Abstract
Aim: The aim of this study was to evaluate the impact of PSA density (PSAD) on surgical outcomes and postoperative complications in patients undergoing robotic radical prostatectomy (RP) for localized prostate cancer. In addition, it was determined whether PSAD could serve as a predictive biomarker.
Materials and Methods: This retrospective cohort study analyzed data from 154 patients who underwent robotic RP between July 2020 and June 2022. Inclusion criteria were patients with localized prostate cancer who underwent robotic RP. Exclusion criteria included missing data or previous prostate surgery. PSAD was calculated as the ratio of preoperative PSA level (ng/mL) to prostate volume (mL) obtained by transrectal ultrasound (TRUS) or multiparametric MRI. Data collected included demographic information, preoperative PSA levels, prostate volume, surgical parameters, and postoperative outcomes. Statistical analyses were performed by Pearson correlation and multivariate regression.
Results: The mean age of the patients was 65 years, with an age range of 46 to 80 years. Preoperative PSA levels ranged from 2.19 to 35.4 ng/mL, with a mean of 7.75 ng/mL. The mean prostate volume was 47.73 mL. In the distribution of PSAD values, 18.8% of the patients were in the low-risk group, 34.4% in the intermediate-low risk group, 22.1% in the intermediate-high risk group, 24.7% in the high-risk group. The positive surgical margin rates with higher PSAD were 18.75%, 31.91%, 44.12%, and 51.22%. No significant effect of PSAD on VUAS or anastomotic leakage was found. Logistic regression analysis showed that PSAD (coefficient 3.02, p=0.051) and T3a cancer (coefficient 1.48, p=0.018) were significant predictors of positive surgical margins. In the ROC curve analysis, it was found that the AUC value of PSAD (0.65) was higher than the AUC value of T3a cancer (0.55), indicating that PSAD may be a better positive surgical margin marker than T3a cancer.
Conclusion: This study shows that high PSAD increases the risk of positive surgical margins in patients undergoing robotic RP and may be an important biomarker for predicting surgical outcomes. However, PSAD has no significant effect on postoperative complications, indicating the need for further research. PSAD may play an important role in improving surgical outcomes.
References
- Rawla P. Epidemiology of prostate cancer. World J Oncol 2019;10(2):63.
- Kalemci S, Ergün KE, Kizilay F, Akyol A, Şimşir A. Do bony pelvis parameters affect perioperative outcomes in open radical prostatectomy? Prostate Int 2022;10(3).
- Kwon O, Hong SK. Active surveillance and surgery in localized prostate cancer. Minerva Urol Nefrol 2014;66(3):175–87.
- Ma J, Xu W, Chen R, Zhu Y, Wang Y, Cao W, et al. Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer: the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies. Int J Surg 2023;109(5):1350–9.
- Corcoran NM, Casey RG, Hong MKH, Pedersen J, Connolly S, Peters J, et al. The ability of prostate-specific antigen density to predict an upgrade in Gleason score between initial prostate biopsy and prostatectomy diminishes with increasing tumour grade. BJU Int 2012;110(1):36–42.
- Benson MC, Whang IS, Pantuck A, Ring K, Kaplan SA, Olsson CA, et al. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 1992;147(3 Pt 2):815–6.
- Sfoungaristos S, Perimenis P. PSA density is superior than PSA and Gleason score for adverse pathologic features prediction in patients with clinically localized prostate cancer. Can Urol Assoc J 2012;6(1):46–50.
- Radwan MH, Yan Y, Luly JR, Figenshau RS, Brandes SB, Bhayani SB, et al. Prostate-specific antigen density predicts adverse pathology and increased risk of biochemical failure. Urology 2007;69(6):1121–7.
- Kundu SD, Roehl KA, Yu X, Antenor JAV, Suarez BK, Catalona WJ. Prostate specific antigen density correlates with features of prostate cancer aggressiveness. J Urol 2007;177(2):505–9.
- Jones TD, Koch MO, Bunde PJ, Cheng L. Is prostate-specific antigen density better than the preoperative PSA level in predicting early biochemical recurrence of prostate cancer after radical prostatectomy? BJU Int 2006;97(3):480–4.
- Freedland SJ, Kane CJ, Presti JC, Terris MK, Amling CL, Dorey F, et al. Comparison of preoperative PSA density and PSA for predicting recurrence after radical prostatectomy: results from the search database. J Urol 2003;169(3):969–73.
- Vives Dilme R, Rivas JG, Fernández Hernández L, De la Parra Sánchez I, Sánchez del Hoyo R, Galante Romo MI, et al. Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor. Ther Adv Urol 2024;16.
