PREDICTIVE VALUE OF PATHOLOGICAL FEATURES FOR PROGRESSION AFTER RADICAL PROSTATECTOMY

Objective: 10-30% of patients with T-1/T-2 prostate cancer submitted t o radical prostatectomy ultimately fail. It may be important to detect failure as early as possible in order to evaluate the extent of recur rent/residual disease and initiate adjuvant therapy. Subjects and Meth ods: 100 consecutive patients with localized prostate cancer treated b y radical prostatectomy have been monitored using the hypersensitive P ros-check prostate-specific antigen (PSA) assay (detection level 0.1 n g/ml). The predictive value of positive surgical margins, involvement of seminal vesicles and perineural spaces as well as Gleason's score f or biological failure (persistent or recurrent detectable PSA) has bee n retrospectively evaluated. Results: Overall 40% of the patients had biological failure (defined as persistence of a detectable or rising P SA after undetectability) and 38% had positive surgical margins. The t hree main predictive criteria of biological failure were capsular perf oration, involvement of seminal vesicles and/or positive margins. All patients in whom these criteria were positive progressed. Seminal vesi cle invasion was associated with biological failure in 95% of the case s. 66.7% of the patients with extracapsular disease but no seminal ves icle invasion progressed. 15% of pT(2) patients experienced a persiste nt/recurrent postoperative PSA and were upstaged to pT(3) after reeval uation of the specimen. Conclusion: Efforts should be made to increase the preoperative evaluation of seminal vesicle and pericapsular statu s by a more sophisticated technique of prostate biopsy in order to avo id noncurative surgery.