title: The impact of prior TURP on radical prostatectomy surgical margins: a multicenter analysis.
abstract: OBJECTIVE
  To analyze positive surgical margins (PSM) after radical prostatectomy (RP) in the overall population and in patients previously treated with transurethral resection of the prostate (TURP).
  
  
  METHODS
  2,408 patients treated with RP for clinically localized prostate cancer (PCa) were consecutively enrolled in 135 departments. We correlated PSM rates and all preoperative, surgical and pathological features. We stratified the site of PSM as unique or multifocal. Moreover, we analyzed differences between 75 patients who had undergone previous TURP and the remaining 2,333 patients.
  
  
  RESULTS
  In the entire study population, we identified 702 patients with PSM (29%). Using univariate analysis, we reported a significant correlation between overall PSM and prostate-specific antigen (PSA), stage cT, biopsy Gleason score, number of biopsy cores, number of positive cores, percentage of positive cores and nerve-sparing approach. PSM proved to be strongly dependent on pT in particular in patients with pT2 PCa. When we compared the data from 75 patients previously treated with TURP and those from 2,333 without previous prostatic surgery, a statistically significant difference in margin localization was found. Moreover, we analyzed the 75 patients mentioned above, stratified in incidental PCa diagnosed at TURP or PCa detected with prostate biopsy for PSA rising during the post-TURP follow-up: no statistical differences were found between the 2 groups regarding margin status, even if PSM were more frequent in incidental PCa with no significance deriving from the stratification for PSM location at the apex or base.
  
  
  CONCLUSIONS
  Men treated with TURP before RP presented an overall incidence of PSM similar to those without previous TURP, but with a higher risk of PSM at the bladder neck and a lower risk of PSM at the prostatic apex.
authors.affiliation: Department of Urology, University of Florence, Italy. maurogacci@yahoo.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Gacci
authors.forename: Alchiede
authors.initials: A
authors.lastname: Simonato
authors.forename: Michele
authors.initials: M
authors.lastname: Lanciotti
authors.forename: Marco
authors.initials: M
authors.lastname: Ennas
authors.forename: Virginia
authors.initials: V
authors.lastname: Varca
authors.forename: Massimo
authors.initials: M
authors.lastname: Maffezzini
authors.forename: Ciro
authors.initials: C
authors.lastname: Imbimbo
authors.forename: Paolo
authors.initials: P
authors.lastname: Gontero
authors.forename: Riccardo
authors.initials: R
authors.lastname: Schiavina
authors.forename: Marco
authors.initials: M
authors.lastname: Carini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Martorana
authors.forename: Giulio
authors.initials: G
authors.lastname: Nicita
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Mirone
authors.forename: Giorgio
authors.initials: G
authors.lastname: Carmignani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011467:Prostate / Q000473:pathology / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000601:surgery*; D012306:Risk; D020728:Transurethral Resection of Prostate / Q000379:methods*; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology
chemical_list: D017430:Prostate-Specific Antigen