BACKGROUNDMany studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China, it is necessary to investigate the risk of positive surgical margin and biochemical recurrence, and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study, we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.

METHODSFrom 2000 to 2009, 149 patients with prostate cancer received radical prostatectomy and were followed up. Among these patients, 111 received retropubic radical prostatectomies, 38 received laparoscopic radical prostatectomies. All patients were followed-up on in the 3rd month, 6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint, serum prostate-specific antigen (PSA), full biochemical test and uroflowmetry was acquired.

RESULTSThe average age was (69.0 ± 6.1) years, preoperative average serum PSA was (10.1 ± 12.1) ng/ml and average Gleason score was 6.4 ± 1.3. The incidence of total complications was about 47.7%, the incidence of the most common complication, bladder outlet obstruction, was about 26.8%, and that of the second most common complication, urinary stress incontinence, was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4 ± 17.6) ng/ml), average Gleason score (7.1 ± 1.3) and pathological T stage score (7.0 ± 1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0 ± 5.8) ng/ml, 6.0 ± 1.2 and 5.4 ± 1.4, respectively) (P = 0.004, P = 0.001 and P = 0.001, respectively). A univariate analysis showed that positive surgical margin had a positive statistical association with serum PSA (P = 0.007), Gleason score (P < 0.001), pathological T stage score (P < 0.001) and biochemical recurrence (BCR) (P = 0.035). The most common location of a positive surgical margin was in the apex of the prostate, which was about 63% (36/57). Sixty-four percent (23/36) of patients with positive surgical margin in apex were also involved in prostate lobe; other locations were prostate lobe (23%, 13/57), seminal vesicle (9%, 5/57). The multivariate analysis showed that positive surgical margin had a positive statistical association with Gleason score (P = 0.03) and pathological T stage score (P = 0.02). Neither univariate analysis or multivariate analysis showed any statistical relationship between BCR and any other risk factors covered in this study.

CONCLUSIONSPositive surgical margin is associated with pre-operative PSA, Gleason score, pathological T stage and biochemical recurrence. Earlier diagnosis and improved techniques of dissection of prostate apex could decrease the incidence of positive surgical margins.

Aged ; Humans ; Male ; Middle Aged ; Prostate-Specific Antigen ; blood ; Prostatectomy ; methods ; Prostatic Neoplasms ; blood ; pathology ; surgery ; Risk Factors

BACKGROUNDAging of population in Macau has become a serious problem and we are diagnosing more and more patients with prostate cancer. To investigate the effect of ethnicity and environment on incidence of prostate carcinoma, we compared the difference of biopsy and postoperative pathology of prostate between indigenous Chinese (Chinese) and Chinese of Portuguese descent (Portuguese) with elevated serologic prostate specific antigen (PSA) and incidence of prostate carcinoma in Macau.

METHODSBetween 1999 and 2006, prostate biopsy was performed in a random sample of 462 patients with elevated serologic PSA who, on followup, were diagnosed in this hospital with benign prostate hyperplasia. Of these, 416 were indigenous Chinese, 46 Portuguese. Based on demographic statistics by Macau government for 2005, we compared differences in incidences of prostate carcinoma, positive rate of random prostate biopsy in patients with elevated serologic PSA, factors related to serological PSA and pathological grade and stage between both ethnic groups.

RESULTSProstate carcinoma was diagnosed on biopsy in 178 cases. Positive biopsies of prostate carcinoma were present in 160 Chinese with positive rate of 38.5% and in 18 Portuguese with 39.1%. For patients diagnosed with prostate carcinoma, there was no significant difference in age, incidence, grade of cancerous cells, stage of the disease, incidence of inflammation of prostatic tissues or prostatic intraepithelial neoplasia (PIN) related to elevated PSA between the groups (All P>0.05).

CONCLUSIONSThere was no significant difference in incidence or characteristics of prostate carcinoma between people of Portuguese and Chinese descent in Macau based on our limited data. Long term residence in the same environment may be associated with the incidence and progression of prostate carcinoma in Portuguese living in Macau, but further rigorous epidemiological investigation and analysis of risk factors about prostate carcinoma are needed to corroborate this conclusion.

Aged ; China ; ethnology ; Humans ; Incidence ; Macau ; epidemiology ; Male ; Middle Aged ; Portugal ; ethnology ; Prostatic Neoplasms ; blood ; epidemiology ; pathology