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Does seminal vesicle-sparing robotic radical prostatectomy influence postoperative prostate-specific antigen measured with an ultrasensitive immunoassay?
Swiss Med Wkly. 2018 11 19; 148:w14685.SM

Abstract

PURPOSE Sparing of the seminal vesicles during robotic radical prostatectomy (SVRP) is an attempt to reduce potential damage to the hypogastric pelvic nerves. However, the seminal vesicles are known to express prostate-specific antigen (PSA) and it is unknown whether SVRP influences oncological outcome measured with ultrasensitive PSA immunoassays. In a retrospective study we analysed whether SVRP affects oncological outcome in terms of ultrasensitive PSA nadir and biochemical recurrence as compared with standard robotic assisted laparoscopic radical prostatectomy (sRALP).

METHODS

Overall, 102 patients underwent robotic prostatectomy. Patients were non-randomly allocated to the following surgical techniques: a SVRP group of 39 patients who underwent robotic radical prostatectomy sparing the tips of the seminal vesicles; a standard group of 63 patients who were treated with sRALP. Inclusion criteria were histologically proven negative margins (R0) and negative lymph node status (pN0). PSA was measured with an ultrasensitive assay. The Mann-Whitney U-test was used to compare the differences in PSA nadir and follow-up PSA. Biochemical recurrence was diagnosed if PSA rose to ≥0.2 mg/ml.

RESULTS

Median (range) follow-up was 31.4 (16.4–43.8) months. Preoperative PSA was 5.8 (0.13–15.29) ng/ml in the SVRP group and 7.1 (0.8–46) ng/ml in the sRALP group. Two cases of biochemical recurrence occurred in the sRALP group during follow-up. One of these two patients presented with locally advanced prostate carcinoma diagnosed from the definitive pathological specimen (pT3b). No patient of the SVRP group had seminal vesicle invasion or biochemical recurrence. No significant between-group difference in terms of PSA nadir and follow-up PSA was recorded. However, the percentage of patients who did not reach PSA nadir values of <0.01 ng/ml was higher in the SVRP group (10 vs 5% in the sRALP group).

CONCLUSIONS

Compared with sRALP, SVRP had no clinical impact on oncological outcome in terms of PSA nadir or biochemical recurrence measured with an ultrasensitive PSA immunoassay. A slightly higher PSA nadir after SVRP seems to be expected, which needs to be mentioned during follow-up of these patients.

Authors+Show Affiliations

Kantonsspital Winterthur, Brauerstrasse 15, 8401, Winterthur (Zürich), SWITZERLAND; o.burkhardt@glattnet.ch.Kantonsspital Winterthur.Kantonsspital Winterthur.Kantonsspital Winterthur.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30474852

Citation

Burkhardt, Orlando, et al. "Does Seminal Vesicle-sparing Robotic Radical Prostatectomy Influence Postoperative Prostate-specific Antigen Measured With an Ultrasensitive Immunoassay?" Swiss Medical Weekly, vol. 148, 2018, pp. w14685.
Burkhardt O, Neuenschwander JE, John H, et al. Does seminal vesicle-sparing robotic radical prostatectomy influence postoperative prostate-specific antigen measured with an ultrasensitive immunoassay? Swiss Med Wkly. 2018;148:w14685.
Burkhardt, O., Neuenschwander, J. E., John, H., & Randazzo, M. (2018). Does seminal vesicle-sparing robotic radical prostatectomy influence postoperative prostate-specific antigen measured with an ultrasensitive immunoassay? Swiss Medical Weekly, 148, w14685. https://doi.org/10.4414/smw.2018.14685
Burkhardt O, et al. Does Seminal Vesicle-sparing Robotic Radical Prostatectomy Influence Postoperative Prostate-specific Antigen Measured With an Ultrasensitive Immunoassay. Swiss Med Wkly. 2018 11 19;148:w14685. PubMed PMID: 30474852.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Does seminal vesicle-sparing robotic radical prostatectomy influence postoperative prostate-specific antigen measured with an ultrasensitive immunoassay? AU - Burkhardt,Orlando, AU - Neuenschwander,Julia Esther, AU - John,Hubert, AU - Randazzo,Marco, Y1 - 2018/11/26/ PY - 2018/11/27/entrez PY - 2018/11/27/pubmed PY - 2019/2/27/medline KW - prostate cancer KW - radical prostatectomy KW - seminal vesicles KW - ultrasensitive PSA SP - w14685 EP - w14685 JF - Swiss medical weekly JO - Swiss Med Wkly VL - 148 N2 - PURPOSE Sparing of the seminal vesicles during robotic radical prostatectomy (SVRP) is an attempt to reduce potential damage to the hypogastric pelvic nerves. However, the seminal vesicles are known to express prostate-specific antigen (PSA) and it is unknown whether SVRP influences oncological outcome measured with ultrasensitive PSA immunoassays. In a retrospective study we analysed whether SVRP affects oncological outcome in terms of ultrasensitive PSA nadir and biochemical recurrence as compared with standard robotic assisted laparoscopic radical prostatectomy (sRALP). METHODS Overall, 102 patients underwent robotic prostatectomy. Patients were non-randomly allocated to the following surgical techniques: a SVRP group of 39 patients who underwent robotic radical prostatectomy sparing the tips of the seminal vesicles; a standard group of 63 patients who were treated with sRALP. Inclusion criteria were histologically proven negative margins (R0) and negative lymph node status (pN0). PSA was measured with an ultrasensitive assay. The Mann-Whitney U-test was used to compare the differences in PSA nadir and follow-up PSA. Biochemical recurrence was diagnosed if PSA rose to ≥0.2 mg/ml. RESULTS Median (range) follow-up was 31.4 (16.4–43.8) months. Preoperative PSA was 5.8 (0.13–15.29) ng/ml in the SVRP group and 7.1 (0.8–46) ng/ml in the sRALP group. Two cases of biochemical recurrence occurred in the sRALP group during follow-up. One of these two patients presented with locally advanced prostate carcinoma diagnosed from the definitive pathological specimen (pT3b). No patient of the SVRP group had seminal vesicle invasion or biochemical recurrence. No significant between-group difference in terms of PSA nadir and follow-up PSA was recorded. However, the percentage of patients who did not reach PSA nadir values of <0.01 ng/ml was higher in the SVRP group (10 vs 5% in the sRALP group). CONCLUSIONS Compared with sRALP, SVRP had no clinical impact on oncological outcome in terms of PSA nadir or biochemical recurrence measured with an ultrasensitive PSA immunoassay. A slightly higher PSA nadir after SVRP seems to be expected, which needs to be mentioned during follow-up of these patients. SN - 1424-3997 UR - https://www.unboundmedicine.com/medline/citation/30474852/Does_seminal_vesicle_sparing_robotic_radical_prostatectomy_influence_postoperative_prostate_specific_antigen_measured_with_an_ultrasensitive_immunoassay L2 - https://doi.emh.ch/10.4414/smw.2018.14685 DB - PRIME DP - Unbound Medicine ER -