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KMID : 1001020090070030113
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Journal of Urologic Oncology
2009 Volume.7 No. 3 p.113 ~ p.121
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Management of Post-operative Surgical Margin Positive Cases -Radical Prostatectomy-
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Jo Moon-Ki
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Abstract
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The presence of cancer cells at the dissected margin indicates incomplete oncological clearance. Positive surgical margins (PSM) in radical prostatectomy (RP) specimens are considered to have a poor prognosis, and are reported 10-40% of patients performing RP. PSM are associated with an increased hazard of biochemical recurrence (BCR) as well as the requirement for additional cancer treatment. The dispute about the optimal management for patients with PSM following RP is continuing. Nowadays, radiotherapy is the only established treatment with curative intent. The timing of postoperative RT remains controversial, because randomized trials to determine the incremental benefit of early Adjuvant radiotherapy (ART) compared with delayed SRT given for BCR have not been performed. Many published data reported that ART is acceptable, well-tolerated transient toxicity that dissipates with time. A randomized trial in patients with PSM comparing immediate postoperative RT to salvage RT is critically needed before definitive recommendations can be made. Randomized controlled trials clearly indicate that adjuvant RT improves BCR rates, reduces clinical progression, and improves overall survival. More studies and longer follow-up from completed randomized controlled trials are required to accurately assess real practice outcome.
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KEYWORD
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Prostate cancer, Radical prostatectomy, Positive surgical margin
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