MP78-18 IMPACT OF CAPSULAR INCISION DURING RADICAL PROSTATECTOMY ON BIOCHEMICAL RECURRENCE RATES

Abstract

You have accessJournal of UrologyProstate Cancer: Localized VIII1 Apr 2015MP78-18 IMPACT OF CAPSULAR INCISION DURING RADICAL PROSTATECTOMY ON BIOCHEMICAL RECURRENCE RATES Philipp Mandel, Pierre Tennstedt, Luis Kluth, Alexander Haese, Hartwig Huland, Markus Graefen, and Derya Tilki Philipp MandelPhilipp Mandel More articles by this author , Pierre TennstedtPierre Tennstedt More articles by this author , Luis KluthLuis Kluth More articles by this author , Alexander HaeseAlexander Haese More articles by this author , Hartwig HulandHartwig Huland More articles by this author , Markus GraefenMarkus Graefen More articles by this author , and Derya TilkiDerya Tilki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2834AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Incision of the prostatic capsule especially during nerve-sparing radical prostatectomy (RP) occurs in a non-negligible number of patients and its impact on cancer recurrence remains controversial as the few existing studies in this area mainly focused on the impact of incision into cancerous tissue (mostly defined as positive surgical margin in organ-confined tumors). However, as the surgeon cannot be sure about the dignity at site of incision during RP an analysis of the impact of any capsular incision is warranted. METHODS We prospectively collected the data of n = 3253 contemporary consecutive patients who underwent robotic (n=532) or open (n=2704) RP between 2009 and 2011. The occurrence and side (left, right or bilateral) of capsular incision (CI) was documented by the surgeon in a standardized fashion immediately after the procedure. Patients with bilateral nerve-sparing RP (n=2268), unilateral nerve-sparing RP (n=768) and with a non nerve-sparing RP (n=217) were included. Biochemical recurrence (BCR) was defined as a PSA level >0.2 ng/ml. The impact of CI on BCR was analyzed using Kaplan-Meier curves and multivariable Cox proportional hazard model including traditional prognosticators after RP. RESULTS Median follow-up was 28.2 months. 17.4% of patients recurred during the follow-up period. Overall, unilateral (bilateral) CI occurred in 22.3% (12.1%) of patients. CI was reported significantly higher following open RP (39.1%) compared to robotic RP (16.7%) (p<0.0001) and in patients with nerve-sparing procedure (35.7%) compared to 15.2% in patients without nerve sparing (p<0.0001). 3-year BCR-free survival rates were 78.8%, 79.9% and 82.1% (p=0.13) for patients with no, unilateral and bilateral CI, respectively. In a multivariate Cox regression model, pT-stage (<0.0001), Gleason grade (<0.0001), nodal status (<0.0001), and preoperative PSA level (p=0.033) were significantly associated with BCR. However, CI had no independent impact on BCR (unilateral vs. no CI, p=0.41, bilateral vs. no CI, p=0.17). Positive surgical margin status did not increase with CI. CONCLUSIONS Capsular incision occurs in a relevant number of RP and is more frequent during nerve-sparing RP compared to non nerve-sparing RP and during open RP compared to robotic RP. However, there seems to be no impact of capsular incision on the incidence of early BCR. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e1009 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Philipp Mandel More articles by this author Pierre Tennstedt More articles by this author Luis Kluth More articles by this author Alexander Haese More articles by this author Hartwig Huland More articles by this author Markus Graefen More articles by this author Derya Tilki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...