EARLY PROSTATE-SPECIFIC ANTIGEN FAILURE FOLLOWING RADICAL PERINEAL VERSUS RETROPUBIC PROSTATECTOMY - THE IMPORTANCE OF SEMINAL-VESICLE EXCISION

Objectives. Because of renewed interest in the radical perineal prosta tectomy, we chose to evaluate factors influencing differences in bioch emical failure as measured by prostate-specific antigen (PSA) between radical perineal and the radical retropubic prostatectomies. Methods. We undertook a retrospective review of 87 men with clinically localize d prostate cancer who underwent radical retropubic (64%) or radical pe rineal (36%) prostatectomy, noting age, race, preoperative PSA, Gleaso n score, clinical stage, capsular penetration, surgical approach, and completeness of seminal vesicle (SV) excision. The two groups were com parable with respect to tumor factors such as preoperative PSA, Gleaso n score, clinical stage, and capsular penetration. Time to postoperati ve PSA failure (0.2 ng/mL or greater) was evaluated with univariate an d multivariate analysis of multiple contributing factors. Results. Twe nty-eight percent of patients had a PSA level rising to 0.2 ng/mL or g reater in the follow-up period. Patients who underwent perineal prosta tectomy had a higher PSA failure rate (45%) than those treated by the retropubic approach (18%) and patients with incomplete SV excision had a higher failure rate (69%) than patients with bilateral SV excision (20%). When time to PSA failure was examined by multivariate analysis, completeness of SV excision, clinical stage, and Cleason score had a statistically significant impact on this outcome. In perineal prostate ctomy patients, bilateral SV excision had a significantly longer time to PSA failure than in patients with incomplete excision. There was no significant difference in time to PSA failure between patients who un derwent radical retropubic prostatectomy and the patients who underwen t perineal prostatectomy with bilateral SV excision. Conclusions. Inco mplete excision of SVs during a radical perineal prostatectomy contrib utes to an earlier postoperative biochemical recurrence as measured by a rising PSA, and may explain the higher disease recurrence rate for radical perineal prostatectomies as opposed to radical retropubic pros tatectomies in this study. (C) 1998, Elsevier Science Inc. All rights reserved.