Evaluation of length, maximum Gleason score, and extension of disease at positive surgical margins during radical prostatectomy.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 98-98
Author(s):  
Hooman Djaladat ◽  
Mehrdad Alemozaffar ◽  
Christina Day ◽  
Manju Aron ◽  
Jie Cai ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Cox Regression ◽  
Surgical Margin ◽  
Oncologic Outcomes ◽  
Positive Surgical Margin ◽  
Extracapsular Extension ◽  
Clinical Recurrence ◽  
The Impact

98 Background: Positive surgical margin (PSM) found following radical prostatectomy (RP) is known to affect subsequent recurrence and survival. The extent of PSM has been shown to impact clinical outcomes. We examined the effect of length of PSM, extent of disease at PSM and maximum Gleason score at PSM on oncologic outcomes. Methods: A retrospective review of 3971 patients undergoing RP for prostate cancer at our institution between1978-2009 revealed 1053 patients with PSM, out of whom 814 received no hormone therapy. The initial 175 patients were selected to maximize available follow-up, and their slides were re-reviewed for following parameters: length of PSM (mm), maximum Gleason score at PSM, and maximal extension of PSM (intraprostatic incision vs. extracapsular extension). Data was available in 107 patients who are the subject of this study. Multivariable Cox regression models were used to evaluate the impact of above features as well as age, preoperative PSA, pathologic Gleason score, stage and adjuvant radiotherapy on biochemical and clinical recurrence-free survival (RFS), and overall survival (OS). Results: Median follow-up was 17.6 years. Maximum extension of PSM was limited to intraprostatic incision in 63 (58.9%) and extracapsular in 44(41.1%) patients. Median length of PSM was 4 mm (range 1-55 mm); 41 (38.3%) with <3mm and 66 (61.7%) with >4mm. Maximum Gleason score at PSM was <6 in 70 (66.0%) and >7 in 36 (34%) patients. 10-yr PSA RFS, clinical RFS, and OS were 60.2%, 80.7%, and 60.2%, respectively. Multivariable Cox regression modeling showed the length of PSM >4mm and extracapsular extension as independent predictors of PSA RFS and clinical RFS. Age and extracapsular extension were independent predictors of OS. Conclusions: PSM >4mm and extracapsular extension have a higher risk of PSA and clinical recurrence after RP. These findings can help decision-making regarding adjuvant therapy in patients with PSM and should be reported by pathologists in addition to the presence of PSM. [Table: see text]

scholarly journals Oncological and functional outcomes of 722 robot-assisted radical prostatectomy (RARP) cases: The largest Canadian 5-year experience

2014 ◽  
Vol 8 (5-6) ◽  
pp. 195 ◽  
Author(s):  
Kevin Christopher Zorn ◽  
Côme Tholomier ◽  
Marc Bienz ◽  
Pierre-Alain Hueber ◽  
Quoc Dien Trinh ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
High Volume ◽  
Oncologic Outcomes ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Transfusion Rate ◽  
Robotic Assisted Radical Prostatectomy

Introduction: While RARP (robotic-assisted radical prostatectomy) has become the predominant surgical approach to treat localized prostate cancer, there is little Canadian data on its oncological and functional outcomes. We describe the largest RARP experience in Canada.Methods: Data from 722 patients who underwent RARP performed by 7 surgeons (AEH performed 288, TH 69, JBL 23, SB 17, HW 15, QT 7, and KCZ 303 patients) were collected prospectively from October 2006 to December 2013. Preoperative characteristics, as well as postoperative surgical and pathological outcomes, were collected. Functional and oncological outcomes were also assessed up to 72 months postoperative.Results: The median follow-up (Q1-Q3) was 18 months (9-36). The D’Amico risk stratification distribution was 31% low, 58% intermediate and 11% high-risk. The median operative time was 178 minutes (142-205), blood loss was 200 mL (150-300) and the postoperative hospital stay was 1 day (1-23). The transfusion rate was only 1.0%. There were 0.7% major (Clavien III-IV) and 10.1% minor (Clavien I-II) postoperative complications, with no mortality. Pathologically, 445 men (70%) were stage pT2, of which 81 (18%) had a positive surgical margin (PSM). In addition, 189 patients (30%) were stage pT3 and 87 (46%) with PSM. Urinary continence (0-pads/day) returned at 3, 6, and 12 months for 68%, 80%, and 90% of patients, respectively. Overall, the potency rates (successful penetration) for all men at 6, 12, and 24 months were 37%, 52%, and 59%, respectively. Biochemical recurrence was observed in 28 patients (4.9%), and 14 patients (2.4%) were referred for early salvage radiotherapy. In total, 49 patients (8.4%) underwent radiotherapy and/or hormonal therapy.Conclusions: This study shows similar results compared to other high-volume RARP programs. Being the largest RARP experience in Canada, we report that RARP is safe with acceptable oncologic outcomes in a Canadian setting.

