Correlation between postoperative prostate-specific antigen and biochemical recurrence in positive surgical margin patients: Single surgeon series

AbstractThe positive surgical margin (PSM) and biochemical recurrence (BCR) are two main factors associated with poor oncotherapeutic outcomes after prostatectomy. This is an Asian population study based on a single-surgeon experience to deeply investigate the predictors for PSM and BCR. We retrospectively included 419 robot-assisted radical prostatectomy cases. The number of PSM cases was 126 (30.1%), stratified as 22 (12.2%) in stage T2 and 103 (43.6%) in stage T3. Preoperative prostate-specific antigen (PSA) > 10 ng/mL (p = 0.047; odds ratio [OR] 1.712), intraoperative blood loss > 200 mL (p = 0.006; OR 4.01), and postoperative pT3 stage (p < 0.001; OR 6.901) were three independent predictors for PSM while PSA > 10 ng/mL (p < 0.015; hazard ratio [HR] 1.8), pT3 stage (p = 0.012; HR 2.264), International Society of Urological Pathology (ISUP) grade > 3 (p = 0.02; HR 1.964), and PSM (p = 0.027; HR 1.725) were four significant predictors for BCR in multivariable analysis. PSMs occurred mostly in the posterolateral regions (73.8%) which were associated with nerve-sparing procedures (p = 0.012) while apical PSMs were correlated intraoperative bleeding (p < 0.001). A high ratio of pT3 stage after RARP in our Asian population-based might surpass the influence of PSM on BCR. PSM was less significant than PSA and ISUP grade for predicting PSA recurrence in pT3 disease. Among PSM cases, unifocal and multifocal positive margins had a similar ratio of the BCR rate (p = 0.172) but ISUP grade > 3 (p = 0.002; HR 2.689) was a significant BCR predictor. These results indicate that PSA and pathological status are key factors influencing PSM and BCR.

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Surgical margins and biochemical recurrence risk at 2 years for robotic prostatectomy: Comprehensive evaluation and CUSUM analysis of oncological outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.7_suppl.80 ◽

2015 ◽

Vol 33 (7_suppl) ◽

pp. 80-80

Author(s):

Arjun Sivaraman ◽

Rafael Sanchez-Salas ◽

Dominic Prapotnich ◽

Kaixin Yu ◽

Fabien Olivier ◽

...

Keyword(s):

Learning Curve ◽

Biochemical Recurrence ◽

Transition Point ◽

Cox Regression ◽

Multivariable Analysis ◽

Specific Antigen ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Oncological Outcomes ◽

Cusum Analysis

80 Background: To evaluate the learning curve of Minimally Invasive Radical Prostatectomy (MIRP) in our institution and apply the cumulative summation (CUSUM) analytical technique to identify salient learning curve transition points in terms of oncological outcomes. Methods: Clinical, pathologic, and oncological outcome data were collected from our prospectively collected MIRP database to estimate Positive Surgical margin (PSM) and Biochemical Recurrence (BCR) trends during a 15 year period from 1998 to 2013. All the RPs (laparoscopic (LRP) / Robotic Assisted [RARP]) were performed by 9 surgeons. PSM was defined as presence of cancer cells at inked margins. BCR was defined as serum Prostate Specific Antigen (PSA) >0.2 ng/ml and rising or start of secondary therapy. Surgical learning curve was assessed with the application of Kaplan-Meier curves, Cox regression model, CUSUM and logistic model in order to define the “transition point” of surgical improvement. Results: We identified 5,547 patients with localized prostate cancer treated with MIRP (3,846 - LRP and 1,701 – RARP). Patient characteristics of LRP and RARP were similar. The overall risk of PSM in LRP was 25%, 20% and 17% for the first 50, 50 to 350 and >350 cases, respectively. For the same population, the 5-year BCR rate decreased from 21.5% to 16.7%. RARP started 3 years after the LRP program (after approximately 250 LRP). The PSM rate for RARP decreased from 21.8% to 20.4% and the corresponding 5-year BCR rate decreased from 17.6% to 7.9%. The CUSUM analysis showed significantly lower PSM and BCR at 2 years occurred at the transition point of 350 cases for LRP and 100 cases for RARP. In multivariable analysis, predictors of BCR were PSA, Gleason score, extra prostatic disease, seminal vesicle invasion and number of operations (p < 0.05). Patients harboring PSM showed higher BCR risk (23% vs. 8%, p < 0.05). Conclusions: Learning curve trends of MIRP in our large, single center experience showed significant reduction in PSM and BCR risk at 2 years are noted after the initial 350 cases and 100 cases of LRP and RARP, respectively.

