Reporting positive surgical margins after radical prostatectomy: time for standardization

To assess the consistency of reporting on positive surgical margins (PSMs) and associated prognostic variables after radical prostatectomy (RP) in the current literature To provide a standardized methodology for quantifying the characteristics and the prognostic impact of PSMs after RP.

We conducted a review of articles that assessed the prognostic value of characteristics of PSMs after RP. The articles were identified using a MEDLINE search. The methodology and quality of the reporting of PSMs were analysed according to six criteria defined according to the guidelines of the College of American Pathologists and the International Society of Uropathologists. Forty-four studies, involving ≥100 patients and published from January 2005 to the present, were reviewed.

Each of the 44 studies was assessed for their reporting of the six defined PSM criteria, as well as for the significance of PSM characteristics on biochemical recurrence (BCR). The definition of a PSM was the only criterion that was consistently reported. All studies were deficient in defining and reporting one or more of the PSM criteria. Major inconsistencies were observed in the reporting of PSM site and length, and the presence of intraprostatic incision. The many conflicting reports gave little insight into the true significance of particular PSM-associated variables on BCR.

There is a lack of consistency in the reporting on and prognostic significance of PSMs and PSM-associated prognostic variables. We hypothesize that these conflicting results are partly attributable to a lack of use of a standardized reporting methodology for PSMs. Implementation of a previously reported standardized scoring system for PSMs may help eliminate these inconsistencies in the future.