The Significance Of Positive Surgical Margin In Areas Of Capsular Incision In Otherwise Organ Confined Disease At Radical Prostatectomy

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology
Article Date: 30 Dec 2007 - 1:00 PDT

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UroToday.com- There is a lack of consensus regarding the impact of prostatic capsular incision in otherwise organ confined disease. In the October issue of the Journal of Urology, Dr. Chuang and the associates from Korea and the Johns Hopkins University report that capsular incision may result in a higher cancer recurrence rate

Cases of capsular incision were retrospectively identified from pathology reports from the period 1993-2004. These pathology specimens were reviewed. Tumor at an inked margin was considered a positive surgical margin (PSM). Extension of the tumor to the inked margins in the same plane where benign prostatic acni were also present at the inked margin were considered to have a PSM due to capsular incision. The study evaluated only cases with a PSM in an area of capsular incision. Elsewhere in the specimen there was no extra-prostatic extension, seminal vesicle invasion, or lymph node metastasis. The lengths of the capsular incision, total tumor, and benign prostate glands at the ink in an area of capsular incision were measured. The capsular incision Gleason score and overall tumor Gleason score were recorded. These data were compared to other pathological groups in the institution's database; to include focal extraprostatic extension (FEPE) margin negative, FEPE margin positive, extensive EPE margin negative and extensive EPE margin positive.

There were 135 cases of capsular incision during this time period representing 1.3% of the total RPs performed with Gleason score 6-7. Median patient age of the capsular incision group was 58 and 94.8% had only one area of capsular incision. The median length of tumor at the capsular incision site was 2mm. Capsular incision was posterolateral in 61.5%, posterior in 18.5%, anterior in 8.9%, lateral in 8.1%, and apical in 3%. The overall Gleason score at the site on incision was 6 in 73% and 7 in 28%. Of the cohort, 113 men had followup data available and the 5-year actuarial freedom from recurrence was 97% for organ confined surgical margin negative, 90% for FEPE margin negative, 79% for FEPE margin positive, 74% for extensive EPE margin negative, 71% for capsular incision into the tumor, and 59% for extensive EPE margin positive. Patients with capsular incision had a higher risk of progression than men with organ confined margin negative or FEPE margin negative disease. The risk of disease progression with capsular incision, FEPE margin negative, and extensive EPE margin negative were not different.

The researchers report that risk of disease recurrence correlated with tumor length at the capsular incision site. For less than 3mm tumor at the capsular incision site, the 5-year risk of PSA progression was 20%, compared to 55% if there was a 3mm or more tumor.

Chuang AY, Nielsen ME, Hernandez DJ, Walsh PC, Epstein JI

J Urol. 178(4): 1306- 1310, October 2007

Reported by UroToday.com Contributing Editor Christopher P. Evans, M.D

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