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Robotic Radical Prostatectomy: Cancer Control and Implications of Margin Positivity

  • Mark H. Katz
  • Kevin C. Zorn
  • Arieh L. ShalhavEmail author
Chapter

Abstract

Current robot-assisted radical prostatectomy (RARP) data suggest comparable and, perhaps, improved pathologic outcomes when compared with laparoscopic and open techniques. In mature RARP series, overall positive surgical margin (PSM) rates have ranged between 9 and 19%. Independent risk factors for PSMs include lower surgeon case volume, pathologic stage and Gleason sum, lower prostate weight, higher pre-operative PSA level, and PSA density. Other possible prognostic indicators include biopsy Gleason sum, body mass index, and neurovascular bundle preservation. Various surgical techniques and tailoring nerve preservation based on disease severity appear to improve cancer control during RARP. The most common locations for PSMs during RARP are posterolateral and apical, but location and number do not appear to impact recurrence. An extensive PSM, however, does appear to be an adverse prognostic finding. Short- and mid-term biochemical recurrence-free survival appears equivalent for robotic, laparoscopic, and open radical prostatectomy. Unfortunately, the RARP data are too immature to estimate cancer-specific and overall survival.

Keywords

Radical Prostatectomy Positive Surgical Margin Biochemical Recurrence Laparoscopic Radical Prostatectomy Salvage Radiation Therapy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

BMI

Body mass index

BRFS

Biochemical recurrence-free survival

DVC

Dorsal venous complex

LRP

Laparoscopic radical prostatectomy

NVB

Neurovascular bundle

ORP

Open radical prostatectomy

PSM

Positive surgical margin

RARP

Robot-assisted radical prostatectomy

RT

Radiation therapy

SWOG

Southwest Oncology Group

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Copyright information

© Springer London 2011

Authors and Affiliations

  • Mark H. Katz
    • 1
  • Kevin C. Zorn
    • 2
  • Arieh L. Shalhav
    • 3
    Email author
  1. 1.Urology, Boston School of MedicineBostonUSA
  2. 2.Department of Urology, Division of Robotic SurgeryUniversity of Montreal Medical CenterMontrealCanada
  3. 3.University of Chicago Medical CenterChicagoUSA

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