Does capsular incision at radical retropubic prostatectomy affect disease-free survival in otherwise organ-confined prostate cancer?

Objectives. To evaluate the influence of isolated, histologically identifie d capsular incision (Cl) (exposure of benign or malignant glands to the ink ed surgical margin in the setting of organ-confined disease) on disease pro gression after anatomic radical retropubic prostatectomy (RRP) for clinical ly localized prostate cancer. Methods. Between March 1993 and September 1999, 4747 men underwent RRP at t he Johns Hopkins Hospital; 107 men (2.3%) were diagnosed with Cl in otherwi se organ-confined disease; 92 (86%) had at least 6 months (mean 30) of foll ow-up. We matched these Cl cases (based on surgeon, age, clinical stage, fi nal pathologic Gleason grade, and preoperative serum prostate-specific anti gen level) one-for-one with controls in three additional pathologically def ined groups and compared the freedom from disease progression (prostate-spe cific antigen level greater than 0.2 ng/mL and/or local palpable recurrence ) after RRP. Results. The actuarial 3-year likelihood of freedom from disease progressio n was 87.8% for the Cl group, 96.4% for men with organ-confined disease (P = 0.10), 91.3% for men with extraprostatic extension and negative surgical margins (P = 0.99), and 73.9% for men with positive surgical margins result ing from extraprostatic extension (P < 0.01). No statistically significant difference was found in the actuarial likelihood of freedom from disease pr ogression between men with Cl into benign glands (n = 22) and men with Cl i nto tumor (n = 70) (P = 0.93). Conclusions. No statistically significant difference was found in the likel ihood of early recurrence between patients with isolated Cl and other speci men-confined disease. Patients with isolated Cl have a significantly lower likelihood of early recurrence than patients with positive surgical margins due to extraprostatic extension, regardless of whether the Cl is into beni gn glands or tumor. Long-term follow-up is necessary to confirm these findi ngs. (C) 2001, Elsevier Science Inc.