Biochemical Recurrence of Pathological T2+ Localized Prostate Cancer After Robotic-assisted Radical Prostatectomy: A 10-year Surveillance

Overview

Journal World J Clin Cases

Publisher Baishideng Publishing Group

Specialty General Medicine

Date 2021 Mar 1

PMID 33644166

Citations 3

Authors

Che Hseuh Yang

Yi Sheng Lin

Yen Chuan Ou

Wei Chun Weng

Li Hua Huang

Chin Heng Lu

Chao Yu Hsu

Min Che Tung

Affiliations

Soon will be listed here.

Abstract

Background: pT2+ prostate cancer (PCa), a term first used in 2004, refers to organ-confined PCa characterized by a positive surgical margin (PSM) without extracapsular extension. Patients with a PSM are vulnerable to biochemical recurrence (BCR) following radical prostatectomy (RP); however, whether adjuvant radiotherapy (aRT) is imperative to PSM after RP remains controversial. This study had the longest follow-up on pT2+ PCa after robotic-assisted RP since 2004. Moreover, we discussed our viewpoints on pT2+ PCa based on real-world experiences.

Aim: To conclude a 10-year surveillance on pT2+ PCa and compare our results with those of the published literature.

Methods: Forty-eight patients who underwent robotic-assisted RP between 2008 and 2011 were enrolled. Two serial tests of prostate specific antigen (PSA) ≥ 0.2 ng/mL were defined as BCR. Various designed factors were analyzed using statistical tools for BCR risk. SAS 9.4 was applied and significance was defined as < 0.05. Univariate, multivariate, linear regression, and receiver operating characteristic (ROC) curve analyses were performed for statistical analyses.

Results: With a median follow-up period of 9 years, 25 (52%) patients had BCR (BCR group), and the remaining 23 (48%) patients did not (non-BCR group). The median time for BCR test was 4 years from the first postoperative PSA nadir. Preoperative PSA was significantly different between the BCR and non-BCR groups ( < 0.001), and ROC curve analysis of preoperative PSA suggested a cut-off value of 19.09 ng/mL (sensitivity, 0.600; specificity: 0.739). The linear regression analysis showed no correlation between time to BCR and preoperative PSA (Pearson's correlation, 0.13; adjusted = 0.026).

Conclusion: Robotic-assisted RP in pT2+ PCa of worse conditions can provide better BCR-free survival. A surgical technique limiting the PSM in favorable situations is warranted to lower the pT2+ PCa BCR rate. Preoperative PSA cut-off value of 19.09 ng/mL is a predictive factor for BCR. Based on our experiences and review of the literature, we do not recommend routine aRT for pT2+ PCa.

Citing Articles

High-Intensity Focus Ultrasound Ablation in Prostate Cancer: A Systematic Review.

Yang C, Barbulescu D, Marian L, Tung M, Ou Y, Wu C J Pers Med. 2024; 14(12).

PMID: 39728075 PMC: 11678519. DOI: 10.3390/jpm14121163.

Theranostic Robot-Assisted Radical Prostatectomy: Things Understood and Not Understood.

Hsu C, Yang C, Tung M, Liu H, Ou Y Cancers (Basel). 2023; 15(17).

PMID: 37686563 PMC: 10486521. DOI: 10.3390/cancers15174288.

Incidental Prostate Cancer from Prostate with Benign Biopsies: A Predictive and Survival Analysis from Cohort Study.

Yang C, Lin Y, Weng W, Hsu C, Tung M, Ou Y Int J Gen Med. 2022; 15:2807-2816.

PMID: 35300134 PMC: 8922340. DOI: 10.2147/IJGM.S357368.

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