Significant reduction of positive surgical margin rate following Laparoscopic Radical Prostatectomy by application of the modified surgical margin recommendations according to the International Society of Urological Pathology (ISUP) consensus 2009.

OBJECTIVES - To retrospectively verify the exact margin status and analyze the location and characteristics of positive surgical margins (PSM) in radical prostatectomy patients by a central pathology review based on the consensus conference 2009 updated margin criteria from the International Society of Urological Pathology (ISUP).

MATERIALS AND METHODS - Detailed PSM characteristics of 441 patients who underwent laparoscopic radical prostatectomy (LRP) between 1999 and 2007 were centrally reviewed with regard to location, number, Gleason score at the PSM and tumor width. Predictors of PSM and the impact of several PSM-characteristics on clinical outcome were examined. Patient characteristics were compared by using chi square test. Differences in recurrence-free-survival (RFS) were analyzed with the log-rank test and displayed by Kaplan-Meier survival curves. Uni- and multivariable cox regression analysis for the prediction of RFS was performed.

RESULTS - Central pathology review including the updated PSM definition according to ISUP 2009 reclassified a substantial number of patients (n=113, 26.6%). with PSM as R0. Several PSM characteristics with a higher risk for BCR were identified: Pathological stage, Gleason score and the presence of multiple PSM (HR 1.78; 95% CI 1.08-2.96; p=0.025) were the strongest independent predictors of RFS. Further analysis replacing the location of PSM by the width categories of PSM revealed that PSM >3mm were independent predictors of RFS (HR 1.72; 95% CI 1.08-2.72; p=0.022).

CONCLUSIONS - The impact of PSM following LRP for prostate cancer remains unclear. PSM in our LRP cohort inherit different characteristics and risks for BCR. A better understanding of PSM characteristics and a careful standardized pathological evaluation is needed to adequately counsel patients with respect to prognosis and adjuvant therapy following LRP. This article is protected by copyright. All rights reserved.

BJU international. 2016 Feb 24 [Epub ahead of print]

A Maxeiner, A Magheli, K Jöhrens, E Kilic, T L Braun, C Kempkensteffen, S Hinz, C Stephan, K Miller, J Busch

Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Pathology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Pathology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany., Charité Universitaetsmedizin Berlin, Department of Urology, Berlin, Germany.

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