PROGNOSTIC-SIGNIFICANCE OF CAPSULAR INVASION AND CAPSULAR PENETRATIONIN PATIENTS WITH CLINICALLY LOCALIZED PROSTATE-CANCER UNDERGOING RADICAL PROSTATECTOMY

One hundred thirty patients with an observed follow-up of more than 10 years after radical prostatectomy were restaged with regard to local extent of the tumor in relation to the prostate capsule. Of 112 patien ts with surgically staged negative pelvic lymph nodes, 62 had a tumor- free prostate capsule, 24 had capsular invasion without penetration, a nd 26 had tumors extending through the capsule of the prostate. Observ ed overall and disease-free 10-year-survival rates were 79% and 69.4%, respectively, in patients with absence of capsular involvement and 70 .8% and 66.7%, respectively, in patients with capsular invasion alone. In patients with capsular penetration, however, the survival rates si gnificantly decreased to 57.7% (P = 0.018) and to 38.5 (P = 0.017), re spectively. The overall progression rate was found to be significantly higher in patients with tumors extending through the prostatic capsul e (46.2%), as compared to those with absence of capsular involvement ( 21%; P = 0.014) as well as to those with capsular invasion alone witho ut penetration (25%; P = 0.034). Thus, in contrast to capsular invasio n alone, capsular penetration means a poor prognostic indicator, which accounts for a reduced survival expectancy and a higher progression r ate following radical prostatectomy. Therefore, tumors with capsular i nvasion and those with capsular penetration should not be grouped toge ther in the same tumor stage as done in the 1987 edition of the TNM tu mor classification system. (C) 1995 Wiley-Liss, Inc.