Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1026-1036
Published online Feb 16, 2021. 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, Yi Sheng Lin, Yen Chuan Ou, Wei Chun Weng, Li Hua Huang, Chin Heng Lu, Chao Yu Hsu, Min Che Tung
Che Hseuh Yang, Yi Sheng Lin, Yen Chuan Ou, Wei Chun Weng, Li Hua Huang, Chin Heng Lu, Chao Yu Hsu, Min Che Tung, Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, Taichung 435403, Taiwan
Author contributions: Yang CH was responsible for data collection and analysis, and drafting the original manuscript; Lin YS was responsible for the process of IRB and review of the original draft; Ou YC was the urologist who performed the surgery, designed the conception, and provided comments on the original draft; Weng WC, Huang LH, and Lu CH were assistants to the surgery and the postoperative follow-ups; Hsu CY and Tung MC were supervisors and responsible for important intellectual content; Ou YC procured informed consent for the operation.
Institutional review board statement: This study was approved by the local ethical committee of Tungs’ Taichung MetroHarbor Hospital.
Informed consent statement: This study only was a review of non-identified existing recordings. So, the informed consent was exempt by the IRB.
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.
Data sharing statement: No additional data.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Sheng Lin, MD, Attending Doctor, Surgeon, Surgical Oncologist, Division of Urology, Department of Surgery, Tungs' Taichung MetroHarbor Hospital, No. 699 Sec. 8, Taiwan Blvd, Wuqi District, Taichung 435403, Taiwan. tung12197@gmail.com
Received: October 11, 2020
Peer-review started: October 11, 2020
First decision: November 29, 2020
Revised: December 13, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: February 16, 2021
Processing time: 111 Days and 2.8 Hours
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 R2 = 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: Prostatectomy/methods; Robotic surgical procedures; Prostatic neopl-asms/pathology; Prostate-specific antigen/metabolism; Margins of excision; Retrospective study

Core Tip: The term pT2+ is coined in 2004 and for prostate cancer (PCa) with a positive surgical margin (PSM) but without extracapsular extension. Although PSM is deemed to be an adverse effect, it is inconclusive whether adjuvant radiotherapy (aRT) is imperative. From this real-world experience, we conclude that robotic-assisted approach can benefit the patients of worse conditions with a non-inferior prognosis, and preoperative prostate specific antigen cut-off value of 19.09 ng/mL can be utilized as a predictive factor for biochemical recurrence after surgery. At the same time, we are not in favor of routine aRT for pT2+ PCa.