Patients With Prior TURP Undergoing Robotic Assisted Laparoscopic Radical Prostatectomy Have Higher Positive Surgical Margin Rates

Main Category: Urology / Nephrology
Also Included In: Prostate / Prostate Cancer
Article Date: 27 Jun 2008 - 8:00 PDT

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ORLANDO, FL (UroToday.com) - With the incidence of robotic-assisted radical prostatectomy (RALP) increasing, questions regarding the significance of margin status have arisen. Patients with a history of a prior transurethral resection of the prostate (TURP), may have a higher incidence of positive margins because of the prior surgery. These investigators examined our IRB-approved database to determine whether patients who had undergone a prior TURP had higher rates of positive margins than those patients who had no history of TURP.

Between July 2003 and March 2007, 4 urologic surgeons in their medical group (City of Hope medical group) performed RALP on 2041 patients. Consent was obtained by 1768 patients. Of these, 51 had undergone a prior TURP. TURP patients were matched for age and nerve sparing status in a 2:1 ratio with patients who had not undergone TURP prior to their RALP. Pathology records were reviewed to determine prevalence and location of positive margins.

Patients with a history of TURP before undergoing RALP had positive margin rates of 35.3% (18 of 51) compared with 17.6% (18 of 102) in patients without a history of TURP (p=0.015). The location of the positive margins was statistically more prevalent at the bladder neck in TURP patients (13.7% vs. 2.0%) than non-TURP patients (Fisher's exact p-value=0.004). Although urethral and radial resection positive margins were somewhat higher in TURP patients (11.8% vs. 5.9% and 21.6% vs. 14.7%, respectively), these results were not statistically significant. These 2 groups were statistically similar in other variables examined including race, BMI, preoperative PSA, Gleason score, clinical, and pathologic stage.

Patients who underwent RALP some time following TURP were found to have higher rates of positive margins. The location of the positive margins was more likely to be located at the bladder neck than non-TURP patients. This may ultimately affect the likelihood of biochemical recurrence after RALP, but will require longer follow up to determine. Robotic surgeons should keep this information in mind when performing robotic assisted laparoscopic radical prostatectomy in men with prior TURP.

Presented by Lance J Hampton, MD, Ken Jacobsohn, MD, Rebecca A Nelson, MD, Laura E Crocitto, MD, Roger W Satterthwaite, MD, Timothy G Wilson, MD, at the Annual Meeting of the American Urological Association (AUA) - May 17 - 22, 2008. Orange County Convention Center - Orlando, Florida, USA.

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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