Biomedical subjects

H Zincke

Publications and source records attributed to H Zincke.

At least 19 recordsLinked to original sources

PubMed1995

Management of sacral and perineal defects following abdominoperineal resection and radiation with transpelvic muscle flaps.

PURPOSES: In this study we present our experience with treating persistent sacral and perineal defects secondary to radiation and abdominoperineal resection with or without sacrectomy. METHODS: Fifteen consecutive patients were treated with an inferiorly based transpelvic rectus abdominis muscle or musculocutaneous flap. RESULTS: Fourteen of the 15 patients achieved healing, and 7 patients had no complications. The remaining eight patients required one or more operative debridements and/or prolonged wound care to accomplish a healed wound. Our technique for the dissection and insetting of the transpelvic muscle flap is presented. CONCLUSION: The difficult postirradiated perineal and sacral wounds can be healed with persistent surgical attention to adequate debridement, control of infections, and a well-vascularized muscle flap. The most satisfying aspects for patients are the discontinuance of foul-smelling discharge, discontinuation of multiple, daily dressing changes, and reduction in the degree of chronic pain.

Adult↗

PubMed1995

Primary chemotherapy for clinical stage II nonseminomatous germ cell testicular tumors: selection criteria and long-term results.

OBJECTIVE: To determine the treatment option for patients with low-volume stage II nonseminomatous germ cell testicular tumors (NSGCTT) that yields the best survival, is associated with the least morbidity, and avoids "double therapy"--that is, chemotherapy and retroperitoneal lymph node dissection (RPLND). DESIGN: We reviewed our institutional experience with 28 patients with stage II NSGCTT who received primary chemotherapy between August 1983 and October 1992. MATERIAL AND METHODS: The 28 study patients (mean age, 28 years; range, 20 to 52) with low-volume stage II NSGCTT were treated with bleomycin, etoposide, and cisplatin. The correlation of response rates with volume of disease and predominant histologic cell type was determined. The duration of survival was measured from the initiation of chemotherapy to the appearance of progressive disease or death or the date of last follow-up visit. RESULTS: Of the 28 patients treated, 27 (96%) achieved a complete response--20 (71%) with only chemotherapy and an additional 7 (25%) with chemotherapy plus surgical treatment. Twenty-seven patients (96%) remained free of disease after a median follow-up of 72 months. The most frequent complication was cisplatin-associated paresthesias or tinnitus which was noted in 13 patients (46%). In 11 of 15 patients (73%), attempts to have children have been successful. CONCLUSION: Excellent long-term survival rates in patients with stage II NSGCTT can be achieved with primary chemotherapy. In this series, 71% of patients were spared RPLND. The need for postchemotherapy RPLND seemed to be related to the initial metastatic tumor volume and possibly the histologic features of the primary tumor. Continued refinement in surgical techniques and chemotherapeutic regimens will necessitate the comparison of these two treatment approaches in a randomized prospective trial.

Adult↗

PubMed1995

Use of exogenous material to bolster closure of the parenchymal defect following partial nephrectomy.

Closure of renal parenchymal defects created by partial nephrectomy can be difficult. We describe a method of using exogenous material to bolster the strength of the parenchymal closure. The horizontal mattress sutures closing the renal parenchyma are less likely to tear through the parenchyma as the result of the application of a more uniform tension across a broad front. This technique is particularly helpful for large and irregular defects. Tying the closure sutures over an exogenous bolster material aids in a rapid, hemostatic, and watertight closure.

Biocompatible Materials↗

PubMed1995

Influence of DNA ploidy and adjuvant treatment on progression and survival in patients with pathologic stage T3 (PT3) prostate cancer after radical retropubic prostatectomy.

