Predictors of pathological upgrading and upstaging in patients eligible for active surveillance submitted to radical prostatectomy (RARP).

2015 ◽  
Vol 33 (7_suppl) ◽  
pp. 59-59
Author(s):  
Ana Maria Autran-Gomez ◽  
Fernando P. Secin ◽  
Arjun Sivaraman ◽  
Rafael Sanchez-Salas ◽  
Juan I Monzo ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Active Surveillance ◽  
Clinical Stage ◽  
Surgical Margin ◽  
Cancer Center ◽  
Positive Surgical Margin ◽  
Cox's Regression ◽  
Positive Core ◽  
Study Population

59 Background: To evaluate the pathological outcomes in patients who were suitable for Active Surveilance (AS) and underwent Radical Prostatectomy (RP) and to explore the potential predictive factors to identify Gleason upgrading and upstaging. Methods: A prospectively maintained database was used to evaluate 1,552 consecutive patients who underwent RP [Laparoscopic / Robotic] at our institution between 1998 and 2012. We identified 405 RP patients fulfilling the Memorial Sloan-Kettering Cancer Center criteria for AS (PSA ≤10 ng/ml, clinical stage ≤2a, Gleason≤6, ≤2 + cores and less 50% cancer in any one core). In the final RP specimen, upgrading was defined as identification of Gleason >6 and upstaging as presence of ≥ pT3. The clinical and the pathological features of upstaged/upgraded patients were compared with the remaining patients and the cox’s regression model was applied to identify potential predictors. Kaplan Meir curve was used to identify Biochemical Recurrence Free Survival (BCR-FS) at 5 years. Results: We noticed upstaging in 195 (48%) patients and Gleason upgrading in 55 (13%) at RP specimen. Multivariate analysis showed percent of positive core had significant association with upstaging/upgrading. Positive Surgical Margin (PSM) was noted in 66(16%) patients, and the PSM rate was significantly higher in upstaged patients. The mean follow-up of the study population was 28 months and the predicted BCR-FS at 5 years was 92% and 88% in the patients who were not and were upstaged/upgraded. Conclusions: Percentage of positive cores in patients subjected to Active Surveillance appears to predict pathological upstaging/upgrading at radical prostatectomy. [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.

General epidemiologic colorectal cancer profile in Oncologos del Occidente from Colombia, South America.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14693-e14693
Author(s):  
Tomas Sanchez Villegas ◽  
Carlos Raul Villegas Mejia ◽  
Jose Arnoby Chacon Cardona
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Colon Cancer ◽  
Clinical Stage ◽  
Surgical Margin ◽  
Partial Report ◽  
Cancer Center ◽  
Positive Surgical Margin ◽  
Final Report ◽  
Preoperative Treatment

e14693 Background: The Colorectal Cancer is one of the most common cancer in the US and the fourth cancer for the developing countries like in our area. Methods: This is a preliminary and partial report of a retrospective analysis from our cancer records in Oncologos del Occidente a Private Oncologic Cancer Center from Colombia. Results: 663 patients (50% of final report) from January 1997 to June 2012 with Colon Cancer 306(46%), Rectal Cancer 309(47%) y Anal Cancer (7%); 51% female; median age 60(range 16-92. sd:13.929); Urban Area 91%. Clinical stage I (7%), IIA (19%), IIB (3%), IIIA (5%), IIIB (13%) and IIIC (10%), IV (11%), Adenocarcinoma 81%, Mucinous (8%); Well differentiated (63%), Poorly differentiated (7%); pretreatment Carcino-embryonic antigen mean 32.778 ng/ml (range 0.18-550.0), Adverse prognostic factors were Obstruction (39%), Ulceration (31%), Lymph Vascular Invasion (10%), T4 Stage (5%), Perforation (4%), Positive Surgical Margin (2%) with two factors 21% and three factors 7%; Low rectal cancer was 90%, Non-Surgical treatment was Chemotherapy (CT) (37%), CT/Radiotherapy (RT) (35%), CT and RT (8%), RT (3%), None (16%); preoperative treatment 37%, First line CT was based on 5FU/LV (52%); 20% relapsed and the main recurrence pattern was Local-marginal (25%), Liver (17%), Pelvic peritoneal (3%), Carcinomatosis (8%) and Lung (23); Rescue treatment was CT (10%), Surgery+CT (1%), CT+RT (1%) and Surgery (1%); the main rescue CT was Folfox 2%, 5FU/LV (3%), Capecitabine (3%), Mixed 6%; Surgical Lymph nodes mean excised was 10.037 (0-38 SD.7.554) and positive nodes mean was 1.972(0-29 SD 3.503); Overall Survival at 5 years for Colon cancer is 63% and 53% to 10 years and Rectal cancer to 5 and 10 years is 45% and 36% respectively (p=0.001). Conclusions: These results reflect the colorectal cancer behavior in a specific area of Colombia and the importance of a multidisciplinary work.

