Pathologic findings at radical prostatectomy: risk factors for failure and death.
BACKGROUND
Failure after radical prostatectomy can occur even out to 25 years after surgery. Therefore, it is important that studies have sufficient follow-up to determine more accurately the risk of failure. We evaluated a large cohort of patients for pathologic findings and risk of failure with a median follow-up of 9.5 years.


METHODS
Between 1985 and 1995, 719 patients underwent radical prostatectomy for lymph node negative prostate cancer. The prostate was inked and evaluated for: (1) positive bladder neck or urethral margin, (2) positive seminal vesicle, (3) into capsule, (4) through capsule, and (5) positive margin. These were considered positive pathologic findings.


RESULTS
Overall, 264 (37%) of the patients had biochemical recurrence. For those patients with failure, median time to biochemical recurrence was 2.4 years. Five and 10-year biochemical failure rates were 28% and 38%, respectively. Pathologic stage of disease significantly (<0.0001) predicted for subsequent failure. If there were no positive pathology findings, the recurrence rate was 25%, compared to 63% for any of the 3 findings. Overall, 212 (29%) of the patients have died. Five and 10-year survival were 91% and 75%, respectively. A total of 45 patients (6%) died of prostate cancer. For patients with negative pathology findings, 3% died as a direct consequence of prostate cancer, compared to 13% if the pathology was positive. Of the patients with positive seminal vesicle, 28% died of cancer.


CONCLUSIONS
Patients with any of the following factors have a risk of failure exceeding 40% and are candidates for studies of adjuvant therapy: seminal vesicle involvement, extension through the capsule, or margin involvement.
Swanson
Gregory P
GP
University of Texas Health Science Center San Antonio, San Antonio, TX 78229, USA. gswanson@ctrc.net <gswanson@ctrc.net>
Riggs
Mark
M
Hermans
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery; D009367:Neoplasm Staging; D011379:Prognosis; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D012307:Risk Factors; D012669:Seminal Vesicles / Q000473:pathology*; D015996:Survival Rate
D017430:Prostate-Specific Antigen