Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy

Abstract

Objective: We compared positive surgical margin (PSM) rates for patients with high risk prostate cancer (HRCaP) who underwent open radical retropubic (RRP), robotic (RALP), and laparoscopic (LRP) prostatectomy at a single institution. Materials and Methods:We performed a retrospective review of our prospectively maintained IRB approved database identifying prostate cancer patients who underwent RRP, RALP, or LRP between January 2000 and March 2010. Patients were considered to have HRCaP if they had biopsy or final pathologic Gleason score ≥ 8, or preoperative PSA ≥ 20, or pathologic stage ≥ T3a. A positive surgical margin (PSM) was defined by the presence of tumor at the inked surface of the specimen. Patients who received neoadjuvant hormonal therapy and those who underwent a perineal prostatectomy were excluded from the study. Results: Of the 445 patients in this study, surgical technique for prostatectomy included RRP (n = 153), RALP (n = 152), and LRP (n = 140). PSM rate for the three groups were not different: 52.9% RRP, 50% RALP, and 41.4% LRP, (p = 0.13). The PSM rate did not differ when comparing RRP to a combined group of RALP and LRP (p = 0.16). Among patients with a PSM, there was no statistical difference between the three groups in terms of the number of patients with a pathologic stage of T3 or higher (p = 0.83). On univariate analysis, a higher preoperative PSA value was associated with a positive margin (p = 0.04). Conclusion: In this HRCaP series, the PSM rate did not differ based on the surgical approach. On univariate analysis, patients with a higher preoperative PSA value were more likely to have a PSM.

Outcomes of robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients: experience in 34 patients with oncologic and functional outcomes

“…Others reported overall PSM rates between 12% and 48.8%. 8,12,[14][15][16][17][18][19] Our PSM rates seem to be similar to those in the published literature. Interestingly, pT0 disease was reported in two patients, and the pathology slides were re-reviewed by the pathology department without any change in the final diagnosis (Table 5).…”

“…We performed bilateral extended pelvic LN dissection in those with an at least 5% risk of pelvic LN involvement by PCa according to Partin's tables. 13 Harty et al 14 12 reported PSM rate as 60% in pT2 and pT3a disease. Others reported overall PSM rates between 12% and 48.8%.…”

Role of robot-assisted radical prostatectomy in the management of high-risk prostate cancer

“…compared the PSM rates for open versus minimally invasive RP in 445 high-risk PCa patients and found that they were not significantly different: 52.9% in ORP, 50% in RARP and 41.4% in laparoscopic RP (LRP) ( P = 0.13). [27] The PSM rate did not differ when comparing ORP with a combined group of RARP and LRP ( P = 0.16). Similar results were seen by Pierorazio et al .…”

Retropubic, Laparoscopic, and Robot-Assisted Radical Prostatectomy: Surgical, Oncological, and Functional Outcomes: A Systematic Review

“…The PSM rates for RRP, LRP, and RALP series are summarised in table 4 [10,14,15,16,18,20,21,22,24,25,26,27,28,29,30,31,32,33,34,36,37,38,39,42,43,44,45,46,47,49,50,51,52,53,56]. …”