Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: can nerve-sparing surgery increase the risk?

Martin Andreas Røder; Frederik Birkebæk Thomsen; Ib Jarle Christensen; Birgitte Grønkær Toft; Klaus Brasso; Ben Vainer; Peter Iversen

doi:10.3109/00365599.2012.749425

Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: can nerve-sparing surgery increase the risk?

Martin Andreas Røder, Frederik Birkebæk Thomsen, Ib Jarle Christensen, Birgitte Grønkær Toft, Klaus Brasso, Ben Vainer, Peter Iversen

9 Citations (Scopus)

Abstract

Objective. The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. Material and methods. A prospective consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage positive biopsies for cancer (PPB), surgeon and surgical technique. Results. The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Waldx²) on PSA (p < 0.0001), PPB (p = 0.003), nerve-sparing surgery (p = 0.03) and the surgeon (p < 0.0001). For every doubling of PSA, the risk of PSM increased by 56%, beginning at 0.5 ng/ml [odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.3-1.9, p < 0.01], and every 10% increase in PPB resulted in an 11% increased risk of PSM (OR = 1.11, 95% CI 1.0-1.2, p = 0.002). Two out of the six surgeons had a 50% reduction of risk of PSM compared to the referent surgeon. Nerve-sparing surgery increased the risk of PSM by 50% compared to wide resection (OR = 1.5, 95% CI 1.0-2.1, p = 0.03). Conclusion: Both preoperative and surgical parameters affect the risk of PSM after radical prostatectomy. Surgeon and high preoperative PSA, PPB and cT category were confirmed as predictors of PSM. Surprisingly, nerve-sparing surgery was independently associated with increased risk of PSM. The correct selection of candidates for nerve-sparing surgery remains unresolved.

Original language	English
Journal	Scandinavian Journal of Urology
Volume	48
Issue number	1
Pages (from-to)	15-20
Number of pages	6
ISSN	2168-1805
DOIs	https://doi.org/10.3109/00365599.2012.749425
Publication status	Published - Feb 2014

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Røder, M. A., Thomsen, F. B., Christensen, I. J., Toft, B. G., Brasso, K., Vainer, B., & Iversen, P. (2014). Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: can nerve-sparing surgery increase the risk? Scandinavian Journal of Urology, 48(1), 15-20. https://doi.org/10.3109/00365599.2012.749425

Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: can nerve-sparing surgery increase the risk? / Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Christensen, Ib Jarle et al.
In: Scandinavian Journal of Urology, Vol. 48, No. 1, 02.2014, p. 15-20.

Research output: Contribution to journal › Journal article › Research › peer-review

Røder, MA, Thomsen, FB, Christensen, IJ, Toft, BG, Brasso, K, Vainer, B & Iversen, P 2014, 'Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: can nerve-sparing surgery increase the risk?', Scandinavian Journal of Urology, vol. 48, no. 1, pp. 15-20. https://doi.org/10.3109/00365599.2012.749425

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title = "Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: can nerve-sparing surgery increase the risk?",

abstract = "Objective. The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. Material and methods. A prospective consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage positive biopsies for cancer (PPB), surgeon and surgical technique. Results. The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Waldx2) on PSA (p < 0.0001), PPB (p = 0.003), nerve-sparing surgery (p = 0.03) and the surgeon (p < 0.0001). For every doubling of PSA, the risk of PSM increased by 56%, beginning at 0.5 ng/ml [odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.3-1.9, p < 0.01], and every 10% increase in PPB resulted in an 11% increased risk of PSM (OR = 1.11, 95% CI 1.0-1.2, p = 0.002). Two out of the six surgeons had a 50% reduction of risk of PSM compared to the referent surgeon. Nerve-sparing surgery increased the risk of PSM by 50% compared to wide resection (OR = 1.5, 95% CI 1.0-2.1, p = 0.03). Conclusion: Both preoperative and surgical parameters affect the risk of PSM after radical prostatectomy. Surgeon and high preoperative PSA, PPB and cT category were confirmed as predictors of PSM. Surprisingly, nerve-sparing surgery was independently associated with increased risk of PSM. The correct selection of candidates for nerve-sparing surgery remains unresolved.",

