Clinical significance of benign glands at surgical margins in robotic radical prostatectomy specimens.

Objectives: Completion of robotic radical prostatectomy compared with conventional open retropubic radical prostatectomy can result in different alterations in the prostatectomy specimens. One difference appears to be an increased incidence of benign glands at the margins, which has been associated with an increase in postoperative prostatic-specific antigen (PSA) levels. We compared the frequency and clinical significance of benign prostate glands at the surgical margins in radical prostatectomy specimens obtained by robotic versus open retropubic prostatectomy.

Methods: We reviewed 38 consecutive prostatectomy specimens from patients with biopsy-proven prostate cancer. Of these 38 specimens, 25 (65%) were obtained by robotic resection and 13 (35%) by open retropubic prostatectomy. Each case was analyzed for Gleason score, pathologic stage, including margin status, and the presence or absence of benign glands at the surgical margin. The study endpoint was the postoperative serum PSA level.

Results: A significantly greater incidence (P = 0.035) of benign glands at the surgical margins was found within the robotic group compared with the open retropubic prostatectomy group (54% versus 15%). With a median follow-up of 12.5 months for the robotic group and 24.5 months for the robotic prostatectomy group, only 2 patients, who also had had positive surgical margins, had a continued and persistent increase in the postoperative PSA level after an initial nadir.

Conclusions: The early clinical follow-up data of our study have suggested that patients undergoing robotic radical prostatectomy with negative surgical margins achieve a PSA nadir of less than 0.1 ng/mL, irrespective of the presence or absence of benign prostatic tissue at the surgical margins.