Radical Prostatectomy for Prostate Cancer: The Perineal Approach Increases the Risk of Surgically Induced Positive Margins and Capsular Incisions

Abstract

Although overall positive margins and biochemical failure rates are similar or identical for the perineal and retropubic approaches for organ confined prostate cancer, the perineal approach is associated with a significantly higher risk of capsular incisions and surgically induced positive margins and, thus, a higher risk of biochemical failure.

Impact of capsular incision on biochemical recurrence after radical perineal prostatectomy

“…Earlier studies have reported variable frequencies for the occurrence of CI. [13][14][15][16][17] The disparity may be attributable to differences in surgical technique, definition of CI, the characteristics of the patients studied and the stringency of the pathological analysis. Although the perineal approach has been reported to be more likely than the retropubic approach, to lead to CI with the risk of positive surgical margins in organ-confined tumors because of a limited surgical field, 17 RPP had pathological results, such as positive surgical margins and CI, similar to retropubic procedures with proper patient selection.…”

“…[13][14][15][16][17] The disparity may be attributable to differences in surgical technique, definition of CI, the characteristics of the patients studied and the stringency of the pathological analysis. Although the perineal approach has been reported to be more likely than the retropubic approach, to lead to CI with the risk of positive surgical margins in organ-confined tumors because of a limited surgical field, 17 RPP had pathological results, such as positive surgical margins and CI, similar to retropubic procedures with proper patient selection. 4 Although an earlier study reported that the anterior prostate was the most common site for surgical margins with the perineal approach, 3 our results showed that positive surgical margins in the anterior prostate were present in six cases (2.2%), including three with organconfined cancer.…”

Apical soft tissue biopsies predict biochemical failure in radical perineal prostatectomy patients with apical cancer involvement

“…Whereas previous studies have addressed the issue of positive apical margins in RPP patients, this study is the first to compare apical margin status directly with apical soft tissue biopsies in RPP. 1,3,11 The two main findings of our study are that apical margin and apical soft tissue status are poorly correlated and that apical soft tissue status predicts biochemical failure whereas apical surgical margin status does not.…”

“…We present here a prospective assessment of the prognostic significance of apical surgical margins and soft tissue biopsies in patients with documented apical prostate cancer (PCA). 3,11 …”

Postradical prostatectomy TRUS-guided anastomotic biopsy. Where do we stand today?

“…Several authors have reported about the incidence of bladder neck or apical soft-tissue margins in relation to surgical technique of radical prostatectomy. [48][49][50][51][52] Djavan et al 53 were among the first to report the need of redefining PSA nadir after radical prostatectomy due to the finding of benign positive surgical margins after radical prostatectomy.…”