Abstract
ABSTRACTObjective: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.
Highlights
Radical prostatectomy (RP) is the standard of care for young men who have organ confined prostate cancer [1]
We aimed to determine whether the features of single positive surgical margins have any impact on biochemical recurrence in patients who underwent robot assisted radical prostatectomy (RARP)
Age, prostate volume measured by transrectal ultrasonography, preoperative PSA level, Gleason score of the preoperative biopsy, Gleason scores of the RP specimen, extraprostatic extension (EPE), positive surgical margin (PSM) and postoperative PSA level of the patients were recorded
Summary
Radical prostatectomy (RP) is the standard of care for young men who have organ confined prostate cancer [1]. In the pathological examination of the specimen, the presence of cancer cells in the resected area stained with ink is called positive surgical margin (PSM) and is considered as incomplete resection. PSM ratios are reported between 6 - 41% after RP [2, 3]. PSM is regarded as an independent risk factor for the development of biochemical recurrence (BCR), local recurrence and distant metastasis [4]. We aimed to determine whether the features of single positive surgical margins have any impact on biochemical recurrence in patients who underwent robot assisted radical prostatectomy (RARP)
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