Positive Surgical Margin in Radical Retropubic Prostatectomy: Incidence and Prognostic Factors
https://doi.org/10.17650/1726-9776-2006-2-1-40-44
Abstract
Increased incidence of radical prostatectomies in the treatment of patients with prostatic cancer (PC) necessitates analysis of causes of the disease relapses after surgery. Positive surgical margin (PSM) is considered as one of the main causes.
Aim — study of the incidence of PSM in patients with a history of retropubic radical prostatectomy for clinically local and locally disseminated PC and evaluation of prognostic factors.
The incidence of PSM was analyzed in 271 patients with a history of retropubic prostatectomy, with consideration for the preoperative level of PSA, tumor differentiation and dissemination; the efficiency of neoadjuvant therapy (NAT) for PSM reduction was evaluated.
PSM was detected in 84 (31.0%) patients. Significant criteria for PSM prognosis are clinical stage of disease, Glisson sum, and relative number of positive biopsy columns. NAT significantly reduced the incidence of PSM only in patients with local PC.
NAT is indicated for patients with clinical signs of extraprostatic extension. It is ineffective in patients with locally disseminated PC because it cannot change the incidence of PSM.
About the Authors
S. B. PetrovRussian Federation
S. A. Rakul
Russian Federation
References
1. Wingo P.A., Guest J.L., McGinnis L. et al. Patterns of inpatient surgeries for the top four cancers in the United States, National Hospital Discharge Survey, 1988–95 // Cancer Causes Control. — 2000. — V. 11, № 6. — P. 497–512.
2. Epstein J.I. Evaluation of radical prostatectomy capsular margins of resection. The significance of margins designated as negative, closely approaching, and positive // Amer. J. Surg. Path. — 1990. — V. 14, № 7 — P. 626–632.
3. Ackerman D.A., Barry J.M., Wicklund R.A. et al. Analysis of risk factors associated with prostate cancer extension to the surgical margin and pelvic node metastasis at radical prostatectomy // J. Urol. — 1993. — V. 150, № 6. — P. 1845–1850.
4. Ohori M., Wheeler T.M., Kattan M.W. et al. Prognostic significance of positive surgical margins in radical prostatectomy specimens // J. Urol. — 1995. — V. 154, № 5. — P. 1818–1824.
5. D'Amico A.V., Whittington R., Malkowicz S.B. et al. An analysis of the time course of postoperative prostate-specific antigen failure in patients with positive surgical margins: implications on the use of adjuvant therapy // Urology. — 1996. — V. 47, № 4 — P. 538–547.
6. Rosen M.A., Goldstone L., Lapin S. et al. Frequency and location of extracapsular extension and positive surgical margins in radical prostatectomy specimens // J. Urol. — 1992. — V. 148, № 2, Pt. 1. — P. 331–337.
7. Watson R.B, Civantos F., Soloway M.S. Positive surgical margins with radical prostatectomy: detailed pathological analysis and prognosis // Urology. — 1996. — V. 48, № 1. — P. 80–90.
8. Tigrani V.S., Bhargava V., Shinohara K., Presti J.C.Jr. Number of positive systematic sextant biopsies predicts surgical margin status at radical prostatectomy // Urology. — 1999. — V. 54, № 4. — P. 689–693.
9. Gao X., Mohideen N., Flanigan R.C. The extent of biopsy involvement as an independent predictor of extraprostatic extension and surgical margin status in low risk prostate cancer: implications for treatment selection // J. Urol. — 2000. — V. 164, № 6. — P. 1982–1986.
10. Horsch R., Jung H., G?tz T. et al. Radical perineal prostatectomy – a single institution study on prospectively controlled results in a consecutive series of 1220 cases // Eur. Urol. — 2005. — V. 4, № 3. — P. 102.
11. Patel V. Histopathologic outcomes of robotic radical prostatectomy 400 cases // Eur. Urol. — 2005. — V. 4, № 3. — P. 10.
