The Gleason Score of Tumor at the Margin in Radical Prostatectomy is Predictive of Biochemical Recurrence

Gleason grading system is recommended by World Health Organization to grade prostate carcinoma. The Gleason score of the main tumor in prostate carcinoma is a powerful predictive factor for biochemical recurrence, but the significance of the Gleason score of tumor at the margin is unknown. In this study we aimed to investigate this subject in 336 patients (mean age 61 y, median 61, range 39 to 80; mean follow-up 41 mo, median 32, range 1 to 202) with a positive surgical margin in radical prostatectomy. The mean preoperative prostate specific antigen level was 8.2 ng/mL (median 5.8, range 0.9 to 85.0). The pathologic stage was T2, T3a, and T3b in 185, 127, and 24 patients, respectively. The Gleason score of the main tumor was 6, 7, 8, and 9 in 70 (all 3+3), 242 (3+4 in 186, 4+3 in 56), 8 (5+3 in 1, 4+4 in 7), and 16 (4+5 in 12, 5+4 in 4) patients, respectively. The Gleason score of the tumor at the margin was 6 in 220 (66%, all 3+3), 7 in 88 (26%, 3+4 in 59, 4+3 in 29), 8 in 19 (6%, all 4+4), 9 in 7 (2%, 4+5 in 4, 5+4 in 3), and 10 in 2 (1%) cases, respectively. The Gleason score concordance rate between the main tumor and the tumor at the margin was 69/70 (99%), 83/242 (34%), 5/8 (63%), and 6/16 (38%) in cases in which the main tumor had a Gleason score 6, 7, 8, and 9, respectively. The Gleason score of the tumor at the margin was lower, equal to, and higher than that of the main tumor in 160 (48%), 163 (49%), and 13 (4%) cases, respectively. The Gleason score of the tumor at the margin was strongly correlated with preoperative prostate-specific antigen, pathologic stage, the Gleason score of the main tumor, lymph node status, and the linear length of the tumor at the margin (P<0.05 for all). On both univariate and multivariate analysis, the Gleason score of the tumor at the margin was a strong predictive factor for biochemical recurrence (P<0.05). Among the patients with the same Gleason score in their main tumors (7 or above), those with a higher Gleason score of the tumor at the margin more likely had biochemical recurrence than those with a lower one. Reporting the Gleason score of the tumor at the margin can improve predictive accuracy of biochemical recurrence. We advocate reporting the Gleason score of tumor at the margin in radical prostatectomy.

[1]  H. Lepor,et al.  Is the apical soft tissue margin a better predictor of biochemical recurrence than the surgical specimen? , 2011, Urologic oncology.

[2]  B. Trock,et al.  Salvage or adjuvant radiation therapy: counseling patients on the benefits. , 2010, Journal of the National Comprehensive Cancer Network : JNCCN.

[3]  S. Herrell,et al.  Impact of positive apical surgical margins on likelihood of biochemical recurrence after radical prostatectomy. , 2009, The Journal of urology.

[4]  S. Sonnad,et al.  Defining pathological variables to predict biochemical failure in patients with positive surgical margins at radical prostatectomy: implications for adjuvant radiotherapy , 2009, BJU international.

[5]  A. Renshaw,et al.  Protocol for the examination of specimens from patients with carcinoma of the prostate gland. , 2009, Archives of pathology & laboratory medicine.

[6]  M. Kattan,et al.  Location, extent and number of positive surgical margins do not improve accuracy of predicting prostate cancer recurrence after radical prostatectomy. , 2009, The Journal of urology.

[7]  A. Shalhav,et al.  Length of positive surgical margin after radical prostatectomy as a predictor of biochemical recurrence. , 2009, The Journal of urology.

[8]  N. Willich,et al.  Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in pT3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. , 2009, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  P. Troncoso,et al.  Natural history of biochemical progression after radical prostatectomy based on length of a positive margin. , 2008, Urology.

[10]  P. Scardino,et al.  Prognostic significance of location of positive margins in radical prostatectomy specimens. , 2007, Urology.

[11]  P. Walsh,et al.  The significance of positive surgical margin in areas of capsular incision in otherwise organ confined disease at radical prostatectomy. , 2007, The Journal of urology.

[12]  R. Montironi,et al.  The relationship between the extent of surgical margin positivity and prostate specific antigen recurrence in radical prostatectomy specimens. , 2007, Human pathology.

