The Preoperative Factors Predicting a Positive Frozen Section during Radical Prostatectomy for Prostate Cancer

Myungsun Shim; Changhee Yoo; In Gab Jeong; Choung-Soo Kim

doi:10.4111/kju.2009.50.8.751

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Shim, Yoo, Jeong, and Kim: The Preoperative Factors Predicting a Positive Frozen Section during Radical Prostatectomy for Prostate Cancer

Original Article

Korean J Urol 2009;50(8):751-758.

Published online: 17 August 2009

DOI: https://doi.org/10.4111/kju.2009.50.8.751

The Preoperative Factors Predicting a Positive Frozen Section during Radical Prostatectomy for Prostate Cancer

Myungsun Shim, Changhee Yoo¹, In Gab Jeong, Choung-Soo Kim

Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

¹Hallym Sacred Heart Hospital, University of Hallym College of Medicine, Seoul, Korea

Correspondence to: Choung-Soo Kim Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Pungnap-dong, Songpa-gu, Seoul 138-736, Korea TEL: 02-3010-3734 FAX: 02-477-8928 E-mail: cskim@amc.seoul.kr

Received 19 March 2009 Accepted 30 June 2009

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the preoperative factors that predict a positive frozen section during radical prostatectomy for prostate cancer.

Materials and Methods

We retrospectively analyzed preoperative prostate-specific antigen (PSA), prostate volume, Gleason score, the number or percent (%) of cancer-positive cores from prostate biopsy, and the clinical stage of 364 patients who underwent radical prostatectomy between 1993 and 2007. We compared these parameters between patients who had positive frozen sections in specimens from the urethra or bladder neck with those who had negative frozen sections.

Results

The PSA and Gleason score were significantly higher and prostate volume was significantly smaller in patients with positive frozen sections in the urethra than in patients with negative frozen sections. The results were the same for the bladder neck. In multivariate analysis, PSA was the only independent predictor for positive frozen sections at the bladder neck, and the cutoff value was 8.71 ng/ml.

Conclusions

Preoperative PSA may be a potent factor for predicting positive frozen sections during radical prostatectomy, especially in the bladder neck. Therefore, it may be beneficial to prepare frozen sections of the bladder neck during the operation to reduce the positive resection margin when PSA is higher than 8.7 ng/ml.

Keywords: Prostatectomy, Frozen sections, Prostatic neoplasms, Prostate-specific antigen

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Fig. 1.

ROC curve and AUC of serum PSA predicting a positive frozen section at the bladder neck. ROC: receiver operation characteristic, AUC: area under the curve, PSA: prostate-specific antigen.

Table 1.

Preoperative characteristics and results of frozen sections

Variables	Mean±SD or number
Mean age (years)	63.5±6.6
Mean PSA (ng/ml)	12.3±11.3
Mean prostate volume (cc)	33.3±11.6
Biopsy Gleason score (%)
2-6	171 (47.0)
7	121 (33.2)
8-10	72 (19.8)
Mean No. of positive cores	2.7±1.8
Clinical stage (%)
T1	235 (64.6)
T2 or higher	129 (35.4)
Frozen section results (%)
Resection margin (+)	90 (24.8)
Urethra	56 (15.4)
Bladder neck	45 (12.4)
Both	11 (3.0)
Resection margin (−)	274 (75.2)

SD: standard deviation, PSA: prostate-specific antigen

Table 2.

Comparative analysis of preoperative variables between subjects according to the results of frozen sections

Variables	Resection margin (−)	Resection margin (+)
Variables	Resection margin (−)	Total	p-value	Urethra	p-value	Bladder neck	p-value
No. of patients	274	90		56		45
Mean PSA (ng/ml)^a	10.7±9.4	18.0±16.5	0.001	17.1±16.5	0.013	19.1±15.5	0.002
Mean prostate volume (cc)^a	34.4±19.1	27.5±7.3	0.001	27.3±7.3	0.002	26.8±5.2	0.005
Biopsy Gleason score (%)^b			0.001		0.006		0.001
2-6	128 (46.7)	18 (20.0)		11 (19.7)		7 (15.6)
7	92 (33.6)	43 (47.8)		27 (48.2)		18 (40.0)
8-10	54 (19.7)	29 (32.2)		18 (32.1)		20 (44.4)
Mean No. of positive cores^a	2.7±1.8	2.9±1.7	0.335	2.8±1.7	0.611	3.3±2.4	0.215
Mean % positive cores/total cores^a	30.1±19.8	32.2±20.4	0.482	31.1±18.7	0.249	36.7±22.7	0.478
Clinical stage (%)^b			0.240		0.226		0.470
T1	188 (68.6)	47 (52.2)		25 (50)		27 (60)
T2 or higher	86 (31.4)	43 (47.8)		25 (50)		18 (40)
Surgeon's experience^b			0.389		0.241		0.441
Prior to 250 RP	185 (74.3)	64 (25.7)		34 (13.7)		27 (10.8)
250 RP and thereafter	89 (77.4)	26 (22.6)		22 (19.1)		18 (15.7)

PSA: prostate-specific antigen, RP: radical prostatectomy

^a PSA, prostate volume, No. of positive cores and % positive cores/total cores were analyzed as continuous variables

^b biopsy Gleason score, clinical stage and surgeon's experience was analyzed as categorical variables

Table 3.

Predictors of a positive frozen section among preoperative variables in binary logistic analysis

	Total		Urethra		Bladder neck
	Odds ratio (95% CI)	p-value	Odds ratio (95% CI)	p-value	Oddsratio (95% CI)	p-value
PSA^a Biopsy Gleason score^b	1.040 (1.005-1.077)	0.027	1.033 (0.996-1.071)	0.079	1.059 (1.002-1.118)	0.041
2-6
7	1.566 (0.639-3.837)	0.308	2.055 (0.709-5.958)	0.347	0.910 (0.245-3.373)	0.552
8-10	0.844 (0.319-2.232)	0.372	1.313 (0.420-4.102)	0.459	0.449 (0.095-2.132)	0.256
Prostate volume^a	0.976 (0.952-1.001)	0.064	0.983 (0.959-1.008)	0.186	0.950 (0.892-1.012)	0.110

CI: confidence interval, PSA: prostate-specific antigen

^a PSA and prostate volume were analyzed as continuous variables,

^b biopsy Gleason score was analyzed as categorical variables

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