The Impact of Prior TURP on Radical Prostatectomy Surgical Margins: A Multicenter Analysis

Abstract

Objective: To analyze positive surgical margins (PSM) after radical prostatectomy (RP) in the overall population and in patients previously treated with transurethral resection of the prostate (TURP). Materials and Methods: 2,408 patients treated with RP for clinically localized prostate cancer (PCa) were consecutively enrolled in 135 departments. We correlated PSM rates and all preoperative, surgical and pathological features. We stratified the site of PSM as unique or multifocal. Moreover, we analyzed differences between 75 patients who had undergone previous TURP and the remaining 2,333 patients. Results: In the entire study population, we identified 702 patients with PSM (29%). Using univariate analysis, we reported a significant correlation between overall PSM and prostate-specific antigen (PSA), stage cT, biopsy Gleason score, number of biopsy cores, number of positive cores, percentage of positive cores and nerve-sparing approach. PSM proved to be strongly dependent on pT in particular in patients with pT2 PCa. When we compared the data from 75 patients previously treated with TURP and those from 2,333 without previous prostatic surgery, a statistically significant difference in margin localization was found. Moreover, we analyzed the 75 patients mentioned above, stratified in incidental PCa diagnosed at TURP or PCa detected with prostate biopsy for PSA rising during the post-TURP follow-up: no statistical differences were found between the 2 groups regarding margin status, even if PSM were more frequent in incidental PCa with no significance deriving from the stratification for PSM location at the apex or base. Conclusion: Men treated with TURP before RP presented an overall incidence of PSM similar to those without previous TURP, but with a higher risk of PSM at the bladder neck and a lower risk of PSM at the prostatic apex.

Comparison Study Between Laparoscopic Radical Prostatectomy versus Robotic Radical Prostatectomy in Patient with TUR-P History

“…In contrast with men without previous TURP, surgeons would perform RP with neurosparring techniques [26]. The results of this data processing are in line with previous meta-analysis studies conducted by Gacci et al in 2013 where there are differences in patients who underwent previous TURP surgery [12].…”

“…Consistently, the increasing incidence of BPH and prostate cancer with age further supports this data [6]. Several studies suggest that compared to patients who were previously treated with TURP, patients without any history of TURP procedure has statistically difference margin of localization [3]. Another study suggests that a patient with a history of undergoing TURP procedure might have less satisfactory outcomes regarding operative time, length of stay (LOS), positive margin rate (PMR) and complication rate [7].…”

“…As mentioned before, RP is the gold standard in localized prostate cancer therapy and has become an elective treatment for primary and incidental localized prostatic cancers after the previous surgery for the obstructive benign disease [3,5]. The previous surgery such as TURP had incidentally detected occult adenocarcinoma prostate with the incidence ranging 1.4-5.2%.…”

“…Pelvic lymph node could also be resected bilaterally when RP is performed to prevent cancer reaching those structures. An ideal RP should eradicate the disease without disturbing patient's continence [3].…”

<p>The Management of Patients Diagnosed with Incidental Prostate Cancer: Narrative Review</p>

“…33 Paul et al 38 studied 52 cases with iPCa after TURP undergoing RP and showed that TURP is not an adverse predictive factor and morbidity is similar to patients who were detected by needle biopsy. Gacci et al 39 showed that Men who treated with TURP before RP presented an overall incidence of positive surgical margin (PSM) similar to those without previous TURP. However, several studies reported higher PSM rates (21.8-34.2%) in patients who underwent latent-RP (LRP) after TURP.…”