Diagnostic potential of radiological apical tumor involvement.

Autor: Liebert C; University College London Medical School, 74 Huntley Street, London, WC1E 6DE, UK. casril.liebert.19@ucl.ac.uk., Morka N; University College London Medical School, 74 Huntley Street, London, WC1E 6DE, UK., Satish P; University College London Medical School, 74 Huntley Street, London, WC1E 6DE, UK., Freeman A; Department of Pathology, University College London Hospitals NHS Foundation Trust, London, UK., Kelly D; School of Healthcare Sciences, Cardiff University, Cardiff, UK., Kirkham A; Department of Radiology, University College London Hospitals NHS Foundation Trust, London, UK., Orczyk C; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Simpson BS; UCL Cancer Institute, University College London, London, UK., Whitaker HC; Division of Surgery and Interventional Science, University College London, London, UK., Emberton M; Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.; Division of Surgery and Interventional Science, University College London, London, UK., Norris JM; Division of Surgery and Interventional Science, University College London, London, UK.
Jazyk: angličtina
Zdroj: Journal of robotic surgery [J Robot Surg] 2023 Apr; Vol. 17 (2), pp. 705-706. Date of Electronic Publication: 2022 Apr 12.
DOI: 10.1007/s11701-022-01413-w
Abstrakt: We commend Veerman et al. for investigating the diagnostic performance of radiological apical tumor involvement (radATI) in preoperative prostate magnetic resonance imaging (MRI) and its impact on clinical outcomes in patients with localized prostate cancer. This retrospective study evaluated the diagnostic accuracy of MRI to detect pathological ATI (pathATI) in robot-assisted radical prostatectomy specimens. They found patients with radATI more likely to develop biochemical recurrence (BCR), p = 0.003, and have apical positive surgical margins (APSM), p = 0.004. We believe that the author's acknowledgement of the relationship between tumor location and cancer risk is an important step in the classification of prostate cancer. An important question that is under addressed is, what is it about apical tumors that carry additional risk? Higher rates of PSM due to incomplete surgical excision may contribute to increased recurrence risk in the apex. If this is the case, surgical management must be tailored by a tumor location-based risk assessment. The literature suggests that a single APSM may be clinically insignificant for long-term outcomes. Conversely, the authors also recommend radATI be treated with reduced apical nerve sparing to avoid APSM. We believe that this approach may lead to overtreatment in the presence of an otherwise good prognosis. We believe the extent of APSMs upon diagnosis would be an interesting topic for further investigation. The authors may also wish to perform multivariable analysis for the effect of radATI on BCR. We believe that MRI may play a critical role in enhancing diagnosis and prognostication of prostate cancer.
(© 2022. The Author(s), under exclusive licence to Springer-Verlag London Ltd., part of Springer Nature.)
Databáze: MEDLINE
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