- Yashi M, Nukui A, Tokura Y, Takei K, Suzuki I, Sakamoto K, et al. PSA density and biopsy core details to predict oncological outcome in patients with intermediate to high-risk prostate cancer undergoing robot-assisted radical prostatectomy. BMC Urol 2017;17(1).
- Schoots IG, Padhani AR. Risk-adapted biopsy decision based on prostate MRI and PSA density for enhanced biopsy avoidance in first prostate cancer diagnostic evaluation. BJU Int 2021;127(2):175–8.
- Bishara S, Vasdev N, Lane T, Boustead G, Adshead J. Robotic prostatectomy has a superior outcome in larger prostates and PSA density is a strong predictor of biochemical recurrence. Prostate Cancer 2014;2014.
- Hayashi N, Urashima M, Ikemoto I, Kuruma H, Arai Y, Kuwao S, et al. PSA adjusted for total prostatic tumor volume as a predictor for outcome after radical prostatectomy. Prostate Cancer Prostatic Dis 2007;10(1):60–5.
- Pettenati C, Neuzillet Y, Radulescu C, Hervé JM, Molinié V, Lebret T. Positive surgical margins after radical prostatectomy: what should we care about? World J Urol 2015;33(12):1973–8.
- Ha YS, Kang DI, Kim JH, Joung JY, Yu J, Parihar JS, et al. Favorable risk factors in patients with positive surgical margin after robot-assisted radical prostatectomy. Can J Urol 2014;21(3):7290–7.
Abstract
Amaç: Prostat spesifik antijen dansitesi (PSAD), prostat kanseri tanısında kullanılan serum prostat spesifik antijen (PSA) düzeyinin prostat volümüne oranlanması ile elde edilen tanısal bir belirteçtir. Prostat büyümesi ile PSA düzeylerindeki artışın korele olması nedeniyle tanısal değerlendirmede bu oran sıklıkla kullanılmaktadır ancak cerrahi sonuçların öngörülmesinde kullanılmamaktadır. Bu çalışmanın amacı, lokalize prostat kanseri için robotik radikal prostatektomi geçiren hastalarda PSA dansitesinin cerrahi sonuçlar ve postoperatif komplikasyonlar üzerindeki etkisini değerlendirmektir.
Gereç ve Yöntem: Bu retrospektif kohort çalışması, Temmuz 2020 ile Haziran 2022 arasında robotik RP uygulanan 154 hastanın verilerini analiz etmiştir. PSAD, preoperatif PSA düzeyinin (ng/mL) transrektal ultrason (TRUS) veya multiparametrik MRG ile elde edilen prostat hacmine (mL) oranı olarak hesaplanmıştır. Elektronik dosya arşivi taraması ile toplanan veriler demografik bilgiler, preoperatif PSA düzeyleri, prostat hacmi, cerrahi parametreler ve postoperatif sonuçları içermektedir.
Bulgular: Hastaların yaş ortalaması 65 (6,69) olup, yaş aralığı 46 ile 80 arasındadır. Preoperatif PSA düzeyleri 2.19 ile 35.4 ng/mL arasında değişmekte ve ortalama 7,75 (4,73) ng/mL olarak bulunmuştur. Prostat hacmi ortalama 47,73 (16,1) mL'dir. PSAD değerlerinin dağılımında hastaların %18,8'i düşük risk, %34,4'ü orta-düşük risk, %22,1'i orta-yüksek risk ve %24,7'si yüksek risk grubundadır. Daha yüksek PSAD ile pozitif cerrahi sınır oranları %18,75, %31,91, %44,12 ve %51,22 olarak saptanmıştır. PSAD'nin vezikoüretral anastomoz stenozu (VUAS) (p=0.8) veya anastomoz kaçakları (p=0.9) üzerinde anlamlı bir etkisi bulunmamıştır. Lojistik regresyon analizi, PSAD (katsayı 3.02, p=0.051) ve T3a kanserin (katsayı 1.48, p=0.018) pozitif cerrahi sınırların anlamlı prediktörleri olduğunu göstermiştir. ROC eğrisi analizinde, PSAD'nin AUC değerinin (0.65), T3a kanserin AUC değerinden (0.55) daha yüksek olduğu saptanmış olup bu durum PSAD’nin T3a kanserden daha iyi bir pozitif cerrahi sınır belirteci olabileceğini göstermektedir.
Sonuç: Bu çalışma, robotik radikal prostatektomi geçiren hastalarda yüksek PSAD'nin pozitif cerrahi sınır riskini artırdığını ve cerrahi sonuçları öngörmede önemli bir biyobelirteç olabileceğini göstermektedir. Ancak, PSAD'nin postoperatif komplikasyonlar üzerinde anlamlı bir etkisi yoktur, bu da daha fazla araştırmaya ihtiyaç olduğunu göstermektedir. PSAD, cerrahi sonuçların iyileştirilmesinde önemli bir rol oynayabilir.
