Extraprostatic Extension in Radical Prostatectomy: Should Be Reported and Quantitated?
A Billis, HA Fernandes, MM Padilha, AS Polidoro, MAM Bisson, AGE Duarte, RG Oliveira, F Rogerio, CAM Silva, LA Magna. School of Medicine, University of Campinas (Unicamp), Campinas, Brazil
Background: During the International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy (RP) specimens, 97.2% of the attendants answered that extraprostatic extension (EPE) should be reported and 93.6% that EPE should be quantitated. However there was no consensus to which subjective or quantitative method should be used. In this study we propose a simple method for EPE evaluation.
Design: The study was based on 360 whole-mount consecutive surgical specimens. Each transversal section of the prostate was subdivided into 2 anterolateral and 2 posterolateral quadrants. Extraprostatic extension was stratified into 2 groups: present in one quadrant (group 1) and in more than one quadrant (group 2). Each group was analyzed according to several clinicopathological variables: preoperative PSA, Gleason grade in the specimen, surgical positive margins, tumor extent, seminal vesicle invasion, and biochemical progression following RP defined as PSA > 0.2ng/mL. The data were analyzed using the Mann-Whitney test, Fisher's exact test, Kaplan-Meier product-limit analysis using the log-rank test for comparison between the groups and the regression model of Cox.
Results: EPE was found in 98/360 (27.2%) patients, 34/98 (34.7%) present in 1 quadrant (group 1) and 64/98 (65.3%) in more than 1 quadrant (group 2). In group 2 preoperative PSA was higher (p=0.02), more tumors were Gleason high-grade in the specimen (p<0.01), tumors were more extensive (p=0.04), and more tumors presented seminal vesicle invasion (p<0.01). There was no significant difference related to positive surgical margins (p=0.43). In 5 years of follow-up, 69% of patients without EPE and 57% of patients with EPE in group 1 were free of biochemical progression (log-rank, p=0.13); in group 2, 69% and 38%, respectively (log-rank, <0.01). In univariate Cox regression analysis, group 1 was not predictive of biochemical progression (p=0.131); group 2 was significantly predictive of biochemical progression (p<0.01).
Conclusions: In whole-mount surgical specimens, EPE present in one quadrant vs. EPE present in more than one quadrant significantly discriminates patients according to several clinicopathological variables including biochemical progression following RP. This is an easy and valuable method for reporting and quantitating EPE.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 1:00 PM
Poster Session II # 119, Monday Afternoon