DOES THE NARROW OPERATING FIELD IN PERINEAL RADICAL PROSTATECTOMY LEAD TO MORE POSITIVE SURGICAL MARGINS

Aims: To assess the risk of leaving cancer-positive surgical margins i n the perineal approach for radical prostatectomy as compared to the r etropubic approach. Methods: Seventy-six patients with clinically orga n-confined prostate cancer (stage T1-2 NoMo) underwent radical prostat ectomy. The 57 patients who underwent retropubic prostatectomy were co mpared to 19 patients in whom the perineal approach was undertaken. Th e two groups were compared for pre-operative PSA levels, clinical stag e, biopsy Gleasson score, and any correlation between pre- and post-op erative stage and grade of the disease and rate of cancer-positive sur gical margins. Results: Although there were no significant differences in the rate of organ-confined diseases and specimen Gleasson score in the two groups, the rate of positive surgical margins in the perineal approach was significantly lower (15.7 vs 29.8%) and the rate of extr acapsular disease with negative margins was significantly higher (15.7 vs 7%). Conclusions: The narrow surgical field in the perineal approa ch for radical prostatectomy does not pose a higher risk for positive surgical margins and it might be the procedure of choice in stage T1C prostate cancer with a Gleasson score of below 7.