Keywords
Prostat Kanseri Robotik Cerrahi PSA Dansitesi Cerrahi Sınırlar Postoperatif Komplikasyonlar
References
- Rawla P. Epidemiology of prostate cancer. World J Oncol 2019;10(2):63.
- Kalemci S, Ergün KE, Kizilay F, Akyol A, Şimşir A. Do bony pelvis parameters affect perioperative outcomes in open radical prostatectomy? Prostate Int 2022;10(3).
- Kwon O, Hong SK. Active surveillance and surgery in localized prostate cancer. Minerva Urol Nefrol 2014;66(3):175–87.
- Ma J, Xu W, Chen R, Zhu Y, Wang Y, Cao W, et al. Robotic-assisted versus laparoscopic radical prostatectomy for prostate cancer: the first separate systematic review and meta-analysis of randomised controlled trials and non-randomised studies. Int J Surg 2023;109(5):1350–9.
- Corcoran NM, Casey RG, Hong MKH, Pedersen J, Connolly S, Peters J, et al. The ability of prostate-specific antigen density to predict an upgrade in Gleason score between initial prostate biopsy and prostatectomy diminishes with increasing tumour grade. BJU Int 2012;110(1):36–42.
- Benson MC, Whang IS, Pantuck A, Ring K, Kaplan SA, Olsson CA, et al. Prostate specific antigen density: a means of distinguishing benign prostatic hypertrophy and prostate cancer. J Urol 1992;147(3 Pt 2):815–6.
- Sfoungaristos S, Perimenis P. PSA density is superior than PSA and Gleason score for adverse pathologic features prediction in patients with clinically localized prostate cancer. Can Urol Assoc J 2012;6(1):46–50.
- Radwan MH, Yan Y, Luly JR, Figenshau RS, Brandes SB, Bhayani SB, et al. Prostate-specific antigen density predicts adverse pathology and increased risk of biochemical failure. Urology 2007;69(6):1121–7.
- Kundu SD, Roehl KA, Yu X, Antenor JAV, Suarez BK, Catalona WJ. Prostate specific antigen density correlates with features of prostate cancer aggressiveness. J Urol 2007;177(2):505–9.
- Jones TD, Koch MO, Bunde PJ, Cheng L. Is prostate-specific antigen density better than the preoperative PSA level in predicting early biochemical recurrence of prostate cancer after radical prostatectomy? BJU Int 2006;97(3):480–4.
- Freedland SJ, Kane CJ, Presti JC, Terris MK, Amling CL, Dorey F, et al. Comparison of preoperative PSA density and PSA for predicting recurrence after radical prostatectomy: results from the search database. J Urol 2003;169(3):969–73.
- Vives Dilme R, Rivas JG, Fernández Hernández L, De la Parra Sánchez I, Sánchez del Hoyo R, Galante Romo MI, et al. Oncological outcomes in robot-assisted radical prostatectomy: the value of PSA density as a preoperative predictive factor. Ther Adv Urol 2024;16.
- Yashi M, Nukui A, Tokura Y, Takei K, Suzuki I, Sakamoto K, et al. PSA density and biopsy core details to predict oncological outcome in patients with intermediate to high-risk prostate cancer undergoing robot-assisted radical prostatectomy. BMC Urol 2017;17(1).
- Schoots IG, Padhani AR. Risk-adapted biopsy decision based on prostate MRI and PSA density for enhanced biopsy avoidance in first prostate cancer diagnostic evaluation. BJU Int 2021;127(2):175–8.
- Bishara S, Vasdev N, Lane T, Boustead G, Adshead J. Robotic prostatectomy has a superior outcome in larger prostates and PSA density is a strong predictor of biochemical recurrence. Prostate Cancer 2014;2014.
- Hayashi N, Urashima M, Ikemoto I, Kuruma H, Arai Y, Kuwao S, et al. PSA adjusted for total prostatic tumor volume as a predictor for outcome after radical prostatectomy. Prostate Cancer Prostatic Dis 2007;10(1):60–5.
- Pettenati C, Neuzillet Y, Radulescu C, Hervé JM, Molinié V, Lebret T. Positive surgical margins after radical prostatectomy: what should we care about? World J Urol 2015;33(12):1973–8.
- Ha YS, Kang DI, Kim JH, Joung JY, Yu J, Parihar JS, et al. Favorable risk factors in patients with positive surgical margin after robot-assisted radical prostatectomy. Can J Urol 2014;21(3):7290–7.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Urology |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | June 10, 2025 |
| Submission Date | November 5, 2024 |
| Acceptance Date | February 10, 2025 |
| Published in Issue | Year 2025Volume: 64 Issue: 2 |
