scholarly journals Prostatic Ductal Adenocarcinoma Controlled for Tumor Grade, Stage, and Margin Status Does Not Independently Influence the Likelihood of Biochemical Recurrence in Localized Prostate Cancer After Radical Prostatectomy

2021 ◽  
Author(s):  
Oleksandr N. Kryvenko ◽  
Oleksii A. Iakymenko ◽  
Luiz P. De Lima Guido ◽  
Amit S. Bhattu ◽  
Ali Merhe ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Odds Ratio ◽  
Biochemical Recurrence ◽  
Surgical Margin ◽  
Tumor Grade ◽  
Margin Status ◽  
Ductal Adenocarcinoma ◽  
Positive Surgical Margin ◽  
Tumor Nodule ◽  
Free Survival

Context.— Prostatic ductal adenocarcinoma (PDA) has historically been considered to be an aggressive subtype of prostate cancer. Objective.— To investigate if PDA is independently associated with worse biochemical recurrence (BCR)–free survival after radical prostatectomy. Design.— A review of 1584 radical prostatectomies was performed to grade, stage, and assess margin status in each tumor nodule. Radical prostatectomies with localized PDA (ie, those lacking metastasis) in the tumor nodule with the highest grade and stage and worst margin status were matched with prostatic acinar adenocarcinoma according to grade, stage, and margin status. The effect of PDA on BCR was assessed by multivariable Cox regression and Kaplan-Meier analyses. Results.— Prostatic ductal adenocarcinoma was present in 171 cases. We excluded 24 cases because of lymph node metastasis (n = 13), PDA not in the highest-grade tumor nodule (n = 9), and positive surgical margin in a lower-grade tumor nodule (n = 2). The remaining 147 cases included 26 Grade Group (GG) 2, 44 GG3, 6 GG4, and 71 GG5 cancers. Seventy-six cases had extraprostatic extension, 33 had seminal vesicle invasion, and 65 had positive margins. Follow-up was available for 113 PDA and 109 prostatic acinar adenocarcinoma cases. Prostate-specific antigen density (odds ratio, 3.7; P = .001), cancer grade (odds ratio, 3.3–4.3; P = .02), positive surgical margin (odds ratio, 1.7; P = .02), and tumor volume (odds ratio, 1.3; P = .02) were associated with BCR in multivariable analysis. Prostatic ductal adenocarcinoma, its percentage, intraductal carcinoma, and cribriform Gleason pattern 4 were not significant independent predictors of BCR. Conclusions.— Advanced locoregional stage, higher tumor grade, and positive surgical margin status rather than the mere presence of PDA are more predictive of worse BCR-free survival outcomes following radical prostatectomy in men with a component of PDA.

Preoperative Prediction of Surgical Margin Status in Patients With Prostate Cancer Treated by Radical Prostatectomy

2000 ◽  
Vol 18 (15) ◽  
pp. 2862-2868 ◽  
Author(s):  
Liang Cheng ◽  
Jeff Slezak ◽  
Erik J. Bergstralh ◽  
Robert P. Myers ◽  
Horst Zincke ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Surgical Margin ◽  
Margin Status ◽  
Surgical Margins ◽  
Positive Surgical Margin ◽  
Biopsy Specimens ◽  
Preoperative Serum

PURPOSE: We sought to determine the preoperative factors associated with surgical margin status in patients who underwent radical prostatectomy for prostate cancer. PATIENTS AND METHODS: The study group consisted of 339 patients who were treated by radical retropubic prostatectomy and bilateral pelvic lymphadenectomy at the Mayo Clinic. None received preoperative adjuvant therapy. The mean age at the time of surgery was 66 years (range, 45 to 79 years). All specimens were totally embedded and whole-mounted. Positive surgical margin was defined as the presence of cancer cells at the inked margins. Numerous pathologic characteristics in needle biopsies and preoperative clinical findings were analyzed. RESULTS: The overall margin positivity rate was 24%. In univariate analysis, preoperative serum prostate-specific antigen (PSA) level, Gleason score, perineural invasion, percentage of cancer in the biopsy specimens, and number and percentage of biopsy cores involved by cancer were all associated with positive surgical margins. In multivariate analysis, preoperative serum PSA level (odds ratio for a doubling of PSA levels, 1.9; 95% confidence interval, 1.5 to 2.4; P < .001) and percentage of cancer in the biopsy specimens (odds ratio for a 10% increase, 1.3; 95% confidence interval, 1.2 to 1.4; P < .001) were predictive of margin status in radical prostatectomy. With use of preoperative serum PSA level and percentage of cancer in the biopsy as predictors of surgical margins, the overall accuracy as measured by the area under the receiver operating characteristic curve was 0.74. CONCLUSION: Preoperative serum PSA level and percentage of cancer in the biopsy specimens were independently associated with surgical margin status in patients who underwent radical prostatectomy for prostate cancer. The combination of these two factors provides a high level of predictive accuracy for margin status.

