Radical prostatectomy: Positive surgical margins matter

Joshua J. Meeks, James A. Eastham*

*Corresponding author for this work

Research output: Contribution to journalReview article

36 Citations (Scopus)

Abstract

Objective: A positive surgical margin (PSM) in the radical prostatectomy (RP) specimen is associated with biochemical recurrence (BCR) and the need for adjuvant radiation therapy, and is a surrogate for surgical quality. We review the available data describing the identification, anatomy, and management of PSM after RP. Methods: A PubMed search (using English language as a filter) was performed to identify factors affecting PSMs and their management. Results: PSMs are associated with an increased likelihood of BCR after RP. The most common location for a PSM is the apex, followed by the posterolateral edge of the prostate. The risk of recurrence in a patient with a PSM is associated with the location, length, and Gleason score of the PSM. The management of a patient with a PSM remains controversial, with some recommending adjuvant radiation therapy for all PSMs and others suggesting only salvage radiation therapy for men who experience BCR. Conclusions: PSMs are associated with an increased likelihood of BCR and often result in initiation of adjuvant treatment. Therefore, the goal of surgery should be to minimize the likelihood of a PSM.

Original languageEnglish (US)
Pages (from-to)974-979
Number of pages6
JournalUrologic Oncology: Seminars and Original Investigations
Volume31
Issue number7
DOIs
StatePublished - Oct 1 2013

Fingerprint

Prostatectomy
Recurrence
Radiotherapy
Salvage Therapy
Neoplasm Grading
Margins of Excision
PubMed
Prostate
Anatomy
Language

Keywords

  • Biochemical recurrence
  • Positive surgical margins
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

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title = "Radical prostatectomy: Positive surgical margins matter",
abstract = "Objective: A positive surgical margin (PSM) in the radical prostatectomy (RP) specimen is associated with biochemical recurrence (BCR) and the need for adjuvant radiation therapy, and is a surrogate for surgical quality. We review the available data describing the identification, anatomy, and management of PSM after RP. Methods: A PubMed search (using English language as a filter) was performed to identify factors affecting PSMs and their management. Results: PSMs are associated with an increased likelihood of BCR after RP. The most common location for a PSM is the apex, followed by the posterolateral edge of the prostate. The risk of recurrence in a patient with a PSM is associated with the location, length, and Gleason score of the PSM. The management of a patient with a PSM remains controversial, with some recommending adjuvant radiation therapy for all PSMs and others suggesting only salvage radiation therapy for men who experience BCR. Conclusions: PSMs are associated with an increased likelihood of BCR and often result in initiation of adjuvant treatment. Therefore, the goal of surgery should be to minimize the likelihood of a PSM.",
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Radical prostatectomy : Positive surgical margins matter. / Meeks, Joshua J.; Eastham, James A.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 31, No. 7, 01.10.2013, p. 974-979.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Radical prostatectomy

T2 - Positive surgical margins matter

AU - Meeks, Joshua J.

AU - Eastham, James A.

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Objective: A positive surgical margin (PSM) in the radical prostatectomy (RP) specimen is associated with biochemical recurrence (BCR) and the need for adjuvant radiation therapy, and is a surrogate for surgical quality. We review the available data describing the identification, anatomy, and management of PSM after RP. Methods: A PubMed search (using English language as a filter) was performed to identify factors affecting PSMs and their management. Results: PSMs are associated with an increased likelihood of BCR after RP. The most common location for a PSM is the apex, followed by the posterolateral edge of the prostate. The risk of recurrence in a patient with a PSM is associated with the location, length, and Gleason score of the PSM. The management of a patient with a PSM remains controversial, with some recommending adjuvant radiation therapy for all PSMs and others suggesting only salvage radiation therapy for men who experience BCR. Conclusions: PSMs are associated with an increased likelihood of BCR and often result in initiation of adjuvant treatment. Therefore, the goal of surgery should be to minimize the likelihood of a PSM.

AB - Objective: A positive surgical margin (PSM) in the radical prostatectomy (RP) specimen is associated with biochemical recurrence (BCR) and the need for adjuvant radiation therapy, and is a surrogate for surgical quality. We review the available data describing the identification, anatomy, and management of PSM after RP. Methods: A PubMed search (using English language as a filter) was performed to identify factors affecting PSMs and their management. Results: PSMs are associated with an increased likelihood of BCR after RP. The most common location for a PSM is the apex, followed by the posterolateral edge of the prostate. The risk of recurrence in a patient with a PSM is associated with the location, length, and Gleason score of the PSM. The management of a patient with a PSM remains controversial, with some recommending adjuvant radiation therapy for all PSMs and others suggesting only salvage radiation therapy for men who experience BCR. Conclusions: PSMs are associated with an increased likelihood of BCR and often result in initiation of adjuvant treatment. Therefore, the goal of surgery should be to minimize the likelihood of a PSM.

KW - Biochemical recurrence

KW - Positive surgical margins

KW - Prostate cancer

KW - Radical prostatectomy

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