Since these publications, there has been increased interest in positive surgical margins subcategorization, mostly focused on 2 parameters: length of margin positivity and highest GS at the margin. While a number of studies have found independent predictive value for each factor,52–57 few have examined the added predictive value or clinical utility of these parameters beyond that conveyed by positive versus negative margin status alone.58–60 In 2016 to 2017, presumably based on the majority of published findings, revised protocols for radical prostatectomy reporting (CAP/ICCR) have begun to recommend, and in some cases require, reporting of positive surgical margins subcategorization. For example, CAP worksheets now require quantitation of tumor at a positive surgical margin, expressed as < or ≥3 mm of linear length of margin positivity; assigning a GS at a positive surgical margin is also recommended.24,40
Adjuvant radiation therapy in the postradical prostatectomy setting is the administration of external beam radiotherapy in the absence of objective evidence that the disease has recurred or persisted, for example, an undetectable PSA.61,62 Although 3 randomized trials have demonstrated that adjuvant radiation therapy in the setting of adverse pathologic features (ie, pT3b or positive surgical margin) may delay BCR,63–65 their interpretation is biased by the inclusion of patients who never achieved undetectable PSA levels following radical prostatectomy, who are best-considered early BCR patients who received early salvage, rather than adjuvant, radiotherapy. Given that observation followed by salvage radiotherapy when BCR occurs has also been associated with durable cancer control, and postoperative adjuvant radiotherapy is associated with short-term and long-term side effects, many centers will wait to intervene until PSA rises.
Pathology reporting at its best provides updated and relevant information regarding diagnosis, staging, and risk stratification to be used in outcome prediction and guiding therapy. Hence, there should be a reluctance to include data elements that will not risk stratify in an actionable way. Given that current AJCC prognostic staging dichotomizes assessment of positive surgical margins (positive: R1; negative: no descriptor),1 one may argue that further study with significant input from clinical colleagues is necessary to determine whether there are truly any positive margin subcategories worthy of inclusion as standard data elements in either pathology reports or AJCC staging.
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