OBJECTIVES: To determine whether adjuvant treatment (AT: hormonal or radiation) affects outcome in pathologic Stage T3 (pT3) prostate cancer when analyzed according to DNA ploidy. METHODS: The predictive value of nuclear DNA ploidy and AT on clinical and prostate-specific antigen (PSA) progression and on overall and cause-specific survival after radical retropubic prostatectomy was assessed in 894 patients with pT3 prostate cancer. RESULTS: Mean follow-up was 6.7 years (range, 0.3 to 20). Mean age was 66 years (range, 39 to 79). Six hundred sixty patients (74%) had no immediate AT, 131 (15%) had early adjuvant radiotherapy (ART), and 103 (12%) had early adjuvant orchiectomy (AHT). DNA diploid tumors were found in 445 patients (52%), tetraploid tumors in 346 (41%), and aneuploid tumors in 59 (7%). DNA ploidy was a significant (P < 0.05) prognostic indicator for clinical systemic progression-free survival. With PSA progression (more than 0.2 ng/mL) as an endpoint, ploidy was an even more powerful predictor for outcome (P = 0.004). Use of early AHT or ART was associated with decreased overall clinical progression for diploid and nondiploid tumors (P < 0.001 and P < 0.001, respectively). With respect to PSA progression, ART and AHT were equally effective and superior to no AT only in patients with diploid tumors. However, in patients with nondiploid tumors, only AHT appeared to have improved PSA progression-free survival (P < 0.001) over ART or no AT, which are similar in outcome. CONCLUSIONS: In the present nonrandomized study, AHT was as effective as ART for all endpoints except for PSA more than 0.2 ng/mL progression, for which it appeared to be superior to ART for patients with nondiploid tumors.

Adult↗

PubMed1995

Prostate-specific antigen detected prostate cancer: pathological characteristics of ultrasound visible versus ultrasound invisible tumors.

Most studies examining the issue of 'early detection of prostate cancer' advocate the combined use of serum prostate-specific antigen (PSA) and digital rectal examination (DRE). As a result, a significant number of new prostate cancers are diagnosed on the basis of an elevated serum PSA when the DRE is unremarkable. The purpose of this study is to determine if the PSA-detected tumors that are visible on transrectal ultrasound (TRUS) have the same pathological characteristics as PSA-detected tumors that are invisible on TRUS. One hundred and ninety-four patients with an elevated serum PSA concentration and nonpalpable prostate cancer who underwent radical retropubic prostatectomy (RRP) at our institution between March 1988 and December 1991 were reviewed. The patients were divided into two groups: 97 (50%) had no identifiable lesion on TRUS, and 97 (50%) had at least one hypoechoic area consistent with adenocarcinoma of the prostate. The pathological characteristics of the RRP specimens from the two groups were compared. There was no significant difference in the age (p = 0.14) or the preoperative serum PSA values (p = 0.18) between the groups. Also, there was no significant difference between the groups with regard to tumor volume (p = 0.89), focality of the cancer (p = 0.43), Gleason score (p = 0.81), DNA ploidy status (p = 0.96), pathological stage (p = 0.92), surgical margin involvement (p = 0.27), and tumor location (p = 0.64). These findings suggest that the clinical TNM staging system for prostate cancer may be simplified by eliminating the distinction between PSA-detected cancers visible on TRUS and PSA detected cancers not visible on TRUS.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1995

Extrapulmonary lymphangioleiomyomatosis and lymphangiomatous cysts in tuberous sclerosis complex.

OBJECTIVE: To describe the clinical manifestations, imaging findings, and histologic features of extrapulmonary lymphangioleiomyomatosis (LAM) in the tuberous sclerosis complex (TSC). DESIGN: We retrospectively reviewed institutional medical records since 1940 to identify patients with TSC and extrapulmonary LAM. MATERIAL AND METHODS: Of 403 patients with TSC, 3 had pulmonary and extrapulmonary LAM and retroperitoneal lymphangiomatous cysts. The clinical, imaging, and histologic features of these three patients were summarized, including analysis of biopsy specimens by conventional histology, immunohistology, radiolabeled ligand-binding assays, and tissue culture. RESULTS: The three young women had characteristic dermatologic findings of TSC and pulmonary LAM. Two patients were of normal intelligence, and one had a recent history of contraceptive use. All three patients had intra-abdominal lymphangiomatous cysts, uterine LAM, and renal angiomyolipomas. Renal and uterine biopsy specimens demonstrated positive immunostaining for melanoma-related antigens and expression of estrogen and progesterone receptors by ligand-binding assay and immunohistology. Cells cultured from LAM tissue of one of the patients exhibited a mitogenic response to estradiol. CONCLUSION: Clinically significant extrapulmonary LAM is a rare manifestation of TSC and may occur in women with this disease who also have pulmonary LAM. The clinical features of these patients confirm the importance of sex steroids in the development of these lesions. Immunohistochemical findings suggest that LAM and angiomyolipomas have a neuroectodermal origin. The development of lymphangiomatous cysts in these patients is probably due to smooth muscle proliferation in lymph vessels, which can result in lymphatic obstruction.

Abdominal Neoplasms↗

PubMed1995

Critical evaluation of salvage surgery for radio-recurrent/resistant prostate cancer.

