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 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.
CONCLUSIONS - 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.
Urologia internationalis. 2015 Nov 18 [Epub ahead of print]
Zentia Bütow, Stefan Schunk, Martin Janssen, Stefan Gräber, Matthias Saar, Jörn Kamradt, Stefan Siemer, Michael Stöckle, Carsten-Henning Ohlmann
Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany.