林口長庚紀念醫院 外科部 泌尿科
The optimal treatment if positive srugical margins after robotic-assisted radical prostatectomy: ajuvant or salvage
Chung-Yi Liu、Ying-Hsu Chang、Cheng-Keng Chuang、Kai-Jie Yu、Po-Hung Lin、, See-Tong Pang
Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan
Purpose: PSMs in Robotic-assisted radical prostatectomy (RARP) specimens are a frequent indication for adjuvant therapy. However, the association between PSMs and prostate cancer–specific oncologic outcome is unclear. Besides, the role of adjuvant therapy or salvage therapy in PSMs is still controversial. We analyze the association of PSMs with adjuvant therapy, and oncologic outcome of salvage therapy.
Materials and Methods: Data was retrospectively reviewed from 64 patients from the Chang-Gung Memorial Hospital, Linkou, with pT2–4 N0 prostate cancer (PCa) undergoing RARP with PSMs between January 2006 to December 2014. All patients were divided to salvage therapy and non-salvage therapy. We recorded the tumor stage, positive location, initial PSA and post operation PSA, and Gleason grade in these two groups. The Kaplan-Meier method and log rank test were used to determine differences in progression-free probability among positive margin features.
Results: A total of 64 patients were included. Mean age was 65 year-old. The Five-year Kaplan-Meier estimates for BCR-free survival were 76% for salvage therapy, 51% for patients without salvage therapy (p = 0.403) that didn’t differ significantly. Besides, progress-free survival and PCa-specific mortality (PCSM) also did not differ significantly between two groups. Patients who received salvage therapy can get well oncologic outcome if PSMs with biochemical failure.
There were no significant difference in biochemical recurrence-free, progress-free survival or prostate cancer-specific mortality between those patients receive adjuvant therapy and don’t receive adjuvant therapy in PSMs. However, adjuvant treatment has trend to avoid reaching biochemical failure. Salvage therapy can also get well prognosis in PSMs