Positive margin length and Gleason grade of tumor focus at the margin predict for biochemical failure after radical prostatectomy in patients with pT2 prostate cancer.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 103-103 ◽  
Author(s):  
Jenny N. Nguyen ◽  
Brian Francis Chapin ◽  
Ina N. Prokhorova ◽  
Xuemei Wang ◽  
John W. Davis ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Multivariable Analysis ◽  
Positive Margin ◽  
Biochemical Failure ◽  
Cancer Center ◽  
Adjuvant Radiation ◽  
Gleason Grade ◽  
Tumor Focus

103 Background: While three prospective trials have demonstrated benefit from adjuvant radiation (XRT) after radical prostatectomy (RP) in patients with positive surgical margins (PSM), its use varies amongst physicians. Many rely on clinical acumen to determine the optimal strategy for application of XRT post RP. We aim to determine if the length of PSM and highest Gleason grade (GG) of tumor at the PSM (hGGPSM) can be used to identify patients at greatest risk of biochemical failure (BCF) post RP. Methods: A retrospective review of all RP patients at The University of Texas MD Anderson Cancer Center from 2002 to 2010 was performed. After a single pathologist review, patients with organ confined disease (pT2), pathologic N0/Nx and a PSM were included. BCF was defined as 2 sequential PSA values of ≥0.2 or any detectable PSA prompting XRT. Patients receiving adjuvant XRT or with <12 months follow-up were excluded. Results: 205 patients met the inclusion criteria. Median PSA was 5.3 ng/mL (0.5-33) and median follow-up was 64 months (13-130). The majority were low clinical stage (cT1c: 65%), low (11%)/intermediate (82%) grade and had a single site of a PSM (90%). BCF occurred in 47 patients for a 5 yr BCF free survival (BCFFS) of 69%. PSM length was significantly associated with BCFFS (≤1mm vs >1, p=0.02). When accounting for hGGPSM, Gl 3 tumors were less likely to experience BF (5 yr BCFFS-96%) regardless of PSM length, while BCFFS for Gl >3 tumors were significantly lower dependent upon length of PSM ( ≤1mm vs >1mm, p=0.03). On multivariable analysis length of PSM (p=0.05) and hGGPSM (p=0.007) remained independent predictors of BCF (Table). Conclusions: Length of PSM and hGGPSM are independent predictors of BCF. These should be considered when evaluating patients for adjuvant XRT and in risk stratifying patients in prospective clinical trials. [Table: see text]

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]

Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: The UK experience

2017 ◽  
Vol 11 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Christopher G Eden ◽  
Dimitrios Moschonas ◽  
Ricardo Soares
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Stage ◽  
Operating Time ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Interquartile Range ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Robot Assisted

Objective: The purpose of this study was to investigate urinary continence four weeks following Retzius-sparing robot-assisted radical prostatectomy. Patients and methods: Forty patients with T2–T3 prostate cancer underwent Retzius-sparing-robot-assisted radical prostatectomy and their results were compared with those from the 40 patients having robot-assisted radical prostatectomy done by the same surgeon immediately prior to the adoption of Retzius-sparing-robot-assisted radical prostatectomy. Results: Patients in the two groups had similar age, body mass index, prostate specific antigen, biopsy Gleason sum, clinical stage, d’Amico risk profile, blood loss, prostate weight and post-operative hospital stay. Median operating time (200 (interquartile range=155–266) vs 223 (interquartile range=100–238) min; p=0.05) and catheterisation (8 (interquartile range=8–8) vs 14 (interquartile range=14–14) days; p<0.0001) were shorter in the Retzius-sparing group, many of whom had suprapubic catheters inserted. The overall complication rate was lower in Retzius-sparing patients (2.5% vs 8.0%; p=0.36). Positive surgical margin rates were similar for Retzius-sparing and non-Retzius-sparing patients and decreased with greater experience with the Retzius-sparing technique: 16.7% vs 7.7% for pT2 ( p=0.65) and 31.8% vs 14.3% for pT3 ( p=0.44). Initial prostate specific antigen was <0.1 ng/ml in 97.5% and 100%, respectively ( p=1.00). At four weeks post-operation 0, 1 and 2 pads/day were needed in the Retzius-sparing group in 90.0%, 7.5% and 2.5% of patients, compared to 37.5% ( p<0.0001), 32.5% ( p=0.01) and 30% ( p=0.002) of men having conventional surgery. Conclusion: Retzius-sparing-robot-assisted radical prostatectomy is faster than the anterior approach to the prostate, allows a shorter catheterisation time and produces dramatically better continence results at four weeks with 90% of patients being pad-free and 97.5% of patients needing 0–1 pads/day.