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Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: The UK experience

Journal of Clinical Urology ◽

10.1177/2051415817706635 ◽

2017 ◽

Vol 11 (1) ◽

pp. 15-20 ◽

Cited By ~ 6

Author(s):

Christopher G Eden ◽

Dimitrios Moschonas ◽

Ricardo Soares

Keyword(s):

Radical Prostatectomy ◽

Prostate Specific Antigen ◽

Clinical Stage ◽

Operating Time ◽

Specific Antigen ◽

Surgical Margin ◽

Interquartile Range ◽

Urinary Continence ◽

Positive Surgical Margin ◽

Robot Assisted

Objective: The purpose of this study was to investigate urinary continence four weeks following Retzius-sparing robot-assisted radical prostatectomy. Patients and methods: Forty patients with T2–T3 prostate cancer underwent Retzius-sparing-robot-assisted radical prostatectomy and their results were compared with those from the 40 patients having robot-assisted radical prostatectomy done by the same surgeon immediately prior to the adoption of Retzius-sparing-robot-assisted radical prostatectomy. Results: Patients in the two groups had similar age, body mass index, prostate specific antigen, biopsy Gleason sum, clinical stage, d’Amico risk profile, blood loss, prostate weight and post-operative hospital stay. Median operating time (200 (interquartile range=155–266) vs 223 (interquartile range=100–238) min; p=0.05) and catheterisation (8 (interquartile range=8–8) vs 14 (interquartile range=14–14) days; p<0.0001) were shorter in the Retzius-sparing group, many of whom had suprapubic catheters inserted. The overall complication rate was lower in Retzius-sparing patients (2.5% vs 8.0%; p=0.36). Positive surgical margin rates were similar for Retzius-sparing and non-Retzius-sparing patients and decreased with greater experience with the Retzius-sparing technique: 16.7% vs 7.7% for pT2 ( p=0.65) and 31.8% vs 14.3% for pT3 ( p=0.44). Initial prostate specific antigen was <0.1 ng/ml in 97.5% and 100%, respectively ( p=1.00). At four weeks post-operation 0, 1 and 2 pads/day were needed in the Retzius-sparing group in 90.0%, 7.5% and 2.5% of patients, compared to 37.5% ( p<0.0001), 32.5% ( p=0.01) and 30% ( p=0.002) of men having conventional surgery. Conclusion: Retzius-sparing-robot-assisted radical prostatectomy is faster than the anterior approach to the prostate, allows a shorter catheterisation time and produces dramatically better continence results at four weeks with 90% of patients being pad-free and 97.5% of patients needing 0–1 pads/day.

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Predictors of biochemical recurrence of prostate cancer

Kazan medical journal ◽

10.17750/kmj2017-890 ◽

2017 ◽

Vol 98 (6) ◽

pp. 890-894 ◽

Cited By ~ 3

Author(s):

