A retrospective analysis of positive surgical margins (PSM) and biochemical recurrence following open and laparoscopic radical prostatectomy


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Madhavi Natarajan1,Omar Al-Kadhi1,Robert Mills1
1NHS

Abstract

Background

Prostate cancer accounted for 13% of all cancer diagnoses in UK in 2013(1). Radical treatment (radical radiotherapy (RT), open, laparoscopic (LP) or robotic prostatectomy(RP)) is offered for localised and locally advanced disease (2)(3). The implications of positive surgical margins(PSM) and their anatomic location following radical surgery are unclear and controversial(4)(5)(6). We have assessed PSM rates with two surgical approaches and patient outcomes over 13 years in a UK unit.

Method

Retrospective cohort study analysing patient characteristics, pre-operative diagnostics, post-operative histology, margin positivity, evidence of biochemical recurrence, mortality and morbidity in 112 patients undergoing open and 316 LP in a university hospital between 2002 and 2016.

Results

The mean age of the cohort was 63(SD.8.12). Preoperative clinical assessment demonstrated 39.9% low, 24.5% intermediate and 35.2% high risk disease [NICE stratification]. PSM rate for Gleason 8-10 was 100%(open,n=3)vs.61.5%(LP,n=39 ), for Gleason 7 was 43%(open,n=105)vs.48%(LP,n=268) and for Gleason 6 was 33%(open n=3)vs.29%(LP,n=7). PSM rate for ≥T3 disease was 67%(open, n=61) vs. 68.5%(LP, n=127); for T2 disease, the rate was 15.7%(open, n=51) vs. 36.7% (LP, n=188). 76 patients (55 PSM) developed biochemical recurrence [EAU definition] (33% (open), 12.3% (LP)) after an average of 45.2 months. 40/48 patients who had salvage radiotherapy (RT) had undetectable PSA after treatment. 7 patients had initial hormone treatment and 2 had palliative RT. Out of 22 deaths, two were attributed to prostate malignancy, and one had PSM.

Conclusion

PSM rate is known to be affected by stage and grade of the malignancy, patient characteristics and surgical expertise(7). PSM resulted in a higher rate of biochemical recurrence and the use of salvage therapy. Mortality was not affected although the mean follow up was relatively short.