scholarly journals Positive surgical margins at radical prostatectomy: Population-based averages within PSA and Gleason strata

2013 ◽  
Vol 7 (9-10) ◽  
pp. 561 ◽  
Author(s):  
Jason P. Izard ◽  
Marco A. Salazar ◽  
Suman Chatterjee ◽  
Daniel W. Lin ◽  
Jonathan L. Wright
Keyword(s):  
Multivariate Analysis ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Multivariate Logistic Regression Analysis ◽  
Population Based ◽  
Surgical Margins ◽  
Chi Square ◽  
Positive Surgical Margins ◽  
Chi Squared

Background: Positive surgical margins (PSM) are an important determinant of biochemical recurrence after radical prostatectomy (RP). We use a population-based cancer registry to evaluate PSM by stage, Gleason and prostate-specific antigen (PSA).Methods: We identified men undergoing RP from the Surveillance, Epidemiology and End Results (SEER) database between 2004 and 2007. Differences between those with and without PSM were compared with chi-squared tests. The proportion of cases with PSM were stratified by PSA and Gleason sum for both pT2 and pT3a tumours. Factors associated with PSM were analyzed using chi-square and multivariate logistic regression analysis. A composite variable was used in a second multivariate analysis to display the odds ratio (OR) for a PSM for each discrete combination of PSA, Gleason score and pT stage.Results: In total, 28 461 RP patients were identified and a PSM was present in 19.5%. PSM were 42% in pT3a and 16% in pT2 cases. Higher PSAs (<4.0, 4-9.9, >10) were associated with higher proportions of PSM (12%, 20% and 28%, p < 0.001). Similarly, higher Gleason scores (≤6, 3+4, 4+3, ≥8) were associated with higher PSM (12%, 22%, 27% and 33%, p < 0.001). For pT2 tumours, the proportion of PSM ranged from 8% (Gleason ≤6, PSA <4.0) to 28% (Gleason 8-10, PSA ≥10). For pT3a tumours, the PSM was higher in each Gleason/PSA strata compared to those with pT2 tumours, reaching 63% for those with pT3a, Gleason 8-10, PSA >10 disease. On multivariate analysis, stage was the largest predictor for PSM (OR 3.05, 95% confidence interval 2.81-3.30), although Gleason score and PSA remained statistically significant.Conclusion: In this population-based study of PSM after RP, the proportion of PSM vary significantly within different PSA and Gleason strata for organ-confined and extracapsular disease. These data can be used as a reference for urologist self-assessment.

scholarly journals The role of PSA density to predict a pathological tumour upgrade between needle biopsy and radical prostatectomy for low risk clinical prostate cancer in the modified Gleason system era

2013 ◽  
Vol 7 (11-12) ◽  
pp. 722 ◽  
Author(s):  
Stavros Sfoungaristos ◽  
Ioannis Katafigiotis ◽  
Petros Perimenis
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Strong Predictor ◽  
Specific Antigen ◽  
Low Risk ◽  
Surgical Margins ◽  
Positive Surgical Margins ◽  
Psa Density

Objectives: We evaluate the role of prostate-specific antigen (PSA) density to predict Gleason score upgrade between prostate biopsy material and radical prostatectomy specimen examination in patients with low-risk prostate cancer.Methods: Between January 2007 and November 2011, 133 low-risk patients underwent a radical prostatectomy. Using the modified Gleason criteria, tumour grade of the surgical specimens was examined and compared to the biopsy results.Results: A tumour upgrade was noticed in 57 (42.9%) patients. Organ-confined disease was found in 110 (82.7%) patients, while extracapsular disease and seminal vesicles invasion was found in 19 (14.3%) and 4 (3.0%) patients, respectively. Positive surgical margins were reported in 23 (17.3%) patients. A statistical significant correlation between the preoperative PSA density value and postoperative upgrade was found (p = 0.001) and this observation had a predictive value (p = 0.002); this is in contrast to the other studied parameters which failed to reach significance, including PSA, percentage of cancer in biopsy and number of biopsy cores. Tumour upgrade was also highly associated with extracapsularcancer extension (p = 0.017) and the presence of positive surgical margins (p = 0.017).Conclusions: PSA density represents a strong predictor for Gleason score upgrade after radical prostatectomy in patients with clinical low-risk disease. Since tumour upgrade increases the potential for postoperative pathological adverse findings and prognosis, PSA density should be considered when treating and consulting patients with low-risk prostate cancer.