scholarly journals Predictive Factors and Oncologic Outcome of Downgrade to Pathologic Gleason Score 6–7 after Radical Prostatectomy in Patients with Biopsy Gleason Score 8–10

2019 ◽  
Vol 8 (4) ◽  
pp. 438 ◽  
Author(s):  
Doo Chung ◽  
Jong Lee ◽  
Hyeok Goh ◽  
Dong Koh ◽  
Min Kim ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Predictive Factors ◽  
Cox Regression ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Cox Regression Analysis ◽  
Pathologic Features

Gleason score (GS) 8–10 is associated with adverse outcomes in prostate cancer (PCa). However, biopsy GS (bGS) may be upgraded or downgraded post-radical prostatectomy (RP). We aimed to investigate predictive factors and oncologic outcomes of downgrade to pathologic GS (pGS) 6–7 after RP in PCa patients with bGSs 8–10. We retrospectively reviewed clinical data of patients with bGS ≥ 8 undergoing RP. pGS downgrade was defined as a pGS ≤ 7 from bGS ≥ 8 post-RP. Univariate and multivariate cox regression analysis, logistic regression analysis, and Kaplan–Meier curves were used to analyze pGS downgrade and biochemical recurrence (BCR). Of 860 patients, 623 and 237 had bGS 8 and bGS ≥ 9, respectively. Post-RP, 332 patients were downgraded to pGS ≤ 7; of these, 284 and 48 had bGS 8 and bGS ≥ 9, respectively. Prostate-specific antigen (PSA) levels; clinical stage; and adverse pathologic features such as extracapsular extension, seminal vesicle invasion and positive surgical margin were significantly different between patients with pGS ≤ 7 and pGS ≥ 8. Furthermore, bGS 8 (odds ratio (OR): 0.349, p < 0.001), PSA level < 10 ng/mL (OR: 0.634, p = 0.004), and ≤cT3a (OR: 0.400, p < 0.001) were identified as significant predictors of pGS downgrade. pGS downgrade was a significant positive predictor of BCR following RP in patients with high bGS (vs. pGS 8, hazard radio (HR): 1.699, p < 0.001; vs. pGS ≥ 9, HR: 1.765, p < 0.001). In addition, the 5-year BCR-free survival rate in patients with pGS downgrade significantly differed from that in patients with bGS 8 and ≥ 9 (52.9% vs. 40.7%, p < 0.001). Among patients with bGS ≥ 8, those with bGS 8, PSA level < 10 ng/mL, and ≤cT3a may achieve pGS downgrade after RP. These patients may have fewer adverse pathologic features and show a favorable prognosis; thus we suggest that active treatment is needed in these patients. In addition, patients with high-grade bGS should be managed aggressively, even if they show pGS downgrade.

Risk of recurrence in patients with positive surgical margin at apex only versus other locations after radical prostatectomy.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 124-124
Author(s):  
Masashi Kato ◽  
Akiyuki Yamamoto ◽  
Ryo Ishida ◽  
Tohru Kimura ◽  
Tomoyasu Sano ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Adjuvant Therapy ◽  
Surgical Margin ◽  
Operative Approach ◽  
Positive Surgical Margin ◽  
Grade Group ◽  
Clinical Recurrence ◽  
Prostate Cancer Death

124 Background: Some reported that positive surgical margin at radical prostatectomy (RP) was a prognostic factor of clinical recurrence and prostate cancer death, and others showed that was not necessarily true. The prostatic apex is most popular location of positive surgical margin at RP and the frequency of apex is reported to be about 20-40% of all positive cases. Prostatic apex is also reported to lack a well-defined capsule and to be hardly retracted during operation. In this study, we evaluated the effect of positive surgical margin at apex-only on prognosis after RP in a large cohort. Methods: We retrospectively evaluated 1019 patients with prostate cancer who underwent radical prostatectomy without neoadjuvant or adjuvant therapy at the hospitals that the authors were affiliated with between 2005 and 2013. The operative approach (open, laparoscopic, or robotic) was decided by each institution. All prostatectomy specimen slides were reviewed by a single genitourinary pathologist according to ISUP 2014 criteria. Recurrence following RP was defined according to AUA guidelines. Results: The median patient age was 67 (range, 45–80) years. The median initial PSA was 6.8 ng/ml (range, 0.4–82 ng/ml). The median follow-up period was 69 (range, 0.7–135) months. Pathological T stage was in 72.5% of pT2 (n = 739), 23.4% of pT3a (n = 238), and 4.1% of pT3b (n = 42). There were 163 Grade Group (GG) 1 cases, 502 GG 2, 217 GG 3, 39 GG 4, and 98 GG 5 cases. 372 cases had positive surgical margin. Details were 201 (54%) apex only, 57 (15%) anterior, 43 (12%) posterior, 76 (20%) lateral, 40 (11%) bladder. Some patients showed multiple positive surgical margin. The patients with positive surgical margin at apex-only showed significantly better prognosis than other locations (P = 0.0001). This result was confirmed in each operative approach (open; P = 0.008, laparoscopic; P = 0.001, robotic; P = 0.01). Conclusions: Among surgical margin positive patients after RP, those at prostatic apex-only showed lower biochemical recurrence than other locations regardless of operative approach. Physician should follow such a patient carefully without adjuvant therapy.

