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Number of positive preoperative biopsy cores is a predictor of positive surgical margins (PSM) in small prostates after robot-assisted radical prostatectomy (RARP).
BJU Int. 2015 Dec; 116(6):897-904.BI

Abstract

OBJECTIVE

To determine the impact of prostate size on positive surgical margin (PSM) rates after robot-assisted radical prostatectomy (RARP) and the preoperative factors associated with PSM.

PATIENTS AND METHODS

In all, 1229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had transurethral resection of the prostate, neoadjuvant 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 prostate size groups: <31 g (group 1), 31-45 g (group 2), >45 g (group 3). Multivariate analysis determined predictors of PSM and biochemical recurrence (BCR).

RESULTS

Console time and blood loss increased with increasing prostate size. There were more high-grade tumours in group 1 (group 1 vs group 2 and group 3, 33.9% vs 25.1% and 25.6%, P = 0.003 and P = 0.005). PSM rates were higher in prostates of <45 g with preoperative PSA levels of >20 ng/dL, Gleason score ≥7, T3 tumour, and ≥3 positive biopsy cores. In group 1, preoperative stage T3 [odds ratio (OR) 3.94, P = 0.020] and ≥3 positive biopsy cores (OR 2.52, P = 0.043) were predictive of PSM, while a PSA level of >20 ng/dL predicted the occurrence of BCR (OR 5.34, P = 0.021). No preoperative factors predicted PSM or BCR for groups 2 and 3.

CONCLUSION

A preoperative biopsy with ≥3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA level of >20 ng/dL is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer postoperative follow-up.

Authors+Show Affiliations

Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25098818

Citation

Tuliao, Patrick H., et al. "Number of Positive Preoperative Biopsy Cores Is a Predictor of Positive Surgical Margins (PSM) in Small Prostates After Robot-assisted Radical Prostatectomy (RARP)." BJU International, vol. 116, no. 6, 2015, pp. 897-904.
Tuliao PH, Koo KC, Komninos C, et al. Number of positive preoperative biopsy cores is a predictor of positive surgical margins (PSM) in small prostates after robot-assisted radical prostatectomy (RARP). BJU Int. 2015;116(6):897-904.
Tuliao, P. H., Koo, K. C., Komninos, C., Chang, C. H., Choi, Y. D., Chung, B. H., Hong, S. J., & Rha, K. H. (2015). Number of positive preoperative biopsy cores is a predictor of positive surgical margins (PSM) in small prostates after robot-assisted radical prostatectomy (RARP). BJU International, 116(6), 897-904. https://doi.org/10.1111/bju.12888
Tuliao PH, et al. Number of Positive Preoperative Biopsy Cores Is a Predictor of Positive Surgical Margins (PSM) in Small Prostates After Robot-assisted Radical Prostatectomy (RARP). BJU Int. 2015;116(6):897-904. PubMed PMID: 25098818.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Number of positive preoperative biopsy cores is a predictor of positive surgical margins (PSM) in small prostates after robot-assisted radical prostatectomy (RARP). AU - Tuliao,Patrick H, AU - Koo,Kyo C, AU - Komninos,Christos, AU - Chang,Chien H, AU - Choi,Young D, AU - Chung,Byung H, AU - Hong,Sung J, AU - Rha,Koon H, Y1 - 2015/06/02/ PY - 2014/8/8/entrez PY - 2014/8/8/pubmed PY - 2016/2/18/medline KW - prostate KW - prostatectomy KW - prostatic neoplasms KW - surgical margins SP - 897 EP - 904 JF - BJU international JO - BJU Int. VL - 116 IS - 6 N2 - OBJECTIVE: To determine the impact of prostate size on positive surgical margin (PSM) rates after robot-assisted radical prostatectomy (RARP) and the preoperative factors associated with PSM. PATIENTS AND METHODS: In all, 1229 men underwent RARP by a single surgeon, from 2005 to August of 2013. Excluded were patients who had transurethral resection of the prostate, neoadjuvant 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 prostate size groups: <31 g (group 1), 31-45 g (group 2), >45 g (group 3). Multivariate analysis determined predictors of PSM and biochemical recurrence (BCR). RESULTS: Console time and blood loss increased with increasing prostate size. There were more high-grade tumours in group 1 (group 1 vs group 2 and group 3, 33.9% vs 25.1% and 25.6%, P = 0.003 and P = 0.005). PSM rates were higher in prostates of <45 g with preoperative PSA levels of >20 ng/dL, Gleason score ≥7, T3 tumour, and ≥3 positive biopsy cores. In group 1, preoperative stage T3 [odds ratio (OR) 3.94, P = 0.020] and ≥3 positive biopsy cores (OR 2.52, P = 0.043) were predictive of PSM, while a PSA level of >20 ng/dL predicted the occurrence of BCR (OR 5.34, P = 0.021). No preoperative factors predicted PSM or BCR for groups 2 and 3. CONCLUSION: A preoperative biopsy with ≥3 positive cores in men with small prostates predicts PSM after RARP. In small prostates with PSM, a PSA level of >20 ng/dL is a predictor of BCR. These factors should guide the choice of therapy and indicate the need for closer postoperative follow-up. SN - 1464-410X UR - https://www.unboundmedicine.com/medline/citation/25098818/Number_of_positive_preoperative_biopsy_cores_is_a_predictor_of_positive_surgical_margins__PSM__in_small_prostates_after_robot_assisted_radical_prostatectomy__RARP__ L2 - https://doi.org/10.1111/bju.12888 DB - PRIME DP - Unbound Medicine ER -