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J I Epstein

Publications and source records attributed to J I Epstein.

At least 127 records · Page 7Linked to original sources
PubMed1998

Treatment with finasteride preserves usefulness of prostate-specific antigen in the detection of prostate cancer: results of a randomized, double-blind, placebo-controlled clinical trial. PLESS Study Group. Proscar Long-term Efficacy and Safety Study.

OBJECTIVES: To evaluate prostate cancer detection and prostate-specific antigen (PSA) among men with benign prostatic hyperplasia treated with finasteride. METHODS: Three thousand forty men 45 to 78 years of age with PSA less than 10 ng/mL and no history of prostate cancer were randomized in a double-blind, placebo-controlled trial to finasteride (n = 1524) or placebo (n = 1516) for up to 4 years. A prerandomization biopsy negative for prostate cancer was obtained in 98% of patients with a screening PSA of 4.0 ng/mL or more, and an end-of-study biopsy was requested of all such patients without a recent second negative biopsy or a prostate cancer diagnosis. RESULTS: Overall, 644 patients (21%) underwent biopsy and 201 (6.6%) underwent transurethral resection of the prostate. Prostate cancer was diagnosed in 4.7% of men on finasteride and 5.1% on placebo (P = 0.7). Elevated PSA prompted diagnosis in 35% of cases on finasteride and 34% on placebo. The area under the receiver operating characteristic curve for last PSA was 0.84 on finasteride and 0.79 on placebo (P = 0.07). Use of an upper limit of normal for last PSA of 2.0 ng/mL for finasteride and 4.0 ng/mL for placebo yielded similar sensitivity (66% versus 70%, P = 0.6), higher specificity (82% versus 74%, P < 0.0001), and a higher likelihood ratio (3.6 versus 2.7, P < 0.05) for finasteride than for placebo. CONCLUSIONS: In men treated with finasteride, multiplying PSA by 2 and using normal ranges for untreated men preserves the usefulness of PSA for prostate cancer detection.

Aged↗
PubMed1998

Repeat biopsy strategies for men with atypical diagnoses on initial prostate needle biopsy.

OBJECTIVES: To evaluate trends in prostate sampling and the efficacy of different sampling methods to detect prostate cancer in subsequent biopsies after an initial "atypical" biopsy. METHODS: We searched Dianon Systems from March 1994 to June 1996 for cases with an initial atypical diagnosis on biopsy and that had repeat biopsies. The files of Dianon and Johns Hopkins Hospital (JHH) were also analyzed for cases with an initial atypical diagnosis on sextant biopsy and for repeat sextant biopsies showing cancer. RESULTS: Of the 1 24 Dianon cases in which we knew the site (sextant, left, right) of the initial and subsequent biopsies, 56 cases (45.2%) were cancer on repeat biopsy; in cases with repeat sextant biopsies, cancer was detected 59.3% of the time. There were 54 cases in which the initial biopsy was atypical and the repeat biopsy was cancer, where both sets of biopsies were sextants (44 Dianon, 10 JHH). Of the 46 cases with only one initial atypical site, the cancer was in the same sextant site as the previously atypical biopsy in 47.8% of cases; cancer was detected in 84.8% of the cases in either the same sextant, adjacent ipsilateral, or adjacent contralateral sites. CONCLUSIONS: Great variation exists in how urologists sample prostates both initially and after an atypical diagnosis. Of the 149 Dianon cases, only 32 were sextant to sextant biopsies, and another 32 were consistently left and right to left and right. Our study shows that in subsequent biopsies after an atypical biopsy, the chance of detecting cancer greatly increases with biopsy not only of the atypical site, but adjacent contralateral and adjacent ipsilateral areas as well. We advocate the precise labeling of the initial biopsies so that rebiopsy of atypical cases can be directed in a more concentrated fashion into the region of the initial atypical biopsy. Other sites should be biopsied as well, which urologists did not always do, because cancer may also be found away from the initial atypical site.

Biopsy, Needle↗
PubMed1998

Sarcomas and related proliferative lesions of specialized prostatic stroma: a clinicopathologic study of 22 cases.

