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

Table 1 Basic characteristics, operative methods, and perioperative assessments between biochemical recurrence and non-biochemical recurrence groups

	BCR group, n = 25 (52%)	Non-BCR group, n = 23 (48%)	P value
Age (yr) (mean ± SD)	66.5 (SD: 4.7)	69 (SD: 5.4)	0.102
Body weight (kg) (mean ± SD)	70.8 (SD: 7.5)	71.1 (SD: 6.8)	0.711
Body height (cm) (mean ± SD)	167.5 (SD: 3.6)	166.9 (SD: 3.3)	0.718
ASA grade (n)			0.818
I	5 (20%)	4 (17.4%)
II	20 (80%)	19 (82.6%)
Surgical method: RARP with:
BPLND	24 (96%)	22 (96%)	0.954
Bilateral NVB preservation	20 (80%)	19 (82.6%)	0.818
DVC ligation	9 (36%)	7 (30.4%)	0.681
Bladder neck sparing	25 (100%)	23 (100%)
Puboprostatic ligament preservation			0.705
1	3 (12%)	2 (8.7%)
2	22 (88%)	21 (91.3%)
Lymph node yield number (n) (mean ± SD)	11.6 (SD: 6.3)	9.8 (SD: 4.5)	0.143
Vesicourethral anastomosis	17.2 (SD: 4.0)	17.4 (SD: 5.9)	0.447
Time (min) (mean ± SD)	109.2 (SD: 24.7)	111.4 (SD: 24.5)	0.386
Operation time (min) (mean ± SD)	82.7 (SD: 66.2)	102.17 (SD: 112.0)	0.242
Blood loss (mL) (mean ± SD)	51.0 (SD: 36.3)	41.7 (SD: 11.5)	0.116
Specimen volume (g) (mean ± SD)	7.0 (SD: 5.7)	4.9 (SD: 3.4)	0.074
Tumor volume (cm3) (mean ± SD)	15.1 (SD: 9.8)	12.8 (SD: 9.5)	0.203
Tumor percentage (%) (mean ± SD)
PSM location:	13 (52%)	10 (43.5%)	0.848
Anterior	3 (12%)	3 (13.0%)
Lateral	1 (4%)	3 (13.0%)
Posterolateral	7 (28%)1	6 (26.1%)2
Apex	1 (4%)	1 (4.4%)
Posterior	3.6 (SD: 0.9)	4.3 (SD: 2.0)	0.080
Postoperative stay (d) (mean ± SD)	7.0 (SD: 0.2)	7.2 (SD: 0.7)	0.119
Foley catheter (d) (mean ± SD)	28.6 (SD: 19.9)	17.0 (SD: 11.3)	< 0.001
Preoperative PSA (ng/mL) (mean ± SD)
Preoperative PSA distribution (n)	3 (12%)	6 (26.1%)
< 10 ng/mL	9 (3%)	11 (47.8%)	0.157
≥ 10 ng/mL, < 20 ng/mL	13 (52%)	6 (26.1%)
≥ 20 ng/mL	4.3 (SD: 2.8)/10.1 (SD: 2.0)	4.1 (SD: 2.5)/10.5 (SD: 1.9)
Positive biopsy cores (mean ± SD)			0.832
Biopsy tumor percentage (%) (mean ± SD)	26.5 (SD: 21.2)	24.0 (SD: 20.3)	0.686
Biopsy core			0.839
< 3 fragments	7 (31.8%)	5 (23.8%)
≥ 3 fragments, < 50%	12 (54.6%)	13 (61.9%)
≥ 50%	3 (13.6%)	3 (14.3%)
Biopsy Gleason group			0.626
1	12 (48.0%)	10 (43.5%)
2	4 (16.0%)	4 (17.4%)
3	1 (4.0%)	4 (17.4%)
4	3 (12.0%)	2 (8.7%)
5	5 (20.0%)	3 (13.0%)
Clinical stage			0.445
cT1	4 (16%)	3 (13.0%)
cT2a	2 (8.0%)	1 (4.4%)
cT2b	7 (28%)	5 (21.7%)
cT2c	8 (32%)	13 (56.5%)
cT3	4 (16%)	1 (4.4%)
Risk category			0.493
Very low and low	1 (4.0%)	4 (17.4%)
Favored-intermediate	8 (32.0%)	6 (26.1%)
Unfavored-intermediate	2 (8.0%)	4 (17.4%)
High	10 (40.0%)	7 (30.4%)
Very high	4 (16.0%)	2 (8.7%)
PNI			0.061
Positive	22 (88.0%)	15 (65.2%)
Negative	3 (12.0%)	8 (34.8%)
ALI			N/A
Positive	2 (8.0%)	0 (0.0%)
Negative	23 (92.0%)	23 (100%)
Pathological Gleason group			0.265
< 3	17 (73.9%)	20 (87%)
≥ 3	6 (26.1%)	3 (13.0%)
Pathological primary Gleason score			0.265
< 3	17 (73.9%)	20 (87%)
≥ 3	6 (26.1%)	3 (13.0%)
Change of Gleason group			0.943
Upgrade	9 (39.1%)	8 (34.8%)
Same	6 (26.1)	6 (26.1%)
Downgrade	8 (34.8%)	9 (39.1%)