PURPOSE: A positive post-irradiation prostatic biopsy associated with an increasing prostate specific antigen level but no palpable evidence of local progression may identify a subgroup of patients who could be cured by salvage surgical therapy. MATERIALS AND METHODS: Between 1967 and 1992, 132 patients underwent salvage surgery, including radical retropubic prostatectomy in 79, anterior exenteration in 38, total exenteration in 5 and bilateral pelvic lymphadenectomy only in 10. RESULTS: The 10-year cancer-specific survival rate in the prostatectomy group was 72%. Local control was equivalent among the surgical groups. Radical retropubic prostatectomy patients with negative surgical margins and nonaneuploid tumors demonstrated a significant survival advantage. Adjuvant hormonal therapy improved the disease-free survival rate in patients with nonaneuploid tumors. CONCLUSIONS: Radical retropubic prostatectomy can achieve excellent survival with low morbidity in select patients. Patients with clinical stage T2 or less disease and with prostate specific antigen detected cancers (52% and 75%, respectively) had pathological stage T2 disease. Thus, by using modern diagnostic techniques patients can be identified who may be cured with salvage surgery.

Adult↗

PubMed1995

Morbidity of contemporary radical retropubic prostatectomy for localized prostate cancer.

Complication rates in 1,000 consecutive patients who underwent radical retropubic prostatectomy for clinically localized prostate cancer between November 1989 and January 1992 were assessed and compared to complication rates in a historical group of patients operated on by primarily the same surgeons prior to 1987. In the contemporary series, there were no operative deaths, only 22% of patients required blood transfusion, and only six (0.6%) patients suffered rectal injuries. Early complications, including myocardial infarction, pulmonary embolism, bacteremia, and wound infection, occurred in less than 1% of patients. Vesical neck contracture, the most common late complication, developed in 87 patients (8.7%). At 1 year post-surgery, 80% of patients were completely continent, and fewer than 1% were totally incontinent.

Aged↗

PubMed1995

Extended experience with radical prostatectomy for clinical stage T3 prostate cancer: outcome and contemporary morbidity.

PURPOSE: Radical prostatectomy for clinical stage T3 prostate cancer has not been widely accepted due to the potential for incomplete excision of the local tumor and high incidence of lymph node metastases. In addition, contemporary morbidity is unknown. We report the long-term results in 812 patients with clinical stage T3 prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS: Between 1966 and 1992, 812 patients with clinical stage T3 prostate cancer underwent radical prostatectomy of whom 479 (60%) received adjuvant therapy. RESULTS: Mean patient age was 65 years (range 40 to 78). Mean followup was 4.5 years (range up to 24). Disease was stage pT2c or less in 17% of patients, pT3a to c in 49% and node-positive in 33%. Of the primary tumors pathological Gleason score was 7 or greater in 62%. Crude and cancer-specific survival rates at 5, 10 and 15 years were 86%, 70% and 51%, and 90%, 80% and 69%, respectively. Operative morbidity paralleled that of patients with clinically localized disease (T2c or less). CONCLUSIONS: An excellent survival rate with low treatment related morbidity can be achieved by performing primary radical prostatectomy with adjuvant therapy in the patient with clinical stage T3 prostate cancer.

Adult↗

PubMed1995

Treatment of renal cell carcinoma in von Hippel-Lindau disease: a multicenter study.

A total of 65 patients with von Hippel-Lindau disease underwent surgery for renal cell carcinoma (54 bilaterally and 11 unilaterally) at 8 medical centers. Only 1 patient presented with metastatic disease. Radical nephrectomy and nephron sparing surgery were performed in 16 and 49 patients, respectively. Mean posttreatment followup was 68 months. The 5 and 10-year cancer-specific survival rates for all patients were 95% and 77%, respectively. The corresponding rates for patients treated with nephron sparing surgery were 100% and 81%, respectively. Of the latter patients 25 (51%) had postoperative local tumor recurrence but only 2 had concomitant metastatic disease. Survival free of local recurrence was 71% at 5 years but only 15% at 10 years. End stage renal failure occurred in 15 patients (23%): 6 underwent renal transplantation (5 are alive with satisfactory renal function and no evidence of malignancy) and 9 were treated with chronic dialysis (6 are free of tumor). Our results indicate that nephron sparing surgery can provide effective initial treatment for patients with renal cell carcinoma and von Hippel-Lindau disease. These patients must be followed closely, since most will eventually have locally recurrent renal cell carcinoma. When removal of all renal tissue is necessary to achieve control of malignancy, renal transplantation can provide satisfactory replacement therapy for end stage renal disease.

