title: [Prognostic impact of tumors localized at the prostatic apex].
abstract: OBJECTIVE
  The apex is a particular region of the prostate in its surgical dissection and pathological analysis. We sought to evaluate the prognostic value of the apical localization of prostate tumors.
  
  
  METHODS
  From 1988 to 2010, data pre- (age, clinical stage, preoperative PSA, biopsy Gleason score) and postoperative (prostate weight, pathologic stage TNM 2010, Gleason score, margin status) of 2765 total prostatectomies were collected prospectively. These data were compared according to existence or absence of tumor at the apex. The prognostic impact of tumor at the apex on biochemical recurrence-free survival (PSA>0.2 ng/mL) has been studied in univariate and multivariate models.
  
  
  RESULTS
  One thousand eight hundred seventeen tumors had a location at the apex (65.7%). In univariate analysis, there was a significant difference in the clinical stage, the biopsy and pathological Gleason score, the result of curage, the pathological stage and the margin status between apical tumors and others. With a mean decline of 34.6 months, 502 patients had a biochemical recurrence (18.1%). Disease-free survival at 10 years was 60.7% for tumor at the apex versus 65.9% in other cases. The location at the apex was significantly associated with biochemical recurrence on univariate analysis (P=0.01). After adjustment for clinical and pathological stage, PSA level, Gleason score and surgical margins, the apex was not anymore a pejorative independent predictor (P=0.0087).
  
  
  CONCLUSIONS
  The existence of tumor in the prostatic apex was associated with more aggressive tumoral criteria and was an independent and pejorative predictor of biochemical recurrence-free survival at 10 years in univariate analysis. The apical localization could be an additional argument in the decision of adjuvant therapy after prostatectomy.
authors.affiliation: Service d'urologie, centre hospitalier de la Côte Basque, 64100 Bayonne, France. antoinedouard@yahoo.fr
authors.forename: A
authors.initials: A
authors.lastname: Douard
authors.forename: A
authors.initials: A
authors.lastname: de la Taille
authors.forename: R
authors.initials: R
authors.lastname: Yiou
authors.forename: Y
authors.initials: Y
authors.lastname: Allory
authors.forename: C
authors.initials: C
authors.lastname: Radulescu
authors.forename: D
authors.initials: D
authors.lastname: Vordos
authors.forename: A
authors.initials: A
authors.lastname: Hoznek
authors.forename: C C
authors.initials: CC
authors.lastname: Abbou
authors.forename: L
authors.initials: L
authors.lastname: Salomon
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D015996:Survival Rate