Increase of the Incidence of Biochemical Recurrence after Radical Prostatectomy in an Uro-Oncology Training Center in Brazil: Are More Advanced Diseases undergoing Surgery?

• Autor(a) principal: Brunetto Neto, Antonio
• Data de Publicação: 2022
• Outros Autores: Oliveira, André Matos de, Rocha, Cecilia Rubini, Tavares, Leonardo Pereira, Caldas, Maria Fernanda Baptista
• Tipo de documento: Artigo
• Idioma: por; eng
• Título da fonte: Revista Brasileira de Cancerologia (Online)
• Texto Completo: https://rbc.inca.gov.br/index.php/revista/article/view/2483
• topic: prostatectomia; neoplasias da próstata; recidiva local de neoplasia; prostatectomy; prostatic neoplasms; neoplasm recurrence, local; prostatectomia; neoplasias de la próstata; recurrencia local de neoplasia

Introduction: Prostate cancer is the most common cancer in men representing 29% of diagnoses of the disease in Brazil according to the National Cancer Institute José Alencar Gomes da Silva (INCA). If digital rectal examination presents alterations and/or altered serum level of prostate-specific antigen (PSA) total is detected, there is suspicion of prostate cancer, but the definitive diagnosis occurs only with histopathological study. Objective: To correlate clinical and pathological parameters after radical prostatectomy with biochemical recurrence during follow-up. Method: Retrospective observational study of clinical parameters (age, initial PSA, digital rectal examination, histopathological classification of the International Society of Urological Pathology (ISUP), D’Amico scale and clinical stage) and pathological (ISUP degree of the surgical specimen, surgical margins, extracapsular tumor extension and presence of positive lymph nodes) of 177 patients who underwent radical prostatectomy in an uro-oncology service from June 2010 to May 2018. Results: Biochemical recurrence occurred in 44.1% of the cases within a mean follow-up time of 34.9 months. Univariate analysis showed that baseline PSA>9 ng/mL, altered rectal examination, pathological ISUP classification 4 and 5, high D’Amico risk, and clinical TNM stage T3 are risk factors for biochemical recurrence. Surgical margins were positive in 46.3%, and in 47.7% extracapsular extension was identified. Positive lymph nodes were detected in 10.9% and positive seminal vesicles occurred in 21.8%. Conclusion: Clinical and pathological factors can be predictors of biochemical recurrence. In these cases, it was identified a more aggressive clinical pattern than the literature in general. In addition, it should be considered the learning curve of surgeons in training at the service, which can result in higher rates of positive surgical margins.