Improving the prediction of biochemical recurrence after radical prostatectomy with the addition of detailed pathology of the positive surgical margin and cribriform growth

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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Impact of positive surgical margin location and perineural invasion on biochemical recurrence in patients undergoing radical prostatectomy

World Journal of Surgical Oncology ◽

10.1186/s12957-020-01977-7 ◽

2020 ◽

Vol 18 (1) ◽

Author(s):

Zhenpeng Lian ◽

Hongtuan Zhang ◽

Zhaowei He ◽

Shenfei Ma ◽

Xiaoming Wang ◽

...

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Perineural Invasion ◽

Surgical Margin ◽

Positive Surgical Margin

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Length of Positive Surgical Margin After Radical Prostatectomy as a Predictor of Biochemical Recurrence

The Journal of Urology ◽

10.1016/j.juro.2009.02.139 ◽

2009 ◽

Vol 182 (1) ◽

pp. 139-144 ◽

Cited By ~ 66

Author(s):

Sergey Shikanov ◽

Jie Song ◽

Cassandra Royce ◽

Hikmat Al-Ahmadie ◽

Kevin Zorn ◽

...

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Surgical Margin ◽

Positive Surgical Margin

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875 Comparison of positive surgical margin rate and biochemical recurrence free survival rate between retropubic radical prostatectomy and robot assisted radical prostatectomy by a single surgeon: Propensity score matching analysis

European Urology Supplements ◽

10.1016/s1569-9056(12)60872-0 ◽

2012 ◽

Vol 11 (1) ◽

pp. e875-e875a

Author(s):

D.S. Yoo ◽

W.S. Kim ◽

J.W. Kim ◽

H.J. Ahn

Keyword(s):

Survival Rate ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Recurrence Free Survival ◽

Robot Assisted ◽

Free Survival ◽

Propensity Score Matching Analysis ◽

Retropubic Radical Prostatectomy

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Does the day or season of operation predict biochemical recurrence after radical prostatectomy?

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e16162 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e16162-e16162

Author(s):

A. L. Hirsh ◽

D. J. Lee ◽

G. Hruby ◽

M. C. Benson ◽

J. M. McKiernan

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Cox Regression ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Urologic Oncology ◽

Mortality And Morbidity ◽

Estimated Blood Loss ◽

Day Of The Week ◽

The Mean

e16162 Background: Outcomes in hospital based medicine are associated with the experience and availability of the medical staff, as mortality and morbidity rates increase each summer with new medical graduates. Hospital staff members are thought to be more fatigued and less available towards the end of the week and on weekends. However it is not known if there is a difference of outcomes based on the season or day of the week. We sought to identify if different seasons or surgical days of the week can predict poor outcomes and biochemical recurrence (BCR) in radical prostatectomy (RP). Methods: A retrospective analysis of the Columbia Urologic Oncology database was performed. 1865 consecutive men underwent RP from 1991 to 2008 by three surgeons. Data was collected in an institutional review board approved registry, with median follow up of 36 months. BCR was defined as two consecutive PSA levels > 0.2 ng/ml. Stratified cox regression methods were used to model the relationship between surgeon, preoperative variables, season, day of the week, and BCR. Winter was defined as December through February, spring as March through May, summer as June through August, and fall as September through November. Results: The mean age of the men undergoing RP was 61.2 years (37–79), with a mean preoperative PSA of 8.12. 424 men (22.7%) had positive surgical margins, and the mean estimated blood loss (EBL) was 1119cc. Patient age (p=0.68), preoperative PSA (p=0.32), EBL (p=0.51), and positive surgical margin rate (p=0.78) were not significantly different between each day. Men undergoing RP did not have different rates of BCR according to the day of the operation (p=0.58) or season (p=0.997). The particular season and day of the operation were not significantly associated with BCR, and were not independent predictors of BCR in a multivariable model after adjusting for preoperative PSA, Gleason sum, tumor stage, and surgeon. Conclusions: Patient surgical outcomes and BCR rates after RP are not associated with the particular season or day of the week of the procedure. These findings suggest that men undergoing RP do not need to be concerned about the particular season or day when scheduling the procedure. No significant financial relationships to disclose.

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Short (≤1 mm) positive surgical margin and risk of biochemical recurrence after radical prostatectomy

BJU International ◽

10.1111/j.1464-410x.2012.11340.x ◽

2012 ◽

Vol 111 (4) ◽

pp. 559-563 ◽

Cited By ~ 15

Author(s):

Sergey Shikanov ◽

Pablo Marchetti ◽

Vikas Desai ◽

Aria Razmaria ◽

Tatjana Antic ◽

...

Keyword(s):

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Surgical Margin ◽

Positive Surgical Margin

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Evaluation of The Tumor Volume From Surgical Specimens After Radical Prostatectomy and Its Clinical Impact on The Prognosis of Patients With Localized Prostate Cancer

10.21203/rs.3.rs-130026/v1 ◽

2021 ◽

Author(s):

Hyeong Dong Yuk ◽

Seok-Soo Byun ◽

Sung Kyu Hong ◽

Hakmin Lee

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Tumor Volume ◽

Risk Group ◽

Surgical Margin ◽

Localized Prostate Cancer ◽

Positive Surgical Margin ◽

Continuous Variables ◽

The Mean

Abstract We evaluated the contribution of tumor volume (TV) to localized prostate cancer (PCa) patients’ prognosis. We retrospectively analyzed the data of 2,394 patients who underwent radical prostatectomy (RP) for localized PCa. The effect of TV volume on prostate cancer patients' prognosis was analyzed through Kaplan-Meier and Cox-proportional analysis. The mean prostate volume for all patients was 36.5 ± 15.4 cc, and the mean TV was 5.9 ± 8.3 cc. A significant positive relationship was observed between the classification by risk group in D’ Amico risk classification and the National Comprehensive Cancer Network risk group. (P < 0.001). The high TV showed significantly worse pathologic outcomes than the low TV in terms of high rates of extra-capsular extension, seminal vesicle invasion, and positive surgical margin (P < 0.05). The patients with high TV had significantly shorter biochemical recurrence-free survivals than those with low TV (P < 0.001). Finally, based on multivariate Cox-proportional analyses, TV was revealed to be an independent predictor of postoperative biochemical recurrence as both categorical (hazard ratio [HR]: 1.42, 95% confidence interval [CI]: 1.13–1.78, P = 0.003] and continuous variables (HR: 1.04, 95% CI: 1.04–1.05, P < 0.001). TV was revealed to be an independent prognostic factor in the postoperative biochemical recurrence. Patients with a high number of positive core and longer tumor length were significantly related to higher TV.

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