Philipp Mandel1,2, Su J Oh1, Christoph Hagner1, Pierre Tennstedt1, Maximilian C Kriegmair3, Hartwig Huland1, Markus Graefen1, Derya Tilki4,5. 1. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. 2. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. 3. Department of Urology, University Hospital Mannheim, Mannheim, Germany. 4. Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. d.tilki@uke.de. 5. Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. d.tilki@uke.de.
Abstract
PURPOSE: To determine the impact of intraoperative surgeon-defined incision of the prostatic capsule (CapI) on cancer recurrence and to give an overview of the different definitions of CapI. CapI during radical prostatectomy (RP) occurs in a non-negligible number of patients; still, its impact on biochemical recurrence (BCR) remains controversial as definition of CapI differs in literature. METHODS: We analyzed the data of 3253 consecutive RP between 2009 and 2011. Occurrence and side of intraoperative CapI was documented by the surgeon. Factors influencing CapI were addressed using logistic regressions. The impact of CapI on BCR was analyzed using Cox regressions including traditional prognosticators. RESULTS: Median follow-up was 36.2 months. Unilateral (bilateral) CapI occurred in 22.2 % (12.1 %) of patients. CapI was reported more often following open RP (p < 0.0001) and nerve-sparing procedure (p = 0.0004). Three-year BCR-free survival was 78.8, 79.9 and 82.1 % (p = 0.13) for patients with no, unilateral and bilateral CapI. In multivariate analysis, pT-stage (p < 0.0001), Gleason grade (p < 0.0005) and nodal status (p < 0.0005) were significantly associated with BCR. However, CapI had no independent impact on BCR (unilateral vs. no CapI, p = 0.55, bilateral vs. no CapI, p = 0.32). CONCLUSIONS: Intraoperative CapI occurs in a relevant number of RP and is more frequent during nerve-sparing procedure and open RP. However, there seems to be no impact of CapI and its extent on the incidence of early BCR.
PURPOSE: To determine the impact of intraoperative surgeon-defined incision of the prostatic capsule (CapI) on cancer recurrence and to give an overview of the different definitions of CapI. CapI during radical prostatectomy (RP) occurs in a non-negligible number of patients; still, its impact on biochemical recurrence (BCR) remains controversial as definition of CapI differs in literature. METHODS: We analyzed the data of 3253 consecutive RP between 2009 and 2011. Occurrence and side of intraoperative CapI was documented by the surgeon. Factors influencing CapI were addressed using logistic regressions. The impact of CapI on BCR was analyzed using Cox regressions including traditional prognosticators. RESULTS: Median follow-up was 36.2 months. Unilateral (bilateral) CapI occurred in 22.2 % (12.1 %) of patients. CapI was reported more often following open RP (p < 0.0001) and nerve-sparing procedure (p = 0.0004). Three-year BCR-free survival was 78.8, 79.9 and 82.1 % (p = 0.13) for patients with no, unilateral and bilateral CapI. In multivariate analysis, pT-stage (p < 0.0001), Gleason grade (p < 0.0005) and nodal status (p < 0.0005) were significantly associated with BCR. However, CapI had no independent impact on BCR (unilateral vs. no CapI, p = 0.55, bilateral vs. no CapI, p = 0.32). CONCLUSIONS: Intraoperative CapI occurs in a relevant number of RP and is more frequent during nerve-sparing procedure and open RP. However, there seems to be no impact of CapI and its extent on the incidence of early BCR.
Authors: Nicolas Koutlidis; Céline Duperron; Mathilde Funes de la Vega; Eric Mourey; Frédéric Michel; Luc Cormier Journal: World J Urol Date: 2013-10-29 Impact factor: 4.226
Authors: Peter Swindle; James A Eastham; Makoto Ohori; Michael W Kattan; Thomas Wheeler; Norio Maru; Kevin Slawin; Peter T Scardino Journal: J Urol Date: 2005-09 Impact factor: 7.450
Authors: Mark A Preston; Mathieu Carrière; Gaayana Raju; Christopher Morash; Steve Doucette; Ronald G Gerridzen; Anthony J Bella; James A Eastham; Peter T Scardino; Ilias Cagiannos Journal: Eur Urol Date: 2010-12-21 Impact factor: 20.096
Authors: Anobel Y Odisho; Samuel L Washington; Maxwell V Meng; Janet E Cowan; Jeffry P Simko; Peter R Carroll Journal: Urology Date: 2013-03-21 Impact factor: 2.649
Authors: Matthew D Shuford; Michael S Cookson; Sam S Chang; Ayumi K Shintani; Athanasios Tsiatis; Joseph A Smith; Scott B Shappell Journal: J Urol Date: 2004-07 Impact factor: 7.450
Authors: Lars Budäus; Hendrik Isbarn; Thorsten Schlomm; Hans Heinzer; Alexander Haese; Thomas Steuber; Georg Salomon; Hartwig Huland; Markus Graefen Journal: Eur Urol Date: 2009-05-29 Impact factor: 20.096
Authors: Mark A Preston; Rodney H Breau; Andrea G Lantz; Christopher Morash; Ronald G Gerridzen; Steve Doucette; Ranjeeta Mallick; James A Eastham; Ilias Cagiannos Journal: Urol Oncol Date: 2014-10-11 Impact factor: 3.498