Clinicopathologic Analysis of Vesicourethral Anastomosis Biopsy after Radical Prostatectomy: Correlation with Systemic Progression
JP Reynolds, JC Cheville, RJ Karnes, RE Jimenez. Mayo Clinic, Rochester, MN
Background: Vesicourethral anastomosis biopsy (VUBx) is occasionally part of the evaluation of patients (pts) with rising PSA level after radical prostatectomy (RP). The identification of pts more likely to benefit from VUBx and the impact of a positive (pos) or negative (neg) VUBx in prognosis remains controversial.
Design: All VUBx performed at Mayo Clinic between the years 1994 and 2009 were reviewed. Documented variables included presence or absence of tumor, Gleason score (GS) in the VUBx, tumor volume, number of cores obtained and involved by tumor, presence of benign prostatic glands, and presence of perineural invasion. For those pts with at least 5 year follow-up (F/U) available, findings were correlated with systemic progression (SP). Additionally, key clinical features and pathologic findings in the previous RP specimen were correlated with VUBx results.
Results: During the study period 188 pts underwent VUBx. Of these, 118 (62%) had a pos VUBx, and 70 a neg VUBx. 6 neg VUBx pts underwent a second VUBx, of which 3 were pos and 3 neg. Of the former, 2 underwent a third VUBx (1 pos, 1 neg). 5 pos VUBx pts underwent a second VUBx, of which 3 were pos and 2 were neg. At least 5 year F/U was available for 89 pts. Mean time of F/U for neg and pos VUBx pts was 9.4 and 12.1 yrs, respectively. 23% of pts with pos VUBx developed SP, compared to 8.3% of pts with neg VUBx (p=0.30). No pathologic feature in VUBx correlated with risk of SP, although perineural invasion showed a trend (p=0.054). Only GS in pre-RP needle core biopsy correlated with a VUBx pos (p=0.028), while GS in RP showed a trend (p=0.062). No other pathologic feature correlated with a VUBx pos. Pre VUBx PSA level was not predictive of a pos or neg result in the VUBx.
Conclusions: Pts with pos VUBx were more likely to develop SP than pts with neg VUBx, although due to the small sample size, this did not reach statistical significance. GS appears to be the only pathologic feature that is associated with a risk of developing a pos VUBx. Larger studies with longer follow-up will be important to determine the significance of these findings.
Category: Genitourinary (including renal tumors)
Tuesday, March 23, 2010 11:45 AM
Platform Session: Section A, Tuesday Morning