Elsevier

Urology

Volume 56, Issue 5, November 2000, Pages 721-725
Urology

Rapid communication
Benign prostatic glands at surgical margins of radical prostatectomy specimens: frequency and associated risk factors

https://doi.org/10.1016/S0090-4295(00)00775-5Get rights and content

Abstract

Objectives. Elevation of serum prostate-specific antigen (PSA) after radical prostatectomy for prostate cancer is considered a surrogate marker of therapeutic failure. The most likely explanation for early PSA failure is considered to be due to local recurrent disease, provided the patient had a nondetectable PSA level after radical prostatectomy. Others have recently suggested that benign prostatic glands located on the surgical margins may often lead to detectable PSA levels. We examined the frequency of benign prostatic glands at the surgical margins of radical prostatectomy specimens and the factors associated with this finding.

Methods. One hundred nineteen consecutive radical prostatectomies were performed by two experienced oncologic surgeons. Whole-mount sectioning of the prostatectomy specimens was performed at 3-mm intervals. Bivariate and multivariate analyses were used to determine which clinical and pathologic factors were associated with benign glands on inked surgical margins.

Results. Of the 119 cases, 13 (11%) had benign glands on the inked surgical margins. Four of these 13 had tumor on the inked margins. The remaining 9 cases (8%) were organ confined (pT2), with negative surgical margins. Benign glands were most often seen to involve the apex focally (7 of 9 cases). On bivariate and multivariate analyses, a high Gleason score and prostate gland volume were significantly associated with finding benign glands on the surgical margins. Only 2 of 86 patients with follow-up had PSA recurrence at 59 and 67 days and neither had benign glands on the inked surgical margins.

Conclusions. The presence of benign prostatic glands identified on inked surgical margins was an infrequent occurrence in this consecutive series of 119 whole-mount prostatectomy specimens. When benign glands were identified, they most often consisted of 1 to 3 glands at the apex margin. These findings suggest that benign glands on surgical margins are an unusual cause of postoperative detectable PSA.

Section snippets

Material and methods

The present study was part of a prospective study examining the usefulness of whole-mount processing of radical prostatectomy specimens and was performed with Institutional Review Board approval.4 One hundred nineteen consecutive whole-mount radical prostatectomy specimens were used for this study. Twelve men from this study group had received neoadjuvant treatment with androgen deprivation. The prostate glands were received fresh from the operating room, weighed, inked, and fixed overnight in

Results

A detailed summary with the preoperative patient demographics and pathologic analysis results for the 119 consecutive whole-mount radical prostatectomy specimens used for this study are presented in Table I. Thirteen (11%) of 119 cases had some evidence of benign glands on the inked surgical margins. Of these 13 cases, 4 had tumor identified on the inked surgical margins. The remaining 9 cases (8% of 119) had benign glands on inked surgical margins without any evidence of tumor on the inked

Comment

In the present study, the presence of benign prostate glands on the surgical margins was infrequent and when positive, found to be focal. In 2 of 13 cases, more than three glands were identified. These findings differ from those reported by Djavan et al.,2 who found approximately 30% of radical prostatectomy specimens to have benign glands on the surgical margins. One major difference between the two studies is that Djavan et al. examined prostatectomy specimens from multiple institutions. Our

Conclusions

The presence of benign glands at the surgical margins was found infrequently in a consecutive series of whole-mount radical prostatectomies. Benign glands were typically found at the apex and were associated with a larger gland volume and a higher Gleason score, suggesting wider excision may have been necessary. We conclude that the presence of benign glands at the surgical margins is likely to be a rare cause of an elevated PSA level after radical prostatectomy.

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This study was supported by a grant from the Specialized Program of Research Excellence (SPORE) in Prostate Cancer, National Cancer Institute, grant CA69568.

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