L Cormier1, C Bastide2, P Beuzeboc3, G Fromont4, C Hennequin5, P Mongiat-Artus6, M Peyromaure7, G Ploussard8, R Renard-Penna9, P Richaud10, F Rozet11, M Soulié12, L Salomon13. 1. Sous-comité « prostate » du CCAFU, hôpital du Bocage, CHU de Dijon, 14, rue Gaffarel, BP 77908, 21079 Dijon cedex, France. Electronic address: luc.cormier@chu-dijon.fr. 2. Sous-comité « prostate » du CCAFU, CHU de Marseille, 13015 Marseille, France. Electronic address: cyrille.bastide@ap-hm.fr. 3. Sous-comité « prostate » du CCAFU, institut Curie, 75248 Paris, France. Electronic address: philippe.beuzeboc@curie.net. 4. Sous-comité « prostate » du CCAFU, CHU de Tours, 37044 Tours, France. Electronic address: gaelle.fromont-hankard@univ-tours.fr. 5. Sous-comité « prostate » du CCAFU, CHU Saint-Louis, 75475 Paris, France. Electronic address: christophe.hennequin@sls.aphp.fr. 6. Sous-comité « prostate » du CCAFU, CHU Saint-Louis, 75475 Paris, France. Electronic address: pierre.mongiat-artus@sls.aphp.fr. 7. Sous-comité « prostate » du CCAFU, CHU de Cochin, 75014 Cochin, France. Electronic address: michael.peyromaure@cch.aphp.fr. 8. Sous-comité « prostate » du CCAFU, CHU Saint-Louis, 75475 Paris, France. Electronic address: g.ploussard@gmail.com. 9. Sous-comité « prostate » du CCAFU, CHU La Pitié, 75013 Paris, France. Electronic address: raphaele.renardpenna@psl.aphp.fr. 10. Sous-comité « prostate » du CCAFU, institut Bergonié, 33076 Bordeaux, France. Electronic address: p.richaud@bordeaux.unicancer.fr. 11. Sous-comité « prostate » du CCAFU, institut Monstsouris, 75014 Paris, France. Electronic address: francois.rozet@imm.fr. 12. Sous-comité « prostate » du CCAFU, CHU de Toulouse, 31403 Toulouse, France. Electronic address: soulie.m@chu-toulouse.fr. 13. Sous-comité « prostate » du CCAFU, CHU Mondor, 94010 Paris, France. Electronic address: laurent.salomon@hmn.aphp.fr.
Abstract
OBJECTIVE: Literature showed the impact of surgical margin status on prognosis after radical prostatectomy (mostly on biochemical survival). Margin status is an easy self-evaluation of surgical practice to assess. The aim of this paper was to define what a positive surgical margin (PSM) is and how to prevent the occurrence, to precise the impact on survival and how to treat. METHOD: A literature analysis with Pubmed has been performed to 2012, furthermore conclusions of the main congresses with selection committee and review publication have also been studied. RESULTS: PSM is defined as "tumor cells touching the ink on the specimen edge". The most frequent reported incidence is between 15 to 20%. Margin status remains one of the major criteria to determine the need of adjuvant radiotherapy after surgery. Quality of life is not or only lightly modified by radiotherapy with the current techniques. Adjuvant radiotherapy improves biological survival but is synonymous with overtreatment in many times. Salvage radiotherapy has to be quickly performed after Prostate Specific Antigen (PSA) relapse (PSA<1 ng/mL even<0.5 ng/mL). CONCLUSION: This literature review did not allow to suggest superiority of one surgical technique over another. In the same way, the kind of dissection i.e. bladder neck or neurovascular bundle preservation does no clearly modify PSM rate. However, it seems logical to "customize" dissection according to prostate cancer characteristics (D'Amico criteria for instance) guided with multiparametric MRI. Intrafascial dissection has to be applied only to low risk. Lastly, the debate between adjuvant or salvage radiotherapy is always ongoing.
OBJECTIVE: Literature showed the impact of surgical margin status on prognosis after radical prostatectomy (mostly on biochemical survival). Margin status is an easy self-evaluation of surgical practice to assess. The aim of this paper was to define what a positive surgical margin (PSM) is and how to prevent the occurrence, to precise the impact on survival and how to treat. METHOD: A literature analysis with Pubmed has been performed to 2012, furthermore conclusions of the main congresses with selection committee and review publication have also been studied. RESULTS: PSM is defined as "tumor cells touching the ink on the specimen edge". The most frequent reported incidence is between 15 to 20%. Margin status remains one of the major criteria to determine the need of adjuvant radiotherapy after surgery. Quality of life is not or only lightly modified by radiotherapy with the current techniques. Adjuvant radiotherapy improves biological survival but is synonymous with overtreatment in many times. Salvage radiotherapy has to be quickly performed after Prostate Specific Antigen (PSA) relapse (PSA<1 ng/mL even<0.5 ng/mL). CONCLUSION: This literature review did not allow to suggest superiority of one surgical technique over another. In the same way, the kind of dissection i.e. bladder neck or neurovascular bundle preservation does no clearly modify PSM rate. However, it seems logical to "customize" dissection according to prostate cancer characteristics (D'Amico criteria for instance) guided with multiparametric MRI. Intrafascial dissection has to be applied only to low risk. Lastly, the debate between adjuvant or salvage radiotherapy is always ongoing.