Analysis of apical soft tissue margins during radical retropubic prostatectomy

Purpose: We determine the use of information gained with intraoperative bio psy and frozen section analysis of the apical soft tissue margin during ner ve sparing radical retropubic prostatectomy. Materials and Methods: A separate 2 to 3 mm. circumferential biopsy was obt ained from the apical soft tissue margin, and was sent for frozen and perma nent section analysis during radical retropubic prostatectomy in 95 men wit h clinically localized adenocarcinoma of the prostate. A single pathologist examined the surgical and apical soft tissue margin specimens for evidence and extent of benign or malignant prostate tissue. Urinary continence was evaluated at catheter removal and 3 months postoperatively. Results: Of the patients 26% had positive surgical margins, of which 64% we re positive apical margins. Permanent section of the apical soft tissue bio psy revealed no prostate in 39%, benign prostate in 54% and prostate cancer in 7% of patients. Because of the frozen section finding of adenocarcinoma in 3 patients, the apical soft tissue margin was further resected until th e specimen was negative for malignancy. The apical soft tissue margin was t he only positive margin site in 2 of these 3 patients. Positive surgical an d apical margins, and percent tumor volumes greater than 26% on prostatecto my specimen had a significantly higher likelihood for positive apical soft tissue margins. The pathological finding of a positive apical margin on the surgical specimen had sensitivity, specificity, and positive and negative predictive values of 57%, 86%, 25% and 96%, respectively, for detecting pro state cancer on the apical soft tissue biopsy. Of the apical soft tissue bi opsies 54% contained an element of benign prostatic tissue, although 92% of them contained benign tissue in less than 25% of the total specimen. Mean continence score in the men with and those without benign prostate tissue o n apical soft tissue biopsy was 15.6 and 14.4, respectively (p = 0.15). The percent of men who required no protective pads for urinary continence at 3 months was 53% and 65% for those who had no prostate and those who had ben ign prostate tissue, respectively, in the apical soft tissue margin. Conclusions: Excising and submitting an additional 2 to 3 mm. of apical sof t tissue margin for permanent section analysis after prostate removal durin g radical prostatectomy represent an effective method for decreasing residu al prostate tissue. Attempts at maximizing urethral length when dividing th e prostate-urethral junction likely increases the chance of leaving residua l prostate without improving continence.