Malignant cytological washings from radical prostatectomy specimens: A possible mechanism for local recurrence of prostate cancer following surgical treatment of organ confined disease - Reply

Purpose: Local recurrence of prostate cancer following complete and successful resection of organ confined disease has been variably reported in men. We hypothesized that observed secretions from the cut distal urethra during radical prostatectomy may contain malignant prostatic epithelial cells and contribute to this problem. Materials and Methods: A prospective study was done of prostate cytology specimens from 50 consecutive men with clinically organ confined adenocarcinoma of the prostate undergoing radical retropubic or radical perineal prostatectomy. Direct cytological evaluation by 1 examiner was used to identify malignant or benign cells in these washings. Results: Of 33 radical perineal and 17 radical retropubic prostatectomy specimens organ confinement was confirmed in 58%. Malignant prostatic epithelial cells were observed in 24% of all cytology specimens. Of cytological washings from prostates with pathologically confirmed organ confined cancers 17% showed malignant cells. While perineural invasion was noted in a majority of tumors with positive washings, only Gleason grade was a statistically significant predictor of recurrence (p = 0.009). Surgical approach did not alter the rate of positive cytology. Conclusions: Malignant prostatic epithelial cells can be identified in the prostatic washings from men with pathologically organ confined prostate cancer. Surgical approach did not change the cytological findings. Gleason grade is a statistically significant predictor of cytological malignancy. These cells may represent a mechanism of failure following successful radical prostatectomy.