Papers by phillip stricker
The Journal of Urology, Apr 1, 2016
these patients underwent RARP than they underwent RRP. This difference may not be easy to be expl... more these patients underwent RARP than they underwent RRP. This difference may not be easy to be explained based only on the standard pathological outcomes: thus, more-detailed analyses of the degree and location of positive surgical and/or benign tissue margins may be needed.
BMC Urology, Mar 2, 2022
Background: To report the feasibility, oncological and functional outcomes of salvage robot-assis... more Background: To report the feasibility, oncological and functional outcomes of salvage robot-assisted radical prostatectomy (sRARP) for recurrent prostate cancer (PCa) after irreversible electroporation (IRE). This was a retrospective analysis of patients who underwent sRARP by a single high-volume surgeon after IRE treatment in our institution. Surgical complications, oncological and functional outcomes were assessed. Results: 15 patients with at least 12 months follow up were identified out of the 234 men who underwent primary IRE between 2013 and 2019. The median [IQR] age was 68 (62-70) years. The median [IQR] time from focal IRE to sRARP was 42 (21-57) months. There were no rectal, bladder or ureteric injuries. The T-stage was pT2 in 9 (60%) patients and pT3a in 6 (40%) patients. Only one (7%) patient had a positive surgical margin. At a median [IQR] follow up of 22 (16-32) months no patient had a biochemical recurrence (PSA > 0.2). All 15 patients were continent (padfree) by 6 months and 9 (60%) patients had erections sufficient for intercourse with or without PDE5 inhibitors. No predisposing factors were identified for predicting erectile dysfunction after sRARP. In patients with recurrent or residual significant PCa after focal IRE ablation it is feasible to obtain good functional and oncological outcomes with sRARP. Our results demonstrate that good outcomes can be achieved with sRARP, when respecting close monitoring post-IRE, good patient selection and surgical experience. The limitations of this study are that it is a small series, with short follow up and a lack of standardised quality of life instruments.
BMC Urology, Apr 28, 2023
Purpose To assess whether completeness of pelvic lymph node dissection (PLND) as measured by lymp... more Purpose To assess whether completeness of pelvic lymph node dissection (PLND) as measured by lymph node yield reduces biochemical recurrence (BCR) in men undergoing radical prostatectomy (RP) for prostate cancer (PCa), stratified according to Briganti nomogram-derived risk (≥5% vs. < 5%) of lymph node invasion (LNI). Retrospective study of 3724 men who underwent RP between January 1995 and January 2015 from our prospectively collected institutional database. All men included had minimum five years follow-up and were not given androgen deprivation therapy or radiotherapy prior to BCR. Primary endpoint was time to BCR as defined by PSA > 0.2ng/ml. Patients were analysed according to Briganti Nomogram derived risk of 'low-risk' (< 5%) vs. 'high-risk' (≥ 5%). Extent of PLND was analysed using number of nodes yielded at dissection as a continuous variable as well as a categorical variable: Group 1 (limited, 1-4 nodes), Group 2 (intermediate, 5-8 nodes) and Group 3(extensive, ≥9 nodes). Median follow-up in the overall cohort was 79.7 months and 65% of the total cohort underwent PLND. There were 2402 patients with Briganti risk of LNI < 5% and 1322 with a Briganti risk of LNI ≥5%. At multivariate analysis, only PSA (HR1.01, p < 0.001), extracapsular extension at RP (HR 1.86, p < 0.001), positive surgical margin (HR 1.61, p < 0.001) and positive lymph node on pathology (HR 1.52, p = 0.02) were independently associated with BCR. In the high-risk group, increased nodal yield at PLND was associated with reduction in risk of BCR (HR 0.97, 95%CI 0.95-1.00 p = 0.05, Cochran Mantel Haenszel test, p < 0.05: respectively). In the low-risk group increased number of nodes at PLND did not reduce risk of BCR.
