Objective: To analyze positive surgical margins (PSM) after radical prostatectomy (RP) in the overall population and in patients previously treated with transurethral resection of the prostate (TURP). Materials and Methods: 2,408 patients treated with RP for clinically localized prostate cancer (PCa) were consecutively enrolled in 135 departments. We correlated PSM rates and all preoperative, surgical and pathological features. We stratified the site of PSM as unique or multifocal. Moreover, we analyzed differences between 75 patients who had undergone previous TURP and the remaining 2,333 patients. Results: In the entire study population, we identified 702 patients with PSM (29%). Using univariate analysis, we reported a significant correlation between overall PSM and prostate-specific antigen (PSA), stage cT, biopsy Gleason score, number of biopsy cores, number of positive cores, percentage of positive cores and nerve-sparing approach. PSM proved to be strongly dependent on pT in particular in patients with pT2 PCa. When we compared the data from 75 patients previously treated with TURP and those from 2,333 without previous prostatic surgery, a statistically significant difference in margin localization was found. Moreover, we analyzed the 75 patients mentioned above, stratified in incidental PCa diagnosed at TURP or PCa detected with prostate biopsy for PSA rising during the post-TURP follow-up: no statistical differences were found between the 2 groups regarding margin status, even if PSM were more frequent in incidental PCa with no significance deriving from the stratification for PSM location at the apex or base. Conclusion: Men treated with TURP before RP presented an overall incidence of PSM similar to those without previous TURP, but with a higher risk of PSM at the bladder neck and a lower risk of PSM at the prostatic apex.

Keywords:
Prostate cancer, Radical prostatectomy, Positive surgical margins, Transurethral prostate resection
1.
Jemal A, Siegel R, Ward E, et al: Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96.
2.
Ferlay J, Shin HR, Bray F, et al: GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC Cancer Base No 10. 2010. http://globocan.iarc.fr (accessed May 18, 2012).
3.
Maffezzini M: The magnitude of the problem and the burden of physicians and patients decisions. Surg Oncol 2009;18:183-184.
4.
Kanno H, Umemoto S, Izumi K, et al: Prostate cancer development after transurethral resection of the prostate: histopathological studies of radical prostatectomy specimens. Jpn J Urol 2006;97:649-659.
5.
Schaeffer EM, Loeb S, Walsh PC: The case for open radical prostatectomy. Urol Clin North Am 2010;37:49-55.
6.
Bianco FJ Jr, Scardino PT, Eastham JA: Radical prostatectomy: long-term cancer control and recovery of sexual and urinary function (‘trifecta'). Urology 2005;66:83-94.
7.
Palisaar JR, Wenske S, Sommerer F, et al: Open radical retropubic prostatectomy gives favourable surgical and functional outcomes after transurethral resection of the prostate. BJU Int 2009;104:611-615.
8.
Teber D, Cresswell J, Ates M, et al: Laparoscopic radical prostatectomy in clinical T1a and T1b prostate cancer: oncologic and functional outcomes - a matched-pair analysis. Urology 2009;73:577-581.
9.
Jaffe J, Stakhovsky O, Cathelineau X, et al: Surgical outcomes for men undergoing laparoscopic radical prostatectomy after transurethral resection of the prostate. J Urol 2007;178:483-487.
10.
Menard J, de la Taille A, Hoznek A, et al: Laparoscopic radical prostatectomy after transurethral resection of the prostate: surgical and functional outcomes. Urology 2008;72:593-597.
11.
Bott SR, Freeman AA, Stenning S, et al: Radical prostatectomy: pathology findings in 1,001 cases compared with other major series and over time. BJU Int 2005;95:34-39.
12.
Bright EA, Manuel C, Goddard JC, et al: Incidence and factors predicting the detection of prostate cancer after transurethral resection of the prostate for clinically benign disease. Urol Int 2009;83:171-174.
13.
Yossepowitch O, Bjartell A, Eastham JA, et al: Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol 2009;55:87-99.
14.
Blute ML, Bostwick DG, Bergstralh EJ, et al: Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. Urology 1997;50:733-739.
15.
Gettman MT, Blute ML: Radical prostatectomy: does surgical technique influence margin control? Urol Oncol 2010;28:219-225.
16.
Hernandez DJ, Epstein J, Trock BJ, et al: Radical retropubic prostatectomy. How often do experienced surgeons have positive surgical margins when there is extraprostatic extension in the region of the neurovascular bundle? J Urol 2005;173:446-449.
17.
Sofer M, Hamilton-Nelson KL, Schlesselman JJ, et al: Risk of positive margins and biochemical recurrence in relation to nerve-sparing radical prostatectomy. J Clin Oncol 2002;20:1853-1858.
18.
Palisaar RJ, Noldus J, Graefen M, et al: Influence of nerve-sparing (NS) procedure during radical prostatectomy (RP) on margin status and biochemical failure. Eur Urol 2005;47:176-184.
19.
Frota R, Stein RJ, Turna B, et al: Are prostate needle biopsies predictive of the laterality of significant cancer and positive surgical margins? BJU Int 2009;104:1599-1603.
20.
Do M, Haefer T, Liatsikos E, et al: Endoscopic extraperitoneal radical prostatectomy after previous transurethral resection of prostate: oncologic and functional outcomes of 100 cases. Urology 2010;75:1348-1352.
21.
Shelfo SW, Obek C, Soloway MS: Update on bladder neck preservation during radical retropubic prostatectomy: impact on pathologic outcome, anastomotic strictures, and continence. Urology 1998;51:73-78.
22.
McVary KT, Roehrborn CG, Avins AL, Barry MJ, Bruskewitz RC, Donnell RF, Foster HE Jr, Gonzalez CM, Kaplan SA, Penson DF, Ulchaker JC, Wei JT: Update on AUA guideline on the management of benign prostatic hyperplasia. J Urol 2011;185:1793-1803.
23.
Oelke M, Burger M, Castro-Diaz D, Chartier-Kastler E, Jimènez Cidre MA, McNicholas T, Radziszewski P, Kirby M: Diagnosis and medical treatment of lower urinary tract symptoms in adult men: applying specialist guidelines in clinical practice. BJU Int 2012;110: 710-718.
24.
Secin FP, Serio A, Bianco FJ Jr, et al: Preoperative and intraoperative risk factors for side-specific positive surgical margins in laparoscopic radical prostatectomy for prostate cancer. Eur Urol 2007;51:764-771.
25.
Stamey TA, Villers AA, McNeal JE, Link PC, Freiha FS: Positive surgical margins at radical prostatectomy: importance of apical dissection. J Urol 1990;143:1166-1173.
26.
Jones EC: Resection margin status in radical retropubic prostatectomy specimens: relationship to type of operation, tumor size, tumor grade and local tumor extension. J Urol 1990;144:89-93.
27.
Thompson I, Thrasher JB, Aus G, Burnett AL, Canby-Hagino ED, Cookson MS, D'Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen CM; AUA Prostate Cancer Clinical Guideline Update Panel: Guideline for the management of clinically localized prostate cancer: 2007 update. J Urol 2007;177:2106-2131.
28.
Donovan MJ, Khan FM, Bayer-Zubek V, Powell D, Costa J, Cordon-Cardo C: A systems-based modelling approach using transurethral resection of the prostate (TURP) specimens yielded incremental prognostic significance to Gleason when predicting long-term outcome in men with localized prostate cancer. BJU Int 2012;109:207-213.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.