Does Frozen Section Analysis of Surgical Margins during Laparoscopic Radical Prostatectomy Reduce the Risk of Biochemical Recurrence?
Bonnie Choy, Jennifer Gordetsky, Hiroshi Miyamoto. University of Rochester, Rochester, NY
Background: Positive surgical margin (SM) in radical prostatectomy (RP) specimens is known to correlate with a high risk of biochemical recurrence. Intraoperative frozen section analysis (FSA) of SMs during RP has been often used to prevent incomplete tumor resection. However, studies have questioned the utility of FSA citing low sensitivity and low positive predictive value. Thus, it remains unanswered whether intraoperative FSA contributes to preventing biochemical recurrence after RP.
Design: We retrospectively reviewed the data from a consecutive series of patients who underwent robot-assisted laparoscopic RP with (n=1086) or without (n=1421) intraoperative FSA performed at our institution between 2004 and 2011. Of the 2631 patients identified from our surgical pathology electronic database, 124 were lost to follow-up and were excluded. A biochemical recurrence was regarded as a postoperative prostate-specific antigen (PSA) level of ≥0.1 ng/mL with a confirmatory increase or immediately receiving salvage treatment.
Results: A total of 99 (9%) and 159 (11%) patients with and without FSA, respectively, had PSA recurrence during the mean follow-up of 24.5 months (range: 2-89). There was no significant difference in biochemical recurrence between all cases with versus without FSA (P=0.5804). Nonetheless, FSA tended to improve outcomes in patients with biopsy Gleason score of 7 (P=0.0633), but not of ≤6 (P=0.4663), ≤7 (P=0.1266), ≥7 (P=0.1607), or ≥8 (P=0.5858). In addition, patients with atypical (n=59) or positive (n=34) FSA had a significantly (P=0.0004) higher risk of biochemical recurrence, compared to those with benign FSA (n=993). No impact of FSA on recurrence was seen in other subgroups of patients with different Gleason scores on RP, pT stages, lymph node involvements, estimated cancer volumes, and FSA sites. Final positive SM in RP was strongly associated with recurrence (P<0.0001).
Conclusions: Overall, FSA during RP did not dramatically reduce the rate of biochemical recurrence. However, it may particularly be beneficial to a select group of patients who are diagnosed with Gleason score 7 prostate cancer on their biopsies.
Category: Genitourinary (including renal tumors)
Tuesday, March 5, 2013 1:00 PM
Poster Session IV # 182, Tuesday Afternoon