F A Guliev

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Prostate Specific Antigen ◽

Biochemical Recurrence ◽

Tumor Volume ◽

Prognostic Significance ◽

Specific Antigen ◽

Surgical Margin ◽

Surgical Margins ◽

Operative Risk

Aim. To study the role of postoperative parameters in predicting the probability of development of biochemical recurrence in patients with prostate cancer with low pre-operative risk of its progression. Methods. 95 patients who underwent radical prostatectomy, were included in the study, the average age being 59.5±0.7 (44-76) years. The average levels of total and free prostate-specific antigen were 5.8±0.2 (1.71-9.9) and 1.03±0.07 (0.2-3.6) ng/ml respectively. Biochemical recurrence was defined as the level of prostate-specific antigen higher than 0.2 ng/ml after radical prostatectomy. Results. 8 (8.4%) patients during the follow-up period were diagnosed with biochemical recurrence. The average period to biochemical recurrence development was 45.8±6.7 (24-84) months. Pathomorphological examination revealed presence of tumor cells at surgical margin in 18 (18.9%) cases. Biochemical recurrence was diagnosed in 5 out of 77 (6.5%) patients with negative surgical margins and in 3 out of 18 (1.7%) patients with positive surgical margins. In our study, no correlation between the state of surgical margin and biochemical recurrence development was revealed (χ2=1.958; р=0.162). In the study group postoperative Gleason score was not prognostically significant as well (р=0.294). The average tumor volume in resected material was 11.8±1.0% (1-55%) of prostate volume (мм3). Extraprostatic extension was diagnosed in 10 (10.5%) cases. Results of univariate dispersion analysis of postoperative parameters revealed prognostic significance of tumor volume in removed specimen (р=0.007) and extracapsular extension (р=0.027). Conclusion. In our study we determined that tumor volume and extracapsular extention are independent risk factors for biochemical recurrence in prostate cancer patients with low pre-operative risk of disease progression.

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The Clinical Significance of Perineural Invasion by Prostate Cancer on Needle Core Biopsy

Archives of Pathology & Laboratory Medicine ◽

10.5858/arpa.2021-0248-oa ◽

2022 ◽

Author(s):

Phoenix D. Bell ◽

Yuki Teramoto ◽

Pratik M. S. Gurung ◽

Numbereye Numbere ◽

Zhiming Yang ◽

...

Keyword(s):

Prostate Cancer ◽

Prostate Specific Antigen ◽

Perineural Invasion ◽

Tumor Volume ◽

Specific Antigen ◽

Surgical Margin ◽

Outcome Analysis ◽

Positive Surgical Margin ◽

Grade Group ◽

Entire Cohort

Context.— Perineural invasion (PNI) by prostate cancer has been associated with adverse pathology, including extraprostatic extension. However, the significance of PNI quantification on prostate biopsy (PBx) remains unclear. Objective.— To compare radical prostatectomy (RP) findings and long-term outcomes in patients whose PBx had exhibited PNI. Design.— We assessed 497 consecutive patients undergoing sextant (6-site/≥12-core) PBx showing conventional adenocarcinoma followed by RP. Results.— PNI was found in 1 (n = 290)/2 (n = 132)/3 (n = 47)/4 (n = 19)/5 (n = 5)/6 (n = 4) of the sites/regions of PBx. Compared with a single PNI site, multiple PNIs were significantly associated with higher preoperative prostate-specific antigen, higher Grade Group (GG) on PBx or RP, higher pT or pN category, positive surgical margin, and larger estimated tumor volume. When compared in subgroups of patients based on PBx GG, significant differences in RP GG (GG1–3), pT (GG1–2/GG1–3/GG2/GG3), surgical margin status (GG1–3/GG3/GG5), or tumor volume (GG1–2/GG1–3/GG2/GG3) between 1 versus multiple PNIs were observed. Moreover, there were significant differences in prostate-specific antigen (PNI sites: 1–2 versus 3–6/1–3 versus 4–6/1–4 versus 5–6), RP GG (1–3 versus 4–6/1–4 versus 5–6), pT (1–2 versus 3–6/1–3 versus 4–6), pN (1–3 versus 4–6), or tumor volume (1–2 versus 3–6/1–4 versus 5–6). Outcome analysis revealed significantly higher risks of disease progression in the entire cohort or PBx GG1–2/GG1–3/GG2/GG3/GG5 cases showing 2 to 6 PNIs, compared with respective controls with 1-site PNI. In multivariate analysis, multisite PNI was an independent predictor for progression (hazard ratio = 1.556, P = .03). Conclusions.— Multiple sites of PNI on PBx were associated with worse histopathologic features in RP specimens and poorer prognosis. PNI may thus need to be specified, if present, in every sextant site on PBx, especially those showing GG1–3 cancer.

