Risk factors for biochemical recurrence after robotic assisted radical prostatectomy: a single surgeon experience

Abstract

BackgroundRadical prostatectomy is a standard surgical treatment of clinically localized prostate cancer. Margin status has been found to be an independent predictor of biochemical recurrence (BCR) after open radical prostatectomy in several large series but this is still controversy in Robotic Assisted Radical Prostatectomy (RARP) series. We therefore wanted to investigate the prognostic significance of positive surgical margin (PSM) and other pathological factors on BCR in patients treated with RARP by a single surgeon.MethodsProspectively collected data of 439 patients treated with RARP between October 2005 and June 2013 by a single surgeon at a single institution were analyzed. BCR was defined as follow-up PSA level > 0.2 ng/ml on two separate occasions or patients who had to undergo salvage therapy. Kaplan Meier curves and Log Rank test were used to compare the risk of BCR. Univariate and Multivariate Cox Regression analyses were performed to determine the prognostic impact of age, BMI, prostate weight, PSA prior to surgery, pathological T-stage, pathological Gleason sum, PSM and operative period.ResultsIn this study period, 34 out of 439 had BCR, giving an overall BCR rate of 7.7% for this cohort. Overall 2- and 3-year BCR-free survival rates were 93% and 88%, respectively. Patients with a PSM had a 2-year BCR free survival of 88% compared to 94% in those with negative margins (p < .0001). On the multivariate analysis, PSM as well as pathological Gleason sum > = 8, PSA, pathological stage and operative period were significantly associated with BCR.ConclusionsIn our case series of RARP performed by a single surgeon, PSM as well as pathological Gleason sum, PSA, pathological stage and early operative period for this surgeon were the independent predictors of BCR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0024-7) contains supplementary material, which is available to authorized users.

Effect of age on biochemical recurrence after radical prostatectomy

“…However, 20–30% of patients who undergo RRP present with isolated BCR at long‐term follow‐up [20]. ECE, PSM, SVI, LNI, high PSA level, and GS are widely accepted risk factors for BCR [21,22]. The addition of advanced age to these risk factors is somewhat controversial.…”

Biochemical recurrence‐free conditional probability after radical prostatectomy: A dynamic prognosis

“…The predictors of BCR in the present study were PSA, PSM, ECE, pathological Gleason ≥4 + 3 and LARP. Most RARP and open RP studies reported pathological Gleason ≥4 + 3, ≥pT3 stage and PSM to be associated with BCR . Although in the literature the surgical approach has not been proven to predict recurrence when comparing open RP, LARP and RARP, in the present study the LARP is significantly associated with higher BCR rates .…”

“…Most RARP and open RP studies reported pathological Gleason ≥4 + 3, ≥pT3 stage and PSM to be associated with BCR. [13][14][15][16][17][22][23][24][25] Although in the literature the surgical approach has not been proven to predict recurrence when comparing open RP, LARP and RARP, in the present study the LARP is significantly associated with higher BCR rates. 25 This might be due to the development of the RARP and completion of the learning curve years ago.…”

Biochemical recurrence after radical prostatectomy: Current status of its use as a treatment endpoint and early management strategies

“…[ 25 ] A single-surgeon case series of 439 patients who underwent RARP demonstrated that positive surgical margins, pathological Gleason sum ≥8, stage pT3 and higher, and preoperative PSA ≥10 were significantly associated with BCR on multivariate analysis. [ 26 ] For reference, one retrospective study of 831 men who underwent ORP by a single surgeon reported a BCR rate of 19% at median follow-up of 52 months. [ 27 ]…”