Adolescent↗

PubMed1995

Potency-sparing radical retropubic prostatectomy: a simplified anatomical approach.

A simplified method of nerve sparing radical retropubic prostatectomy for clinical stage T2a prostate cancer is described based on primary isolation of both neurovascular bundles and secondary division of the urethra, with the puboprostatic ligaments undivided to provide suspension of the deep venous complex above the urethra. The principles for this approach after division of the deep vein complex are based on early unilateral incision of the prostatic fascia laterally, parallel to the ipsilateral neurovascular bundle and extending from the proximal prostate to the urethra; separation of anterior (prostatic) and posterior (rectal) Denonilliers' fascia, which leaves the neurovascular bundle invested in the latter tissue; perforation and incision of contralateral prostatic fascia at its urethroprostatic angle, with cranial extension of the fascial opening dropping the ipsilateral neurovascular bundle invested in its fascia (Denonvilliers' posterior), and anastomotic division of the urethra at its entrance into the prostate.

Humans↗

PubMed1994

Long-term (15 years) results after radical prostatectomy for clinically localized (stage T2c or lower) prostate cancer.

To provide information about long-term outcome after radical prostatectomy for clinically localized prostatic cancer (stage T2c or lower), we undertook a retrospective analysis of 3,170 consecutive patients (mean age 65.3 +/- 6.4 years, range 31 to 81) with a mean followup of 5 years. Complication rates for patients who underwent prostatectomy before 1988 were compared with those who underwent radical prostatectomy more recently. Of the patients 49 (1.5%), 178 (5.6%), 897 (28%) and 2,047 (65%) had clinical stages T1a, T1b, T2a and T2b,c disease, respectively. The Gleason score was 3 or less in 292 patients (9%) and 7 or greater in 782 (25%). Overall, 438 patients (14%) died, 159 (5%) of cancer. The crude 10 and 15-year survival rates for all patients were 75% and 60%, respectively, which is comparable to the expected survival of a control group (67% and 46%). The cause specific survival rates were 90% and 82%, respectively, metastasis-free survival rates 82% and 76%, local recurrence-free survival rates 83% and 75%, overall recurrence-free rates 72% and 61%, and overall recurrence plus prostate specific antigen progression-free (greater than 0.2 ng./ml.) rates 52% and 40%, respectively. Clinical stage did not significantly affect survival but tumor grade was associated: 10 and 15-year cause specific survival rates were 95% and 93%, respectively, for a Gleason score of 3 or less, 90% and 82%, respectively, for a score of 4 to 6, and 82% and 71%, respectively, for a score of 7 or more. Of all patients 26% received adjuvant treatment (hormonal and/or radiation) within 3 months postoperatively because of advanced local pathological stage (pT3 or higher) or margin positive disease. The 30-day mortality rate was 0.3% (0% for 1,728 patients who underwent surgery in 1988 or later). Only 1 patient in the 70 year or older age group died during hospitalization. Complications decreased with time. In a contemporary group the complications were rectal injury in 0.6% of the patients, colostomy in 0.06%, myocardial infarction in 0.4%, deep venous thrombosis in 1.1%, pulmonary embolism in 0.7% and total urinary incontinence (3 or more pads per day) in 0.8%. Recent intraoperative blood loss was a median of 600 ml., and the incidence of recent need for any transfusion was 31% and it is presently less than 5%. In this series patients undergoing radical prostatectomy for clinically localized prostate cancer were usually healthy and, thus, had low co-morbidity. Survival rates at 10 and 15 years compare favorably with those of an age-matched control group.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1994

Measurement of serum prostate specific antigen using IMx prostate specific antigen assay.

The analytical characteristics of singlet determinations of the IMx prostate specific antigen (PSA) assay are similar to the mean of duplicates using the Tandem-R not equal to PSA assay. The 2 assays are standardized equally and provide test results that correlate well (r = 0.9997). The IMx PSA assay is more automated, requires less technologist time and provides faster test results. This assay has a minimal detection limit of 0.02 to 0.04 ng./ml. and functional sensitivity at a 20% coefficient of variation of 0.06 to 0.13 ng./ml. With a sensitive lot of IMx PSA reagents, only 38% of post-radical prostatectomy patients had nondetectable values compared to 60% with the Tandem-R PSA assay. The within-person, biological standard deviation of PSA concentrations in post-radical prostatectomy patients was 0.01 ng./ml. Therefore, with a sensitive assay these low concentration measurements should be reliable for monitoring. However, the clinical use of these low concentrations for early detection of tumor recurrence must await further studies.

