You have accessJournal of UrologyProstate Cancer: Localized (VII)1 Apr 20131503 DOES FROZEN SECTION ANALYSIS DURING PROSTATECTOMY HELP REDUCE THE RISK OF POSITIVE MARGINS AND BIOCHEMICAL RECURRENCE? Emelian Scosyrev, Ingrid Mikk, Hiroshi Miyamoto, and Jean Joseph Emelian ScosyrevEmelian Scosyrev Rochester, NY More articles by this author , Ingrid MikkIngrid Mikk Rochester, NY More articles by this author , Hiroshi MiyamotoHiroshi Miyamoto Rochester, NY More articles by this author , and Jean JosephJean Joseph Rochester, NY More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2982AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The purpose of this study was to determine whether the use of frozen sections during radical prostatectomy reduces the risk of positive margins and/or the risk of biochemical recurrence. METHODS This is a prospective cohort study. Data were collected on robot-assisted radical prostatectomy cases performed by a single surgeon at a tertiary care center between 2003 and 2010. The primary independent variable in these analyses was the use of frozen section during prostatectomy (yes or no). The outcome variables were positive surgical margins and time to biochemical recurrence, defined as two consecutive PSA values ≥0.1 ng/ml. Other variables included in the analyses were age, BMI, surgical approach (extra vs. trans-peritoneal), nerve-sparing (none, unilateral, bilateral), pre-operative PSA, clinical and pathological T stage, clinical and pathological Gleason sum, prostate volume, lymphadenectomy (yes/no), number of nodes examined, and positive nodes (yes/no). Covariate-adjusted association of frozen sections with positive margins was examined using a linear least-squares model with robust covariance matrix estimator. Covariate-adjusted association of frozen section with biochemical recurrence was examined using the Cox model. RESULTS Among the 1,166 patients without frozen sections, 9.4% had positive margins, compared with 12.9% of the 867 patients with frozen sections, a risk difference of 3.5% (95%CI: 0.6% to 6.3%, p=0.01). After adjusting for baseline covariates, the risk difference was 3.6% (95%CI: 0.8% to 6.3%, p=0.01). Independent predictors of positive margins were pre-RP PSA (p=0.01), clinical and pathological T stage (both p<0.001), and RP Gleason sum (p=0.017). After a mean follow-up of 30 months, the proportion of subjects with biochemical recurrence were 4.9% in those treated without frozen sections, and 4.2% in those treated with frozen sections (a difference of -0.7%, 95% CI: -2.5% to 1.2%, p=0.52; hazard ratio 0.99, 95% CI: 0.65 to 1.50, p=0.94). After adjusting for baseline covariates, the hazard ratio was 0.86 (95% CI: 0.55 to 1.35, p=0.52). Independent predictors of biochemical recurrence were pathological Gleason sum (p<0.001) and pre-RP PSA (p=0.009). CONCLUSIONS In these series, use of frozen section was not associated with lower rate of positive margins or lower rate of biochemical recurrence, suggesting either there was no causal effect of frozen sections on margins and recurrence, or this effect was cancelled by selection bias. This study is limited by its observational nature and short follow-up. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e616 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Emelian Scosyrev Rochester, NY More articles by this author Ingrid Mikk Rochester, NY More articles by this author Hiroshi Miyamoto Rochester, NY More articles by this author Jean Joseph Rochester, NY More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...