THE USEFULNESS OF TOUCH PREPARATION CYTOLOGICAL EVALUATION AND PROSTATIC CAPSULE INVOLVEMENT IN PREDICTION OF PROSTATE-CANCER RECURRENCE

Purpose: Touch preparation cytology has been used in oncology as a tec hnique to assist in predicting local tumor recurrence. We prospectivel y investigated the relationship between this cytological evaluation an d the standard histological method of assessing specimens, measuring t he distance from the tumor to the various anatomical boundaries and di sease recurrence in radical retropubic prostatectomy patients. Materia ls and Methods: In a prospective study of 91 consecutive clinical stag es T1c and T2 cancer cases radical retropubic prostatectomy touch prep aration cytology was performed intraoperatively in an anatomical fashi on (apex, posterior, lateral right and left, and base). A single blind ed cytopathologist reviewed all prostate touch preparation specimens a nd categorized them as malignant, benign or atypical cells. Benign or atypical cells were classified as negative cytology. Detailed histolog ical margin analysis of the surgical specimens was also done in which distances between the tumor front, and prostate capsule (inner and out er edge) and surgical margins (apex, posterior, right and left lateral , and base) were measured. All specimens were re-staged by the same pa thologist. Median followup was 38 months. Disease recurrence was deter mined biochemically (prostate specific antigen), and with bone scans, prostatic fossa biopsies and digital rectal examinations. Results: Of the 91 specimens 25 were excluded from study because distance measurem ents could not be made for technical reasons. Multivariate analysis wa s performed on the remaining 66 patients based on the variables of sta ge, age, cytology status, distance from tumor to the inner prostatic c apsule, distance from tumor to the surgical margin and postoperative G leason sum. The only variable with independent prognostic value was po stoperative Gleason sum (p = 0.04). Cytology status was not statistica lly significant (p = 0.07) nor were distance data to the inner capsule (p >0.05) and surgical margin (p >0.05). Conclusions: Although touch preparation cytology does not enhance prognostic information already p rovided by Gleason sum, it does correlate highly with postoperative Gl eason sum. Other gross macroscopic variables, that is pathological sta ge, margin status and distance measurements, although lacking in indep endent predictive value, correlated with postoperative Gleason sum. Th e constancy of Gleason sum leads us to believe that the key to predict ing prostatic cancer behavior lies not on the macroscopic but on the m olecular or cellular level. Of the various factors analyzed in this st udy postoperative Gleason sum remains the most powerful predictor of r ecurrence risk.