Robot-Assisted Radical Prostatectomy: Current Evaluation of Surgical Margins in Clinically Low-, Intermediate-, and High-Risk Prostate Cancer

Abstract Purpose: Concern exists over a lack of tactile sensation and positive surgical margins (PSMs) in patients undergoing robot-assisted radical prostatectomy. We report our PSM rates in our most current 500 cases and particularly in clinically high-risk disease. Materials and Methods: After implementation of our present technique at case #251, we report PSM rates according to pathologic stage and D'Amico's risk stratification: low risk (prostate-specific antigen [PSA] 20, GS 8–10, cT3). Patients with cT2b/T3 disease or GS 8 to 10 and multiple cores with >30% involvement underwent wide excision of the neurovascular bundle. PSM was defined as ink on tumor. Results: The overall PSM rate was 7.4%: pT2 = 3.1%, pT3 = 15.9%, and pT4 = 55.6%. PSMs occurred in 13 (4.9%) low, 10 (5.8%) intermediate, and 14 (22.6%) high D'Amico risk patients. Of the 62 high-risk patients, the median PSA was 6.9 (range 2.2–97.9)...