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

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.

scholarly journals Positive Surgical Margin Status after Minimally Invasive Radical Prostatectomy: a Multicenter Study

2015 ◽  
Vol 82 (4) ◽  
pp. 229-237
Author(s):  
Ardit Tafa ◽  
Angelica Grasso ◽  
Alessandro Antonelli ◽  
Pierluigi Bove ◽  
Antonio Celia ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Minimally Invasive ◽  
Multicenter Study ◽  
Surgical Margin ◽  
Margin Status ◽  
Positive Surgical Margin

Variation in positive surgical margin status following radical prostatectomy for pT2 prostate cancer

2019 ◽  
Vol 18 (1) ◽  
pp. e294-e295
Author(s):  
W.S. Tan ◽  
M. Krimphove ◽  
A. Cole ◽  
S. Berg ◽  
M. Marchese ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Surgical Margin ◽  
Margin Status ◽  
Positive Surgical Margin

Biochemical Recurrence After Radical Prostatectomy: Multiplicative Interaction Between Surgical Margin Status and Pathological Stage

2010 ◽  
Vol 184 (4) ◽  
pp. 1341-1346 ◽  
Author(s):  
Lars Budäus ◽  
Hendrik Isbarn ◽  
Christian Eichelberg ◽  
Giovanni Lughezzani ◽  
Maxine Sun ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Biochemical Recurrence ◽  
Surgical Margin ◽  
Margin Status ◽  
Pathological Stage ◽  
Multiplicative Interaction

Recurrence prediction for breast phyllodes tumours: validation of the Singapore nomogram in Korean women

2020 ◽  
pp. jclinpath-2020-207093
Author(s):  
Jung Eun Choi ◽  
Su Hwan Kang ◽  
Puay Hoon Tan ◽  
Young Kyung Bae
Keyword(s):  
Univariate Analysis ◽  
Surgical Margin ◽  
Recurrence Risk ◽  
Margin Status ◽  
Positive Surgical Margin ◽  
Free Survival ◽  
Recurrence Prediction ◽  
Malignant Grade ◽  
Pathology Reports ◽  
Phyllodes Tumours

AimThe Singapore nomogram was developed to predict recurrence risk of phyllodes tumours (PTs) of the breast based on histological features of stromal atypia, stromal mitoses, stromal overgrowth and surgical margin status. We aimed to validate the utility of the Singapore nomogram in a Korean PT cohort.MethodsOne hundred and twenty-four patients with Korean PT who underwent surgical resection between 1996 and 2015 were included in this study. Pathology reports and slides were reviewed to obtain histopathologic features and acquire Singapore nomogram scores. The probability of concordance between predicted and observed survivals by means of the Singapore nomogram was evaluated using a concordance index (C-index).ResultsOf the 124 cases, 57 (46%) were diagnosed as benign, 50 (40.3%) as borderline and 17 (13.7%) as malignant. Recurrences occurred in 25 (20.2%) patients. Univariate analysis showed PTs with higher stromal mitotic counts, marked stromal cellularity, stromal overgrowth, positive surgical margin, marked stromal atypia or a malignant grade presented higher risks of recurrence. Multivariate analysis showed stromal mitoses and surgical margin status independently predicted recurrence-free survival. Patients with high nomogram scores were at greater risk of recurrence (HR=1.05, 95% CI: 1.02 to 1.07, p<0.001) with a C-index of 0.762.ConclusionThe Singapore nomogram provided a useful means of predicting PT outcomes in a Korean PT cohort.

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