Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy

Abstract

Purpose: Positive surgical margins (PSM) during robot-assisted radical prostatectomy (RARP) negatively influence patients' prognosis. The aim of our study was to identify risk factors for PSM in patients with organ-confined prostate cancer (PCa). Methods: A clinical database of all patients that underwent a RARP at our institution was used. Uni- and multivariable logistic regression analyses were conducted on the PSM rates for all patients with organ-confined PCa. Results: Altogether, 1,600 patients were identified, including 1,085 organ-confined PCa with a PSM rate of 7.8%. On multivariable analysis, bilateral nerve-sparing (OR 3.025, 95% CI 1.587-5.765), surgeon volume <200 cases (OR 1.881, 95% CI 1.120-3.159) and a preoperative PSA >10 ng/ml (OR 3.674, 95% CI 1.379-9.796) remained independent prognostic factors. In a subgroup of patients undergoing a nerve-sparing RARP, the quality of the prostate biopsy (OR 2.398, 95% CI 1.325-4.341) was the sole independent risk factor for a PSM. Conclusion: An elevated preoperative PSA, surgical experience and a nerve-sparing procedure are all significantly associated with a higher risk for a PSM after RARP. For those undergoing a nerve sparing RARP, an accurate preoperative biopsy with detailed information on the location of positive cores is essential to prevent PSMs.

Low-Risk Prostate Cancer and Tumor Upgrading to Higher Patterns in the Surgical Specimen. Analysis of Clinical Factors Predicting Tumor Upgrading to Higher Gleason Patterns in a Contemporary Series of Patients Who Have Been Evaluated According to the Modified Gleason Score Grading System

“…Indeed, in recent years, mpMRI of the prostate has shown to be an effective tool for identifying areas of suspicion that correlate with cancer upgrading and upstaging [22,23,24]. Moreover, it has recently been shown that mpMRI is an effective tool for both local staging and planning nerve-sparing surgery in patients undergoing RP [25,26,27]. …”

Differences in Patient Characteristics among Men Choosing Open or Robot-Assisted Radical Prostatectomy in Contemporary Practice - Analysis of Surveillance, Epidemiology, and End Results Database

“…Available population data demonstrate short-term advantages of RARP relative to ORP, such as fewer blood transfusions, fewer complications and shorter length of hospital stay [4] . Additionally, RARP is at least equivalent [5] if not superior [6] to ORP in terms of margin rates [7] . Moreover, the advantage of pelvic lymph node dissection (PLND) extent and/or yield at RARP vs. ORP is also being debated [8,9] .…”

The association between prostate weight and positive surgical margins in prostate cancer: A meta‐analysis

“…And then, we eliminated 153 studies based on screening the titles and abstract. After full‐text assessing of 45 studies were performed, eventually 22 studies (Allaparthi, Hoang, Dhanani, & Tuerk, ; Butow et al, ; Caliskan, Kaba, Koca, & Ozturk, ; Chang, Moon, Gianduzzo, & Eden, ; Chu et al, ; Descazeaud, Zerbib, Vieillefond, Debre, & Peyromaure, ; Foley, Bott, Thomas, Parkinson, & Kirby, ; Freedland et al, ; Galfano et al, ; Goetzl, Krebill, Griebling, & Thrasher, ; Hong et al, ; Kim et al, ; Labanaris et al, ; Lallas et al, ; Levinson et al, ; Marchetti, Shikanov, Razmaria, Zagaja, & Shalhav, ; Msezane et al, ; Olsson et al, ; Pettus et al, ; Yadav et al, ; Yasui et al, ; Zorn et al, ) were enrolled in our meta‐analysis. The characteristics of them were introduced in Table .…”