Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Freedland SJ, Aronson W, Presti JC Jr, Kane CJ, Terris MK, Elashoff D, Amling CL SEARCH Database Study Group. Should a positive surgical margin following radical prostatectomy be pathological stage T2 or T3? J Urol. 2003;169:2142–2146. - PubMed
    1. Mohler JL, Antonarakis ES, Armstrong AJ, D'Amico AV, Davis BJ, Dorff T, Eastham JA, Enke CA, Farrington TA, Higano CS, Horwitz EM, Hurwitz M, Ippolito JE, Kane CJ, Kuettel MR, Lang JM, McKenney J, Netto G, Penson DF, Plimack ER, Pow-Sang JM, Pugh TJ, Richey S, Roach M, Rosenfeld S, Schaeffer E, Shabsigh A, Small EJ, Spratt DE, Srinivas S, Tward J, Shead DA, Freedman-Cass DA. Prostate Cancer, Version 2.2019, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2019;17:479–505. - PubMed
    1. Bill-Axelson A, Holmberg L, Garmo H, Taari K, Busch C, Nordling S, Häggman M, Andersson SO, Andrén O, Steineck G, Adami HO, Johansson JE. Radical Prostatectomy or Watchful Waiting in Prostate Cancer - 29-Year Follow-up. N Engl J Med. 2018;379:2319–2329. - PubMed
    1. Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, Nordling S, Häggman M, Andersson SO, Spångberg A, Andrén O, Palmgren J, Steineck G, Adami HO, Johansson JE. Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med. 2014;370:932–942. - PMC - PubMed
    1. Bill-Axelson A, Holmberg L, Filén F, Ruutu M, Garmo H, Busch C, Nordling S, Häggman M, Andersson SO, Bratell S, Spångberg A, Palmgren J, Adami HO, Johansson JE Scandinavian Prostate Cancer Group Study Number 4. Radical prostatectomy versus watchful waiting in localized prostate cancer: the Scandinavian prostate cancer group-4 randomized trial. J Natl Cancer Inst. 2008;100:1144–1154. - PMC - PubMed