系統的生検とMRI-US融合画像ガイド下前立腺生検後のロボット支援腹腔鏡下前立腺全摘除術における切除断端陽性のリスク因子の検討

Abstract

There is a riskof positive resection margins (RMs) in patients who had undergone robot-assisted laparoscopic radical prostatectomy (RARP) following systematic prostate biopsies. This study examined the riskof positive RM post-RARP when magnetic resonance imaging-ultrasonography (MRI-US) fusion biopsy was performed along with systematic prostate biopsy. Sixty-one patients who had undergone MRI fusion biopsy and systematic transrectal and transperineal biopsies, followed by RARP, at our hospital between September 2020 and October 2023 were included. The median age was 61 years, and the median PSA level was 8.4 ng/ml. Although there was no significant difference between the two groups, the RM-positive group exhibited a significantly higher clinical stage. Of the 122 lobes of the prostate (including the right and left lobes), the RM-positive group (26 lobes) had a significantly higher proportion of positive transrectal biopsies of the internal and external glands of the 61 cases. Additionally, in the RM-positive group, the proportion of positive transperineal biopsies of the internal glands and the ratio of positive systematic biopsies were significantly higher. Logistic regression analysis of riskfactors linked to increased RM-positivity revealed that neurovascular bundle (NVB) preservation and positive target biopsy were not significant variables. However, systematic biopsies positivity rate was a significant riskfactor. Thus, the riskof RMpositivity was shown to be associated with the systematic biopsy positivity rate, which suggested that systematic biopsies may be necessary for evaluating the indications for NVB preservation.