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.

• Authors: Zentia Bütow, Stefan Schunk, Martin Janssen, Stefan Gräber, Matthias Saar, Jörn Kamradt, Stefan Siemer, Michael Stöckle, Carsten-Henning Ohlmann
• Journal: Urologia internationalis (Urol Int) Vol. 95 Issue 4 Pg. 465-71 ( 2015) ISSN: 1423-0399 [Electronic] Switzerland
• PMID: 26575991 (Publication Type: Journal Article)
• Copyright: © 2015 S. Karger AG, Basel.

Topics

• Adult
• Aged
• Biopsy (standards)
• Humans
• Male
• Middle Aged
• Preoperative Care (methods)
• Prognosis
• Prostate (innervation, pathology)
• Prostatectomy (methods)
• Prostatic Neoplasms (pathology, surgery)
• Reproducibility of Results
• Retrospective Studies
• Risk Factors
• Robotic Surgical Procedures (methods)