IMPACT OF PREOPERATIVE STAGING OF PROSTATIC CANCER ON POSITIVE SURGICAL MARGIN INCIDENCE FOLLOWING RADICAL PROSTATECTOMY

Background Despite improvement of the equipment for polyfocal biopsy of the prostate gland (PBPG), a sufficient percent of data divergence in morphological characteristics of the prostate cancer (PC) at preoperative and postoperative stages is noted. Besides data of PBPG and clinical stage are quite important part of nomograms applied for indication detections for lymphadenectomy and neuro-sparing technique during radical prostatectomy (RPE). Regarding this fact error limits in clinical assessment of the primary tumor could influence surgical outcomes. Aim The aim of the present study was assessment of coincidence frequency of morphological characteristics of PC according to transrectal PBPG and clinical examination with morphological assessment of operational material after radical prostatectomy (RPE). Evaluation of errors influence on frequency of positive surgical margin (PSM) at clinical staging of PC was performed. Materials and methods Data of transrectal PBPG and operational material after RPE in 276 patients with PC were studied. Both biopsy and operative materials were exposed to preservation in 10% buffering solution of formalin, and after automatic conducting was painted by hematoxylin-eozinom. Each histologic conclusion was formed by at least two pathologists who estimated PBPG and samples after RPE in the same structure. The interrelation between staging errors and frequency of PSM was studied. Outcomes Analysis For patients with locally-advanced PC the adequate staging according to TPFB was noted only in 18,7% cases. Errors for clinical staging of the localized PC had no significant influence on PSM frequency: 3.7% in patients with correct staging and 6,5% in patients with poor staging with stage migration within pT2b - pT2c (p = 0,07). With down-staging of locally-advanced PC which was observed in 81,3% patients, significant increase in PSM frequency reached 23,1% in comparison with proper staging - 6.6% patients (p<0,01). Conclusions Down-staging of locally advanced prostate cancer at the preoperative stage is a frequent phenomenon which leads to essential increase in PSM after RPE.

locally advanced cancer of prostatic gland, radical prostatectomy, positive surgical margin

1. Epstein J.I., Egevad L., Amin M.B., et al. The 2014 International Society of Urological Pathology (ISUP) Consensus Conference on Gleason Grading of Prostatic Carcinoma: definition of grading patterns and proposal for a new grading system. Am J Surg Pathol. 2016; 40: 244-52.

2. Christopher J. Kane, Scott E. Eggener, Alan W. Shindel, Gerald L. Andriole. Variability in Outcomes for Patients with Intermediate-risk Prostate Cancer (Gleason Score 7, International Society of Urological Pathology Gleason Group 2-3) and Implications for Risk Stratification: A Systematic Review. Eur. Urol. Focus 3 (2017): 487-497.

3. Mariam Imnadze, Daniel D. Sjoberg, Andrew J. Vickers. Adverse Pathologic Features at Radical Prostatectomy: Effect of Preoperative Risk on Oncologic Outcomes. Eur. Urol. 69 (2016): 143 - 148.

4. Alberto Briganti, Steven Joniau, Paolo Gontero et al. Identifying the Best Candidate for Radical Prostatectomy Among Patients with High-Risk Prostate Cancer. Eur. Urol. 61, 2012, P. 584-592.

5. Bastian PJ, Boorjian SA., Bossi A., Briganti A., Heidenreich A., Freedland Stephen J., Montorsi Francesco, Roach III Mack, SchroЁder F., van Poppel H.,Stief C.G., Stephenson A.J., Zelefsky M.J. High-Risk Prostate Cancer: From Definition to Contemporary Management. Eur. Urol. 2012; 61(6): 1096-1106.

6. Briganti A., Spahn M., Joniau S., Montorsi F. Predicting favourable pathological outcome in patients with clinical high risk prostate cancer. A novel nomogram based on a multiinstitutional analysis. Eur Urol. 2010; 9(2): 318.

7. Giovanni Lughezzani, Alberto Briganti, Pierre I. Karakiewicz et al. Predictive and Prognostic Models in Radical Prostatectomy Candidates: A Critical Analysis of the Literature. Eur. Urol. 2010; 58: 687-700.

8. Bandini M. 1, Marchioni M. 2, Pompe R. North American validation and head-to-head comparison of four preoperative nomograms for prediction of lymph node invasion before radical prostatectomy. Eur Urol. 2018; 17(2); 1316.

9. Samson W. Fine, Mahul B. Amin, Daniel M. Berney et al. A Contemporary Update on Pathology Reporting for Prostate Cancer: Biopsy and Radical Prostatectomy Specimens. Eur. Urol. 2012; 62: 20-39.

10. Jonathan I. Epstein, Zhaoyong Feng, Bruce J. Trock, Phillip M. Pierorazio. Upgrading and Downgrading of Prostate Cancer from Biopsy to Radical Prostatectomy: Incidence and Predictive Factors Using the Modified Gleason Grading Systemand Factoring in Tertiary Grades. Eur. Urol. 2012; 61: 1019-1024.

11. Bandini M. 1, Dell’Oglio P. 1, Gandaglia G. Stage-migration and survival of lymph node positive prostate cancer patients: A comprehensive trend analyses of surgically treated men over the last two decades. Eur Urol. 2018; 17(2); e1170.