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Comparison of Positive Surgical Margin Rates in High Risk Prostate Cancer
Niall J Harty1, Spencer Kozinn1, Jessica DeLong1, David Canes1, Andrea Sorcini1, Jason Gee1, Mark Silverman1, Robin Ruthazer2, John Libertino1, Ali Moinzadeh1
1Lahey Clinic, Burlington, MA;2Tufts Medical Center, Boston, MA

Introduction: High risk prostate cancer (HRCaP) represents a complex disease entity. We compared positive surgical margin (PSM) rates for patients with HRCaP who underwent open radical retropubic (RRP), robotic (RALP), and laparoscopic (LAP) prostatectomy.
Materials & Methods: We performed a review of prostate cancer patients at our institution that underwent RRP, RALP, or LAP between January 2000 and March 2010. Patients were considered to have HRCaP if they had biopsy or final pathologic Gleason score ≥ 8, PSA ≥ 20, or pathologic stage of T3a or higher. PSM was defined by the presence of tumor at the inked surface of the specimen. Patients who received neoadjuvant hormonal therapy and those who underwent a perineal prostatectomy were excluded.
Results: We identified 513 patients with HRCaP. Sixty-eight patients were excluded. Of the 445 patients, surgical technique was RRP (n=153), RALP (n=152), and LAP (n=140). No age difference was noted between the three groups. Overall PSM was 52.9% for RRP, 50% for RALP, and 41.4% for LAP. The PSM rate did not differ between the three groups nor when comparing RRP to RALP and LAP combined. There was no statistical difference between the three groups in terms of the number of patients with a pathologic stage of T3 or higher. A higher preoperative PSA value was associated with a positive margin (p=0.04).
Conclusions:
In patients with HRCaP, the PSM rate does not differ based on the surgical approach. Patients with a higher preoperative PSA value were more likely to have a PSM.


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