scholarly journals Laparoscopic radical prostatectomy: a single surgeon’s experience in 80 cases after 2 years of formal training

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Sinan Çelen ◽  
Yusuf Özlülerden ◽  
Aslı Mete ◽  
Aykut Başer ◽  
Ömer Levent Tuncay ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Learning Curve ◽  
Complication Rate ◽  
Functional Outcomes ◽  
Surgical Margin ◽  
High Volume ◽  
Laparoscopic Radical Prostatectomy ◽  
Positive Surgical Margin ◽  
Visceral Injury

Abstract Background To assess the learning curve in laparoscopic radical prostatectomy (LRP) performed by a single surgeon who had a healthcare career as a surgical first assistant for 2 years in high-volume centers treating > 150 cases per year. Methods The records of 80 LRP cases performed between October 2017 and August 2018 by a single surgeon were consecutively divided into four groups (groups A = first 20 cases, B = second 20 cases, C = third 20 cases, and D = last 20 cases). The groups were compared in terms of surgical and functional outcomes with a minimum follow-up of 6 months. Results Clinical and surgical stages of the four groups were similar between groups. The operative time (126.8 ± 5.48 min; P = 0.001) and time of removal of the drain (1.65 ± 0.93 days; P = 0.029) were significantly lower in group D; however, hospitalization, catheterization time, and blood loss were similar between groups. The complication rate was low. No patient had a visceral injury, and there were no procedures needed to open conversion. The positive surgical margin (PSM) rates were similar between groups. In terms of continence and potency, all groups were similar at the 6th-month follow-up after surgery. Conclusions Our results showed that prior experience in laparoscopic surgery as a surgical first assistant in a high-volume center improves the learning curve and oncological and functional outcomes, and helps to minimize the complication rate

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.

scholarly journals Partial Cystectomy after Neoadjuvant Chemotherapy: Memorial Sloan Kettering Cancer Center Contemporary Experience

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Wassim M. Bazzi ◽  
Ryan P. Kopp ◽  
Timothy F. Donahue ◽  
Melanie Bernstein ◽  
Paul Russo ◽  
...  
Keyword(s):  
Overall Survival ◽  
Neoadjuvant Chemotherapy ◽  
Cox Regression ◽  
Surgical Margin ◽  
Partial Cystectomy ◽  
Intravesical Therapy ◽  
Rank Test ◽  
Cancer Center ◽  
Positive Surgical Margin

Objective. To report our contemporary experience with partial cystectomy after neoadjuvant chemotherapy. Patients and Methods. Retrospective review of patients who underwent neoadjuvant chemotherapy and partial cystectomy for urothelial cell carcinoma of the bladder at Memorial Sloan Kettering Cancer Center from 1995 to 2013. Log-rank test and Cox regression models were used to analyze variables possibly associated with recurrence-free, advanced recurrence-free (free from recurrence beyond salvage with intravesical therapy or radical cystectomy), and overall survival. Results. All 36 patients had a solitary tumor <5 cm in size. Twenty-one patients (58%) achieved cT0 following neoadjuvant chemotherapy with 7 (33%) having residual disease at PC. At last follow-up, 19 (53%) patients had recurrence, 15 (42%) had advanced recurrence, 10 (28%) died of disease, and 22 (61%) maintained an intact bladder. Median follow-up of those who were with no evidence of disease was 17 months. On univariable analysis, after neoadjuvant chemotherapy positive nodes on imaging and positive surgical margin at partial cystectomy were both associated with worse recurrence-free, advanced recurrence-free, and overall survival. Five-year recurrence-free, advanced recurrence-free, and overall survival were 28%, 51%, and 63%, respectively. Conclusion. Partial cystectomy following neoadjuvant chemotherapy provides acceptable oncologic outcomes in highly selected patients with muscle-invasive bladder cancer.

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.

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