Benign Prostate Tissue at RP Surgical Margins Not a Recurrence Risk

Patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALRP) are more likely that those undergoing open radical prostatectomy (ORP) to have benign glandular tissue at the surgical margin, but this tissue is not independently associated with an increased risk of biochemical recurrence, a study found.

Compared with patients who had ORP, those who underwent RALRP had a threefold greater likelihood of having benign glandular tissue at the surgical margin (BGM) after adjusting for sociodemographic and clinical characteristics, Peter R. Carroll, MD, and colleagues at the University of California San Francisco reported online ahead of print in Urology.

The retrospective study included 934 patients, of whom 431 were treated with ORP and 503 underwent RALRP. The median follow-up periods were 49 months and 28 months, respectively. Biochemical recurrence (BCR) rates were similar between patients with and without BGM regardless of surgical treatment. The researchers defined BCR as two postoperative increases of serum PSA of 0.2 ng/mL or greater at least eight weeks after surgery or administration of nonadjuvant second treatment six months or more after primary treatment. Within six months of surgery, 89% of patients had undetectable postoperative PSA. In 11% of cases, patients had a detectable PSA that did not yet reach the threshold for PSA failure.

Study findings also revealed that white patients had a significant 2.3 times increased likelihood of BMG than other patients, and each 1 cc increment in prostate volume was associated with a 2% increased likelihood of BMG.

Dr. Carroll's group noted that clinicians rely heavily on the validity of postoperative PSA values when monitoring for biochemical recurrence. The predictive value of postoperative PSA for BCR comes into question when considering the presence of benign glandular tissue at the surgical margin of the prostate, according to the researchers.

“This tissue also secretes PSA and is not associated with prostate cancer,” they wrote. “The presence of this benign PSA-secreting tissue could possibly elevate postoperative PSA, with levels meeting the criterion for BCR in the absence of cancer recurrence.”

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