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. 2021 Feb 16;9(5):1026-1036.
doi: 10.12998/wjcc.v9.i5.1026.

Biochemical recurrence of pathological T2+ localized prostate cancer after robotic-assisted radical prostatectomy: A 10-year surveillance

Che Hseuh Yang  1 , Yi Sheng Lin  2 , Yen Chuan Ou  1 , Wei Chun Weng  1 , Li Hua Huang  1 , Chin Heng Lu  1 , Chao Yu Hsu  1 , Min Che Tung  1
Affiliations

Biochemical recurrence of pathological T2+ localized prostate cancer after robotic-assisted radical prostatectomy: A 10-year surveillance

Che Hseuh Yang et al. World J Clin Cases. .

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 P < 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 (P < 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 R 2 = 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.

Keywords: Margins of excision; Prostate-specific antigen/metabolism; Prostatectomy/methods; Prostatic neopl-asms/pathology; Retrospective study; Robotic surgical procedures.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no financial or other conflicts of interest in relation to this research and its publication.

Figures

Figure 1
Figure 1
Receiver operating characteristic curve showing meaningful prostate specific antigen cut-off value (arrow). Cut-off value: 19.09 ng/mL; sensitivity: 0.600, specificity: 0.739.
Figure 2
Figure 2
Distributions divided by prostate specific antigen intervals in biochemical recurrence and non-biochemical recurrence groups. PSA: Prostate specific antigen; BCR: Biochemical recurrence.
Figure 3
Figure 3
Linear regression model between preoperative prostate specific antigen and time to biochemical recurrence. Pearson’s correlation: 0.13; adjusted R2 = 0.026. PSA: Prostate specific antigen; BCR: Biochemical recurrence.
See this image and copyright information in PMC

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