Residual benign prostatic glands at the urethrovesical anastomosis after radical retropubic prostatectomy: prediction and impact on disease outcome.

Abstract

Biochemical failure after radical prostatectomy (RP) for localized prostate cancer (PC) is the first evidence of disease recurrence. If residual benign prostatic glands are left behind on RP a theoretical PSA production from benign glands or residual neoplastic tissue could explain PSA failure. This study investigates the prediction and impact on disease outcome of residual benign glands at the urethrovesical anastomosis. 802 patients who underwent RP were retrospectively evaluated with special focus on residual benign glands (B+) at the urethrovesical anastomosis. B-status was defined from a biopsy of the urethral stump at 9, 12 and 3 o'clock position. From 802 patients 73.6% were classified as B+, 26.4% B0. 92.0% of B+ patients demonstrated only isolated glands (B1), 8.0% showed abundant glands (B2). There was no difference in disease outcome for B0 and B+ patients. Patients with early PC who are candidates for nerve sparing procedures are more likely for B+ status. Benign prostatic glands at the apical margin of the RP specimen are a common finding, but neither isolated nor abundant glands have an impact on disease outcome. We think that a precise apical dissection to improve continence rates is possible, although these patients are at risk for residual benign tissue at the apex.