Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

A
B
Fig. 3.57 A Pathological stage and survival. Kaplan Meir plot of the level of invasion vs progression. ECE = extracapsular extension, SVI = seminal vesicle involvement,
+LN = positive for lymph node metastasis.. B Kaplan Meir plot of Gleason score vs recurrence.
{659}, although these tests are not used
in routine clinical practice {1948}. Various
prognostic parameters based on the
assessment of tumour within the node
have been reported. These include
Gleason grade, number of positive
nodes, tumour volume, tumour diameter,
DNA ploidy, and perinodal tumour extension.
In part because of conflicting studies,
these nodal parameters are not routinely
reported in clinical practice {859,
946,1477,2372,2500}. In a rare patient, a
small lymph node is seen in the periprostatic
soft tissue, and may be involved by
metastatic prostate cancer, even in the
absence of other pelvic lymph node
metastases {1364}. These patients also
have a poor prognosis.
Surgical margin status
Positive surgical margins (+SM) are generally
considered to indicate that the
cancer has not been completely excised
and is an important prognostic parameter
following surgery. Positive margins in
a radical prostatectomy specimen may
be classified as equivocal, focal, or
extensive, with correspondingly worse
prognosis {1661}. The site of the +SM is
frequently at the same site as the area of
EPE. However, a +SM may result from
incision into an otherwise confined focus
of prostate cancer. A +SM without EPE at
the site of the +SM is not infrequently
seen, having been reported in from 9-
62% of cases of +SM in the literature.
The most common sites of intra-prostatic
incision are at the apex and at the site of
the neurovascular bundle posterolaterally.
Stage designations to denote a +SM
in the absence of EPE anywhere in the
gland include stage pT2X and stage
pT2+, because extraprostatic tumour at
the site of the +SM cannot be excluded.
Most studies suggest a lower risk of progression
in men with positive margins as
a reflection of capsular incision, as
opposed to +SM with EPE {170,
1945,2790}. However, in a series of 1273
patients treated with radical prostatectomy,
+SM had an impact on PSA non-progression
rate over the spectrum of pathologic
stages, including pT2 (confined)
cancer. PSA non-progression rate at 5
years for patients with EPE (pT3a) with
positive +SM was 50%, compared to
80% of patients with EPE and –SM
(p