author = "R{\o}der, {Martin Andreas} and Thomsen, {Frederik Birkeb{\ae}k} and Christensen, {Ib Jarle} and Toft, {Birgitte Gr{\o}nk{\ae}r} and Klaus Brasso and Ben Vainer and Peter Iversen",

year = "2014",

month = feb,

doi = "10.3109/00365599.2012.749425",

language = "English",

volume = "48",

pages = "15--20",

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T1 - Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer

T2 - can nerve-sparing surgery increase the risk?

AU - Røder, Martin Andreas

AU - Thomsen, Frederik Birkebæk

AU - Christensen, Ib Jarle

AU - Toft, Birgitte Grønkær

AU - Brasso, Klaus

AU - Vainer, Ben

AU - Iversen, Peter

PY - 2014/2

Y1 - 2014/2

N2 - Objective. The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. Material and methods. A prospective consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage positive biopsies for cancer (PPB), surgeon and surgical technique. Results. The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Waldx2) on PSA (p < 0.0001), PPB (p = 0.003), nerve-sparing surgery (p = 0.03) and the surgeon (p < 0.0001). For every doubling of PSA, the risk of PSM increased by 56%, beginning at 0.5 ng/ml [odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.3-1.9, p < 0.01], and every 10% increase in PPB resulted in an 11% increased risk of PSM (OR = 1.11, 95% CI 1.0-1.2, p = 0.002). Two out of the six surgeons had a 50% reduction of risk of PSM compared to the referent surgeon. Nerve-sparing surgery increased the risk of PSM by 50% compared to wide resection (OR = 1.5, 95% CI 1.0-2.1, p = 0.03). Conclusion: Both preoperative and surgical parameters affect the risk of PSM after radical prostatectomy. Surgeon and high preoperative PSA, PPB and cT category were confirmed as predictors of PSM. Surprisingly, nerve-sparing surgery was independently associated with increased risk of PSM. The correct selection of candidates for nerve-sparing surgery remains unresolved.

AB - Objective. The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. Material and methods. A prospective consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage positive biopsies for cancer (PPB), surgeon and surgical technique. Results. The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Waldx2) on PSA (p < 0.0001), PPB (p = 0.003), nerve-sparing surgery (p = 0.03) and the surgeon (p < 0.0001). For every doubling of PSA, the risk of PSM increased by 56%, beginning at 0.5 ng/ml [odds ratio (OR) = 1.56, 95% confidence interval (CI) 1.3-1.9, p < 0.01], and every 10% increase in PPB resulted in an 11% increased risk of PSM (OR = 1.11, 95% CI 1.0-1.2, p = 0.002). Two out of the six surgeons had a 50% reduction of risk of PSM compared to the referent surgeon. Nerve-sparing surgery increased the risk of PSM by 50% compared to wide resection (OR = 1.5, 95% CI 1.0-2.1, p = 0.03). Conclusion: Both preoperative and surgical parameters affect the risk of PSM after radical prostatectomy. Surgeon and high preoperative PSA, PPB and cT category were confirmed as predictors of PSM. Surprisingly, nerve-sparing surgery was independently associated with increased risk of PSM. The correct selection of candidates for nerve-sparing surgery remains unresolved.

U2 - 10.3109/00365599.2012.749425

DO - 10.3109/00365599.2012.749425

M3 - Journal article

C2 - 23181451

SN - 2168-1805

VL - 48

SP - 15

EP - 20

JO - Scandinavian Journal of Urology

JF - Scandinavian Journal of Urology

IS - 1

ER -

Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer: can nerve-sparing surgery increase the risk?

Abstract

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