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Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era

Canadian Urological Association Journal ◽

10.5489/cuaj.3163 ◽

2016 ◽

Vol 10 (1-2) ◽

pp. 17 ◽

Cited By ~ 6

Author(s):

Ahva Shahabi ◽

Raj Satkunasivam ◽

Inderbir S. Gill ◽

Gary Lieskovsky ◽

Sia Daneshmand ◽

...

Keyword(s):

Prostate Cancer ◽

Radical Prostatectomy ◽

Competing Risks ◽

Gleason Score ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Surgical Margin ◽

Localized Prostate Cancer ◽

Positive Surgical Margin ◽

Clinical Recurrence

Introduction: We sought to determine predictors for early and late biochemical recurrence following radical prostatectomy among localized prostate cancer patients.Methods: The study included localized prostate cancer patients treated with radical prostatectomy (RP) at the University of Southern California from 1988 to 2008. Competing risks regression models were used to determine risk factors associated with earlier or late biochemical recurrence, defined using the median time to biochemical recurrence in this population (2.9 years after radical prostatectomy).Results: The cohort for this study included 2262 localized prostate cancer (pT2-3N0M0) patients who did not receive neoadjuvant or adjuvant therapies. Of these patients, 188 experienced biochemical recurrence and a subset continued to clinical recurrence, either within (n=19, 10%) or following (n=13, 7%) 2.9 years after RP. Multivariable stepwise competing risks analysis showed Gleason score ≥7, positive surgical margin status, and ≥pT3a stage to be associated with biochemical recurrence within 2.9 years following surgery. Predictors of biochemical recurrence after 2.9 years were Gleason score 7 (4+3), preoperative prostate-specific antigen (PSA) level, and ≥pT3a stage.Conclusions: Higher stage was associated with biochemical recurrence at any time following radical prostatectomy. Particular attention may need to be made to patients with stage ≥pT3a, higher preoperative PSA, and Gleason 7 prostate cancer with primary high-grade patterns when considering longer followup after RP.

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Prediction of A Positive Surgical Margin and Biochemical Recurrence After Robot-Assisted Radical Prostatectomy

10.21203/rs.3.rs-134960/v1 ◽

2021 ◽

Author(s):

Ching-Wei Yang ◽

Hsiao-Hsien Wang ◽

Mohamed Hassouna ◽

Manish Chand ◽

Hsiao-Jen Chung

Keyword(s):

Multivariate Analysis ◽

Radical Prostatectomy ◽

Biochemical Recurrence ◽

Specific Antigen ◽

Surgical Margin ◽

Positive Surgical Margin ◽

Intraoperative Blood Loss ◽

Pathological Stage ◽

Robot Assisted

Abstract A positive surgical margin (PSM) detected in a prostatectomy specimen is associated with poor oncotherapeutic outcomes. Certain aspects regarding the determination of surgical margins and their effects on biochemical recurrence (BCR) remain unclear. This study investigated the predictive factors for PSM and BCR. We prospectively included 419 robot-assisted radical prostatectomy cases. The number of PSM cases was 126 (30.1%), stratified as 22 (12.2%) in stage T2 and 103 (43.6%) in stage T3. Preoperative prostate-specific antigen (PSA) > 10 ng/mL (p = 0.047; odds ratio [OR] 1.712), intraoperative blood loss > 200 mL (p = 0.006; OR 4.01), and postoperative pT3 stage (p < .001; OR 6.901) were three independent predictors for PSM in multivariate analysis. PSA > 10 ng/mL (p < 0.015; hazard ratio [HR] 1.8), pT3 stage (p = 0.012; HR 2.264), ISUP grade > 3 (p = 0.02; HR 1.964), and PSM (p = 0.027; HR 1.725) were four significant predictors for BCR in multivariate analysis. Among PSM cases, ISUP grade > 3 (p = 0.002; HR 2.689) was a significant BCR predictor. These results indicate that PSA level and pathological stage markedly influence the PSM and BCR.

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