POSITIVE MARGIN: Edge of a surgical specimen that is involved with the disease process. This is found when a prostatectomy is performed and the gland is inked by the pathologist and cancer is found around the edge of the gland.
For most solid tumors, the absence of tumor cells at the inked resection margin is considered an important feature of successful cancer surgery. For prostate cancer, however, there is some controversy regarding their prognostic significance.
It may be wise, since the experts may disagree, to error on the safe side and treat it as a negative indicator of faster recurrence and treat it as a more advanced disease. It would seem that most doctors would consider them as a negative in the diagnosis. This does not mean no cure but might indicate that radiation should be given to the prostate bed after surgery.
Radical prostatectomy with positive surgical margins: how are patients managed?
RAMESH THURAIRAJA, JONATHAN OSBORN*, JONATHAN MCFARLANE†,
AMIT BAHL‡ and RAJENDRA PERSAD
Departments of Urology, Bristol Royal Infirmary, Bristol, *Weston General Hospital, Weston
super-Mare, †Royal United Hospital, Bath and ‡Department of Oncology, Bristol Royal Infirmary,
Bristol, UK
Accepted for publication 29 September 2005
INTRODUCTION
The last decade has seen a trend towards organ-confined prostate cancer, primarily due to the widespread use of PSA testing [1]. As a result, local treatment options such as brachytherapy, cryotherapy, radiotherapy and radical prostatectomy (RP) are used increasingly. The aim of RP is to completely excise the prostate, with clear margins. However, despite the availability of pretreatment staging and predictive
nomograms, . . . .
To read the balance of the complete study click "here".
Positive surgical margins increase the risk of biochemical recurrence independently from pathological stage or grade.
Abstract No: 314
Author(s): A. Gallina, J. Walz, J. A. Eastham, P. T. Scardino, E. Klein, A. Reuther, M. Graefen, H. Huland, P. Perrotte, P. I. Karakiewicz
Abstract: Introduction and Objective: Positive surgical margins (+SM) status at radical prostatectomy are a well known prognostic factor for biochemical recurrence after radical prostatectomy (RP). However, some have questioned the value of +SM in either clearly favorable or clearly unfavorable prostate cancer (PCa) patients. We tested the effect of +SM on the rate of BCR-free survival in patients with either clearly favorable or clearly unfavorable pathological characteristics. Methods: Clinical and pathological data were available for 8,620 patients from 1 European and 2 North American referral centers, subjected to retropubic RP between 1987 and 2006. Patients were stratified between favorable (PSA <10 ng/mL, RP Gleason sum <6, no extracapsular extension [ECE], no seminal vesicle invasion [SVI] and no lymph node invasion [LNI]), unfavorable (PSA >20 ng/mL or RP Gleason sum 8-10 and SVI or LNI) and intermediate (all remaining patients) pathological characteristics. Kaplan-Meier and Cox regression analyses addressed the rate of BCR after RP in each stratum. Results: At RP, 2,474 (28.7%), 5,267 (61.1%) and 879 (10.2%) patients were classified as favorable, intermediate and unfavorable PCa patients, respectively. In favorable patients, +SM conferred a 4.3 fold increase in the risk of BCR (p<0.001) vs. a 2.3-fold increase (p<0.001) in intermediate patients vs. a 1.5-fold increase in unfavorable patients. Conclusions: Patients with positive surgical margins have a statistically significant lower BCR-free survival, across all pathological stages.
From http://tinyurl.com/2bzn2v.
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Erectile Dysfunction
Brachytherapy / Seed Implants
Hormonal Ablation Treatment
Radiation External - All Kinds
Surgical Removal - All Kinds
Watchful Waiting
Other Conventional Treatments
