Positive surgical margins after radical prostatectomy: a systematic review and contemporary update
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Positive surgical margins after radical prostatectomy: a systematic review and contemporary update. / Yossepowitch, Ofer; Briganti, Alberto; Eastham, James A; Epstein, Jonathan; Graefen, Markus; Montironi, Rodolfo; Touijer, Karim.
in: EUR UROL, Jahrgang 65, Nr. 2, 01.02.2014, S. 303-313.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Positive surgical margins after radical prostatectomy: a systematic review and contemporary update
AU - Yossepowitch, Ofer
AU - Briganti, Alberto
AU - Eastham, James A
AU - Epstein, Jonathan
AU - Graefen, Markus
AU - Montironi, Rodolfo
AU - Touijer, Karim
N1 - Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
PY - 2014/2/1
Y1 - 2014/2/1
N2 - CONTEXT: The clinical significance of positive surgical margins (PSMs) in radical prostatectomy (RP) specimens and the management of affected patients remain unclear.OBJECTIVE: To address pitfalls in the pathologic interpretation of margin status; provide an update on the incidence, predictors, and long-term oncologic implications of PSMs in the era of robot-assisted laparoscopic RP (RALRP); and suggest a practical evidence-based approach to patient management.EVIDENCE ACQUISITION: A systematic review of the literature was performed in April 2013 using Medline/PubMed, Web of Science, and Scopus databases and the Cochrane Database of Systematic Reviews. Studies focusing on PSMs in RP pertinent to the objectives of this review were included. Particular attention was paid to publications within the last 5 yr and those concerning RALRP.EVIDENCE SYNTHESIS: A total of 74 publications were retrieved. Standardized measures to overcome variability in the pathologic interpretation of surgical margins have recently been established by the International Society of Urological Pathology. The average rate of PSMs in contemporary RALRP series is 15% (range: 6.5-32%), which is higher in men with a more advanced pathologic stage and equivalent to the rate reported in prior open and laparoscopic prostatectomy series. The likelihood of PSMs is strongly influenced by the surgeon's experience irrespective of the surgical approach. Technical modifications using the robotic platform and the role of frozen-section analysis to reduce the margin positivity rate continue to evolve. Positive margins are associated with a twofold increased hazard of biochemical relapse, but their association with more robust clinical end points is controversial. Level 1 evidence suggests that adjuvant radiation therapy (RT) may favorably affect prostate-specific antigen recurrence rates, but whether the therapy also affects systemic progression, prostate cancer-specific mortality, and overall survival remains debatable.CONCLUSIONS: Although positive margins in prostate cancer are considered an adverse oncologic outcome, their long-term impact on survival is highly variable and largely influenced by other risk modifiers. Adjuvant RT appears to be effective, but further study is required to determine whether early salvage RT is an equivalent alternative.
AB - CONTEXT: The clinical significance of positive surgical margins (PSMs) in radical prostatectomy (RP) specimens and the management of affected patients remain unclear.OBJECTIVE: To address pitfalls in the pathologic interpretation of margin status; provide an update on the incidence, predictors, and long-term oncologic implications of PSMs in the era of robot-assisted laparoscopic RP (RALRP); and suggest a practical evidence-based approach to patient management.EVIDENCE ACQUISITION: A systematic review of the literature was performed in April 2013 using Medline/PubMed, Web of Science, and Scopus databases and the Cochrane Database of Systematic Reviews. Studies focusing on PSMs in RP pertinent to the objectives of this review were included. Particular attention was paid to publications within the last 5 yr and those concerning RALRP.EVIDENCE SYNTHESIS: A total of 74 publications were retrieved. Standardized measures to overcome variability in the pathologic interpretation of surgical margins have recently been established by the International Society of Urological Pathology. The average rate of PSMs in contemporary RALRP series is 15% (range: 6.5-32%), which is higher in men with a more advanced pathologic stage and equivalent to the rate reported in prior open and laparoscopic prostatectomy series. The likelihood of PSMs is strongly influenced by the surgeon's experience irrespective of the surgical approach. Technical modifications using the robotic platform and the role of frozen-section analysis to reduce the margin positivity rate continue to evolve. Positive margins are associated with a twofold increased hazard of biochemical relapse, but their association with more robust clinical end points is controversial. Level 1 evidence suggests that adjuvant radiation therapy (RT) may favorably affect prostate-specific antigen recurrence rates, but whether the therapy also affects systemic progression, prostate cancer-specific mortality, and overall survival remains debatable.CONCLUSIONS: Although positive margins in prostate cancer are considered an adverse oncologic outcome, their long-term impact on survival is highly variable and largely influenced by other risk modifiers. Adjuvant RT appears to be effective, but further study is required to determine whether early salvage RT is an equivalent alternative.
KW - Disease Progression
KW - Frozen Sections
KW - Humans
KW - Laparoscopy
KW - Male
KW - Neoplasm Recurrence, Local
KW - Neoplasm, Residual
KW - Predictive Value of Tests
KW - Prostatectomy
KW - Prostatic Neoplasms
KW - Radiotherapy, Adjuvant
KW - Risk Factors
KW - Salvage Therapy
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.eururo.2013.07.039
DO - 10.1016/j.eururo.2013.07.039
M3 - SCORING: Journal article
C2 - 23932439
VL - 65
SP - 303
EP - 313
JO - EUR UROL
JF - EUR UROL
SN - 0302-2838
IS - 2
ER -