The Journal of Nuclear Medicine, Jun 23, 2017
scanning has been shown to be more sensitive than conventional imaging techniques in patients wit... more scanning has been shown to be more sensitive than conventional imaging techniques in patients with prostate cancer. This prospective Australian multicenter study assessed whether 68 Ga-PSMA PET/CT imaging affects management intent in patients with primary or recurrent prostate cancer. Methods: Before undertaking 68 Ga-PSMA PET imaging, referring medical specialists completed a questionnaire detailing relevant demographic and clinical data as well as their proposed management plan. A separate followup questionnaire was completed after the 68 Ga-PSMA PET/CT scan results were available to determine whether the management plan would change. Results: A total of 431 patients with prostate cancer from 4 Australian centers had pre-and post-68 Ga-PSMA management plans completed. Scans were obtained for primary staging of intermediate-and high-risk disease in 25% of patients and for restaging/biochemical recurrence in 75% of patients. Overall, 68 Ga-PSMA PET/CT scanning led to a change in planned management in 51% of patients. The impact was greater in the group of patients with biochemical failure after definitive surgery or radiation treatment (62% change in management intent) than in patients undergoing primary staging (21% change). Imaging with 68 Ga-PSMA PET/CT revealed unsuspected disease in the prostate bed in 27% of patients, locoregional lymph nodes in 39%, and distant metastatic disease in 16%. Conclusion: 68 Ga-PSMA PET/CT scans detect previously unsuspected disease and may influence planned clinical management in a high proportion of patients with prostate cancer. The impact was greater in patients with biochemical recurrence. These results demonstrate the potential clinical value of 68 Ga-PSMA PET/CT in management of prostate cancer.
Research and Reports in Urology, Oct 1, 2018
Introduction: Three percent of all new diagnosed prostate cancer (PC) patients are under the age ... more Introduction: Three percent of all new diagnosed prostate cancer (PC) patients are under the age of 50. Multiparametric MRI (mpMRI) is considered as increasingly powerful tool for decision-making in diagnosis of PC and in some active surveillance protocols. Since prostate architecture changes with age, we evaluated the sensitivity of mpMRI to detect clinically significant PC in patients under the age of 50 compared to pair-matched older patients. Methods: Data from a prospective collected and ethics approved database were retrospectively analyzed. We reviewed 1,395 records of PC patients from the years 2012-2017, identifying those under the age of 50 who had radical prostatectomy as primary treatment, a pre-operative mpMRI, a full clinical data set and who had clinically significant cancer (N=51). Tumor size and International Society of Urological Pathology (ISUP) score pair-matching was performed for patients older than 55 years. Clinically significant cancer was defined as ISUP >2 or ISUP 2 with >5% Gleason 4. The sensitivity to detect clinically significant cancer with mpMRI was calculated using pre-operative Prostate Imaging Reporting and Data System (PI-RADS) score and whole-gland final pathology. The median patient age in the young and older groups was 47 and 62, respectively. Both cohorts matched significantly regarding tumor volume (P =0.91) and ISUP score (P =1.0). The median PI-RADS score for the young group was 3, and 4 for the older group. The sensitivity for mpMRI, for PI-RADS 3,4 and 5 was 80.3% (95% CI 66.8%-90.1%) in the young group and 84.3% in the older group (95% CI 71.4%-92.9%), demonstrating no statistically significant difference (P=0.603). Sensitivity of mpMRI for PI-RADS 4,5 was 49.0% (95% CI 34.7%-63.4%) for the young group and 72.5% (95% CI 58.2%-84.1%) for the older group, which differ significantly (P=0.014). Conclusions: mpMRI may have a reduced sensitivity for detecting clinically significant PC in patients under the age of 50 for PI-RADS score 4,5 lesions. Many significant PC lesions were reported as PI-RADS 3 under the age of 50. We recommend that increased significance is placed on PI-RADS 3 lesions found in patients under the age of 50.
