Open Access

ARTICLE

Predictors of positive surgical margins after radical perineal prostatectomy

Manlio A. Goetzl¹, Ron Krebill², Tomas L. Griebling^1,3, J. Brantley Thrasher¹

1 Department of Urology, University of Kansas Medical Center, Kansas City, Kansas, USA
2 Department of Biostatistics and the Center for Biostatistics and Advanced Informatics, University of Kansas Medical Center, Kansas City, Kansas, USA
3 The Landon Center on Aging, University of Kansas Medical Center, Kansas City, Kansas, USA
Address correspondence to Dr. J. Brantley Thrasher, DepartmentofUrology,MailStop3016,UniversityofKansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160-7390 USA

Canadian Journal of Urology 2009, 16(2), 4553-4557.

Abstract

Introduction/objective: Margin positivity has been a well described adverse prognostic factor in patients undergoing radical prostatectomy. Previous studies with regards to predictors of margin positivity after prostatectomy have primarily focused on the retropubic or robotic approach. We sought to examine the predictors of margin positivity in a contemporary series of men undergoing radical perineal prostatectomy (RPP).
Materials and methods: We reviewed the records of 103 patients who underwent RPP at our institution from July 1998 until May 2008. A positive surgical margin (PSM) was defined as the presence of cancer cells at the inked margin of the surgical specimen. Records were reviewed for the following preoperative parameters: age at operation, body mass index (BMI), preoperative PSA, clinical stage and biopsy Gleason sum score. Pathological data included prostate weight (PW) and tumor volume.
Results: Mean age was 60.9 (range 45-76). Mean BMI was 31.4 kg/m² (20.9-51.6). The preoperative prevalence of palpable disease was 50.5%. A PSM was found in 23.3%. Age, BMI, clinical stage, biopsy Gleason sum score and preoperative PSA were not found to be independent predictors of a PSM after RPP. Only prostate weight was found to be a significant preoperative predictor of a PSM after RPP with men with smaller prostates at higher risk.
Conclusions: Prostate weight was found to be significantly and inversely related to the PSM rate in this cohort of RPP patients. Patients with smaller volume prostates should be counseled preoperatively that they are at higher risk for a PSM when undergoing a RPP.

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