Impact of nerve sparing on surgical margins and biochemical recurrence: results from the SEARCH database

Nelles, Jason L.; Freedland, Stephen J.; Presti, Joseph C.; Terris, Martha K.; Aronson, William J.; Amling, Christopher L.; Kane, Christopher J.

doi:10.1038/pcan.2008.40

Cited by 25 publications

(20 citation statements)

References 18 publications

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“…Table 1 lists the characteristics of the study population for all the study subjects, as well as a subset analysis of men who had a biopsy Gleason sum ≤6. During the follow-up period, 46 (44.7%) of all study subjects had a PSA recurrence, which is in the range with previous reports4.…”

Section: Resultssupporting

confidence: 84%

“…Pathological stage, the most reliable predictor of tumor progression, recurrence and overall disease outcome, is only available if a patient chooses to undergo radical prostatectomy. Several limiting factors surrounding the use of staging and common clinical tumor markers argue for the development of more reliable prognostic markers prior to therapeutic intervention2–4. To meet this need, efforts have focused on development of molecular markers available at the time of biopsy.…”

Section: Introductionmentioning

confidence: 99%

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Telomere DNA Content in Prostate Biopsies Predicts Early Rise in Prostate-specific Antigen After Radical Prostatectomy for Prostate Cancer

Treat

Heaphy

Massie

et al. 2010

Urology

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Objective To determine whether measurement of telomere DNA content (TC) in prostate biopsy tissue predicts PSA recurrence in men after undergoing radical prostatectomy for prostate cancer. Methods Slot blot titration assay was used to quantitate TC in archived diagnostic prostate needle biopsy specimens for subjects (n=103) diagnosed with prostate cancer and who subsequently underwent radical prostatectomy between 1993 and 1997. TC was compared to the clinical outcome measure, PSA recurrence, defined as an increase in PSA ≥0.2ng/mL on two or more consecutive measurements post-prostatectomy, observed retrospectively, for a mean follow-up period of 114 months (range 1–165). Results In the cohort, 46 subjects had a PSA recurrence. In a univariate Cox proportional hazards model, low TC (<0.3 of standard) demonstrated a significant risk for PSA recurrence (HR=1.94; 95% CI:1.02–3.69, p=0.04). In a subset analysis of men with biopsy Gleason sum ≤6 (n=63; 25 recurrences), a univariate Cox proportional hazards model demonstrated low TC had a greater risk of PSA recurrence (HR=4.53; 95% CI:2.00–10.2, p<0.01). In a multivariate Cox proportional hazards model, low TC was also significantly associated with PSA recurrence in this subset after controlling for pre-operative PSA levels (HR=6.62; 95% CI:2.69–16.3, p<0.01). Conclusions Low TC measured in prostate biopsy tissue predicts early likelihood of post-prostatectomy PSA recurrence in a retrospective analysis and in men with biopsy Gleason sum ≤6 disease is also independent of pre-operative PSA level.

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Section: Resultssupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Telomere DNA Content in Prostate Biopsies Predicts Early Rise in Prostate-specific Antigen After Radical Prostatectomy for Prostate Cancer

Treat

Heaphy

Massie

et al. 2010

Urology

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“…This suggests that preoperative clinicopathological features predict margin status more accurately than NSS technique. Several other single‐institutional [10–12,17] and multi‐institutional [13] studies have also reported that NSS technique is not a risk factor for PSMs. Nelles et al .…”

Section: Discussionmentioning

confidence: 89%

“…Several single‐surgeon [11,12] and multicenter [13] studies have found no significant association between NSS and PSM after adjusting for other risk factors such as age, PSA level, Gleason grade, P stage and year of surgery. Billis et al .…”

Section: Introductionmentioning

confidence: 99%

The impact of nerve sparing on incidence and location of positive surgical margins in radical prostatectomy

et al. 2011

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Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Nerve sparing radical prostatectomy has been associated with increased risk of positive surgical margins due to the close anatomical relationship of the neurovascular bundle to the posterolateral aspect of the prostatic fascia. Our study of 945 men who underwent radical prostatectomy be one experienced surgeon found no increased risk of positive surgical margins, whether the cancer was organ confined or extracapsular extension was present. OBJECTIVE To examine whether nerve‐sparing surgery (NSS) is a risk factor for positive surgical margins (PSMs) in patients with either organ‐confined prostate cancer or extracapsular extension (ECE). PATIENTS AND METHODS Clinicopathological outcome data on 945 consecutive patients treated with radical prostatectomy (RP) were prospectively collected. All patients underwent RP (bilateral, unilateral or non‐NSS) by one surgeon between 2002 and 2007. Risk of PSMs and their locations with respect to NSS was determined by multivariate logistic regression analysis adjusting for preoperative risk factors for PSMs within pT2, pT3a and pT3b tumours. RESULTS Overall a PSM was identified in 19.6% of patients in an unscreened population with mean prostate‐specific antigen (PSA) level of 8.1 ng/mL. There was no significant difference in rates of PSMs between NSS groups on multivariate analysis (P= 0.147). There was no significant difference in pT2 (P= 0.880), pT3a (P= 0.175) or pT3b (P= 0.354) tumours. The only significant predictor of PSMs was preoperative PSA level (risk ratio 1.289, P= 0.006). There was no significant difference in the location of PSMs except for the pT3a group, where the patients that had bilateral NSS were at higher risk of a posterolateral PSM (P= 0.028). CONCLUSIONS With appropriate selection of patients, NSS does not increase the risk of PSMs, whether the cancer is organ confined or ECE is present. The adverse impact of the NSS procedure in the hands of an experienced surgeon is minimal and is a realistic compromise to obtain the increase in health‐related quality of life offered by NSS.

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“…Two large database studies of RPs did not report a correlation between the 2 factors [7,21]. In contrast, in a large series of patients having undergone ORP, an increase in the PSM from 7.8 to 13.9% was seen when performing a nerve-sparing prostatectomy, irrespective of tumour stage [22].…”

Section: Discussionmentioning

confidence: 99%

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

Bütow

Schunk²,

Janssen³

et al. 2015

Urol Int

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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.

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Impact of nerve sparing on surgical margins and biochemical recurrence: results from the SEARCH database

Cited by 25 publications

References 18 publications

Telomere DNA Content in Prostate Biopsies Predicts Early Rise in Prostate-specific Antigen After Radical Prostatectomy for Prostate Cancer

Telomere DNA Content in Prostate Biopsies Predicts Early Rise in Prostate-specific Antigen After Radical Prostatectomy for Prostate Cancer

The impact of nerve sparing on incidence and location of positive surgical margins in radical prostatectomy

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

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