Oncologic Outcome after Extraperitoneal Laparoscopic Radical Prostatectomy: Midterm Follow-up of 1115 Procedures

Staging prostate cancer and its relationship to prognosis

“…In recent studies, the positive surgical margin rate ranges from 13 to 26%. 5,6 Progression-free probability for men with positive surgical margins on RP ranges from 58% to 64% in contrast with 81% to 83% in patients with negative surgical margin. 20,36 Despite general consensus of the importance and clinical relevance of RP surgical margin status, marked variability still exists in the interpretation of surgical margins by pathologists practicing in different institutions.…”

“…4 Seminal vesicles invasion (SVI, pT3b): seminal vesicle invasion by PCA, defined as invasion of its muscular wall, 30 has generally been shown to be a poor prognostic factor after RP and is commonly associated with EPE. However, the considerable variation in the pathological handling and sampling of seminal vesicles in RP specimens is responsible for the large differences reported in major series, in both the percentages of cases with SVI (5e10%) 5,6 and in the 5-year BRFS (5e60%). 31,32 It is recommended that the junction of the seminal vesicle and the prostate should always be assessed for contiguous spread.…”

“…17 In contemporary studies, 27e30% of PCA patients have EPE. 5,6 Microscopic bladder neck invasion (pT3a): the stage classification of PCA invading bladder neck has been controversial for the last few years due to its uncommon occurrence and poorly defined clinical course. In the 6th edition of AJCC staging, bladder neck involvement was considered as advanced disease and categorized as pT4, based on the belief that tumors that invade surrounding structures are more aggressive and warrant higher staging.…”

“…4 In two contemporary studies on the outcome of patients with long-term follow-up who underwent radical prostatectomy for clinically localized prostate cancer, 69e82% of men were clinical stage T1, 17e30% cT2, and <1% of cases were cT3. 5,6 Pathologic T staging Pathologic staging (pTNM) is performed after surgical resection of the primary tumor and is based on gross and microscopic examination. Reporting pathologic staging parameters in RP specimens and characteristic of each PCA removed is essential not only in determining the most appropriate choice of therapy of individual patients, but also in predicting the likelihood of local and distant disease recurrence, so that the chance of cure can be accurately estimated.…”

“…49 Prognosis Two recent studies reported on the oncologic outcome after laparoscopic RP for clinically localized PCA in patients with longterm follow-up treated in centers with high-volume experience. 5,6 The patients were stratified as low-, intermediate-or high-risk based on the pretreatment prostate cancer nomogram progression-free probability of >90%, 89e71%, and <70%, respectively. 50 The intermediate and high-risk groups represented approximately 50% and 10% of the patient population.…”