The Gleason grading system in various forms has been in use for almost 50 years with the latest I... more The Gleason grading system in various forms has been in use for almost 50 years with the latest International Society of Urological Pathology (ISUP) endorsed modifications (2005) enjoying almost universal acceptance in contemporary practice. However, the impact of these changes on the clinical management of prostate cancer, as well as the significant implications for research and clinical trials, is often poorly appreciated. Donald Gleason developed the first version of his grading system for prostatic adenocarcinoma in 1966 based on the 270 patients forming the Veterans Administration Cooperative Urological Research Group (VACURG) series. Initially 9 grades were defined, but these were soon consolidated into 5 grading categories, also known as patterns, based on similarities in outcome. Since more than one morphological pattern was identified in most cases (designated primary and secondary based on the extent of each), and as the prognosis of cases with mixed grades/patterns was intermediate between that of either the primary or secondary grade alone, Gleason advocated the use of a combined score to give more comprehensive prognostic information. By 1974 his cohort had increased to 1032 patients and Gleason made several modifications to the definitions of grades/patterns 1-4. With only minor local modifications this was the system in general use worldwide for two decades, supported by evidence from a number of independent that studies showed Gleason score correlated with biochemical 24 ANZUP Annual Scientific Meeting
European urology focus, Jul 1, 2019
Background: It is recommended to perform multiparametric magnetic resonance imaging (mpMRI) in th... more Background: It is recommended to perform multiparametric magnetic resonance imaging (mpMRI) in the follow-up following focal therapy of prostate cancer (PCa). Objective: To determine the diagnostic accuracy of mpMRI to detect residual PCa following focal therapy with irreversible electroporation. Design, setting, and participants: Seventy-six patients with biopsy-proven localized PCa consented for primary irreversible electroporation between February 2013 and March 2016. Final analysis was performed on 50 patients that received follow-up mpMRI at 6 mo, serial prostate-specific antigen (PSA) testing, and transperineal template-mapping biopsies at 12 mo. Outcome measurements and statistical analysis: Outfield regions of interest (ROI) were reported using PI-RADS version 2. A binary outcome (suspicious vs nonsuspicious) was given for the infield ablation zone. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated for different definitions of significant PCa: (1) Gleason !4 + 3 or Gleason !3 + 3 with a maximum cancer core length !6 mm, (2) Gleason !3 + 4 or Gleason !3 + 3 with a maximum cancer core length !4 mm, for outfield and infield ROI. Multivariate linear regression analyses evaluated the additional value of nadir PSA. Results and limitations: Sensitivity, specificity, positive predictive values, and negative predictive values of infield ROI was 43%, 86%, 33%, and 90% for definition 1 and 38%, 86%, 33%, and 88% for definition 2, respectively. For outfield ROI this was 33%, 82%, 20%, and 90% for definition 1 and 38%, 86%, 50%, and 80% for definition 2. PSA had no additional value in predicting residual significant PCa. Limitations include retrospective design, single reader, and low incidence of residual PCa. Conclusions: Our preliminary data suggest that mpMRI can rule out high-volume residual PCa. However, follow-up biopsies should still be performed to determine oncological control. Patient summary: Multiparametric magnetic resonance imaging is able to detect highvolume significant prostate cancer following focal therapy. Prostate biopsies are still required in the follow-up of focal therapy as (low-volume) significant prostate cancer is being missed by multiparametric magnetic resonance imaging.
Modern Pathology, Feb 1, 2014
were to determine the: (1) agreement between MSI and MMR status (2) percent BRAF V600E IHC positi... more were to determine the: (1) agreement between MSI and MMR status (2) percent BRAF V600E IHC positivity (3) percent of MLH1 defi ciency and (4) percent MLH1 defi cient, BRAF V600E positivity. Design: This study evaluated 204 consecutive colorectal cancer resections at single academic institution using FFPE tissues. The antibodies MLH-1 (M1), PMS2 (EPR3947), MSH2 (G219-1129) and CONFIRM MSH6 (44), and the mutation specifi c BRAF V600E (VE1) were run on the BenchMark XT automated platform (Ventana Medical Systems Inc. Tucson, Arizona). MSI status was determined by the MSI Analysis System (Version 1.2, Promega, Madison, WI), and BRAF V600E molecular status by the ABI 3730 (Life Technologies, Grand Island, NY). Results: In this cohort, 83% (169/204) were MSS, 17% (35/204) were MSI-H, 84% (172/204) were MMR profi cient, 16% (32/204) were MMR defi cient, and 12% (26/204) were MLH1 defi cient. Average positive and negative agreement between MMR and MSI status (method of Cicchetti and Feinstein) was 95.5% and 99.1%. Overall agreement was 98.5%. Among BRAF IHC samples, 13.2% (27/204) were positive, 85.2% (174/204) were wildtype, and were 3 indeterminate. On repeat analysis, 2/3 were reclassifi ed as positive. Among MLH1 defi cient samples, 54% (14/26) were positive and 46% (12/26) were negative for BRAF V600E (VE1) IHC. Among the cases with both BRAF V600E IHC and sequencing results, 30/31 were in agreement: 13/13 negative agreement and 17/18 positive agreement (1 was IHC positive, sequence negative). Conclusions: This study demonstrated high overall agreement between MMR IHC and MSI, and the predominance of MLH1 defi ciency. The BRAF V600E (VE1) IHC positivity rate (13.2%) is comparable to the published mutation rate. As demonstrated in larger studies, there was a high overall agreement (30/31) for BRAF V600E status between Sanger sequencing and the VE1 antibody. Studies have also demonstrated a higher level of sensitivity for detection of BRAF V600E mutation by the BRAF V600E (VE1) antibody in comparison to some molecular methods including Sanger sequencing and PCR. A combination of the MMR and BRAF V600E (VE1) antibodies can be used effectively to aid sub-classifi cation of colorectal carcinoma in the pathology laboratory.
