The value of transperineal prostate apical zone biopsy in predicting urethral or apical margin status after radical prostatectomy in prostate cancer.

127 Background: To investigate potential preoperative predictors of positive surgical margin (PSM) after radical prostatectomy, and how to reduce the possibility of urethral or apical PSM with positive biopsy cores in the apical zone of prostate (AZP). Methods: 531 patients who had radical prostatectomy during 2010-2017 in West China hospital was enrolled. The logistic regression was used to assess the preoperative factors associated with PSM. 399 patients with high/very high risk prostate cancer were recognized by National comprehensive cancer Network guidelines and 339 patients were reported positive biopsy cores in the AZP. Results: The overall PSM rate of all patients was about 30.1% (160/531) and 117 of them were reported urethral or apical PSM. The occurrence rate of urethral or apical PSM in patients with positive cores in AZP was obviously higher than that in total group (p = 0.022). We further found that the addition of positive AZP to a standard multivariable model could significantly increase the predictive value of urethral or apical PSM (p = 0.016) in different groups. The analysis also showed that neo-adjuvant hormone therapy was an independent protective factor for urethral or apical PSM in positive AZP patients, but not all patients. Conclusions: This is the first study to investigate the necessity of getting cores in the apical zone by transperineal prostate biopsy to predict the possibility of apical or urethral PSM. In clinical practice, neo-adjuvant hormone therapy should be given when patients with AZP(+) to reduce the presence of PSM, especially patients with high/very high risk prostate cancer.