title: Prostate cancer biochemical recurrence rates after robotic-assisted laparoscopic radical prostatectomy.
abstract: OBJECTIVE
  To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP).
  
  
  METHODS
  IRB-approved radical prostatectomy database  was queried. Patients were stratified as low, intermediate, and high risk according to D'Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined  as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤ 3mm  focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates.
  
  
  RESULTS
  At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative  SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis.
  
  
  CONCLUSIONS
  Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal  and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated.
authors: University of Connecticut Health Center, Farmington, CT, USA.
authors: Serge
authors: S
authors: Ginzburg
authors: Thomas
authors: T
authors: Nevers
authors: Ilene
authors: I
authors: Staff
authors: Joseph
authors: J
authors: Tortora
authors: Alison
authors: A
authors: Champagne
authors: Stuart S
authors: SS
authors: Kesler
authors: Vincent P
authors: VP
authors: Laudone
authors: Joseph R
authors: JR
authors: Wagner
mesh_terms: D014408:Biomarkers, Tumor / Q000097:blood; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology*; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen