OBJECTIVE: To determine the impact of prostate size on positive surgical margin (PSM) rates after RARP and the pre-operative factors associated with PSM.
MATERIALS AND METHODS: A total of 1,229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had trans-urethral resection of the prostate, neo-adjuvant therapy, clinically-advanced cancer, and the first 200 performed cases, to reduce the effect of learning curve. Included were 815 patients who were then divided into three groups: < 31 g (group 1), 31-45 g (group2), >45 g (group3). Multivariate analysis determined predictors of PSM and BCR.
RESULTS: Console time and blood loss increased with increasing prostate size. There were more high-grade tumors in group one (group1 vs. group2 and group3, 33.9% vs. 25.1 and 25.6%, p=0.003 and p=0.005). PSM were increased in < 45 g prostates with pre-operative PSA >20 ng/dl, Gleason score >7, T3 tumor, and >3 positive biopsy cores. In group one, pre-operative stage T3 (OR=3.94, p=0.020) and >3 positive biopsy core (OR=2.52, p=0.043) were predictive of PSM while a PSA >20ng/dl predicted the occurrence of BCR (OR=5.34, p=0.021). No pre-operative factors predicted PSM or BCR for groups two and three.
CONCLUSION: A pre-operative biopsy with >3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA >20 ng/dl is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer post-operative follow-up.
Tuliao PH, Koo KC, Komninos C, Chang CH, Choi YD, Chung BH, Hong SJ, Rha KH. Are you the author?
Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
Reference: BJU Int. 2014 Aug 7. Epub ahead of print.