2008 Annual Meeting Abstracts

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Robotic Assisted Radical Prostatectomy For Locally Advanced Prostate Cancer: The Incidence and Clinical Features of Positive Surgical Margins
Jonathan J Hwang, Jonah Murdock, John H Lynch, Reza Ghasemian, Mohan Verghese
Georgetown Univ. Hospital/Washington Hospital Center, Washington, DC

Introduction:
Although robotic assisted radical prostatectomy (RAP) has gain great popularity, its therapeutic role in locally advanced prostate cancer is less clear. We evaluated the incidence and clinical features of positive surgical margins in this cohort.
Methods:
Between August 2003 and October 2007, 456 patients with clinically localized prostate cancer underwent a RAP, of which 55 patients had pathologically confirmed locally advanced prostate cancer (stage T3 or T4). The clinical features of these patients were subsequently evaluated in the context of the RAP learning curve.
Results:
The mean age of men was 60 ± 7 years with mean PSA level of 6.3 ± 1.9 ng/ml. 30 patients (55%) had a palpable nodule on DRE. The median Gleason score was 3+4 with 11 men (20%) having Gleason grade 5. The overall margin positive rate was 60%, of which 23 and 10 patients having uni-focal and multi-focal positive margins, respectively. When further stratified by RAP experience, the margin positive rate was 67% (24/36 men) in the first 200 cases, and 47% (9/19 men) in the latter cases. The most common site of positive surgical margins was the posterior-lateral surface (67%), followed by the apex (52 %). Seven patients had elevated PSA (above 0.2 ng/ml) at 3 months follow-up.
Conclusions:
In our series, up to 2 out of 3 men with locally advanced prostate cancer had positive surgical margins. More studies are needed before RAP is routinely offered to patients with high risk prostate cancer such as high Gleason score and abnormal DRE.

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