What is the difference between a positive surgical margin and extraprostatic extension in pathology reports of radical prostatectomy? What is the clinical relevance of these findings?

Context.— Seminal vesicle invasion (SVI) by prostate cancer (pT3b disease) has been considered as a key prognostic factor. Objective.— To assess the clinical impact of T3a lesions (ie, extraprostatic extension other than bladder neck invasion [BNI] or SVI [EPE], microscopic bladder neck invasion [mBNI]) in pT3b disease. Design.— We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients with pT3b disease, with versus without EPE/mBNI. Results.— Extraprostatic extension/mBNI was found in 219 (88.3%)/48 (19.4%) cases, respectively. Extraprostatic extension was significantly associated with higher preoperative prostate-specific antigen (PSA) level, higher rates of positive surgical margin (pSM) and lymphovascular invasion (LVI), and larger tumor volume. Similarly, mBNI was significantly associated with higher PSA level, higher rates of Grade Group(s) 4-5 or 5, pSM, LVI, and pN1, and larger tumor volume. Significant differences in all of these clinicopathologic features (except lymph node metastasis) between EPE−/mBNI+ or EPE+/mBNI− and EPE+/mBNI+ cases were also observed. Outcome analysis revealed that patients with EPE (P < .001) or mBNI (P < .001) had a significantly higher risk of disease progression than respective controls. Notably, there were significant differences in progression-free survival between EPE−/mBNI+ or EPE+/mBNI− cases and EPE−/mBNI− (P = .001) or EPE+/mBNI+ (P < .001) cases. In multivariate analysis, EPE (hazard ratio [HR] = 6.53, P = .009) and mBNI (HR = 2.33, P = .003), as well as EPE−/mBNI+ or EPE+/mBNI− (HR = 11.7, P = .01) and EPE+/mBNI+ (HR = 25.9, P = .002) (versus EPE−/mBNI−), showed significance for progression. Conclusions.— From these significant findings, we propose a novel pT3b subclassification: pT3b1 (SVI alone without EPE or mBNI), pT3b2 (SVI with either EPE or mBNI), and pT3b3 (SVI with both EPE and mBNI).

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Clinical effect of a positive surgical margin without extraprostatic extension after robot-assisted radical prostatectomy

Urologic Oncology Seminars and Original Investigations ◽

10.1016/j.urolonc.2015.07.009 ◽

2015 ◽

Vol 33 (12) ◽

pp. 503.e1-503.e6 ◽

Cited By ~ 4

Author(s):

Takeshi Hashimoto ◽

Kunihiko Yoshioka ◽

Yutaka Horiguchi ◽

Rie Inoue ◽

Ohno Yoshio ◽

...

Keyword(s):

Radical Prostatectomy ◽

Clinical Effect ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Extraprostatic Extension

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LOCATION OF EXTRAPROSTATIC EXTENSION AND POSITIVE SURGICAL MARGIN IN RADICAL PROSTATECTOMY SPECIMENS

The Japanese Journal of Urology ◽

10.5980/jpnjurol1989.95.42 ◽

2004 ◽

Vol 95 (1) ◽

pp. 42-49

Author(s):

Naotaka Sakamoto ◽

Yoshihiko Kagawa ◽

Sachiko Tanaka ◽

Atsushi Iguchi ◽

Yoshihiro Hasegawa ◽

...

Keyword(s):

Radical Prostatectomy ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Extraprostatic Extension

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667: The Positive Surgical Margin (SM) is no Independent Predictor for Biochemical Failure after Radical Prostatectomy (RRP)

The Journal of Urology ◽

10.1016/s0022-5347(18)34907-3 ◽

2005 ◽

Vol 173 (4S) ◽

pp. 182-182

Author(s):

Rein J. Palisaar ◽

Joachim Noldus ◽

Alexander Haese ◽

Markus Graefen ◽

Hartwig Huland

Keyword(s):

Radical Prostatectomy ◽

Independent Predictor ◽

Surgical Margin ◽

Biochemical Failure ◽

Positive Surgical Margin

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Prediction of a positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy

Scientific Reports ◽

10.1038/s41598-021-93860-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Ching-Wei Yang ◽

Hsiao-Hsien Wang ◽

Mohamed Fayez Hassouna ◽

Manish Chand ◽

William J. S. Huang ◽

...

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Multivariable Analysis ◽

Specific Antigen ◽

Surgical Margin ◽

Asian Population ◽

Nerve Sparing ◽

Positive Surgical Margin ◽

Robot Assisted ◽

Surgeon Experience

AbstractThe positive surgical margin (PSM) and biochemical recurrence (BCR) are two main factors associated with poor oncotherapeutic outcomes after prostatectomy. This is an Asian population study based on a single-surgeon experience to deeply investigate the predictors for PSM and BCR. We retrospectively included 419 robot-assisted radical prostatectomy cases. The number of PSM cases was 126 (30.1%), stratified as 22 (12.2%) in stage T2 and 103 (43.6%) in stage T3. Preoperative prostate-specific antigen (PSA) > 10 ng/mL (p = 0.047; odds ratio [OR] 1.712), intraoperative blood loss > 200 mL (p = 0.006; OR 4.01), and postoperative pT3 stage (p < 0.001; OR 6.901) were three independent predictors for PSM while PSA > 10 ng/mL (p < 0.015; hazard ratio [HR] 1.8), pT3 stage (p = 0.012; HR 2.264), International Society of Urological Pathology (ISUP) grade > 3 (p = 0.02; HR 1.964), and PSM (p = 0.027; HR 1.725) were four significant predictors for BCR in multivariable analysis. PSMs occurred mostly in the posterolateral regions (73.8%) which were associated with nerve-sparing procedures (p = 0.012) while apical PSMs were correlated intraoperative bleeding (p < 0.001). A high ratio of pT3 stage after RARP in our Asian population-based might surpass the influence of PSM on BCR. PSM was less significant than PSA and ISUP grade for predicting PSA recurrence in pT3 disease. Among PSM cases, unifocal and multifocal positive margins had a similar ratio of the BCR rate (p = 0.172) but ISUP grade > 3 (p = 0.002; HR 2.689) was a significant BCR predictor. These results indicate that PSA and pathological status are key factors influencing PSM and BCR.

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