¹One specimen had a positive surgical margin of 2 mm.

²One had multiple positive surgical margins but only with length described at apex site.

BCR: Biochemical recurrence; ASA: American Society of Anesthesiologists; BPLND: Bilateral pelvic lymph node dissection; RARP: Robotic-assisted radical prostatectomy; NVB: Neurovascular bundle; DVC: Dorsal venous complex; PSM: Positive surgical margin; PSA: Prostate specific antigen; PNI: Perineural invasion; ALI: Angiolymphatic invasion; N/A: Not assessable.

Table 2 Brief conclusions of pT2+ from the past published literature

	Year	Sample size	Surgical method	PSA level (ng/mL)	Clinical TNM stage	Pathology Gleason group	BCR rate
Freedland et al[1]	2003	Retrospective, 214 men, SEARCH Database	RP (no mention of open RP or RARP)	Mean: 10.5 ± 8.6, median: 8.0	T1: 97 (46%); T2: 110 (53%); T3: 3 (1%)	1: 105 (51%); 2 and 3: 89 (43%); 4 and 5: 14 (7%)	6-yr BCR rate 50%
Leite et al[19]	2014	Retrospective, 58 men	Open RP	N/M	N/M	N/M	Mean follow-up: 35.9 ± 23.1 mo; BCR rate: 31%
Hashimoto et al[12]	2015	Retrospective, 837 men	RARP	6.90, range: 3-47.4	T1c: 634 (75.7%); T2a: 111 (13.3%); T2b: 46 (5.5%); T2c: 39 (4.7%); T3: 7 (0.8%)	1: 65 (7.8%); 2: 377 (45%); 3: 230 (26.2%); 4 and 5: 165 (19.7%)	5-yr BCR free-survival: 62.4%
Karl et al[13]	2015	Retrospective, 956 men	Retropubic RP: 88%; Laparoscopic RP: 6%; RARP: 4%; Perineal RP: 3%	< 4: 13%; 4-9.9: 65%; 10-19.9: 18%; ≥ 20: 4%	N/M	1: 39%; 2: 52%; 3: 7%; 4 and 5: 2%	Mean follow-up: 48 mo; BCR rate: 25.4%

SEARCH: Shared Equal Access Regional Cancer Hospital; N/M^: Not mentioned; BCR: Biochemical recurrence; TNM: Tumor-Node-Metastasis; PSA: Prostate specific antigen; RARP: Robotic-assisted radical prostatectomy; RP: Radical prostatectomy.