A risk grouping algorithm for predicting factors of persistently elevated prostate‐specific antigen in patients following robot‐assisted radical prostatectomy

2021 ◽  
Author(s):  
Uygar Micoogullari ◽  
Mehmet Caglar Cakici ◽  
Erdem Kisa ◽  
Abdullah Erdem Canda ◽  
Furkan Umut Kilic ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Robot Assisted ◽  
Predicting Factors ◽  
Grouping Algorithm ◽  
Risk Grouping

scholarly journals A Nomogram for Predicting Factors of Persistently Elevated Prostate-Specific Antigen in Patients Following Robot-Assisted Radical Prostatectomy

2021 ◽  
Author(s):  
Uygar Micoogullari ◽  
Mehmet Caglar Cakici ◽  
Erdem Kısa ◽  
Erdem Canda ◽  
Furkan Umut Kilic ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Specific Antigen ◽  
Operation Time ◽  
Daily Practice ◽  
Treatment Modalities ◽  
Robot Assisted ◽  
Factors Affecting ◽  
Aggressive Disease ◽  
Predicting Factors

Objective:After radical prostatectomy,prostate-specific antigen(PSA) value measuring ≥0.1ng/ml is defined as persistent PSA(pPSA) and in many studies,it was found to be associated with aggressive disease and poor prognosis.Our aim in this study is to point out the pathological and clinical factors affecting pPSA among the patients who underwent robot-assisted radical prostatectomy(RARP) in an experienced academic center and to make a nomogram,predicting pPSA value based on operative data,useful. Methods:We examined records of 1273 patients who underwent RARP retrospectively. Preoperative,operative,and postoperative data were collected.Based on the PSA values (ng/ml) measured after 4-to-8 weeks of RARP,patients were divided into 2 groups as pPSA group (Group1)(n=97) with PSA values ≥0.1ng/ml and undetectable PSA group (Group2)(n=778) with PSA values <0.1ng/ml.Later on,Group1 was further divided into Group1a (PSA:0.1-0.2ng/ml) and Group 1b (PSA≥0.2ng/ml) to evaluate biochemical recurrence(BCR). Results:Multivariate logistic regression analyses of the collected data revealed that PSA>20ng/ml,operation time,a postoperative international society of urological pathology (ISUP) grade of ≥4, pT 3-4, and pN were independently associated with pPSA.According to the results, a nomogram predicting pPSA was developed(Table 4).By looking at the nomogram pPSA was found in 98.9% of the cases with a PSA value of ≥20ng/ml, an operation time of 150 minutes, a postoperative ISUP grade of 4-5, a positive lymphovascular invasion (LVI) status, pT3-T4, and pN+; while pPSA was found in 25.5% of the cases with a PSA value of <20 ng/ml, an operation time of 100 minutes, a postoperative ISUP grade of <4-5, a negative LVI status, pT<3-4, and pN-.The estimated BCR-free survival time was 16.3 months in Group 1a and 57.0 months in Group2 (p<0.001).Adjuvant treatment ratio was 64.9% in Group1 and 7.1% in Group2 (p<0.001). Conclusion:For the patients who underwent RARP,factors associated with aggressive disease can predict the PSA persistence.To plan our treatment modalities accurately,an applicable nomogram in daily practice would be useful.

Urinary continence four weeks following Retzius-sparing robotic radical prostatectomy: The UK experience

2017 ◽  
Vol 11 (1) ◽  
pp. 15-20 ◽  
Author(s):  
Christopher G Eden ◽  
Dimitrios Moschonas ◽  
Ricardo Soares
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Clinical Stage ◽  
Operating Time ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Interquartile Range ◽  
Urinary Continence ◽  
Positive Surgical Margin ◽  
Robot Assisted

Objective: The purpose of this study was to investigate urinary continence four weeks following Retzius-sparing robot-assisted radical prostatectomy. Patients and methods: Forty patients with T2–T3 prostate cancer underwent Retzius-sparing-robot-assisted radical prostatectomy and their results were compared with those from the 40 patients having robot-assisted radical prostatectomy done by the same surgeon immediately prior to the adoption of Retzius-sparing-robot-assisted radical prostatectomy. Results: Patients in the two groups had similar age, body mass index, prostate specific antigen, biopsy Gleason sum, clinical stage, d’Amico risk profile, blood loss, prostate weight and post-operative hospital stay. Median operating time (200 (interquartile range=155–266) vs 223 (interquartile range=100–238) min; p=0.05) and catheterisation (8 (interquartile range=8–8) vs 14 (interquartile range=14–14) days; p<0.0001) were shorter in the Retzius-sparing group, many of whom had suprapubic catheters inserted. The overall complication rate was lower in Retzius-sparing patients (2.5% vs 8.0%; p=0.36). Positive surgical margin rates were similar for Retzius-sparing and non-Retzius-sparing patients and decreased with greater experience with the Retzius-sparing technique: 16.7% vs 7.7% for pT2 ( p=0.65) and 31.8% vs 14.3% for pT3 ( p=0.44). Initial prostate specific antigen was <0.1 ng/ml in 97.5% and 100%, respectively ( p=1.00). At four weeks post-operation 0, 1 and 2 pads/day were needed in the Retzius-sparing group in 90.0%, 7.5% and 2.5% of patients, compared to 37.5% ( p<0.0001), 32.5% ( p=0.01) and 30% ( p=0.002) of men having conventional surgery. Conclusion: Retzius-sparing-robot-assisted radical prostatectomy is faster than the anterior approach to the prostate, allows a shorter catheterisation time and produces dramatically better continence results at four weeks with 90% of patients being pad-free and 97.5% of patients needing 0–1 pads/day.

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