Impact Of Capsular Incision On Biochemical Recurrence After Radical Perineal Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 10 Aug 2009 - 5:00 PDT

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UroToday.com - In the online edition of Prostate Cancer and Prostatic Diseases, a group of Korean investigators report on the impact on biochemical recurrence (BR) of an iatrogenic prostatic capsular incision at the time of radical perineal prostatectomy (RPP). The study included 266 men who underwent RPP for prostate cancer (CaP) between 1995 and 2007, by a single surgeon. Nerve sparing was performed in 96 of these men. Clinical and pathologic variables were assessed in multivariate analysis.

Of the 266 patients, 186 were pT2 with negative surgical margins (SM), 12 were pT2 with apex positive margin and capsular incision (CI), 19 were pT3a surgical margin negative and 14 were pT3a and surgical margin positive. CI was present in 35 men. CI was in a single area in 24 men and two different areas in 11 men. Most men (87.5%) with a single CI had positive margin at the posterolateral and the rest were positive at the base of the prostate. The men with CI at the apex (AM) or anterior margin had a positive margin at the other site. Mean follow-up was 36 months and the 3-year BCR-free probability was 92.7%in the pT2/SM- group, 75.8% in the pT2/AM+ group, 70.7% in the CI group, 84% in the pT3a/SM- group and 51% in the pT3a/SM+ group. The men with CI had a higher likelihood of BCR than did the men with pT2/SM- disease, comparable BCR to men with pT2/AM+ and pT3a/SM- disease, but better than those with pT3a/SM+ after adjusting for pre-operative PSA and pathologic Gleason score.

In multivariate analysis, the number of cases experienced and the percentage of positive biopsy cores were the only significant independent predictors of CI with RPP. A patient with more than 25% biopsy cores positive had an increased risk of BCR. The incidence of CI decreased over time as surgeon experience increased.

Kwak KW, Lee HM, Choi HY
Prostate Cancer Prostatic Dis. 2009 Jun 2. (Epub ahead of print)
10.1038/pcan.2009.19

Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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