title: Midterm oncological outcome and clinicopathological characteristics of anterior prostate cancers treated by endoscopic extraperitoneal radical prostatectomy.
abstract: OBJECTIVE
  The purpose of the study is to characterise the clinicopathological characteristics of anterior prostate cancer (APC) compared to posterior prostate cancer (PPC)s and to determine the midterm oncological outcomes of patients with APCs undergoing endoscopic extraperitoneal radical prostatectomy (EERPE).
  
  
  METHODS
  A retrospective review was carried out on all EERPEs performed in 2009. Pathology reports (transrectal ultrasound biopsy and surgical specimen), specimen photographs, demographic details and oncological outcome data from a prospectively maintained database were reviewed. Unpaired t test, chi-squared test and Kaplan-Meier curves were used for the analysis.
  
  
  RESULTS
  Of 139 patients identified, 53 were APCs (38 %) and 86 were PPCs (62 %). Significantly, greater number of repeat biopsies were required to diagnose APCs (p = 0.02) and they had significantly fewer positive biopsy cores (p = 0.0005). The APC group had a significantly higher PSA density (PSAd) with (<5 and 5-25 %) tumour involvement in positive cores compared to PPCs (p = 0.036 and 0.024, respectively). APCs had higher positive surgical margin (PSM) rates (p = ns), the apical margin more likely positive than PPCs (p = 0.0006). Biochemical recurrence-free survival (BRFS) for APCs at 1, 2 and 3 years was lower than PPCs, although not statistically significant (p = 0.16).
  
  
  CONCLUSIONS
  In our study, APCs proved more difficult to diagnose and stage, had a higher PSM rate and a trend towards a worse bRFS than PPCs. Additionally, the use of PSAd low core involvement biopsies might aide clinicians to investigate this cohort of patients more thoroughly before advising active surveillance.
authors.affiliation: Edinburgh Urological Cancer Group, University of Edinburgh, Crewe Road South, Edinburgh, EH2 4XU, UK, daniel.good@ed.ac.uk.
authors.forename: Daniel W
authors.initials: DW
authors.lastname: Good
authors.forename: Grant D
authors.initials: GD
authors.lastname: Stewart
authors.forename: Paimaun
authors.initials: P
authors.lastname: Zakikhani
authors.forename: Henry
authors.initials: H
authors.lastname: Yuen
authors.forename: Antony C P
authors.initials: AC
authors.lastname: Riddick
authors.forename: Prasad R
authors.initials: PR
authors.lastname: Bollina
authors.forename: Marie
authors.initials: M
authors.lastname: O'Donnell
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Stolzenburg
authors.forename: S Alan
authors.initials: SA
authors.lastname: McNeill
mesh_terms: D000368:Aged; D015331:Cohort Studies; D018572:Disease-Free Survival; D006801:Humans; D007610:Kallikreins / Q000097:blood; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011467:Prostate / Q000473:pathology / Q000601:surgery*; D017430:Prostate-Specific Antigen / Q000097:blood; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: C549870:KLK3 protein, human; D007610:Kallikreins; D017430:Prostate-Specific Antigen