Factors associated with biochemical recurrence of prostate cancer post radical prostatectomy

Abstract

Background: Prostate cancer (PCa) is a common solid organ male malignancy with high global mortality. In South Africa, one in 28 men develop PCa. Determining biochemical recurrence (BCR) factors after radical prostatectomy will enable close surveillance and early management. Aim: The study aims to determine pathological parameters associated with BCR post-radical prostatectomy at a tertiary hospital in the Free State, South Africa. Setting: All patients (N = 200) who underwent radical prostatectomy in 2013–2018 at the Department of Urology, Universitas Academic Hospital, Bloemfontein were included. Methods: This was a retrospective descriptive study. Relevant data were extracted from the hospital’s electronic database. Results: The patients’ median age was 66 years (range: 46–80). A total of 70 patients (35.0%) had BCR, of whom 31 (44.3%) had positive surgical margins (PSM) alone and recurrence occurred at various intervals in their follow-up period, from 9 to 48 months. Patients who had PSMs, extracapsular expansion (ECE), and seminal vesicle invasion (SVI) made up 10.0% (n = 7) of these and had a relapse within 18 months of follow-up. Patients with negative post-operative specimens experienced BCR, ranging from 15 to 48 months, made up 25.7% (n = 18). Extracapsular extension and PSM as combined parameters were 10.0% (n = 7). One patient had SVI as an independent parameter. Conclusion: These pathological parameters can be linked to BCR after radical prostatectomy. Positive surgical margins prove a strong predictor of BCR after radical prostatectomy. Contribution: Knowing the most sensitive predictive pathological parameters – either in isolation or combination – is essential to optimise patient management and tighten follow-up schedules.

Keywords

• biochemical recurrence
• prostate-specific antigen
• prostate cancer
• radical prostatectomy
• surgical margins
• extracapsular extension.