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 identified capsular incision (Cl) (exposure of benign or malignant glands to the inked surgical margin in the setting of organ-confined disease) on disease progression after anatomic radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. Methods. Between March 1993 and September 1999, 4747 men underwent RRP at the Johns Hopkins Hospital; 107 men (2.3%) were diagnosed with Cl in otherwise organ-confined disease; 92 (86%) had at least 6 months (mean 30) of follow-up. We matched these Cl cases (based on surgeon, age, clinical stage, final pathologic Gleason grade, and preoperative serum prostate-specific antigen level) one-for-one with controls in three additional pathologically defined groups and compared the freedom from disease progression (prostate-specific 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 progression 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 resulting from extraprostatic extension (P < 0.01). No statistically significant difference was found in the actuarial likelihood of freedom from disease progression between men with Cl into benign glands (n = 22) and men with Cl into tumor (n = 70) (P = 0.93). Conclusions. No statistically significant difference was found in the likelihood of early recurrence between patients with isolated Cl and other specimen-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 benign glands or tumor. Long-term follow-up is necessary to confirm these findings. (C) 2001, Elsevier Science Inc.