BJU International, 2019
ObjectivesTo review the literature to determine the sensitivity and specificity of gallium‐68 pro... more ObjectivesTo review the literature to determine the sensitivity and specificity of gallium‐68 prostate‐specific membrane antigen (68Ga‐PSMA) positron‐emission tomography (PET) for detecting pelvic lymph node metastases in patients with primary prostate cancer (PCa), and the positive predictive value in patients with biochemical recurrence (BCR) after initial curative treatment, and, in addition, to determine the detection rate and management impact of 68Ga‐PSMA PET in patients with BCR after radical prostatectomy (RP).Materials and MethodsWe performed a comprehensive literature search. Search terms used in MEDLINE, EMBASE and Science Direct were ‘(PSMA, 68Ga‐PSMA, 68Gallium‐PSMA, Ga‐68‐PSMA or prostate‐specific membrane antigen)’ and ‘(histology, lymph node, staging, sensitivity, specificity, positive predictive value, recurrence, recurrent or detection)’. Relevant abstracts were reviewed and full‐text articles obtained where possible. References to and from obtained articles were s...
British Journal of Cancer, 2019
BACKGROUND: After radical prostatectomy (RP) for prostate cancer (PC), p53 alterations predict bi... more BACKGROUND: After radical prostatectomy (RP) for prostate cancer (PC), p53 alterations predict biochemical relapse (BCR), however, recent evidence suggests that metastatic relapse (MR) not BCR is a surrogate for PC specific mortality (PCSM). This updated analysis of a previously published study investigated the association between p53 aberrations, MR and PCSM in men with localised PC. METHODS: Two hundred and seventy-one men with localised PC treated with RP were included. RP specimens stained for p53 by immunohistochemistry were scored as (a) percentage of p53-positive tumour nuclei; and (b) clustering, where ≥12 p53-positive cells within a ×200 power field was deemed 'cluster positive'. Associations between p53 status and clinical outcomes (BCR, MR and PCSM) were evaluated. RESULTS: Increasing percentage of p53-positive nuclei was significantly associated with shorter time to BCR, MR and PCSM (All p < 0.001). Half of the patients were p53 cluster positive. p53 cluster positivity was significantly associated with poorer outcomes at all clinical endpoints (BCR: HR 2.0, 95% CI 1.51-2.65, p < 0.001; MR: HR 4.1, 95% CI 2.02-8.14, p < 0.001; PCSM: HR 12.2, 95% CI 1.6-93; p = 0.016). These associations were independent of other established prognostic variables. CONCLUSIONS: p53 aberrations in radical prostatectomy tissue predict clinically relevant endpoints of MR and PCSM.
Research and reports in urology, 2018
Three percent of all new diagnosed prostate cancer (PC) patients are under the age of 50. Multipa... more Three percent of all new diagnosed prostate cancer (PC) patients are under the age of 50. Multiparametric MRI (mpMRI) is considered as increasingly powerful tool for decision-making in diagnosis of PC and in some active surveillance protocols. Since prostate architecture changes with age, we evaluated the sensitivity of mpMRI to detect clinically significant PC in patients under the age of 50 compared to pair-matched older patients. Data from a prospective collected and ethics approved database were retrospectively analyzed. We reviewed 1,395 records of PC patients from the years 2012-2017, identifying those under the age of 50 who had radical prostatectomy as primary treatment, a pre-operative mpMRI, a full clinical data set and who had clinically significant cancer (N=51). Tumor size and International Society of Urological Pathology (ISUP) score pair-matching was performed for patients older than 55 years. Clinically significant cancer was defined as ISUP >2 or ISUP 2 with >...