Is systematic 10 core prostate needle biopsy enough for treatment determination of localized prostate cancer?

2012 ◽  
Vol 30 (5_suppl) ◽  
pp. 163-163
Author(s):  
Ryo Kishimoto ◽  
Ryuta Tanimoto ◽  
Kensuke Bekku ◽  
Yasuyuki Kobayashi ◽  
Shin Ebara ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Multivariate Analysis ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Needle Biopsy ◽  
Chi Square ◽  
Prostate Needle Biopsy ◽  
Significant Difference ◽  
Chi Square Test

163 Background: To evaluate whether the systematic 10 cores prostate needle biopsy is enough for determination of NCCN risk classification (NRC), we analyzed migration of Gleason score (GS), cancer location, and NRC between pre and postoperative periods in a cohort of patients who underwent radical prostatectomy. Methods: A total of 197 patients were included in this study. These patients were divided into three groups along the number of biopsy cores: less than 10 (L), 10, and more than 10 (M). We compared between three groups about Gleason score, cancer location and NCCN risk classification change (CC) between prostate biopsy and radical prostatectomy specimen. Statistical analysis were performed with chi-square test, and multiple logistic regression with p<0.05, and Bonferroni correction with p<0.017 considered significant difference. Results: The rate of CC in L, 10, M was 55.1%, 43.0%, 26.5%, respectively. On chi-square test rates of CC were significantly different between three groups (P=0.035), but rates of Gleason score and cancer location were not. On univariate analysis, PSA (Odds rate (OR) 0.872 p<0.001), preoperative NRC (low vs. intermediate, and poor, OR 0.157 and 0.241, p<0.001), prostate volume (normal vs. mild or moderate, OR 1.989 p=0.025), the number of biopsy cores (L vs. M, OR 0.293 p=0.011), GS (6 vs. 8, OR 2.374 p=0.021) were correlated with CC. On multivariate analysis, the most important independent predictive factors for CC were preoperative NRC (low vs. intermediate, p<0.001, OR 0.198, 95% CI 0.09-0.45) and PSA (p=0.007, OR 0.903, 95%CI 0.83-0.98), but the number of biopsy cores was not associated CC significantly. Conclusions: Although multivariate analysis showed no significant difference, the more biopsy cores reduced the risk of CC. Systematic 10 core biopsy might be insufficient for accurate diagnosis and treatment decision of prostate cancer.

scholarly journals Ar galima remiantis objektyviais ikioperaciniais veiksniais prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos?

2005 ◽  
Vol 3 (4) ◽  
pp. 0-0
Author(s):  
Daimantas Milonas ◽  
Dainius Burinskas ◽  
Stasys Auškalnis ◽  
Mindaugas Jievaltas
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Biochemical Failure ◽  
Surgical Margins ◽  
Antigen Concentration ◽  
The Mean

Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasKauno medicinos universiteto Urologijos klinika,Eivenių g. 2, LT-50009 KaunasEl paštas: [email protected] Tikslas Nustatyti objektyvius veiksnius, kurie leistų prognozuoti ankstyvą biocheminį atkrytį po radikalios prostatektomijos. Ligoniai ir metodai Į tyrimą įtraukti 142 prostatos vėžiu sergantys ligoniai, kuriems buvo atliktos radikalios prostatektomijos. Ankstyvas biocheminis atkrytis konstatuotas, kai prostatos specifinio antigeno koncentracija, praėjus 3 mėn. po operacijos, buvo >0,2 ng/ml. Neoadjuvantinė terapija (hormonų ar spindulių) buvo pagrindinis atmetimo kriterijus. Vertinta prostatos specifinio antigeno koncentracija, vėžio diferenciacijos laipsnis iki ir po operacijos, vėžio stadija, prostatos chirurginio šalinimo išlaidos. Rezultatai Galutinei analizei panaudoti 94 ligonų duomenys. Vidutinis jų amžius buvo 66,6 metų, prostatos specifinis antigenas iki operacijos – 9,87 ng/ml, Gleason diferenciacijos laipsnis iki operacijos – 5,87, diferenciacijos laipsnis po operacijos – 6,38, teigiami rezekciniai kraštai rasti 36 (38%), ankstyvas biocheminis atkrytis – 13 (14%) pacientų. Atlikus logistinę regresijos analizę nustatyta, jog ankstyvą biocheminį atkrytį galima patikimai prognozuoti, kai Gleason pooperacinis vėžio diferenciacijos laipsnis didesnis nei 7 (p = 0,02, tikimybių santykis – 7,8) ir vėžio stadija T3b (p = 0,012, tikimybių santykis – 6,76). Išvados Remiantis ikioperaciniais objektyviais veiksniais negalima patikimai prognozuoti ankstyvo biocheminio atkryčio. Prostatos vėžio išplitimas į sėklines pūsleles (T3b stadija) ir Gleasono pooperacinis vėžio diferenciacijos laipsnis > 7 leidžia reikšmingai prognozuoti ankstyvą biocheminį atkryti, po radikalios prostatektomijos, tokiems ligoniams indikuojamas ankstyvas adjuvantinis gydymas, nelaukiant biocheminio atkryčio požymių. Reikšminiai žodžiai: prostatos vėžys, radikali prostatektomija, ankstyvas biocheminis atkrytis Can objective preoperative parameters predict early biochemical recurrence after radical prostatectomy? Daimantas Milonas, Dainius Burinskas, Stasys Auškalnis, Mindaugas JievaltasClinic of Urology, Kaunas University of Medicine,Eivenių str. 2, LT-50009 Kaunas, LithuaniaE-mail: [email protected] Objective To estimate objective parameters which can be useful for predicting early biochemical recurrence after radical prostatectomy due to prostate cancer. Patients and methods The study embraced 142 patients that underwent radical retropubic prostatectomy. Early biochemical failure was defined as a prostate-specific antigen level 3 months after radical prostatectomy > 0.2 ng/ml. Neoadjuvant treatment (hormonal therapy or radiation) was the mane exclusion criteria. Preoperative antigen concentration, Gleason score at the biopsy, patients’ age, postoperative Gleason score, stage and surgical margins were investigated as possible predictors of early biochemical recurrence. Results Final analysis was done using data on 94 patients. The mean patients’ age was 66.6 years and mean preoperative prostate specific antigen concentration 9.87 (range 0.44–98.4) ng/ml. The mean Gleason score preoperatively was 5.87 (range 2–8) and postoperatively 6.38 (range 4–9). Positive surgical margins were in 36 (38%) and early biochemical failure was detected in 13 (14%) cases. Logistic regression analysis shows that postoperative Gleason score >7 (p = 0.02, OR-7.8) and stage pT3b (p = 0.012, OR-6.76) are powerful parameters for predicting early biochemical recurrence. Conclusions Preoperative parameters cannot predict early biochemical recurrence. Postoperative parameters such as Gleason score >7 and stage pT3b are useful in the prediction of early biochemical recurrence. In such patients early adjuvant treatment is advisable. Keywords: prostate cancer, radical prostatectomy, early biochemical recurrence

Impact of positive surgical margins on prostate-specific antigen failure after radical prostatectomy in adjuvant treatment-naïve patients

2010 ◽  
Vol 107 (11) ◽  
pp. 1748-1754 ◽  
Author(s):  
Guillaume Ploussard ◽  
Mohammad Ali Agamy ◽  
Olivier Alenda ◽  
Yves Allory ◽  
Pascal Mouracade ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Adjuvant Treatment ◽  
Specific Antigen ◽  
Surgical Margins ◽  
Positive Surgical Margins ◽  
Treatment Naïve

