Benign Prostate Glandular Tissue at Radical Prostatectomy Surgical Margins

Abstract

Objective To determine whether presence of benign glandular tissue at the radical prostatectomy surgical margin is associated with technique (open (ORP) or robotic assisted laparoscopic radical prostatectomy (RALRP)) and if benign glandular tissue increases the risk of biochemical recurrence. Methods Surgical specimens from men with clinical T1–T2 disease who underwent RP between 2004–2010 were re-reviewed by a single uropathologist, examining all sections from the prostate apex and base for the presence of benign glandular tissue and tumor at the margin. Regression analysis was utilized to examine associations of benign glandular tissue with surgical approach and biochemical recurrence. Results Of 934 cases reviewed, 431 were managed by ORP and 503 by RALRP with a median follow up of 48 and 25 months, respectively. Overall, benign glandular tissue was found in 274 (29%) cases: 98 (36%) at the apex, 138 (50%) at the base and 38 (14%) at both. Compared with those who underwent ORP, patients who underwent RALRP had 3-fold greater odds of benign glandular tissue at the margin (P<0.01), including significantly greater number of cases with benign glandular tissue at the base (P<0.01). However, recurrence-free survival rates were similar between patients with and without BGM regardless of surgical approach and across all clinical risk groups (log-rank P=0.20). Conclusions Patients undergoing RALRP were more likely to have benign glandular tissue at the surgical margin. However, the presence of benign glandular tissue was not an independent risk factor for biochemical recurrence.

Prostatic capsular incision during radical prostatectomy has important oncological implications: a systematic review and meta‐analysis

“…However, patients with CapI had a lower BCR compared to patients with EPE and PSM. Other studies focused on the impact of CapI into benign tissue only and failed to show a significant association with bRFS (Table ).…”

Current Use of Imaging after Primary Treatment of Prostate Cancer

“…Some groups reported that the rate of surgical margins with benign prostatic tissue was as high as 60% after RP. 25,26 Many patients receive salvage therapy, mainly ADT, in response to biochemical failure after RP or radiation therapy without posttreatment imaging. 27 In the current study positive findings on posttreatment imaging were associated with salvage treatment, suggesting that posttreatment imaging may influence subsequent management.…”

The use of early postoperative prostate-specific antigen to stratify risk in patients with positive surgical margins after radical prostatectomy

“…Odisho et al have reviewed 274 patients with benign glandular tissue at the surgical margin after radical prostatectomy. They concluded that this finding was not associated with postoperative elevation of PSA [ 15 ]. Thus, it seems that the only significant source of PSA after radical prostatectomy may be retained malignant cells and PSA kinetics early after the surgery are key to identification of patients with prostate cancer who have received failed prior therapy.…”

“…Moreover, recently introduced ultrasensitive PSA detection techniques are offering a new insight into the changes in serum PSA at very low concentration. It has been demonstrated that after a properly performed radical prostatectomy, measurable PSA is most likely attributed to the presence of active prostate cancer cells rather than to retained benign prostatic tissue [ 15 , 16 ]. It is therefore conceivable, that real candidates for immediate adjuvant therapy, who have active prostate cancer cells remaining in the body after the surgery, should present with higher postoperative serum PSA in a comparison to individuals with incorrect diagnosis of PSM.…”