Analysis of Variance↗

PubMed1994

Combining prostate specific antigen with cancer and gland volume to predict more reliably pathological stage: the influence of prostate specific antigen cancer density.

The serum prostate specific antigen (PSA) level was determined in 311 men with documented prostate cancer (stages T1cN0, T2N0 and T3N0) before bilateral pelvic lymphadenectomy and radical retropubic prostatectomy. The prostates were whole mounted, serially sectioned, and examined for cancer volume, capsular perforation, seminal vesicle invasion, lymph node involvement, Gleason grade, nuclear grade and nuclear deoxyribonucleic acid content. Median serum PSA level was significantly different between cancers that were organ confined, those that had capsular perforation or seminal vesicle invasion and those with positive lymph nodes (p < 0.001). Median serum PSA level was also significantly different between tumors with Gleason scores of less than 6 and those with higher Gleason scores (p < 0.001), and between tumors with greater than 30% of poorly differentiated cancer (Gleason primary grades 4 and 5) and those with 30% or less poorly differentiated cancer (p < 0.001). Bivariate analysis revealed that the strongest correlations of serum PSA level were with cancer volume (r = 0.56), per cent of poorly differentiated cancer (r = 0.42), positive surgical margins (r = 0.39) and pathological stage (r = 0.38), for all p < 0.001. Multivariate analysis showed that cancer volume was the major contributor to serum PSA level. The derivative, PSA-cancer density (serum PSA times cancer volume divided by prostate volume), accounted for the effects of prostate volume and cancer volume on serum PSA. PSA-cancer density showed a significant correlation with pathological stage (r = 0.56), Gleason score (r = 0.53) and per cent of poorly differentiated cancer (r = 0.49, for all p < 0.001), and these correlations were significantly stronger than serum PSA level alone or PSA density (serum PSA divided by prostate volume; volume determined from tissue specimens) for all variables. These results indicate that preoperative serum PSA level has significant predictive value in determining tumor burden and pathological stage, and this predictive value is increased by accounting for cancer and gland volume with PSA-cancer density.

Adenocarcinoma↗

PubMed1994

Prostate-specific antigen levels after radical prostatectomy and immediate adjuvant hormonal treatment for stage D1 prostate cancer are predictive of early disease outcome.

Detectable prostate-specific antigen (PSA) levels (> or = 0.1 ng/ml) after radical prostatectomy (RPx) for prostate cancer are consistent with residual disease. Conversely, androgen deprivation therapy that produces 'negative' PSA values may not reflect actual disease status. One hundred forty-four patients with stage D1 prostate cancer treated with RPx and immediate adjuvant hormonal therapy (IAHT) had preoperative PSA tests and serial PSA evaluation up to 5.5 years postoperatively. Initial postoperative PSA levels (Hybritech method), performed a median of 3.7 months postoperatively, were undetectable (< 0.1 ng/ml) in 72% of patients, 0.1 ng/ml in 10%, 0.2 ng/ml in 8%, and > or = 0.3 ng/ml in 10%. Among patients whose initial PSA levels were detectable, 84% attained an undetectable level at a median time of 14.4 months postoperatively. The 3-year clinical progression rate after the initial postoperative (3.7 months) PSA determination was higher (20%) for those patients with a detectable PSA level compared with those with an undetectable level (7%; p = 0.09). Mean time to last PSA determination was 2.6 years (range 0.2-5.2 years). The course of the follow-up PSA values was classified for 126 patients as (a) negative (all PSA levels undetectable or decreasing), (b) solitary spikes (a one-time increase in PSA level), (c) positive (two or more increasing PSA levels), or (d) indeterminate. For the 74 patients (59%) with a negative course, only 1 progressed clinically. Similarly, no clinical progression has been observed in the 21 patients with solitary spikes, and only one progression has been noted in the 12 patients with an indeterminate course.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗

PubMed1993

Stage D1 prostate cancer. A nonrandomized comparison of conservative treatment options versus radical prostatectomy.

