CI adversely affects postop prognosis in patients with prostate cancer

MedWire News: Capsular incision (CI) adversely affects the prognosis of patients with prostate cancer who have undergone radical perineal prostatectomy (RPP), researchers report.

K Kwak (Hanil General Hospital, Seoul, South Korea) and colleagues studied data from 266 patients who underwent RPP between 1995 and 2007 with follow-up of at least 6 months. The patients had no evidence of seminal vesicle or lymph node involvement in their prostatectomy specimen.

Kwak et al defined CI as tumor extending into the inked margins at sites except the apex of the prostate but without documented extraprostatic extension (EPE).

Overall, 186 patients had organ-confined disease and negative surgical margins (pT2/SM–), 12 had organ-confined disease and an apex-only positive margin (pT2/AM+), and 35 had CI. Nineteen had EPE and negative surgical margins (pT3a/SM–) and 13 had EPE and positive surgical margins (pT3a/SM+).

The 3-year biochemical recurrence (BCR)-free probability was 92.7% for pT2/SM–patients, 75.8% for pT2/AM+ patients, 70.7% for CI patients, 84% for pT3a/SM– patients, and 51% for pT3a/SM+ patients.

The BCR-free probability was significantly worse for patients with CI than for those with pT2/SM–, and did not significantly differ from that for patients with pT2/AM+ and pT3/SM– disease, after adjusting for the pre-operative prostate-specific antigen and pathological Gleason score.

However, the BCR-free probability was better for patients with CI than for those with pT3/SM+ disease.

On multivariate analysis, the presence of 25% or more positive biopsy cores significantly and independently predicted CI in RPP. Also, assessing the incidence of CI over time with RPP showed that the incidence of CI significantly decreased over time with more experience with RPP.

Kwak et al comment in the journal Prostate Cancer and Prostatic Diseases: “To reduce the occurrence of CI, surgeons should consider the proportion of positive biopsy cores and use the most appropriate surgical technique for each patient.”

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