Gleason score of PSM on BR is not currently acknowledged since too few studies have analyzed this factor [ 10 ].
We need better accuracy in analysis of PSM by pathologists if we are to move forward on this issue. Regarding the primary endpoint, we choose the BR. This criterion is the most widely used in the literature for this type of analysis and certainly a relevant criterion when it comes to assessing disease recurrence. Nevertheless, the consideration of other criteria, such as metastasis-free survival, resistance to castration, or specific mortality to prostate cancer, would also be of value.
In our study, only one patient 0. In a recent study, Mauermann investigated these factors in a cohort of patients, including patients with PSM [ 8 ]. Patients with PSM were divided into two groups: single margin regardless of size and multiple margins. In total, 1. In the multivariate model, PSM single or multiple were never significantly associated with metastatic disease, resistance to castration, or specific mortality.
Finally, the question remains whether treatment deferral should be recommended only when BR occurs. This can prevent a number of patient side effects, for example in our study, Three large randomized trials compared AR vs.
Overall survival and clinical progression were not significantly affected. The Southwest Oncology Group SWOG trial reported greater metastasis-free survival and overall survival in the postoperative radiotherapy arm It should be note that in these three trials, patients in the wait and see arm who presented with BR did not undergo radiotherapy early on early salvage radiation therapy , meaning this treatment was less effective due to being performed late.
Also, Briganti [ 25 ] studied this very point in a series of patients. His objective was to evaluate BR-free survival in patients receiving AR versus observation only, followed by early salvage radiotherapy in cases of relapse in patients undergoing RP for pT3, pN0, and R0—R1 disease. There was no difference found between the two groups. It is important to note that the margin was not taken into account in this analysis, however. In the end, the therapeutic dilemma for patients with PSMs following radical prostatectomy is to distinguish those who need adjuvant therapy from those for whom simple monitoring would suffice.
While it is still unclear what the best treatment is for patients with PSMs, our data may provide beneficial information regarding how to best proceed, particularly for patients with fPSM. Our study strongly suggests that the PSM extent should be taken into account in therapeutic decisions following radical prostatectomy. The existence of fPSM does not constitute a poor prognosis factor, as it was very rarely found associated with BR in our study. Therefore, it seems legitimate for us to propose close monitoring in these cases.
For patients with ePSM, however, the question remains whether early treatment would be beneficial. Nevertheless, in these cases we believe it essential that the final therapeutic decision integrate the other prognostic factors Gleason, preoperative PSA, pT and life expectancy in order to treat these patients as well as possible.
Further studies are now required to determine whether early salvage RT or RT associated with chemical castration are an equivalent alternative.
Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. Eur Urol. Impact of surgical margin status on prostate-cancer-specific mortality. BJU Int. Working group 5: surgical margins. Mod Pathol. Positive surgical margins after radical prostatectomy: do they have an impact on biochemical or clinical progression?
Positive surgical margins at radical prostatectomy predict prostate cancer specific mortality. J Urol. Systematic review and meta-analysis of studies reporting oncologic outcome after robot- assisted radical prostatectomy. The impact of positive surgical margins on mortality following radical prostatectomy during the prostate specific antigen era. The impact of solitary and multiple positive surgical margins on hard clinical end points in adjuvant treatment—naive pT2—4 N0 radical prostatectomy patients.
Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens. Reporting positive surgical margins after radical prostatectomy: time for standardization. An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series.