12. Grossfeld G.D., Chang J.J., Broering J.M. et al. Impact of positive surgical margins on prostate cancer recurrence and the use of secondary cancer treatment: data from the CAPSURE database // J. Urol. — 2000. — V. 163, № 4. — P. 1171–1177.
13. Pettus J.A., Weight C.J., Thompson C.J. et al. Biochemical failure in men following radical retropubic prostatectomy: impact of surgical margin status and location // J. Urol. — 2004. — V. 171, № 1. — P. 129–132.
14. Epstein J.I., Carmichael M.J., Pizov G., Walsh, P.C. Influence of capsular penetration on progression following radical prostatectomy: a study of 196 cases with long-term followup // J. Urol. — 1993. — V. 150, № 1. — P. 135–141.
15. Stamey T.A., Villers A.A., McNeal J.E. et al. Positive surgical margins at radical prostatectomy: importance of the apical dissection // J. Urol. — 1990. — V. 143, № 6. — P. 1166–1172.
16. Voges G.E., McNeal J.E., Redwine E.A. et al. Morphologic analysis of surgical margins with positive findings in prostatectomy for adenocarcinoma of the prostate // Cancer. — 1992. — V. 69, № 2. — P. 520–526.
17. Weldon V.E., Tavel F.R., Neuwirth H. et al. Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy // J. Urol. — 1995. — V. 153, № 5. — P. 1565–1569.
18. Stephenson R.A., Middleton R.G., Abbott T.M.: Wide excision (nonnerve sparing) radical retropubic prostatectomy using an initial perirectal dissection // J. Urol. — 1997. — V. 157, № 1. — P. 251–255.
19. Shuford M.D., Cookson M.S., Chang S.S. et al. Adverse prognostic significance of capsular incision with radical retropubic prostatectomy // J. Urol. — 2004. — V. 172, № 1. — P. 119–123.
20. Iselin C.E., Robertson J.E., Paulson D.F. Radical perineal prostatectomy: oncological outcome during a 20-year period // J. Urol. — 1999. — V. 161, № 1. — P. 163–168.
21. Barocas D.A., Han M., Epstein J.I. et al. Does capsular incision at radical retropubic prostatectomy affect disease-free survival in otherwise organ-confined prostate cancer? // Urology. — 2001. — V. 58, № 5. — P. 746–751.
22. Swindle P., Eastham J.A., Ohori M. et al. Do margins matter? The prognostic significance of positive surgical margins in radical prostatectomy specimens // J. Urol. — 2005. — V. 174, № 3. — P. 903–907.
23. Vallet B.B. Radical perineal prostatectomy subsequent to bilateral orchiectomy // Del. Med. J. — 1944. — V. 6. — P. 19.
24. Polito M., Muzzonigro G., Minardi D. et al. Effects of neoadjuvant androgen deprivation therapy on prostatic cancer // Eur. Urol. — 1996. — V. 30, Suppl. 1. — P. 26–31.
25. Soloway M.S. Role of induction androgen deprivation before radical prostatectomy // Semin. Urol. — 1995. — V. 13, № 2. — P. 142–147.
26. Civantos F., Soloway M.S., Pinto J.E. Histopathological effects of androgen deprivation in prostatic cancer // Semin. Urol. Oncol. — 1996. — V. 14, № 2, Suppl. 2. — P. 22–31.
27. Witjes, W. P., Schulman, C. C., Debruyne, F. M. Preliminary results of a prospective randomized study comparing radical prostatectomy versus radical prosta tectomy associated with neoadjuvant hormonal combination therapy in T2-3 N0 M0 prostatic carcinoma // Urology. — 1997. — V. 49, № 3A, Suppl. — P. 65–69.
Review
For citations:
Petrov S.B., Rakul S.A. Positive Surgical Margin in Radical Retropubic Prostatectomy: Incidence and Prognostic Factors. Cancer Urology. 2006;2(1):40-44. (In Russ.) https://doi.org/10.17650/1726-9776-2006-2-1-40-44