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Margins in Prostate Cancer Surgery

Key findings

In 2017, the positive margin rate for pT2 radical prostatectomy was 21%. This rate has remained steady for the last 5 years. The positive margin rate in 2017 for pT3 radical prostatectomy was 47%.

Why is this important to Ontarians?

  • Prostate surgery is an option for treating people with prostate cancer.
  • During prostate cancer surgery, the surgeon will try to remove the entire tumour and some normal tissue surrounding it (“the margin”). A margin is the area of tissue at the edge of the specimen. A positive margin means cancer cells may have been left behind.
  • The Cancer Care Ontario Guideline for Optimization of Surgical and Pathological Quality Performance for Radical Prostatectomy in Prostate Cancer Management identifies the main goals of radical prostatectomy as: completely remove the cancer from the prostate with negative margins while preserving the urinary and erectile functions.
  • The code pT2 stands for the pathologic staging of the cancer when the tumour is located only in the prostate, while pT3 is when the tumour has grown through the prostate on one or both sides (extraprostatic extension).

See Margins in Prostate Cancer Surgery Methodology for technical information.

Report date: March 2019
Data sources: Pathology Data Mart-EDW
Prepared by: Analytics and Informatics, Cancer Care Ontario

Report date: March 2019
Data sources: Pathology Data Mart-Enterprise Data Warehouse
Prepared by: Analytics and Informatics, Cancer Care Ontario

Table 1: Percentage of pT2 radical (or total) prostatectomy reports with positive (involved) margins, 2013 to 2017
Calendar year Percentage Reports with Positive Margins (pT2)
2013 20.6
2014 21.1
2015 20.4
2016 22.0
2017 20.6

Report date: March 2019
Data sources: Pathology Data Mart-EDW
Prepared by: Analytics and Informatics, Cancer Care Ontario

Data Table 2: Percentage of pT3 radical (or total) prostatectomy reports with positive (involved) margins, 2013 to 2017
Year Percentage Reports with Positive Margins (pT3)
2013 47.3
2014 47.2
2015 44.3
2016 47.1
2017 47.2

Report date: March 2019
Data sources: Pathology Data Mart-Enterprise Data Warehouse
Prepared by: Analytics and Informatics, Cancer Care Ontario

Results

  • In 2017, 21% of pT2 radical prostatectomy reports showed positive margins. This represents 292 patients.
  • This is just above Cancer Care Ontario’s target of 20%.
  • The rate of positive margins is higher, at 47%, for pT3 radical prostatectomies. This rate has not changed over the last 5 years. Cancer Care Ontario aims to reduce the positive margin rate for these prostatectomies.

Comparisons

Getting comparable data and measures from multiple jurisdictions is a challenge. Be aware of the different data definitions, methodologies and years used in indicators measured outside of Ontario. Jurisdictional comparison is still useful to provide a rough indication of how well Ontario is doing relative to other provinces and countries.

  • In 2014/15 in Scotland, 20% of pT2 radical prostatectomy reports showed positive margins. This represents 42 patients.[1]

Opportunities

  • Cancer Care Ontario will continue to work with the urology and radiation oncology communities of practice to establish targets for prostatectomy margins for pT3 disease.

For more information

For more information about the Surgical Oncology Program, visit the Surgical Oncology Program on Cancer Care Ontario’s website.

Also visit Quality Improvement Resources for Surgical Oncology for resources to help physicians learn, discuss and provide feedback on quality issues in cancer.

References

  1. National Health Service Scotland. Prostate Cancer Quality Performance Indicators [Internet]. (2016) [cited 2019/04/08] Available from: https://www.isdscotland.org/Health-Topics/Quality-Indicators/Publications/2016-12-13/2016-12-13-Prostate-QPI-Report.pdf