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Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy.
Urol Int. 2015; 95(4):465-71.UI

Abstract

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 <200 cases (OR 1.881, 95% CI 1.120-3.159) and a preoperative PSA >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.

CONCLUSION

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.

Authors+Show Affiliations

Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26575991

Citation

Bütow, Zentia, et al. "Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated With Nerve-Sparing Robot-Assisted Radical Prostatectomy." Urologia Internationalis, vol. 95, no. 4, 2015, pp. 465-71.
Bütow Z, Schunk S, Janssen M, et al. Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy. Urol Int. 2015;95(4):465-71.
Bütow, Z., Schunk, S., Janssen, M., Gräber, S., Saar, M., Kamradt, J., Siemer, S., Stöckle, M., & Ohlmann, C. H. (2015). Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy. Urologia Internationalis, 95(4), 465-71. https://doi.org/10.1159/000440666
Bütow Z, et al. Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated With Nerve-Sparing Robot-Assisted Radical Prostatectomy. Urol Int. 2015;95(4):465-71. PubMed PMID: 26575991.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy. AU - Bütow,Zentia, AU - Schunk,Stefan, AU - Janssen,Martin, AU - Gräber,Stefan, AU - Saar,Matthias, AU - Kamradt,Jörn, AU - Siemer,Stefan, AU - Stöckle,Michael, AU - Ohlmann,Carsten-Henning, Y1 - 2015/11/18/ PY - 2015/06/15/received PY - 2015/08/24/accepted PY - 2015/11/18/entrez PY - 2015/11/18/pubmed PY - 2016/9/22/medline SP - 465 EP - 71 JF - Urologia internationalis JO - Urol. Int. VL - 95 IS - 4 N2 - 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 <200 cases (OR 1.881, 95% CI 1.120-3.159) and a preoperative PSA >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. CONCLUSION: 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. SN - 1423-0399 UR - https://www.unboundmedicine.com/medline/citation/26575991/Quality_of_Preoperative_Biopsy_Is_a_Risk_Factor_for_Positive_Surgical_Margins_in_Organ_Confined_Prostate_Cancer_Treated_with_Nerve_Sparing_Robot_Assisted_Radical_Prostatectomy_ L2 - https://www.karger.com?DOI=10.1159/000440666 DB - PRIME DP - Unbound Medicine ER -