Login to Access Video or Poster Abstract: MP64-17
Sources of Funding: none

Introduction

Positive surgical margins (PSM) are a known risk factor for biochemical recurrence (BC) after radical prostatectomy (RP). The relevance for the survival remains unclear. Frozen section is a possible approach to reduce the risk for PSM. The aim of the present study is to compare the oncologic outcome of patients treated by open radical prostatectomy and robot assisted laparoscopic prostatectomy (RALP) using standard frozen section and a new procedure of frozen section named Tue-Safe.

Methods

We included 111 and 180 patients with intermediate and high risk prostate cancer undergoing radical prostatectomy with standard frozen section and a new approach between 2014 and 2016. Clinical, pathological and perioperative parameters were obtained retrospectively. The Tue-safe approach included assessment of the whole circumference separated in the apical and basal section and both sided layer corresponding to the neurovascular bundle. In the standard frozen section group number and region of specimen was decided individually on behalf of the surgeon. Pathologic outcome was compared in the whole cohort and in the subgroups of intermediate and high risk.

Results

The two groups did not differ in terms of Age, PSA value, D Amico-Risk-Score, Gleason-score. In the whole cohort there was no significant difference, but a clear trend in reduced postoperative surgical margin between the Tue-Safe-technique and standard frozen section (20.72% and 29.83%; p=0.0561). In the high risk group we could show a trend towards reduction in PSM with Tue-Safe compared to standard frozen section (26.09% and 39.39%; p=0.1032) In the intermediate risk group we found a significant reduction in PSM at the base of the prostate in the Tue-Safe group compared to standard frozen section (1.54% and 8.70%; p=0.0335).

Conclusions

Due to the Tue-Safe technique the rate of PSM showed a trend towards a reduction, thereby lowering the rate of potential subsequent therapies like adjuvant radiotherapy. This trend was also present in the high risk cohort. This shows that RPx is a valid option in the treatment of high-risk patients and is thereby able to avoid the concomitant use of ADT which is required if radiotherapy is chosen as a therapy in this high-risk population. In addition, within a concept of multimodal therapy of high-risk patients, a negative residual margin may decrease the rate of bi or trimodal treatments in this patient cohort. Further investigation in a bigger cohort is needed to prove the benefit of the Tue-Safe technique.

Funding

none