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Prostate Cancer: Localized: Surgical Therapy II (PD19): Podium 19: Saturday, September 11, 2021

PD19-07 RISK FACTORS AND IMPACTS OF POSITIVE SURGICAL MARGIN IN AFRICAN AMERICAN UNDERGOING ROBOTIC-ASSISTED RADICAL PROSTATECTOMY

Liu, Shuo; Krol, Bridget; Refugia, Justin; Cohen, Adam; Pathak, Ram; Hemal, Ashok

doi: 10.1097/JU.0000000000002008.07
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INTRODUCTION AND OBJECTIVE:

Prostate cancer disproportionately impacts African American (AA) males. Margin status remains an important measure of the quality of disease clearance by radical prostatectomy. Unfortunately, historical series have shown that AA men tend to fare worse in this metric comparing to other ethnicities. Furthermore, recent studies have reported positive surgical margin (PSM) rates of up to 34.7% in AA men undergoing robot-assisted radical prostatectomy (RARP). Our study aims to investigate the potential risk factors for PSM in this patient group and its impact on biochemical recurrence-free survival (BCRFS).

METHODS:

246 AA men underwent RARP between 2009 and 2019 at our institution. Preoperative patient and disease characteristics, perioperative variables, postoperative and pathological outcomes were recorded and compared according to final margin status. Favorable PSM was defined as PSM noted on pathology with additional margins as negative or with a sub-millimeter unifocal margin. Unfavorable PSM was defined as any PSM not favorable.

RESULTS:

Adverse pathology (pathological stage >T3, pathological ISUP >3, or positive nodal disease) was seen in 45.1% (111). Favorable PSM status was observed in 52 (21.1%) and unfavorable PSM in 28 (11.4%). PSM was associated with reduction in BCRFS (log-rank p<0.001). Margin multifocality did not further increase disease recurrence. Patients with PSM had higher preoperative PSA (p<0.001), higher clinical risk category (p=0.007), higher pathological grade (p=0.002) and incidences of perineural invasion (PNI) (p<0.001), as well as higher percentages of clinical and pathological T3 disease. Furthermore, patients with PSM were more likely to clinically understaged on final pathological analysis (p<0.001).

CONCLUSIONS:

PSM rate in AA men remained high in the era of robot-assisted surgery and significantly affected BCRFS. These patients were also more likely to have other adverse pathological features.

Source of Funding:

None

© 2021 by American Urological Association Education and Research, Inc.