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
ARTICLE HIGHLIGHTS
Research background

Prostate cancer (PCa) is overwhelmingly prevalent in Western countries, and also seen with an escalating trend in Asia. Its oncological outcome is affected by many factors, and pathological status is one of the essential ones. In the early results of studies with open radical prostatectomy (RP), pathologically localized organ-confined PCa with a positive surgical margin (PSM) but without extracapsular extension (ECE) (pT2+; pT2R1) was equal to that of ECE with or without PSM in terms of oncological outcomes.

Research motivation

Nowadays, robotics-assisted RP (RARP) is proved to provide better functional and oncological outcomes to men with PCa, and it herein emerges as the first choice to surgeons intending to perform RP. The most pivotal and large-scale analysis on this pathological topic was issued in 2003 only with open RP, and the present reports regarding it were few and only with a short surveillance. Hence, we conducted an analysis with RARP and a long duration of follow-up.

Research objectives

To examine the oncological outcomes of localized pT2+ PCa after RARP in a 10-year surveillance and to address our contemporary viewpoints based on our real-world experiences.

Research methods

We enrolled the data of 48 men from 2008 to 2011 with localized pT2+ PCa after RARP, and recorded their pathological status and postoperative follow-up in detail. Postoperative visits were scheduled at the 1st week, 6th week, 3rd month, 6th month, and 12th month in the first year, and every 6 mo after the second year. The included men needed to have their postoperative prostate specific antigen (PSA) detected at nadir (PSA < 0.008 ng/mL) in 3 mo after RARP, or they would be excluded from this analysis. The patients were divided into two groups, with biochemical recurrence (BCR) or without BCR. BCR was defined as serial PSA that was tested above 0.2 ng/mL. Characteristics of these two groups were compared using corresponding statistical methods.

Research results

RARP was successfully performed without any major complication or intraoperative conversion. In a median follow-up of 9 years, BCR occurred in 25 (52%) men, and most of them experienced it in the first 5-year surveillance. Our data seemed to be similar to that of open RP, but ours consisted of a longer duration of surveillance. Compared to similar reports, the unfavored margin status and initially worse presentation of our included patients made our data inferior on the surface. Of all analyzed predicted factors, preoperative PSA was the only meaningful one, with a cut-off value of 19.09 ng/mL (sensitivity: 0.600; specificity: 0.739).

Research conclusions

RARP can provide better BCR-free survival to those with localized pT2+ PCa than open RP. Preoperative PSA can act as an auxiliary parameter to predict the coming of BCR. Skilled surgical techniques can help to minimize unfavorable margin status, and furthermore lower the BCR rate.

Research perspectives

This study is retrospective with a small sample size. For discussing more aspects in this topic and probing for more meaningful predictive factors, we anticipate inclusions of more data in the future, and also comparing pT2+ with pT3aR0 and pT3aR1 after RARP.