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Difference between revisions of "Prostate gland"
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→Margins + Extension: re-work
(→Margins + Extension: re-work) |
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Note: | Note: | ||
*The usual caveats apply to the above; if the patient is moribund-- nothing is done, if the patient refuses treatment... nothing is done et cetera. | *The usual caveats apply to the above; if the patient is moribund-- nothing is done, if the patient refuses treatment... nothing is done et cetera. | ||
=== | ===Surgical margins and extraprostatic extension=== | ||
Definitions: | Definitions: | ||
*Extraprostatic extension (EPE) is difficult to assess (in prostatectomy specimens) as there is no consensus definition. | *Extraprostatic extension (EPE) is difficult to assess (in prostatectomy specimens) as there is no consensus definition. | ||
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*EPE cannot be called on a biopsy unless the tumour is next to adipose tissue.<ref>AE. 4 June 2010.</ref> | *EPE cannot be called on a biopsy unless the tumour is next to adipose tissue.<ref>AE. 4 June 2010.</ref> | ||
====Extraprostatic extension | ====Surgical margins==== | ||
{{Main|Surgical margins}} | |||
*Positive is ''tumour touching ink''.<ref name=pmid22578729>{{Cite journal | last1 = Lu | first1 = J. | last2 = Wirth | first2 = GJ. | last3 = Wu | first3 = S. | last4 = Chen | first4 = J. | last5 = Dahl | first5 = DM. | last6 = Olumi | first6 = AF. | last7 = Young | first7 = RH. | last8 = McDougal | first8 = WS. | last9 = Wu | first9 = CL. | title = A close surgical margin after radical prostatectomy is an independent predictor of recurrence. | journal = J Urol | volume = 188 | issue = 1 | pages = 91-7 | month = Jul | year = 2012 | doi = 10.1016/j.juro.2012.02.2565 | PMID = 22578729 }}</ref> | |||
**"Close" margins have an increase recurrence risk. | |||
Positivity rate varies substantially: | |||
*26%.<ref name=pmid22860630>{{Cite journal | last1 = Steinsvik | first1 = EA. | last2 = Axcrona | first2 = K. | last3 = Angelsen | first3 = A. | last4 = Beisland | first4 = C. | last5 = Dahl | first5 = A. | last6 = Eri | first6 = LM. | last7 = Haug | first7 = ES. | last8 = Svindland | first8 = A. | last9 = Fosså | first9 = S. | title = Does a surgeon's annual radical prostatectomy volume predict the risk of positive surgical margins and urinary incontinence at one-year follow-up? - Findings from a prospective national study. | journal = Scand J Urol Nephrol | volume = | issue = | pages = | month = Aug | year = 2012 | doi = 10.3109/00365599.2012.707684 | PMID = 22860630 }}</ref> | |||
*15%.<ref name=pmid22860572>{{Cite journal | last1 = Koutlidis | first1 = N. | last2 = Mourey | first2 = E. | last3 = Champigneulle | first3 = J. | last4 = Mangin | first4 = P. | last5 = Cormier | first5 = L. | title = Robot-assisted or pure laparoscopic nerve-sparing radical prostatectomy: What is the optimal procedure for the surgical margins? A single center experience. | journal = Int J Urol | volume = | issue = | pages = | month = Jul | year = 2012 | doi = 10.1111/j.1442-2042.2012.03102.x | PMID = 22860572 }}</ref> | |||
====Extraprostatic extension==== | |||
:Abbreviated ''EPE''. | |||
*Prostatectomy specimens: EPE is present if there is either: | *Prostatectomy specimens: EPE is present if there is either: | ||
*#A "significant bulge" in the contour of the prostate at low power ''and'' no fibromuscular tissue surrounding the malignant cells. | *#A "significant bulge" in the contour of the prostate at low power ''and'' no fibromuscular tissue surrounding the malignant cells. | ||