The impact of single positive surgical margin features on biochemical recurrence after robotic radical prostatectomy

Abstract

Objective: Parameters predictive of biochemical or clinical recurrence after Radical Prostatectomy (RP) were determined as pre-treatment PSA value, pathologic tumor stage, tumor grade and presence of Positive Surgical Margin (PSM), extracapsular extension and seminal vesicle invasion and the status of pelvic lymph nodes. The aim of our study is to evaluate the effect of additional features in patients undergoing RP in our clinic. Materials and Methods: We studied 556 RP operations performed between 2009 and 2016 for prostate cancer at this clinic. Preoperative and postoperative data of the patients were retrospectively reviewed. RP specimens were examined by two pathologists specialized in this subject. Of these patients, 78 (14.02%) patients with PSM were included in the study. The pathology slides of these patients were reassessed. The length of PSM (mm), localization (apex, basis and posterolateral) and Gleason pattern at this margin was determined and statistical correlations with BCR were calculated. Results: The mean follow-up after the RP of 41 patients included in the study was 37.4 ± 13.2 months. During the follow-up period of the patients, BCR was observed in 16 patients (39.02%). No statistically significant difference was observed in age and prostate volume between the groups with and without BCR development (p > 0.05). Preoperative PSA level was found to be statistically significantly higher in the group with BCR development compared to the group without recurrence (p = 0.004). In-group comparisons in each aforementioned Gleason score groups were performed in terms of BCR development and the preoperative Gleason score in the group with development of recurrence was found to be statistically significantly higher compared to the group without recurrence (p = 0.007). The length of the surgical margin was measured as 7.4 ± 4.4 mm in the BCR-developing group and 4.7 ± 3.8 mm in the no-BCR- developing group; it was statistically significantly higher in the group with development of recurrence (p = 0.03). Conclusion: Length and location of the PSM and the Gleason score detected in the PSM region could not predict biochemical recurrence according to the results of this present study. However high preoperative PSA value is an independent prognostic factor for biochemical recurrence.

Primary Gleason grade and Gleason grade group at positive surgical margins: a systematic review and meta‐analysis

“…There were several other methodological issues also identified with these studies. Some had a low sample size and/or a short follow-up period [7,21,[25][26][27]. Maxeiner et al [28] also showed GS 8-10 increased risk of BCR in univariable analysis; however, they failed to perform a multivariable analysis due to insufficient sample size.…”

Prediction of a positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy

“…RARP offers potential benefits such as a low PSM rate compared with open RP owing to better visibility and less blood loss 19 , 20 . Previous studies have discussed the prediction of PSM after RARPs using single-surgeon case study 21 , 22 . The benefit of single-surgeon case series is taking a similar surgical approach to decrease the variation and bias as compared with other studies that retrieved the RARPs performed by plenty of urologists with different methods from various centers.…”

Reply to: Kumsar S. Re: Kupski T, Małek M, Mor I. The association of a risk group with positive margin in the intraoperative and final pathology examination after robotic radical prostatectomy. Cent European J Urol. 2021; 74: 491-495.

“…We considered the decision to resect NVB at Rmicro quite controversial and the decision was made by the operator individually. A positive margin in the final study increases the risk of biochemical recurrence, however, it is not the only factor affecting it [ 1 , 2 , 3 ]. Particularly, when talking about Rmicro where the margin is <1 mm.…”