PloS one, 2018
Translation of radiomics into the clinic may require a more comprehensive understanding of the un... more Translation of radiomics into the clinic may require a more comprehensive understanding of the underlying morphologic tissue characteristics they reflect. In the context of prostate cancer (PCa), some studies have correlated gross histological measurements of gland lumen, epithelium, and nuclei with disease appearance on MRI. Quantitative histomorphometry (QH), like radiomics for radiologic images, is the computer based extraction of features for describing tumor morphology on digitized tissue images. In this work, we attempt to establish the histomorphometric basis for radiomic features for prostate cancer by (1) identifying the radiomic features from T2w MRI most discriminating of low vs. intermediate/high Gleason score, (2) identifying QH features correlated with the most discriminating radiomic features previously identified, and (3) evaluating the discriminative ability of QH features found to be correlated with spatially co-localized radiomic features. On a cohort of 36 patien...
Diagnostic and interventional radiology (Ankara, Turkey), 2018
We aimed to evaluate the genitourinary function and quality of life (QoL) following the ablation ... more We aimed to evaluate the genitourinary function and quality of life (QoL) following the ablation of different prostate segments with irreversible electroporation (IRE) for localized prostate cancer (PCa). Sixty patients who received primary focal IRE for organ-confined PCa were recruited for this study. Patients were evaluated for genitourinary function and QoL per prostate segment treated (anterior vs. posterior, apex vs. base vs. apex-to-base, unilateral vs. bilateral). IRE system settings and patient characteristics were compared between patients with preserved vs. those with impaired erectile function and urinary continence. Data were prospectively collected at baseline, 3, 6, and 12 months using the expanded prostate cancer index composite, American Urological Association symptom score, SF-12 physical and mental component summary surveys. Difference over time within segments per questionnaire was evaluated using the Wilcoxon's signed rank test. Outcome differences between s...
European urology focus, 2017
It is recommended to perform multiparametric magnetic resonance imaging (mpMRI) in the follow-up ... more It is recommended to perform multiparametric magnetic resonance imaging (mpMRI) in the follow-up following focal therapy of prostate cancer (PCa). To determine the diagnostic accuracy of mpMRI to detect residual PCa following focal therapy with irreversible electroporation. Seventy-six patients with biopsy-proven localized PCa consented for primary irreversible electroporation between February 2013 and March 2016. Final analysis was performed on 50 patients that received follow-up mpMRI at 6 mo, serial prostate-specific antigen (PSA) testing, and transperineal template-mapping biopsies at 12 mo. Outfield regions of interest (ROI) were reported using PI-RADS version 2. A binary outcome (suspicious vs nonsuspicious) was given for the infield ablation zone. Sensitivity, specificity, positive predictive values, and negative predictive values were calculated for different definitions of significant PCa: (1) Gleason ≥4+3 or Gleason ≥3+3 with a maximum cancer core length ≥6mm, (2) Gleason ...
BJU international, Nov 28, 2017
To assess the relationship between the ISUP 2014 grading system, biochemical relapse (BCR) and cl... more To assess the relationship between the ISUP 2014 grading system, biochemical relapse (BCR) and clinical relapse (CLR) following radical prostatectomy, to determine whether the 2014 ISUP grading system is a better predictor of survival compared to the previous Gleason scoring systems, and to investigate whether incorporation of the tertiary pattern/grade into the ISUP scoring system significantly improves its efficacy. 635 radical prostatectomy cases (1991-1999) were identified from a database at a single institution. A histopathology review was performed to re-grade the cases as per the ISUP 2014 grading system. All relevant clinicopathological data and clinical follow up (median 15.25 years, 0.3-26 years) were obtained. Log rank, Kaplan Meier, Cox regression and Harrell's concordance c-indices analyses were performed. At a median follow up of 15 years, 276 (44%) of patients had BCR and 41 (7%) had clinical relapse. Grade Groups 1, 2, 3, 4 and 5 were seen in 112 (18%), 307 (48%)...
