Initial Experience and Assessment of Surgical Margins after Robotic Assisted Radical Prostatectomy at a Mexican University General Hospital

Abstract

Background: Prostate Cancer (PC) is the most common malignant neoplasm in men and it's the second cause of cancer specific mortality. The finding of Positive Surgical Margins (PSMs) after Radical Prostatectomy (RP) is an important predictive variable for Biochemical Recurrence (BR). Predictive variables are necessary to discriminate those prone to develop BR and therefore would benefit from adjuvant therapy from those that can safely be surveilled.Objective: To identify patients with PSMs after Robotic-Assisted Radical Prostatectomy (RARP) at our urology department. Materials and Methods:Observational, descriptive, transversal and retrospective study. Between December 2014 and December 2017, 68 patients with PC underwent RARP by a single surgeon. We assessed multiple variables to identify the ones associated with increased PSMs. Variables included: age, Prostate Specific Antigen (PSA), T clinical stage, biopsy's Gleason score, and number of positive fragments, perineural invasion, lymphovascular invasion, surgical specimen's Gleason score, and pathologic stage. For statistical analysis we used SPSS v23.0.Results: 40/68 (58.8%) patients had PSMs, of them: 19/40 (47.5%) had a Gleason score 3+3=6, 7/40 (17.5%) had lymphovascular invasion, the region with greater PSMs was the prostate apex (70%), mean age was 64.2 years (SD 7.03 years), and mean PSA12.59 ng/mL (SD 12.12 ng/mL). Pathologic stage (p=0.04), PSA (p=0.021), and perineural invasion (p=0.0003) were statistically significant. 22 patients underwent surveillance, 2 Androgen Deprivation Therapy (ADT), 9 radiotherapy, and 7 radiotherapy+ADT. Conclusion:It is of utmost importance to consider preoperative PSA as a predictive factor for PSMs and to correlate it with RARP's pathology report. These factors should guide treatment election and the need for closer postoperative follow-up.