MP51-06 EVALUATION OF LENGTH, MAXIMUM GLEASON SCORE, AND EXTENSION OF DISEASE AT POSITIVE SURGICAL MARGINS DURING RADICAL PROSTATECTOMY

2014 ◽  
Vol 191 (4S) ◽  
Author(s):  
Hooman Djaladat ◽  
Mehrdad Alemozaffar ◽  
Christina Day ◽  
Manju Aron ◽  
Jie Cai ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Surgical Margins ◽  
Positive Surgical Margins

scholarly journals Significance of nuclear factor kappa beta activation on prostate needle biopsy samples in the evaluation of Gleason score 6 prostatic carcinoma indolence

2019 ◽  
Author(s):  
Marko Zupančič ◽  
Boris Pospihalj ◽  
Snežana Cerović ◽  
Barbara Gazić ◽  
Primož Drev ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Needle Biopsy ◽  
Surgical Margins ◽  
Cutoff Point ◽  
Positive Surgical Margin ◽  
Pathological Stage ◽  
Positive Surgical Margins ◽  
Prostate Needle Biopsy ◽  
Biopsy Specimens

Abstract Background. Prostate cancer (PCa) is the most common cancer in men in developed European countries. Majority of men newly diagnosed with PCa are candidates for primary curative therapy, either with radical prostatectomy (RP) or radiation. However, many PCa are low risk, even indolent and these patients are candidates for active surveillance, so the prediction of such cancers is needed to avoid overtreatment. The main goal of our study was to find out whether the immunohistochemical expression of NF-κB p65 in biopsy samples with Gleason score 3+3=6 (GS 6) can be a negative predictive factor for PCa indolence. Methods. Study was based on a retrospective cohort of 178 PCa patients with initial total PSA ≤ 10 ng/ml, number of needle biopsy specimens ≥8, GS 6 on biopsy and T1/T2 estimated clinical stage who underwent laparoscopic radical prostatectomy and whose archived formalin-fixed and paraffin-embedded (FFPE) prostate needle biopsy specimens were used for additional immunohistochemistry staining for detection of NF-κβ p65. Both cytoplasmatic and nuclear NF-κB p65 expression in biopsy cores with PCa were correlated with postoperative pathological stage, positive surgical margins, GS and biochemical progression (BP) of disease. The final analysis involved 123 patients regarding the postoperative stage, surgical margins and GS and 118 regarding the BP. Results. Postoperative pathological stage 3 was noticed in 27 (22%) and positive surgical margins were detected in 13 patients (10,6%). After median follow-up of 66 months, BP (PSA ≥ 0,05 ng/ml) occurred in 20 (16,9%) patients, 11 (55%) with GS 6 after RP and 9 (45%) with GS 7. Cytoplasmatic nor nuclear NF-κB p65 expressions were not significantly associated with pathological stage, positive surgical margin and postoperative GS. Patients with positive cytoplasmic NF-kB reaction had significantly more BP compared to those with negative cytoplasmic NF-kB reaction with PSA 0,2 ng/ml as cutoff point (p=0,015) and a trend towards more BP with PSA ≥ 0,05 ng/ml as cutoff point (p=0,068). Conclusions. Cytoplasmic expression of NF-κB is associated with more BP and might be an independent prognostic factor for recurrence-free survival (RFS), but further studies including larger patient cohorts are needed to confirm these initial results.

The Impact of Positive Surgical Margins on Mortality Following Radical Prostatectomy During the Prostate Specific Antigen Era

2010 ◽  
Vol 183 (3) ◽  
pp. 1003-1009 ◽  
Author(s):  
Stephen A. Boorjian ◽  
R. Jeffrey Karnes ◽  
Paul L. Crispen ◽  
Rachel E. Carlson ◽  
Laureano J. Rangel ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Surgical Margins ◽  
Positive Surgical Margins ◽  
The Impact
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