Reporting positive surgical margins after radical prostatectomy: time for standardization

Authors

  • Philip A. Fontenot,

    1. Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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  • Ahmed M. Mansour

    Corresponding author
    1. Department of Urology, Urology and Nephrology Centre, Mansoura University, Mansoura, Egypt
    • Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
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Correspondence: Ahmed M. Mansour, Department of Urology, University of Miami Miller School of Medicine, 1400 NW 10th Avenue, Miami, FL 33136, USA.

e-mail: ahmedmansour1st@hotmail.com; amansour@mans.edu.eg

Abstract

What's known on the subject? and What does the study add?

  • It is known that positive surgical margins (PSMs) after radical prostatectomy (RP) in patients with prostate cancer are a significant predictor of biochemical recurrence (BCR). Furthermore, no general consensus exists in the literature on how specific PSM-associated prognostic variables, namely, location, focality, length, uniformity of specimen and Gleason score at the margin, influence BCR or assist in clinical decision-making.
  • The study shows the inconsistencies in the reporting of PSMs and PSM-associated prognostic variables in the current literature and suggests the implementation of a novel scoring system, the F.U.S.E. score, which quantifies the anatomical and pathological variables associated with PSMs and represents a standardized methodology for reporting PSMs in the literature.

Objectives

  • To assess the consistency of reporting on positive surgical margins (PSMs) and associated prognostic variables after radical prostatectomy (RP) in the current literature
  • To provide a standardized methodology for quantifying the characteristics and the prognostic impact of PSMs after RP.

Patients and Methods

  • We conducted a review of articles that assessed the prognostic value of characteristics of PSMs after RP. The articles were identified using a MEDLINE search.
  • The methodology and quality of the reporting of PSMs were analysed according to six criteria defined according to the guidelines of the College of American Pathologists and the International Society of Uropathologists.
  • Forty-four studies, involving ≥100 patients and published from January 2005 to the present, were reviewed.

Results

  • Each of the 44 studies was assessed for their reporting of the six defined PSM criteria, as well as for the significance of PSM characteristics on biochemical recurrence (BCR).
  • The definition of a PSM was the only criterion that was consistently reported.
  • All studies were deficient in defining and reporting one or more of the PSM criteria. Major inconsistencies were observed in the reporting of PSM site and length, and the presence of intraprostatic incision.
  • The many conflicting reports gave little insight into the true significance of particular PSM-associated variables on BCR.

Conclusions

  • There is a lack of consistency in the reporting on and prognostic significance of PSMs and PSM-associated prognostic variables.
  • We hypothesize that these conflicting results are partly attributable to a lack of use of a standardized reporting methodology for PSMs. Implementation of a previously reported standardized scoring system for PSMs may help eliminate these inconsistencies in the future.

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