Detectable serum PSA after radical prostatectomy. Clinical and pathological relevance of perianastomotic biopsies

Background: Few reports have detailed the histopathological results of biopsies of the vesicourethral anastomosis or prostatic bed in patients with a detectable postoperative PSA. Patients and Methods: Among a series of 153 patients who underwent radical retropubic prostatectomies, we analyzed the results of 64 perianastomotic biopsies performed in 17 men with a detectable PSA and no evidence of local recurrence or distant metastases. Results: Fourteen of the 17 patients had a relapse of prostatic carcinoma; the results of histology in the three pT(2b)N(0)M(0) patients revealed the presence of benign prostatic hyperplasia in 2 patients and atypical cribriform proliferation in I patient. The first two patients are free from prostatic cancer recurrence 36 months after perianastomotic biopsies; a further biopsy performed 6 months after in the third patient showed the presence of prostatic carcinoma. Conclusion: The present study raises the possibility that residual benign tissue, resulting from unintentional disruption of the prostatic capsule during surgery, may be responsible for a detectable postoperative PSA. These cases comprise a histopathological classification described as "intraprostatic surgical margin".