Прогноз статуса хирургического края после радикальной позадилонной простатэктомии на основании данных биопсии простаты

Postoperative progression of prostatic cancer (PC) after radical prostatectomy (RPE) may be caused by a residual tumor that is suggested by the presence of tumor cells in the resection positive surgical edge (PSE), regional and distant metastases. Objective . To reveal the preoperative prognostic factors of PSE occurrence during retropubic RPE in patients with clinically localized PC. Subjects and methods. The incidence of PSE was analyzed in 288 PC patients treated with retropubic RPE between November 1997 and May 2006. The correlation between the results of transrectal multifocal prostatic biopsy and the incidence of PSE was assessed. Results . PSE was detected in 87 (30.2%) of the 288 patients. Single and multiple PSEs were found in 70 (80.5%) and 17 (19.5%) patients, respectively. The commonest site of PSE was the posterolateral prostate surface [n = 26 (37.1%)]. In males who had less than 30.0% positive biopsies, PSE was diagnosed in 10.4% of cases. With the positive columns exceeding 30.0%, it was revealed in 52.5% of cases. In patients with PSE, the mean maximum tumor amount in the biopsy specimen was 84.8% (84.8±5.2%). PSE was detected in 71.1% of the patients with a Gleason grade of 7 or more, whereas in patients with lower grades, it was found in 19.9%. In the groups of patients with positive and negative surgical edges, perineural invasion was identified in 63 (73.3%) and 12 (5.9%) cases, respectively. In patients with PSE, the signs of capsular tumor invasion were detected in 58 (67.4%) cases and in those without PSE it was present in 20 (9.95%) cases only. Conclusion . The incidence of PSE during retropubic RPE was associated with a number of positive columns of over 30.0%, the tumor amount in the biopsy specimen of more than 80.0%, a Gleason grade of 7 or more, capsular and perineural invasion.