Impact of capsular incision on biochemical recurrence after radical perineal prostatectomy

Abstract

The prognostic implications of capsular incision (CI) remain to be defined. We evaluated the impact of CI on biochemical recurrence (BCR) and the potential risk factors of CI. Between June 1995 and July 2007, 266 patients with follow-up for at least 6 months, who had neither the seminal vesicle nor lymph node involvement on prostatectomy specimen, were included. Patients with insufficient biopsy data and those with neoadjuvant and/or adjuvant therapy were excluded. CI was defined as tumor extending into the inked margins, at sites except the apex of the prostate, without documented extraprostatic extension (EPE). There were 186 with organ-confined disease and negative surgical margins (pT2/SM-), 12 with organ-confined disease and an apex-only positive margin (pT2/AM þ ), 35 with CI, 19 with EPE and negative surgical margins (pT3a/SM-) and 13 with EPE and positive surgical margins (pT3a/SM þ ). We compared BCR-free probability among these five groups and the risk factors for CI were assessed. The 3-year BCR-free probability for each group was 92.7% for pT2/SM-, 75.8% for pT2/AM þ , 70.7% with CI, 84% with pT3/SM-and 51% in pT3/SM þ . That for CI was worse than pT2/SM-(P ¼ 0.007), not significantly different from pT2/AM þ and pT3/SM-(P ¼ 0.614, P ¼ 0.318, respectively), but better than pT3/SM þ (P ¼ 0.044), adjusting for the pre-operative prostate-specific antigen and pathological Gleason score. The risk for CI was significantly associated with more than 25% positive biopsy cores. CI seems to affect BCR and is more likely to occur in proportion to positive biopsy cores.

Risk Factors for Intraprostatic Incision into Malignant Glands at Radical Prostatectomy

“…In our previous reports, isolated IPI rates in OC disease ranged from 1.8% to 2.3% [8,16]. However, others reported the IPI rates in OC disease as high as 20% [9,15]. This variation in IPI rate can be partly attributed to pathologic interpretation.…”

“…IPI in the RP specimen is associated with an increased risk of progression following surgery [5–7,9]. Most studies that evaluated the prognostic significance of IPI reported the IPI rate in men with organ-confined (OC) disease only [6–9,15].…”

“…Most studies that evaluated the prognostic significance of IPI reported the IPI rate in men with organ-confined (OC) disease only [6–9,15]. The current study was performed to evaluate the IPI rate across different pathologic stages and to identify predictors of IPI.…”

“…Because histologic boundaries of the prostate are vague and benign prostate glands are seen admixed with skeletal muscle in the apex [5], a recent update recommended using IPI, not capsular incision, to describe this condition [4]. IPI has a significant negative impact on patient outcome following RP [6–9]. A high probability of IPI in obese patients could predict difficulty in achieving the optimal surgical approach and outcome, and it could also negatively impact disease-free survival of these men [10,11].…”

Prevalence and risk factors of contralateral extraprostatic extension in men undergoing radical prostatectomy for unilateral disease at biopsy: A global multi-institutional experience

“…These results compare favourably with rates obtained by Kwak and colleagues. 23 In their cohort, they reported 15.6% of PSM for organ-confined disease. Although contralateral disease was common, it was associated with a low risk of extension beyond the contralateral capsule.…”