Biochemical Recurrence Rate In Patients With Positive Surgical Margins At Radical Prostatectomy With Further Negative Resected Tissue

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 26 Oct 2009 - 4:00 PDT

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UroToday.com - At the time of radical prostatectomy (RP) for prostate cancer, a positive surgical margin (SM) increases the likelihood of PSA biochemical recurrence (BCR). Some surgeons use frozen section analysis at the time of surgery, and if positive, then resect more periprostatic tissue. In the September 2009 of the British Journal of Urology International, Dr. Farhang Rabbani and colleagues from Memorial Sloan Kettering Cancer Center address what the outcomes are for patients who have additional tissue resected at the time of RP.

Of 4,217 patients eligible for analysis, 98 were identified as having a positive SM (PSM) with additional resected tissue from the prostate bed. For the final analysis, 2,659 men had a negative SM (NSM), 216 had a positive frozen section with negative periprostatic tissue in the additional resected tissue (M+-). Further periprostatic tissue was sent for pathological review in 56 men with PSM and organ confined disease and 43 men with PSM and ECE alone. At the time of surgery in these 98 patients, tissue was sent for routine pathologic analysis in 24 men and for frozen section analysis in 74. In patients with organ-confined disease who had further tissue resection, 27 (49%) were rendered negative (M-) by further resection. In men with organ-confined cancer, the mean 36-month actuarial BCR-free probability was 97.9% for M- vs. 89.0% for M+ vs. 100% for M+-. In 43 patients with extracapsular extension, 12 men (28%) were rendered M- by further resection. For men with ECE, the mean 36-month actuarial BCR-free probability was 82.7% for M- vs. 73.7% for M+ vs. 90% for M+-.

In this study 38 of 98 patients had no further cancer in the resected tissue. In men whose additional resected tissue rendered the final margin status to M+-, the BCR was improved. Although the study was ultimately limited by the small number of men who had circumstances fitting the eligibility criteria, it is an intraoperative surgical strategy that deserves consideration. A final variable to consider however is the accuracy of intraoperative frozen section analysis, which varies among institutions.

Rabbani F, Vora KC, Yunis LH, Eastham JA, Guillonneau B, Scardino PT, Touijer K
BJU Int. 2009 Sep;104(5):605-10
10.1111/j.1464-410X.2009.08757.x

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

"Biochemical recurrence rate in patients with positive surgical margins at radical prostatectomy with further negative resected tissue - Abstract"
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