[13]  E. Messing,et al.  Adjuvant radiotherapy for pathologically advanced prostate cancer: a randomized clinical trial. , 2006, JAMA.

[14]  T. H. van der Kwast,et al.  The actual value of the surgical margin status as a predictor of disease progression in men with early prostate cancer. , 2006, European urology.

[15]  M. Zelefsky.  Postoperative radiotherapy after radical prostatectomy: A randomised controlled trial (EORTC trial 22911) , 2006 .

[16]  A. Bjartell,et al.  Words of wisdom. The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma. , 2006, European urology.

[17]  L. Cheng,et al.  The influence of extent of surgical margin positivity on prostate specific antigen recurrence , 2005, Journal of Clinical Pathology.

[18]  L. Egevad,et al.  The 2005 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma , 2005, The American journal of surgical pathology.

[19]  M. Piérart,et al.  Postoperative radiotherapy after radical prostatectomy: a randomised controlled trial (EORTC trial 22911) , 2005, The Lancet.

[20]  I. Sesterhenn,et al.  World health organization classifications of tumours. pathology and genetics of tumours of the urinary system and male genital organs , 2005 .

[21]  R. Manecksha,et al.  Positive apical surgical margins after radical retropubic prostatectomy, truth or artefact? , 2004, Scandinavian journal of urology and nephrology.

[22]  A. Partin,et al.  Probability of biochemical recurrence by analysis of pathologic stage, Gleason score, and margin status for localized prostate cancer. , 2003, Urology.

[23]  B. Norlén,et al.  Postoperative Radiotherapy after Prostatectomy A Review , 2003, Scandinavian journal of urology and nephrology.

[24]  E. Bergstralh,et al.  Prognostic significance of positive surgical margins in patients with extraprostatic carcinoma after radical prostatectomy , 2002, Cancer.

[25]  K. Hamilton-Nelson,et al.  Positive surgical margins after radical retropubic prostatectomy: the influence of site and number on progression. , 2002, The Journal of urology.

[26]  D. Johnston,et al.  Outcome of patients with Gleason score 8 or higher prostate cancer following radical prostatectomy alone. , 2002, The Journal of urology.

[27]  Michael W Kattan,et al.  Cancer control with radical prostatectomy alone in 1,000 consecutive patients. , 2002, The Journal of urology.

[28]  A. Partin,et al.  Long-term biochemical disease-free and cancer-specific survival following anatomic radical retropubic prostatectomy. The 15-year Johns Hopkins experience. , 2001, The Urologic clinics of North America.

[29]  D. Johnston,et al.  Analysis of clinicopathologic factors predicting outcome after radical prostatectomy , 2001, Cancer.

[30]  C. Öbek,et al.  Positive surgical margins with radical retropubic prostatectomy: anatomic site-specific pathologic analysis and impact on prognosis. , 1999, Urology.

[31]  D. Bostwick,et al.  Anatomic site-specific positive margins in organ-confined prostate cancer and its impact on outcome after radical prostatectomy. , 1997, Urology.

[32]  H. Levin,et al.  Correlation of clinical and pathologic factors with rising prostate-specific antigen profiles after radical prostatectomy alone for clinically localized prostate cancer. , 1996, Urology.

[33]  A. Partin,et al.  Prediction of progression following radical prostatectomy. A multivariate analysis of 721 men with long-term follow-up. , 1996, The American journal of surgical pathology.

[34]  F. Harrell,et al.  Prognostic/Clinical Prediction Models: Multivariable Prognostic Models: Issues in Developing Models, Evaluating Assumptions and Adequacy, and Measuring and Reducing Errors , 2005 .

[35]  H. Neuwirth,et al.  Patterns of positive specimen margins and detectable prostate specific antigen after radical perineal prostatectomy. , 1995, The Journal of urology.

[36]  Galina Pizov,et al.  Correlation of pathologic findings with progression after radical retropubic prostatectomy , 1993, Cancer.

[37]  J. Epstein,et al.  Evaluation of Radical Prostatectomy Specimens: A Comparative Analysis of Sampling Methods , 1992, The American journal of surgical pathology.

[38]  C. Compton,et al.  AJCC Cancer Staging Manual , 2002, Springer New York.

[39]  D. Gleason.  Classification of prostatic carcinomas. , 1966, Cancer chemotherapy reports.