title: Quality of Preoperative Biopsy Is a Risk Factor for Positive Surgical Margins in Organ-Confined Prostate Cancer Treated with Nerve-Sparing Robot-Assisted Radical Prostatectomy.
abstract: OBJECTIVE
  Positive surgical margins (PSM) during robot-assisted radical prostatectomy (RARP) negatively influence patients' prognosis. The aim of our study was to identify risk factors for PSM in patients with organ-confined prostate cancer (PCa).
  
  
  METHODS
  A clinical database of all patients that underwent a RARP at our institution was used. Uni- and multivariable logistic regression analyses were conducted on the PSM rates for all patients with organ-confined PCa.
  
  
  RESULTS
  Altogether, 1,600 patients were identified, including 1,085 organ-confined PCa with a PSM rate of 7.8%. On multivariable analysis, bilateral nerve-sparing (OR 3.025, 95% CI 1.587-5.765), surgeon volume <200 cases (OR 1.881, 95% CI 1.120-3.159) and a preoperative PSA >10 ng/ml (OR 3.674, 95% CI 1.379-9.796) remained independent prognostic factors. In a subgroup of patients undergoing a nerve-sparing RARP, the quality of the prostate biopsy (OR 2.398, 95% CI 1.325-4.341) was the sole independent risk factor for a PSM.
  
  
  CONCLUSIONS
  An elevated preoperative PSA, surgical experience and a nerve-sparing procedure are all significantly associated with a higher risk for a PSM after RARP. For those undergoing a nerve sparing RARP, an accurate preoperative biopsy with detailed information on the location of positive cores is essential to prevent PSMs.
authors.affiliation: Department of Urology, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Zentia
authors.initials: Z
authors.lastname: Bütow
authors.forename: Stefan
authors.initials: S
authors.lastname: Schunk
authors.forename: Martin
authors.initials: M
authors.lastname: Janssen
authors.forename: Stefan
authors.initials: S
authors.lastname: Gräber
authors.forename: Matthias
authors.initials: M
authors.lastname: Saar
authors.forename: Jörn
authors.initials: J
authors.lastname: Kamradt
authors.forename: Stefan
authors.initials: S
authors.lastname: Siemer
authors.forename: Michael
authors.initials: M
authors.lastname: Stöckle
authors.forename: Carsten-Henning
authors.initials: CH
authors.lastname: Ohlmann
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011467:Prostate / Q000294:innervation* / Q000473:pathology; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000601:surgery; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*