Kosin Medical Journal

Original articles

Initial experience with Retzius-sparing robot-assisted radical prostatectomy compared to the conventional method: is it a suitable option for robotic prostatectomy beginners?: Su Hwan Kang; Kosin Med J. 2023;38(4):267-273. Published online November 9, 2023; DOI: https://doi.org/10.7180/kmj.23.143

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Abstract PDF PubReader ePub: Background
Retzius-sparing robot-assisted radical prostatectomy (rsRARP) is a surgical procedure that can minimize the resection of surrounding prostate tissue by enabling access through the anterior surface of the Douglas pouch. We reported our initial experiences with rsRARP compared to conventional robot-assisted radical prostatectomy (RARP).
Methods
Retrospective data were collected from March 2019 to June 2022, including 69 patients who underwent robotic radical prostatectomy for localized prostate cancer. The operations were performed at a single center, and we alternated between the two methods. Perioperative characteristics and oncologic and functional outcomes were analyzed.
Results
In total, 35 patients underwent RARP and 34 patients underwent rsRARP. The preoperative characteristics of the patients were similar. Oncologic and functional parameters were analyzed postoperatively. Except for early recovery of urinary incontinence (immediate, 1 month, 3 months, 6 months: p<0.001, p=0.002, p=0.004, and p=0.014, respectively), there were no significant differences between the two groups. We also analyzed trends in operation time and oncologic and functional outcomes according to the progression of rsRARP cases.
Conclusions
rsRARP has the major advantage of enabling an early recovery from urinary incontinence after surgery, and it is also a good surgical approach that shows oncologically similar results to the conventional approach. It is also highly reproducible and can be recommended to surgeons new to robotic radical prostatectomy.

Cribriform Pattern at the Surgical Margin is Highly Predictive of Biochemical Recurrence in Patients Undergoing Radical Prostatectomy: Kyung Hwan Kim, Ja Yoon Ku, Chan Ho Lee, Won Young Park, Hong Koo Ha; Kosin Med J. 2019;34(2):95-105. Published online December 31, 2019; DOI: https://doi.org/10.7180/kmj.2019.34.2.95

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Objectives

We investigated the relationship between cribriform patterns and biochemical recurrence in patients with positive surgical margins after radical prostatectomy.

Methods

This study was based on radical prostatectomy specimens obtained from 817 patients (165 with margin-positive status) collected at a single center between 2010 and 2016. We retrospectively analyzed and compared body mass index, preoperative prostate-specific antigen, Gleason score, operative methods, postoperative Gleason score, pathological T-stage, tumor percentage involvement, lymphatic and perineural invasion, prostate-specific antigen nadir, location and length of the positive margin, cribriform pattern status, and Gleason grade at the surgical margin in terms of their association with biochemical recurrence. Risk factors for biochemical recurrence were also investigated.

Results

21% (31/146) of surgical margin-positive patients had a cribriform pattern. Nadir prostate-specific antigen, perineural invasion and biochemical recurrence rates were significantly higher in cribriform pattern present group than absent group (P = 0.031, 0.043 and 0.045, respectively). According to the Cox regression model, postoperative Gleason score, tumor percentage involvement, location and length of the positive margin, and the presence of a cribriform pattern at the surgical margin were significant predictive factors of biochemical recurrence (P = 0.022, < 0.001, 0.015, 0.001, and 0.022, respectively). Moreover, the biochemical recurrence risk was approximately 3-fold higher in patients with a cribriform pattern at the surgical margin than in those without (HR: 3.41, 95% CI 1.20-9.70, P = 0.022).

Conclusions

A cribriform pattern at the surgical margin is a significant predictor of biochemical recurrence in patients who undergo radical prostatectomy.

Citations

Citations to this article as recorded by

Length of positive surgical margins after radical prostatectomy: Does size matter? – A systematic review and meta-analysis
Athul John, Alicia Lim, Rick Catterwell, Luke Selth, Michael O’Callaghan
Prostate Cancer and Prostatic Diseases.2023; 26(4): 673. CrossRef

Case report

Metachronous anterior urethral metastasis of prostatic ductal adenocarcinoma: Jeong Hyun Oh, Taek Sang Kim, Hyun Yul Rhew, Bong Kwon Chun; Kosin Med J. 2016;31(1):66-70. Published online February 4, 2016; DOI: https://doi.org/10.7180/kmj.2016.31.1.66

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Abstract PDF PubReader ePub: Abstract
Prostate cancer is increasing in frequency in Korea. Among them, ductal adenocarcinoma (DCP) has a more aggressive and poor prognosis than acinar adenocarcinoma (ACP), despite its low incidence. Patients usually present with symptoms of lower urinary tract symptoms and hematuria due to increasing tumor mass within the lumen of the prostatic urethra, making diagnosis of DCP by the transrectal prostate biopsy difficult. DCP is often metastasized at the time of diagnosis. DCP is transferable to most other organs but the metastasis to the anterior urethra is rare. There is no doubt that localized DCP requires radical prostatectomy (RP) but the guidelines for adjuvant therapy after RP have not yet been established. Methods of the treatment are confounded by individual differences, and arriving at a consensus is challenging due to insufficient data. We report a case of DCP and urethral metastasis after RP, thus aiding in the determination of treatment guidelines.

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