Lepor H, Chan S, Melamed J
Department of Urology, New York University School of Medicine, New York, USA.
J Urol. 1998 Dec;160(6 Pt 2):2435-9. doi: 10.1097/00005392-199812020-00013.
Radical retropubic prostatectomy is often performed with preservation of the bladder neck. We examine the incidence of benign and malignant prostatic tissue at the bladder neck margin in men undergoing radical retropubic prostatectomy with preservation of the bladder neck for clinically localized prostate cancer.
The study included 100 cases of radical retropubic prostatectomy with preservation of the bladder neck performed by a single surgeon (H. L.). A 2 mm. thick circumferential specimen was excised from the bladder neck, divided into 4 quadrants (anterior, posterior, right and left) and submitted for frozen section examination. The permanent sections from these bladder neck biopsies and the entire surgical specimens were analyzed by a single pathologist (J. M.).
The frozen section diagnosis from the bladder neck biopsies were adenocarcinoma, benign prostatic tissue and no prostatic tissue in 3, 38 and 59 cases, respectively. The permanent section diagnosis of the bladder neck biopsies was adenocarcinoma, benign prostatic tissue and no prostatic tissue in 4, 57 and 39 cases, respectively. The sensitivity specificity, and positive and negative predictive values for examination of the surgical specimen to identify benign prostatic tissue was 67, 90, 90 and 65%, respectively. The bladder neck was re-biopsied because of the findings of adenocarcinoma and benign prostatic tissue in 3 and 8 cases, respectively. The initial bladder neck biopsy resulted in pathological down staging to pT2c in only 1 case. Repeat resection of the bladder neck in all cases with 10% or less benign prostatic tissue showed no prostatic tissue, whereas 50% of the cases with more than 10% benign prostatic tissue demonstrated residual benign prostatic tissue. Serum prostate specific antigen was undetectable immediately after radical retropubic prostatectomy in all cases with benign prostatic tissue only.
Preservation of the bladder neck during radical retropubic prostatectomy does not significantly compromise total extirpation of the malignant process. Benign prostatic tissue at the bladder neck margin is relatively common. Examination of the surgical specimen has limited sensitivity, and negative and positive predictive values for the presence of benign prostatic tissue at the bladder neck margin. The impact of benign prostatic tissue as it relates to future malignant transformation is unknown. Submitting frozen section specimens from the bladder neck is reasonable for the younger man who may be at risk from benign prostatic tissue at the bladder neck margin.
耻骨后根治性前列腺切除术通常在保留膀胱颈的情况下进行。我们研究了因临床局限性前列腺癌接受保留膀胱颈的耻骨后根治性前列腺切除术的男性患者膀胱颈切缘处良性和恶性前列腺组织的发生率。
本研究纳入了由单一外科医生（H.L.）实施的100例保留膀胱颈的耻骨后根治性前列腺切除术病例。从膀胱颈切取一块2毫米厚的环形标本，分为4个象限（前、后、右和左），送冰冻切片检查。这些膀胱颈活检的永久切片以及整个手术标本由同一位病理学家（J.M.）进行分析。
膀胱颈活检的冰冻切片诊断结果分别为腺癌3例、良性前列腺组织38例、无前列腺组织59例。膀胱颈活检的永久切片诊断结果分别为腺癌4例
