Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences

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Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences. / Yossepowitch, Ofer; Bjartell, Anders; Eastham, James A.; Graefen, Markus; Guillonneau, Bertrand D.; Karakiewicz, Pierre I.; Montironi, Rodolfo; Montorsi, Franceso.

I: European Urology, Vol. 55, Nr. 1, 2009, s. 87-99.

Forskningsoutput: TidskriftsbidragÖversiktsartikel

Harvard

Yossepowitch, O, Bjartell, A, Eastham, JA, Graefen, M, Guillonneau, BD, Karakiewicz, PI, Montironi, R & Montorsi, F 2009, 'Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences', European Urology, vol. 55, nr. 1, s. 87-99. https://doi.org/10.1016/j.eururo.2008.09.051

APA

Yossepowitch, O., Bjartell, A., Eastham, J. A., Graefen, M., Guillonneau, B. D., Karakiewicz, P. I., Montironi, R., & Montorsi, F. (2009). Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences. European Urology, 55(1), 87-99. https://doi.org/10.1016/j.eururo.2008.09.051

CBE

Yossepowitch O, Bjartell A, Eastham JA, Graefen M, Guillonneau BD, Karakiewicz PI, Montironi R, Montorsi F. 2009. Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences. European Urology. 55(1):87-99. https://doi.org/10.1016/j.eururo.2008.09.051

MLA

Vancouver

Author

Yossepowitch, Ofer ; Bjartell, Anders ; Eastham, James A. ; Graefen, Markus ; Guillonneau, Bertrand D. ; Karakiewicz, Pierre I. ; Montironi, Rodolfo ; Montorsi, Franceso. / Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences. I: European Urology. 2009 ; Vol. 55, Nr. 1. s. 87-99.

RIS

TY - JOUR

T1 - Positive Surgical Margins in Radical Prostatectomy: Outlining the Problem and Its Long-Term Consequences

AU - Yossepowitch, Ofer

AU - Bjartell, Anders

AU - Eastham, James A.

AU - Graefen, Markus

AU - Guillonneau, Bertrand D.

AU - Karakiewicz, Pierre I.

AU - Montironi, Rodolfo

AU - Montorsi, Franceso

PY - 2009

Y1 - 2009

N2 - Context: This review focuses on positive surgical margins (PSM) in radical prostatectomy (RP). Objective: To address the etiology, incidence, and oncologic impact of PSM and discuss technical points to help surgeons minimize their positive margin rate. An evidence-based approach to assist clinicians in counseling patients with a PSM is provided. Evidence acquisition: A literature search in English was performed using the National Library of Medicine database and the following key words: prostate cancer, surgical margins, and radical prostatectomy. Seven hundred sixty-eight references were scrutinized, and 73 were selected for rigorous review based on their pertinence, study size, and overall contribution to the field. Evidence synthesis: In contemporary series, PSM are reported in 11-38% of patients undergoing RP. Although variability exists in the pathologic interpretation of surgical margins, PSM are associated with an increased hazard of biochemical recurrence (BCR) and local disease recurrence as well as the need for secondary cancer treatment. A posterolateral PSM appears to confer the greatest risk of recurrence, whereas the prognostic significance of positive apical margins remains controversial. The role of preoperative imaging and intraoperative frozen section analysis are being investigated to reduce margin positivity rates. Level-1 evidence indicates that adjuvant radiotherapy (RT) in men with PSM reduces BCR rates and clinical progression and possibly improves overall survival (OS). Conclusions: PSM in RP specimens are uniformly considered an adverse outcome. Regardless of approach (open or laparoscopic), attention to surgical detail is essential to minimize rates. For patients with a PSM destined to experience a cancer recurrence, RT is the only established treatment with curative potential. A randomized trial in patients with PSM comparing immediate postoperative RT to salvage RT is critically needed before definitive recommendations can be made. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.

AB - Context: This review focuses on positive surgical margins (PSM) in radical prostatectomy (RP). Objective: To address the etiology, incidence, and oncologic impact of PSM and discuss technical points to help surgeons minimize their positive margin rate. An evidence-based approach to assist clinicians in counseling patients with a PSM is provided. Evidence acquisition: A literature search in English was performed using the National Library of Medicine database and the following key words: prostate cancer, surgical margins, and radical prostatectomy. Seven hundred sixty-eight references were scrutinized, and 73 were selected for rigorous review based on their pertinence, study size, and overall contribution to the field. Evidence synthesis: In contemporary series, PSM are reported in 11-38% of patients undergoing RP. Although variability exists in the pathologic interpretation of surgical margins, PSM are associated with an increased hazard of biochemical recurrence (BCR) and local disease recurrence as well as the need for secondary cancer treatment. A posterolateral PSM appears to confer the greatest risk of recurrence, whereas the prognostic significance of positive apical margins remains controversial. The role of preoperative imaging and intraoperative frozen section analysis are being investigated to reduce margin positivity rates. Level-1 evidence indicates that adjuvant radiotherapy (RT) in men with PSM reduces BCR rates and clinical progression and possibly improves overall survival (OS). Conclusions: PSM in RP specimens are uniformly considered an adverse outcome. Regardless of approach (open or laparoscopic), attention to surgical detail is essential to minimize rates. For patients with a PSM destined to experience a cancer recurrence, RT is the only established treatment with curative potential. A randomized trial in patients with PSM comparing immediate postoperative RT to salvage RT is critically needed before definitive recommendations can be made. (C) 2008 European Association of Urology. Published by Elsevier B.V. All rights reserved.

KW - Endorectal MRI

KW - section analysis

KW - Frozen

KW - Radiation therapy

KW - Biochemical recurrence

KW - PSA

KW - Nerve sparing

KW - Radical prostatectomy

KW - Prostate cancer

KW - Positive surgical margins

U2 - 10.1016/j.eururo.2008.09.051

DO - 10.1016/j.eururo.2008.09.051

M3 - Review article

C2 - 18838211

VL - 55

SP - 87

EP - 99

JO - European Urology

JF - European Urology

SN - 0302-2838

IS - 1

ER -