Biochemical recurrence after radical prostatectomy: is the disease or the surgeon to blame?

Abstract

Purpose:The PSA recurrence develops in 27 to 53% within ten years after radical prostatectomy (RP). We investigated the factors (disease grade and stage or the surgeon's expertise,) more likely to influence biochemical recurrence in men post-radical prostatectomy for organ-confined prostate cancer by different surgeons in the same institution. Materials and Methods: A total of 510 patients that underwent radical prostatectomy were investigated retrospectively. Biochemical recurrence was defined as detection of a PSA level of ≥ 0.20 ng/mL by two subsequent measurements. The causes, which are likely to influence the development of PSA recurrence, were separated into two groups as those related to the disease and those related to the surgical technique. Results: Biochemical recurrence was detected in 23.5% (120 cases) of 510 cases. The parameters most likely to influence biochemical recurrence were: PSA level (p < 0.0001), T stage (p < 0.0001), the presence of extracapsular invasion prostate (p < 0.0001), Gleason scores (p = 0.042, p < 0.0001) and the presence of biopsy with perineural invasion (p = 0.03).The only surgical factor that demonstrated relevance was inadvertent capsular incision during the surgery that influenced the PSA recurrence (p < 0.0001). Conclusion:The PSA recurrence was detected in 21.6% of patients who had been treated with radical prostatectomy within 5 years, which indicates that the parameters related to the disease and the patient have a pivotal role in the PSA recurrence.

Predictive factors for biochemical recurrence in radical prostatectomy patients

“…However, due to drawbacks in clinical staging, 30–40% of clinically localized prostate cancer patients reveal extraprostatic disease in RP specimens [ 12 , 13 ]. PSM existence can be affected by the preferred surgery method and surgeon's experience [ 14 , 15 ]. In the first 10 years after operation, 35% of the patients experience biochemical recurrence [ 16 , 17 ].…”

“…The difference between the given ratios is based on the experience of the surgeon. These rates decrease with surgeon's experience [ 14 , 15 ]. In our study, this rate was detected as 28.1%.…”