Clinical predictors for biochemical failure in patients with positive surgical margin after robotic-assisted radical prostatectomy

2021 ◽  
pp. 030089162110079
Author(s):  
Shih-Huan Su ◽  
Ying-Hsu Chang ◽  
Liang-Kang Huang ◽  
Yuan-Cheng Chu ◽  
Hung-Cheng Kan ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Cox Regression ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Biochemical Failure ◽  
Positive Surgical Margin ◽  
Cox Regression Analysis ◽  
Robotic Assisted ◽  
Robotic Assisted Radical Prostatectomy

Objective: Patients with positive surgical margins (PSMs) after radical prostatectomy for localized prostate cancer have a higher risk of biochemical failure (BCF). We investigated the risk factors of BCF in patients with PSMs after robotic-assisted radical prostatectomy (RARP). Methods: We evaluated 462 patients who underwent RARP in a single medical center from 2006 through 2013. Of them, 61 with PSMs did not receive any treatment before BCF. Kaplan-Meier curve and Cox regression analysis were used to compare patients with (n = 19) and without (n = 41) BCF. Results: Overall, 13.2% of patients had PSMs, and of those, 31.7% experienced BCF during follow-up. The mean follow-up duration was 43.7 months (42.4 [non-BCF] vs 46.35 (BCF], p = 0.51). In univariant analyses, the platelet to lymphocyte ratio (6.26 [non-BCF] vs 8.02 [BCF], p = 0.04) differed statistically. When patients were grouped by pathologic grade ≦2 or ≧3 ( p = 0.004), the BCF-free survival rates differed significantly. Seminal vesicle invasion also differed significantly (5 [non-BCF] vs 7 [BCF], p = 0.005). Patients with undetectable nadir prostate-specific antigen (PSA) after RARP (BCF rate 4/34) differed statistically from those with detectable PSA after RARP (BCF rate 15/26) ( p < 0.001). In the multivariate analysis, the platelet/lymphocyte (P/L) ratio, pathologic grade, and undetectable nadir PSA remained statistically significant. Conclusions: In patients who undergo RARP and have PSMs, P/L ratio >9 preoperatively, pathologic grade ⩾3, and detectable nadir PSA after RARP should be considered adverse features. Early intervention such as salvage radiation therapy or androgen deprivation therapy should be offered to these patients.

scholarly journals Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era

2016 ◽  
Vol 10 (1-2) ◽  
pp. 17 ◽  
Author(s):  
Ahva Shahabi ◽  
Raj Satkunasivam ◽  
Inderbir S. Gill ◽  
Gary Lieskovsky ◽  
Sia Daneshmand ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Competing Risks ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Localized Prostate Cancer ◽  
Positive Surgical Margin ◽  
Clinical Recurrence

Introduction: We sought to determine predictors for early and late biochemical recurrence following radical prostatectomy among localized prostate cancer patients.Methods: The study included localized prostate cancer patients treated with radical prostatectomy (RP) at the University of Southern California from 1988 to 2008. Competing risks regression models were used to determine risk factors associated with earlier or late biochemical recurrence, defined using the median time to biochemical recurrence in this population (2.9 years after radical prostatectomy).Results: The cohort for this study included 2262 localized prostate cancer (pT2-3N0M0) patients who did not receive neoadjuvant or adjuvant therapies. Of these patients, 188 experienced biochemical recurrence and a subset continued to clinical recurrence, either within (n=19, 10%) or following (n=13, 7%) 2.9 years after RP. Multivariable stepwise competing risks analysis showed Gleason score ≥7, positive surgical margin status, and ≥pT3a stage to be associated with biochemical recurrence within 2.9 years following surgery. Predictors of biochemical recurrence after 2.9 years were Gleason score 7 (4+3), preoperative prostate-specific antigen (PSA) level, and ≥pT3a stage.Conclusions: Higher stage was associated with biochemical recurrence at any time following radical prostatectomy. Particular attention may need to be made to patients with stage ≥pT3a, higher preoperative PSA, and Gleason 7 prostate cancer with primary high-grade patterns when considering longer followup after RP.

