Biochemical Recurrence Rates after Minimally Invasive Radical Prostatectomy and Positive Surgical Margins in Localized Prostate Cancer
Keywords:
prostate cancer, laparoscopic and robotic radical prostatectomy, positive margins, biochemical recurrenceAbstract
Objective: To retrospectively evaluate biochemical recurrence rates of the patients who underwent minimally invasive radical prostatectomy and positive margins in localized prostate cancer. Treatment in men with positive surgical margins after radical prostatectomy is controversial. Immediate adjuvant therapy reduces the risk of biochemical recurrence at the cost of increased toxicity. Providing the appropriate treatment should be based on an understanding of the risk of recurrence without treatment.
Materials and Methods: We performed a retrospective analysis of the records of 944 men who underwent minimally invasive radical prostatectomy (laparoscopic or robotic assisted laparoscopic radical prostatectomy) in Siriraj hospital between December 2005 to July 2009. Patient age at surgery, clinical stage, preoperative PSA, operative time, estimated blood loss, surgical specimen pathology(specimen weight, tumor grade, tumor volume, stage and surgical margin status) and follow up PSA were recorded. All specimens were reviewed by one pathologist. Of 944 patients, 122 met criteria for analysis.
Results: Mean follow up was 21.4 months (3.2-58.3). The positive margin rate was 12.9% (122 of 944 patients). The overall PSA biochemical recurrence rate was 13.9% (17 of 122, 95%CI: 8.9%-21.2%). Mean PSA slightly higher in patients with biochemical recurrence (11.9 vs 11.5, p = 0.864). The recurrence rate was higher in patients with multiple positive margins compared to those with a solitary positive margin (17.2% vs 12.9%, p = 0.549). However, these differences failed to attain statistical significance. Mean interval to biochemical recurrence (n=17) was 10.9+8.4 months (2.8-29.1). No statistically significant risk factors for recurrence in patients with a positive margin on univariated analysis were found.
Conclusions: A low biochemical recurrence rate, (13.9%) was found in patients with a positive surgical margin following minimally invasive radical prostatectomy. If adjuvant radiation is given to every patient with a positive surgical margin, more than 86% of patients will receive unnecessary adjuvant radiation and/or hormonal therapy.
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