Robot-assisted radical prostatectomy

Current evaluation of surgical margins in clinically low-, intermediate-, and high-risk prostate cancer

David S. Yee, Navneet Narula, Mahul Amin, Douglas W. Skarecky, Thomas E. Ahlering

Research output: Contribution to journalArticle

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Abstract

Purpose: Concern exists over a lack of tactile sensation and positive surgical margins (PSMs) in patients undergoing robot-assisted radical prostatectomy. We report our PSM rates in our most current 500 cases and particularly in clinically high-risk disease. Materials and Methods: After implementation of our present technique at case #251, we report PSM rates according to pathologic stage and D'Amico's risk stratification: low risk (prostate-specific antigen [PSA] <10, Gleason score [GS] 5-6, cT1-T2A), intermediate risk (PSA 10-20, GS 7, cT2B), and high risk (PSA >20, GS 8-10, cT3). Patients with cT2b/T3 disease or GS 8 to 10 and multiple cores with >30% involvement underwent wide excision of the neurovascular bundle. PSM was defined as ink on tumor. Results: The overall PSM rate was 7.4%: pT2=3.1%, pT3=15.9%, and pT4=55.6%. PSMs occurred in 13 (4.9%) low, 10 (5.8%) intermediate, and 14 (22.6%) high D'Amico risk patients. Of the 62 high-risk patients, the median PSA was 6.9 (range 2.2-97.9); biopsy GS was 6 to 7 (26%) and 8 to 10 (74%). For preoperatively palpable disease, the PSM rate was 9.9%: cT1=6.0%, cT2=7.7%, and cT3=26.3%. No PSMs occurred along the neurovascular bundle. Conclusion: Since 2005, 500 men with clinically low-, intermediate-, and high-risk prostate cancer have undergone robot-assisted radical prostatectomy with acceptable surgical margin rates. In patients with high-risk and usually palpable disease, PSM rates were also acceptable despite the lack of tactile sensation with the robot.

Original languageEnglish (US)
Pages (from-to)1461-1465
Number of pages5
JournalJournal of Endourology
Volume23
Issue number9
DOIs
StatePublished - Sep 1 2009

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Prostatectomy
Prostatic Neoplasms
Touch
Prostate-Specific Antigen
Margins of Excision
Ink
Biopsy

All Science Journal Classification (ASJC) codes

  • Urology

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Robot-assisted radical prostatectomy : Current evaluation of surgical margins in clinically low-, intermediate-, and high-risk prostate cancer. / Yee, David S.; Narula, Navneet; Amin, Mahul; Skarecky, Douglas W.; Ahlering, Thomas E.

In: Journal of Endourology, Vol. 23, No. 9, 01.09.2009, p. 1461-1465.

Research output: Contribution to journalArticle

Yee, David S. ; Narula, Navneet ; Amin, Mahul ; Skarecky, Douglas W. ; Ahlering, Thomas E. / Robot-assisted radical prostatectomy : Current evaluation of surgical margins in clinically low-, intermediate-, and high-risk prostate cancer. In: Journal of Endourology. 2009 ; Vol. 23, No. 9. pp. 1461-1465.
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title = "Robot-assisted radical prostatectomy: Current evaluation of surgical margins in clinically low-, intermediate-, and high-risk prostate cancer",
abstract = "Purpose: Concern exists over a lack of tactile sensation and positive surgical margins (PSMs) in patients undergoing robot-assisted radical prostatectomy. We report our PSM rates in our most current 500 cases and particularly in clinically high-risk disease. Materials and Methods: After implementation of our present technique at case #251, we report PSM rates according to pathologic stage and D'Amico's risk stratification: low risk (prostate-specific antigen [PSA] <10, Gleason score [GS] 5-6, cT1-T2A), intermediate risk (PSA 10-20, GS 7, cT2B), and high risk (PSA >20, GS 8-10, cT3). Patients with cT2b/T3 disease or GS 8 to 10 and multiple cores with >30{\%} involvement underwent wide excision of the neurovascular bundle. PSM was defined as ink on tumor. Results: The overall PSM rate was 7.4{\%}: pT2=3.1{\%}, pT3=15.9{\%}, and pT4=55.6{\%}. PSMs occurred in 13 (4.9{\%}) low, 10 (5.8{\%}) intermediate, and 14 (22.6{\%}) high D'Amico risk patients. Of the 62 high-risk patients, the median PSA was 6.9 (range 2.2-97.9); biopsy GS was 6 to 7 (26{\%}) and 8 to 10 (74{\%}). For preoperatively palpable disease, the PSM rate was 9.9{\%}: cT1=6.0{\%}, cT2=7.7{\%}, and cT3=26.3{\%}. No PSMs occurred along the neurovascular bundle. Conclusion: Since 2005, 500 men with clinically low-, intermediate-, and high-risk prostate cancer have undergone robot-assisted radical prostatectomy with acceptable surgical margin rates. In patients with high-risk and usually palpable disease, PSM rates were also acceptable despite the lack of tactile sensation with the robot.",
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AB - Purpose: Concern exists over a lack of tactile sensation and positive surgical margins (PSMs) in patients undergoing robot-assisted radical prostatectomy. We report our PSM rates in our most current 500 cases and particularly in clinically high-risk disease. Materials and Methods: After implementation of our present technique at case #251, we report PSM rates according to pathologic stage and D'Amico's risk stratification: low risk (prostate-specific antigen [PSA] <10, Gleason score [GS] 5-6, cT1-T2A), intermediate risk (PSA 10-20, GS 7, cT2B), and high risk (PSA >20, GS 8-10, cT3). Patients with cT2b/T3 disease or GS 8 to 10 and multiple cores with >30% involvement underwent wide excision of the neurovascular bundle. PSM was defined as ink on tumor. Results: The overall PSM rate was 7.4%: pT2=3.1%, pT3=15.9%, and pT4=55.6%. PSMs occurred in 13 (4.9%) low, 10 (5.8%) intermediate, and 14 (22.6%) high D'Amico risk patients. Of the 62 high-risk patients, the median PSA was 6.9 (range 2.2-97.9); biopsy GS was 6 to 7 (26%) and 8 to 10 (74%). For preoperatively palpable disease, the PSM rate was 9.9%: cT1=6.0%, cT2=7.7%, and cT3=26.3%. No PSMs occurred along the neurovascular bundle. Conclusion: Since 2005, 500 men with clinically low-, intermediate-, and high-risk prostate cancer have undergone robot-assisted radical prostatectomy with acceptable surgical margin rates. In patients with high-risk and usually palpable disease, PSM rates were also acceptable despite the lack of tactile sensation with the robot.

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