Oncological outcomes in high-risk prostate cancer after radical prostatectomy based on Gleason score: USC experience with 3,755 cases.

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 60-60
Author(s):  
Hooman Djaladat ◽  
Weichen Xu ◽  
Jie Cai ◽  
Gary Lieskovsky ◽  
Siamak Daneshmand
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Cox Regression ◽  
Adjuvant Radiation ◽  
Recurrence Free Survival ◽  
Clinical Recurrence ◽  
Free Survival ◽  
Oncological Outcomes

60 Background: Gleason score is an important predictor of oncological outcomes after radical prostatectomy. However, it remains unclear whether there is a difference in outcomes between Gleason score (GS) 8 and 9-10 disease. We compare oncological outcomes after open radical prostatectomy for prostate cancer patients with GS of 8 versus 9-10. Methods: Of 3,755 radical prostatectomy patients (1987-2008), 360 patients with final pathology of GS 8, 9 or 10 and N0M0 were included. No significant differences between age, race and surgical margins between the two groups. Impact of GS on outcomes was controlled for preoperative PSA, pathological stage, use of adjuvant radiation therapy and use of neoadjuvant/adjuvant hormone deprivation therapy in multivariable analyses. Outcomes of interest were biochemical recurrence free survival (BCRFS), clinical recurrence free survival (CRFS) and overall survival (OS). Kaplan Meier plots, log rank tests and multivariable Cox regression model were used to analyze the data. Results: Median follow-up for GS 8 and GS 9-10 were 10.0 years and 8.6 years, respectively (p=0.43). Conclusions: Long term follow up after radical prostatectomy reveals significant differences in BCRFS and CRFS but not OS between patients with GS 8 vs. 9-10 prostate cancers. Further studies may examine sub-stratification of GS 8 tumors into a lower risk category than GS 9-10 tumors. [Table: see text] [Table: see text]

Importance of Reporting the Gleason Score at the Positive Surgical Margin Site: Analysis of 4,082 Consecutive Radical Prostatectomy Cases

2016 ◽  
Vol 195 (2) ◽  
pp. 337-342 ◽  
Author(s):  
Max Kates ◽  
Nikolai A. Sopko ◽  
Misop Han ◽  
Alan W. Partin ◽  
Jonathan I. Epstein
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Site Analysis

Oncological outcomes of surgery in very high risk pT3b prostate cancer

2011 ◽  
Vol 18 (3) ◽  
pp. 113-119
Author(s):  
Daimantas MILONAS ◽  
Giedrė SMAILYTĖ ◽  
Darius TRUMBECKAS ◽  
Mindaugas JIEVALTAS
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Cox Regression ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Oncologic Outcomes ◽  
Cancer Specific Survival ◽  
Risk Of Death ◽  
Surgery Outcome

Background. The aim of the study was to present the oncologic outcomes and to determine the prognostic factors of overall (OS) and cancer-specific survival (CSS) as well as disease-progression-free survival (DPFS) after surgery for pT3b prostate cancer. Materials and methods. In 2002–2007, a pT3b stage after radical prostatectomy was detected in 56 patients. Patients were divided into groups according to the prostate-specific antigen (PSA) level (20 ng/ml), lymph nodes status (N0 vs. Nx vs. N1) and the Gleason score (6–7 vs. 8–10). The Kaplan–Meier analysis was used to calculate OS, CSS and DPFS. The Cox regression was used to identify the predictive factors of survival. Results. Five-year OS, CSS and DPFS rates were 75.1%, 79.6% and 79.3%, respectively. The survival was significantly different when comparing the Gleason 6–7 and 8–10 groups. The 5-year OS, CSS and DPFS were 91.2% vs. 48.6%, 97.1% vs. 51.1% and 93.8 vs. 51.1%, respectively. There was no difference in survival among the groups with a different PSA level. The OS and CSS but not DPFS were significantly different when comparing the N0 and N1 groups. The 5-year OS and CSS was 84.4% vs. 37.5% and 87.3% vs. 47.6%, respectively. The specimen Gleason score was a significant predictor of OS and CSS. The risk of death increased up to 4-fold when a Gleason score 8–10 was present at the final pathology. Conclusions. Radical prostatectomy may offer acceptable CSS, DPFS and OS rates in pT3b PCa. However, outcomes in patients with N1 and specimen Gleason ≥8 were significantly worse, suggesting the need of multimodality treatment in such cases. Keywords: prostate cancer, locally advanced, surgery, outcome

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

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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