Urology - Original Paper

International Urology and Nephrology

, Volume 41, Issue 3, pp 581-586

First online:

Adverse prognostic impact of capsular incision at radical prostatectomy for Japanese men with clinically localized prostate cancer

  • Masafumi KumanoAffiliated withDivision of Urology, Kobe University Graduate School of Medicine
  • , Hideaki MiyakeAffiliated withDivision of Urology, Kobe University Graduate School of Medicine Email author 
  • , Mototsugu MuramakiAffiliated withDivision of Urology, Kobe University Graduate School of Medicine
  • , Toshifumi KurahashiAffiliated withDivision of Urology, Kobe University Graduate School of Medicine
  • , Atsushi TakenakaAffiliated withDivision of Urology, Kobe University Graduate School of Medicine
  • , Masato FujisawaAffiliated withDivision of Urology, Kobe University Graduate School of Medicine

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Abstract

Objectives

The objective of this study was to evaluate the significance of capsular incision (CI) at radical prostatectomy (RP) for men with prostate cancer.

Materials and methods

This study included 267 men who underwent RP without neoadjuvant therapy and were pathologically diagnosed as having organ-confined disease. CI was defined as exposing benign or malignant glands at the inked margin without documented extraprostatic extension.

Results

Pathological examinations identified CI in 53 RP specimens (19.9%), while CI was not detected in the remaining 214 specimens (80.1%). The locations of CIs in RP specimens from these 53 patients were as follows: 39 (73.6%) at the apex, 11 (20.0%) at the anterior site, 4 (7.5%) at the posterior site and 12 (22.6%) at the bladder neck. The incidence of CI was significantly affected by surgical procedure, preoperative serum PSA and microvenous invasion in RP specimen. During the observation period of this study, biochemical recurrence occurred in 10 (18.9%) of the 53 with CI and 20 (9.3%) of the 214 without CI, and the biochemical recurrence-free survival in patients with CI was significantly poorer than those without CI. Furthermore, of several factors examined, biochemical recurrence was significantly associated with preoperative serum PSA, Gleason score, perineural invasion and capsular incision, among which only preoperative serum PSA appeared to be an independent predictor of biochemical recurrence.

Conclusions

Despite the lack of independent significance, the presence of CI has an adverse impact on biochemical outcome in patients undergoing RP for clinically localized prostate cancer.

Keywords

Capsular incision Prognosis Prostate cancer Radical prostatectomy