Sarcomas and related proliferative lesions of the specialized prostatic stroma have been the subject of case reports and, thus, have not been well characterized. We reviewed the clinicopathologic features of 22 cases and studied the immunohistochemical profile of 9. Patient age ranged from 25 to 86 years; mean age was 54 years, and peak incidence was in the 6th and 7th decades. The most common clinical presentation was urinary retention, then abnormal results of digital rectal examination, hematuria or hematospermia, and a palpable rectal mass. The cases were grouped into two categories: prostatic stromal proliferation of uncertain malignant potential (PSPUMP, 18 cases) and prostatic stromal sarcoma (PSS, 4 cases) based on the degree of stromal cellularity and the presence of mitotic figures, necrosis, and stromal overgrowth. Four histologic patterns of PSPUMP were identified: (1) hypercellular stroma with scattered cytologically atypical cells associated with benign glands, (2) hypercellular stroma with minimal cytological atypia associated with benign glands, (3) hypercellular stroma with or without cytologically atypical cells, associated with benign glands in a "leaflike" growth pattern that resembled phyllodes tumors of the mammary gland, and (4) hypercellular stroma without cytologically atypical stromal cells and without glands. Prostatic stromal sarcoma showed greater cellularity, mitoses, necrosis, and stromal overgrowth than PSPUMP and consisted either of stromal elements with benign glands in a pattern that resembled malignant phyllodes tumors of the mammary gland (3 cases) or of purely stromal elements (1 case). Positive immunohistochemical reactions were noted using vimentin in 9 of 9 cases, CD34 in 8 of 8, HHF-35 in 2 of 8, smooth muscle actin in 3 of 9, desmin in 4 of 8, S-100 protein in 0 of 9, estrogen receptor in 1 of 7, and progesterone receptor in 6 of 7. None of the cases classified as PSS were positive for HHF-35, smooth muscle actin, or desmin. Of the 13 patients classified as having PSPUMP who did not undergo definitive local therapy at the time of diagnosis, recurrent signs or symptoms were seen in six (46%), necessitating additional therapy. Distant metastases to lung and bone developed in one patient classified as having PSS. Clinical and pathologic findings in this patient suggested a progression from PSPUMP to PSS. We conclude that sarcomas and related proliferative lesions of the specialized prostatic stroma encompass a spectrum of histologic features and may be grouped into two clinicopathologic categories: PSPUMP and PSS. Based on their distinctive histologic appearance and immunohistochemical profile, PSPUMP and PSS can be differentiated from other mesenchymal lesions of the prostate.

Adult↗
PubMed1998

Partial atrophy in prostate needle cores: another diagnostic pitfall for the surgical pathologist.

We have seen in consultation a variant of atrophy, which is frequently confused with well-differentiated adenocarcinoma of the prostate. We have designated this entity as partial atrophy to distinguish it from its more common counterpart of fully developed atrophy. Partial atrophy is defined as benign prostate glands with relatively scant cytoplasm, yet the glands are not fully atrophic in that they do not appear basophilic at low magnification. Fifty-one cases of partial atrophy were identified (4 from Johns Hopkins Hospital, 47 from consultation). Within the partial atrophy focus, irregular (crinkled) nuclei were frequent in 23.5% and occasionally present in 33.3% of cases. Visible nucleoli were frequent in 25.4% of cases. Basal cells were not identifiable in 27.4% of cases or were hard to identify in 35.3% of cases. No intraluminal crystalloids or blue-tinged mucinous secretion was identified in partial atrophy. Adenocarcinoma or glands suspicious for cancer were present in other cores in 15.6% of cases. More fully developed atrophy was present in simultaneously obtained needle cores in 35.3% of cases. In the cases in which regular atrophy was the only coexisting condition, it was present within one 10x field from the partial atrophy in 22.2%, farther than one 10x field from the partial atrophy in 11.1%, and present in the same gland as the partial atrophy in 66.7%. Partial atrophy may be confused with low-grade adenocarcinoma because of the focus of crowded glands, irregular nuclei, and visible nucleoli. Clues for recognizing partial atrophy include relatively scant cytoplasm, distinct crinkled nuclei, pale cytoplasm similar to adjacent, more recognizably benign glands, and association with more fully developed benign atrophy.

