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. 2014 Oct;30(4):423-8.
doi: 10.4103/0970-1591.134240.

Significance and management of positive surgical margins at the time of radical prostatectomy

Jonathan L Silberstein  1 , James A Eastham  2
Affiliations

Significance and management of positive surgical margins at the time of radical prostatectomy

Jonathan L Silberstein et al. Indian J Urol. 2014 Oct.

Abstract

Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

Keywords: Biochemical recurrence; prostate cancer; radical prostatectomy; robotic; surgical margin.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
(a) Prostatectomy specimen demonstrating extraprostatic extension with tumor extending beyond the capsule of the prostate and a positive surgical margin (pT3a+). (b) Prostatectomy specimen demonstrating an organ confined tumor with tumor extending to the inked margin due to capsular incision (pT2+) (Figure adapted from Meeks and Eastham[13])
Figure 2
Figure 2
Kaplan-Meier curve demonstrating BCR according to SM status based on the collected data from 7816 consecutively treated patients from eight institutions. PSM are associated with greater rates of BCR over time, adapted from Karakiewicz et al.[4]
See this image and copyright information in PMC

References

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