BACKGROUND: Untreated Stage D1 prostate cancer is associated with a high progression rate. Various treatment modalities involving monotherapy alone have been associated with dismal results. In this retrospective study, the impact of combination therapy, local (surgery or radiation) and systemic (hormonal), compared with that of monotherapy on disease outcome was evaluated. METHODS: The authors reviewed 631 patients who underwent pelvic lymphadenectomy for Stage D1 prostate cancer: 251 had radical prostatectomies and orchiectomies, 78 had radical prostatectomies alone, 97 received local irradiation and underwent orchiectomies, and 60 had orchiectomies alone. RESULTS: Cause-specific survival rates for prostatectomy-orchiectomy-treated (PO) patients at 5 and 10 years were 91% and 78%, respectively; they were 84% and 54% for irradiation-orchiectomy-treated (IO) patients and 66% and 39% for orchiectomy alone-treated (O) patients, respectively. Controlling for the number of nodes, the difference between PO-treated and IO-treated patients was not significant; the former group had a significantly longer survival than the O-treated patients (P = 0.037). The 5-year and 10-year cause-specific survival rates for prostatectomy alone-treated patients were 91% and 75%, respectively, and 84% and 45% for irradiation alone-treated patients. Thus, cause-specific survival rates in prostatectomy alone-treated patients were significantly better (P = 0.0085). CONCLUSIONS: For patients with Stage D1 prostate adenocarcinoma, radical prostatectomy and local irradiation as local treatments when combined with orchiectomy produce similar outcomes. These results should be verified in a prospective study.

Biomarkers, Tumor↗

PubMed1993

Long-term evaluation of radical prostatectomy as treatment for clinical stage C (T3) prostate cancer.

We reviewed the results of radical prostatectomy in 232 patients with clinical Stage C prostate cancer for comparison with published results of irradiation for clinical Stage C patients. Twenty-two percent were Stage B pathologically (i.e., overstaged clinically); 36 percent were pathologic Stage C and 42 percent were Stage D1. Fifty-four percent had had adjuvant treatment immediately postoperatively. Mean follow-up was 4.9 years, with 86 and 32 patients under observation at five and ten years, respectively. Overall, cause-specific, disease-free, and local recurrence-free survival rates were 84 percent, 89 percent, 69 percent, and 90 percent, respectively, at five years, and 72 percent, 82 percent, 56 percent, and 82 percent, respectively, at ten years. Although adjuvant hormonal treatment affected progression significantly (P = 0.0069), it did not affect survival significantly. When the analysis of survival to a female prostate-specific antigen (PSA) level was combined with clinical disease-free survival to provide a more accurate measure of disease progression, 90 percent, 51 percent, and 38 percent of patients with clinical Stage C prostate cancer were free of disease at one, five, and ten years, respectively. The clinical data suggest that radical surgery often combined with immediate adjuvant therapy may provide better disease control (including PSA values) than primary radiotherapy.

Adult↗

PubMed1993

Clinical Stage B0 or T1c prostate cancer: nonpalpable disease identified by elevated serum prostate-specific antigen concentration.

A retrospective study was performed to evaluate the clinical and pathologic characteristics of 60 patients with a palpably benign prostate gland, but with biopsy-proved prostate cancer. All patients underwent prostate biopsy because of elevated serum prostate-specific antigen (PSA) concentration, and subsequently underwent radical retropubic prostatectomy (RRP). Similar analysis was performed for a randomly selected group of 60 clinical Stage B1 prostate cancers from the same period (control cohort). Patients with nonpalpable prostate cancers had a higher preoperative PSA level as compared with the clinical Stage B1 group (median value: 12.3 ng/mL versus 4.6 ng/mL, p < 0.001). There was no significant difference between the two groups with regard to clinical parameters (voiding symptoms, hematuria, age). The nonpalpable prostate cancers exhibited a significant tumor volume (mean: 7.4 cc; range: 0.3-56 cc), and 18 (30%) demonstrated capsular perforation to involve the periprostatic tissues. Of these, three (5%) had seminal vesicle invasion, and one (2%) had pelvic lymph node involvement. There was no difference between these pathologic characteristics and those of the clinical Stage B1 prostate cancers. These findings suggest that nonpalpable prostate cancers identified by an elevated serum PSA level can be of clinical significance and warrant therapeutic consideration. Although nonpalpable, these cancers are peripherally located and were clinically suspected prior to biopsy. Therefore, we propose that these cancers be classified as clinical Stage B0 in the Whitmore-Jewett staging system; in the new TNM staging system, they are designated as clinical Stage T1c.

Adult↗