Adenocarcinoma↗
PubMed1998

Histology and cellular kinetics of prostatic atrophy.

This study addresses two issues regarding prostatic atrophy: (1) the histologic features of atrophy as seen on needle biopsy results and how they affect the diagnosis of atrophy and (2) the cellular kinetics of atrophy and what it suggests about the mechanism of atrophy. We reviewed hematoxylin and eosin sections for 103 prostate needle biopsy specimens with atrophy. Each biopsy specimen was classified as either simple atrophy (large atrophic glands without crowding: 53 cases) or postatrophic hyperplasia (PAH) (crowded focus of small atrophic acini: 50 cases). Cell proliferation in both the atrophic and benign glands was evaluated in 103 cases by immunohistochemistry using antibodies against MIB-1. The TdT-mediated dUTP-biotin nick-end labeling technique was performed on 61 cases to quantitate apoptosis in atrophic and benign glands. Thirty-two percent of cases showed chronic inflammation, 21% showed acute inflammation, 14% showed nucleoli, and 1% showed mitoses. In comparison to simple atrophy, PAH contained more frequent prominent nucleoli (p < 0.0001) and acute inflammation (p < 0.0001), yet not chronic inflammation. In a multivariate analysis, acute inflammation and PAH pattern influenced the presence of prominent nucleoli. Staining for MIB-1 was greater in atrophic (27.5 cells/1000 cells) than in benign glands (3.5 cells/1000 cells), greater in PAH than in simple atrophy (p = 0.0015), and greater with acute (p = 0.05) but not chronic inflammation. In a multivariate analysis, only the pattern of atrophy and not acute inflammation was found to influence MIB-1. The rate of apoptosis was negligible in both the benign and atrophic glands, did not vary with pattern of atrophy, and did not correlate with MIB-1. Despite the atrophic appearance, atrophic glands in PAH show more proliferative activity than benign, nonatrophic glands and show no evidence of active involution, justifying the term "postatrophic hyperplasia" for this pattern of atrophy. Prominent nucleoli are seen more frequently in postatrophic hyperplasia, even in the absence of acute inflammation. To avoid a potential erroneous diagnosis of cancer, a constellation of features suggestive of malignancy should be considered, rather than relying on prominent nucleoli as the sole criteria for the diagnosis of prostate cancer.

Antigens, Nuclear↗
PubMed1998

The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee.

This WHO/ISUP system is an attempt to develop as broad a consensus as possible in the classification of urothelial neoplasms, building upon earlier works and classification systems. It is meant to serve as a springboard for future studies that will help refine this classification, thus enabling us to provide better correlation of these lesions with their biologic behavior using uniform terminology.

Carcinoma, Transitional Cell↗
PubMed1998

Analysis of the prostatic central zone in patients with unilateral absence of wolffian duct structures: further evidence of the mesodermal origin of the prostatic central zone.

PURPOSE: We evaluate the status of the prostatic central zone in patients with unilateral absence of the seminal vesicles and vas deferens. MATERIALS AND METHODS: The entire bases of the prostate specimens from 3 patients with unilateral absence of the seminal vesicles and vas deferens who underwent radical prostatectomy for prostatic adenocarcinoma were evaluated on hemotoxylin and eosin stained sections for the distribution of the central zone. Immunohistochemical stains for pepsinogen II were performed on areas thought to be central zone and on corresponding contralateral sections. RESULTS: In 1 patient who appeared to have complete unilateral absence of wolffian duct structures the central zone was absent on that side. In the 2 other patients who did not have complete wolffian duct absence the central zone was present on the side lacking the seminal vesicle and vas deferens. The ejaculatory duct was absent on the side ipsilateral to the absent seminal vesicle and vas deferens in the 2 patients for whom it could be evaluated. CONCLUSIONS: The findings support the concept that the prostatic central zone is mesodermally derived. However, not all patients lacking the seminal vesicle and vas deferens are missing a prostatic central zone, suggesting that this is a heterogeneous disorder.

Abnormalities, Multiple↗
PubMed1998

The use of percent free prostate specific antigen for staging clinically localized prostate cancer.

