title: Impact of surgeon-defined capsular incision during radical prostatectomy on biochemical recurrence rates.
abstract: OBJECTIVE
  To determine the impact of intraoperative surgeon-defined incision of the prostatic capsule (CapI) on cancer recurrence and to give an overview of the different definitions of CapI. CapI during radical prostatectomy (RP) occurs in a non-negligible number of patients; still, its impact on biochemical recurrence (BCR) remains controversial as definition of CapI differs in literature.
  
  
  METHODS
  We analyzed the data of 3253 consecutive RP between 2009 and 2011. Occurrence and side of intraoperative CapI was documented by the surgeon. Factors influencing CapI were addressed using logistic regressions. The impact of CapI on BCR was analyzed using Cox regressions including traditional prognosticators.
  
  
  RESULTS
  Median follow-up was 36.2 months. Unilateral (bilateral) CapI occurred in 22.2 % (12.1 %) of patients. CapI was reported more often following open RP (p < 0.0001) and nerve-sparing procedure (p = 0.0004). Three-year BCR-free survival was 78.8, 79.9 and 82.1 % (p = 0.13) for patients with no, unilateral and bilateral CapI. In multivariate analysis, pT-stage (p < 0.0001), Gleason grade (p < 0.0005) and nodal status (p < 0.0005) were significantly associated with BCR. However, CapI had no independent impact on BCR (unilateral vs. no CapI, p = 0.55, bilateral vs. no CapI, p = 0.32).
  
  
  CONCLUSIONS
  Intraoperative CapI occurs in a relevant number of RP and is more frequent during nerve-sparing procedure and open RP. However, there seems to be no impact of CapI and its extent on the incidence of early BCR.
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.|Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Mandel
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Su J
authors.initials: SJ
authors.lastname: Oh
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Hagner
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Pierre
authors.initials: P
authors.lastname: Tennstedt
authors.affiliation: Department of Urology, University Hospital Mannheim, Mannheim, Germany.
authors.forename: Maximilian C
authors.initials: MC
authors.lastname: Kriegmair
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Hartwig
authors.initials: H
authors.lastname: Huland
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Graefen
authors.affiliation: Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany. d.tilki@uke.de.|Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany. d.tilki@uke.de.
authors.forename: Derya
authors.initials: D
authors.lastname: Tilki
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D011467:Prostate / Q000473:pathology / Q000601:surgery; D017430:Prostate-Specific Antigen / Q000097:blood*; D011468:Prostatectomy / Q000379:methods*; D011471:Prostatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D066231:Surgeons; D013997:Time Factors; D047368:Tumor Burden
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: Capsular incision; Outcomes; Positive surgical margin; Prostate cancer; Radical prostatectomy