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KMID : 1001020070050030153
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Korean Journal of Urological Oncology
2007 Volume.5 No. 3 p.153 ~ p.158
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Predictive Risk Factors of Positive Surgical Margins in Radical Perineal Prostatectomy
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Kwak Kyung-Won
Lee Hyun-Moo
Choi Han-Yong
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Abstract
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Purpose: A positive surgical margin(PSM) after radical prostatectomy is an independent predictor of clinical recurrence and biochemical failure in patients with prostate cancer. We investigate the predictive risk factors of PSMs in radical perineal prostatectomy(RPP).
Materials and Methods : From June 1995 to May 2007, a total of 509 men with localized prostate cancer underwent RPP. Among them, 300 patients whose biopsy cores were labeled according to the location of the biopsy and in whom the number of sampled cores was identified were included in this study. We retrospectively reviewed the clinical and pathological data of the population. A PSM was defined as the presence of any tumor cells identified at any margin on the surgical specimen. Clinical information such as PSA level, clinical stage, Gleason score, prostate volume, neoadjuvant hormone therapy, nerve-sparing procedure, and the percentage of positive biopsy cores were used to attempt the prediction of PSMs.
Results: Of 300 patients who underwent RPP for prostate cancer, 83(27.7%) had at least one PSM. In univariate analysis, preoperative PSA of 10 or more, Gleason score of 7 or more, lower prostate volume, neoadjuvant hormone therapy, and the percentage of biopsy cores positive of 25% or more were associated with an increased risk of PSMs. However, preoperative PSA of 10 or more, lower prostate volume and the percentage of biopsy cores positive of 25% or more were the significant independent predictors of PSMs on multivariate analysis. Assessing the incidence of PSM over time for RPP, there was a statistically significant decrease over time in the rate of PSM for RPP(p=0.015).
Conclusions : Preoperative PSA of 10 or more, lower prostate volume and the percentage of biopsy cores positive of 25% or more were the independent predictor of PSMs after RPP, and should be considered during RPP. The PSM rate over time significantly decreased, indicating the impact of surgeon’s experience on PSMs.
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KEYWORD
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Prostate cancer, Radical perineal prostatectomy, Positive surgical margin
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