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Dissertation/Thesis Abstract

Lowering Positive Margin Rates at Radical Prostatectomy by Color Coding of Biopsy Specimens to Permit Individualized Preservation of the Neurovascular Bundles: Is it Feasible? A Pilot Investigation.
by Deane, Leslie Allan, M.S., Rush University, 2016, 29; 10582876
Abstract (Summary)

Introduction: Prostate cancer is the most common solid organ malignancy in men. The most frequently employed therapy is radical prostatectomy and this is associated with significant immediate and long-term risk of erectile functional impairment. We sought to evaluate whether color-coding of core biopsy specimens could aid in the clinical decision making process whether preservation of the neurovascular bundles would be safe and feasible from an oncological perspective.

Methods: A prospective cohort pilot study was undertaken with institution review board (IRB) approval to investigate the outcome of color-coding core biopsy prostate specimens. A single attending urologist performed multi-parametric Magnetic Resonance Image (MRI) guided transrectal ultrasound and biopsy of the prostate in 20 patients suspected of being high risk for harboring prostate cancer. Any lesions seen on MRI were designated as located in the peripheral, transition or central zone and specifically targeted. Core specimens were labeled with blue dye at the deep aspect and red dye at the superficial peripheral aspect of the core. Each was placed in a separate labeled container with formalin and sent for pathological examination. The pathologist reported cores as either benign or having cancer present and assigned a grade based on the Gleason Grading system. The distance of the cancer cells from the dye at each end of the core was reported, as was the percent involvement of each core. Data was maintained and stored in a secure spreadsheet. Patients deemed to be appropriate candidates for surgical intervention underwent radical prostatectomy with resection or preservation of the neurovascular bundles determined by current accepted oncological standards. Positive surgical margin status (PSM), presence or extra-prostatic extension (EPE) and distance of cancer from the surgical capsule were recorded.

Results: Of the 26 patients undergoing prostate biopsy, 15 (57.7 %) were found to have cancer of the prostate. This was Grade Group 1 in 7.7 %, 2 in 19.2 %, 3 in 11.5 %, 4 in 11.5 % and 5 in 7.7 % of the cohort. Eleven patients (42.3 %) did not have cancer on biopsy. A total of 268 cores were analyzed in the cohort, of which 69 showed cancer. The mean distance of tumor from the most superficial aspect of the red dye was 4.71 mm (Range 0 – 20 mm). There were 10 cores with cancer < 1 mm from the red dye margin. 3 patients opted to undergo robotic assisted laparoscopic radical prostatectomy, of which none had cancer < 1 mm from the red dye on biopsy, none had PSM in the zone of the positive lesion, none had EPE and in those with organ confined disease, the mean distance from the biopsy positive lesion was 6 mm (Range 1 – 15 mm) In no patient was there a cancer free segment of a core and a positive surgical margin or evidence of EPE in the region noted to be positive on biopsy. The first post-operative prostate specific antigen level PSA was undetectable in all patients undergoing surgery.

Conclusion: Color-coding of prostate biopsy core specimens in patients undergoing evaluation for high suspicion of prostate cancer provides useful information that assists in the decision making process and tailoring the approach to preservation of the neurovascular bundles without compromising early oncological efficacy. Further study is required to determine whether this simple modification of the prostate biopsy protocol is valuable in larger groups of patients.

Indexing (document details)
Advisor: Ekbal, Shahid
School: Rush University
School Location: United States -- Illinois
Source: MAI 56/03M(E), Masters Abstracts International
Subjects: Surgery
Publication Number: 10582876
ISBN: 978-1-369-61097-0
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