Facteurs de risque de marges chirurgicales positives après prostatectomie radicale : mise au point

Abstract

The presence of positive surgical margins on radical prostatectomy specimen is an adverse prognostic factor. Parameters supposed to influence surgical margin status includes pathology method analysis, surgical technique, tumoural and non tumoural patient parameters, and neoadjuvant hormonal therapy. Regarding the surgical technique, surgeon's experience and neuro-vascular bundles preservation are the most important factors of margin status, whereas surgical approach, bladder neck conservation, intraoperative frozen analysis, and bleeding are minor factors. Non tumoural patient parameters influencing surgical margin status include patient's age and weight, and prostate gland weight. For tumoural parameters, pathological stage and tumour volume are more important factors than the tumour grade and PSA. Five preoperative tumoural risk factors of positive surgical margins are particularly important, including abnormal digital rectal examination, preoperative PSA > 10ng/mL, biopsy Gleason score ≥7, number of positive biopsy cores ≥ 2, and suspicion of extraprostatic extension on radical prostatectomy specimen.