Cancer research, Jan 15, 2001
The molecular basis of androgen-independent prostate cancer is unknown; however, functional andro... more The molecular basis of androgen-independent prostate cancer is unknown; however, functional androgen receptor (AR) signaling is maintained after the acquisition of hormone-refractory disease. Because normal and malignant prostate epithelial cell proliferation is regulated by androgen stimulation via both the AR-positive stroma and epithelium, we sought to evaluate patterns of AR expression in these cells and to determine any relationships with prostate cancer progression. AR expression in the malignant epithelium and associated periepithelial and nonperiepithelial stroma was measured in a cohort of 96 patients with clinically localized prostate cancer treated with radical prostatectomy. Data were evaluated for disease relapse using the Kaplan-Meier method and in a Cox proportional hazards model with other variables of known clinical relevance, including Gleason score, pathological stage, clinical stage, and pretreatment prostate-specific antigen concentration. Concurrent overexpress...
Cancer research, Jan 15, 2003
Current models of prostate cancer classification are poor at distinguishing between tumors that h... more Current models of prostate cancer classification are poor at distinguishing between tumors that have similar histopathological features but vary in clinical course and outcome. Here, we applied classical survival analysis to genome-wide gene expression profiles of prostate cancers and preoperative prostate-specific antigen (PSA) levels from each patient, to identify prognostic markers of disease relapse that provide additional predictive value relative to PSA concentration. Three of approximately 200 probesets showing strongest correlation with relapse were identified as the gene for the putative calcium channel protein, trp-p8, with loss of trp-p8 mRNA expression associated with a significantly shorter time to PSA relapse-free survival. We observed subsequently that trp-p8 is lost in the transition to androgen independence in a prostate cancer xenograft model and in prostate cancer tissue from patients treated preoperatively with antiandrogen therapy, suggesting that trp-p8 is andr...
European Urology, 2014
Background: Positive surgical margins (PSMs) are a known risk factor for biochemical recurrence i... more Background: Positive surgical margins (PSMs) are a known risk factor for biochemical recurrence in patients with prostate cancer (PCa) and are potentially affected by surgical technique and volume. Objective: To investigate whether radical prostatectomy (RP) modality and volume affect PSM rates. Design, setting, and participants: Fourteen institutions in Europe, the United States, and Australia were invited to participate in this study, all of which retrospectively provided margins data on 9778 open RP, 4918 laparoscopic RP, and 7697 robotic RP patients operated on between January 2000 and October 2011. Outcome measurements and statistical analyses: The outcome measure was PSM rate. Multivariable logistic regression analyses and propensity score methods identified odds ratios for risk of a PSM for one modality compared with another, after adjustment for age, preoperative prostate-specific antigen, postoperative Gleason score, pathologic stage, and year of surgery. Classic adjustment using standard covariates was also implemented to compare PSM rates based on center volume for each minimally invasive surgical cohort.
Clinical Cancer Research, 2004
Purpose: Activation of the Wnt-signaling pathway is implicated in aberrant cellular proliferation... more Purpose: Activation of the Wnt-signaling pathway is implicated in aberrant cellular proliferation in a variety of cancers. Secreted frizzled-related protein 4 (sFRP4) is a secreted protein with putative inhibitory activity of the Wnt-signaling cascade through binding and sequestering Wnt ligands. Because sFRP4 mRNA is overexpressed in prostate cancers (PCs), the aim of this study was to define the pattern of sFRP4 protein expression in normal and malignant human prostate tissue and to determine whether changes in expression were associated with disease progression and prognosis, as well as to define the phenotype of sFRP4-overexpression in an in vitro model of PC. Experimental Design: Polyclonal antibodies were raised against a COOH-terminal peptide of sFRP4, characterized and used to assess sFRP4 protein expression in benign prostate tissue and 229 patients with clinically localized PC (median follow-up 77 months, range 1–156). In vitro studies of the function of sFRP4 overexpressi...
BJU International, 2011
What ' s known on the subject? and What does the study add? Only 30 -35% of patients with positiv... more What ' s known on the subject? and What does the study add? Only 30 -35% of patients with positive surgical margins after radical prostatectomy develop recurrent disease. Adjuvant radiotherapy reduces the rate of biochemical relapse or metastasis and improves overall survival after radical prostatectomy. Various pathological factors, such as location and extent of positive margins, have been proposed as possible prognostic factors in men with margin-positive prostate cancer, however, the recent International Society of Urological Pathology consensus meeting in Boston noted that there is limited data on the signifi cance of Gleason grade of the carcinoma at a positive margin.
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Papers by phillip stricker