PURPOSE: The free-to-total serum prostate specific antigen (PSA) ratio (percent free PSA) has been demonstrated to have clinical use for early detection of men with prostate cancer with total PSA levels between 4.0 and 10.0 ng./ml. Several studies evaluating the usefulness of percent free PSA for the staging of clinically localized prostate cancer have provided conflicting results. We further investigate the usefulness of percent free PSA for staging of clinically localized prostate cancer. MATERIALS AND METHODS: In 263 men with clinically localized prostate cancer who underwent radical prostatectomy total PSA and free PSA were measured preoperatively. Pathological stages were classified as organ confined in 134 cases, capsular penetration in 92, seminal vesicle involvement in 7, involvement of the surgical margins in 20 and lymph node involvement in 10. RESULTS: Percent free PSA was significantly different between men with organ confined versus nonorgan confined tumors (p <0.0001) and between those with favorable versus unfavorable pathology (p <0.0001). A cutoff of 12% free PSA provided a 72% positive predictive value and 52% negative predictive value for favorable pathology. A cutoff of 15% free PSA provided a 76% and 53% positive and negative predictive value, respectively, for organ confined disease. CONCLUSIONS: These data demonstrate that the use of percent free PSA may be of additional value for the staging of clinically localized prostate cancer. The recommendations for cutoff levels of percent free PSA for detection and staging of localized prostate cancer are preliminary and can only be given for this particular assay. A large multicenter trial, controlling for age, stage and grade distribution, as well as for a uniform pathological evaluation and comparable total and free PSA assays, is required to elucidate this issue further.

Aged↗
PubMed1998

Disease progression following radical prostatectomy in men with Gleason score 7 tumor.

PURPOSE: The long-term prognosis of men with Gleason score 7 adenocarcinoma of the prostate is uncertain. MATERIALS AND METHODS: We studied 488 men whose radical prostatectomy specimen showed Gleason score 7 tumor without involvement of the seminal vesicles or lymph nodes. Of the 400 men without progression 318 had been followed for 2 years or more and 93 for 7 years or more. RESULTS: Cases of organ confined disease and negative margins regardless of extent of extraprostatic extension had roughly similar and better prognoses than cases of focal and established extraprostatic extension with positive margins. The greater influence of margin status on progression (p <0.0001) compared to extent of extraprostatic extension (p = 0.023) was evidenced in the multivariate analysis. Of 30 men with established extraprostatic extension and positive margins 6 (20%) had progression to distant metastases, which was similar to 14 of 58 (24%) without established extraprostatic extension and positive margins. There was no difference in response to radiotherapy between men with established extraprostatic extension and positive margins compared to the other cases. CONCLUSIONS: Margins status greatly influences the risk of progression in men with Gleason score 7 tumors. Among men with Gleason score 7 tumors, except for those with established extraprostatic extension and positive margins, more than 50% appear to be cured at long-term followup. Because of the high risk of progression in patients with positive margins, clinical studies of adjuvant therapy in this population appear warranted.

Adenocarcinoma↗
PubMed1998

CG island methylation changes near the GSTP1 gene in prostatic intraepithelial neoplasia.

Prostate intraepithelial neoplasia (PIN) is a purported prostate cancer precursor lesion and a candidate biomarker for efficacy assessment in prostate cancer chemoprevention trials. Loss of expression of the pi-class glutathione S-transferase enzyme GSTP1, which is associated with the hypermethylation of deoxycytidine residues in the 5'-regulatory CG island region of the GSTP1 gene, is a near-universal finding in human prostate cancer. GSTP1 expression was assessed by immunohistochemistry in 60 high-grade PIN samples adjacent to and distant from prostate adenocarcinoma. Whereas abundant enzyme polypeptide expression was evident in all normal prostatic tissues, all samples of high-grade PIN and adenocarcinoma were completely devoid of GSTP1. DNA from 10 high-grade PIN lesions was analyzed for GSTP1 CG island methylation changes using a PCR technique targeting a polymorphic (ATAAA)n repeat sequence in the promoter region of the GSTP1 gene. Somatic GSTP1 CG island methylation changes were detected in DNA from 7 of the 10 PIN lesions. Allele discrimination was possible for 5 of the 10 DNA samples: 2 of the 5 samples exhibited DNA methylation changes at both alleles; whereas 3 samples displayed no DNA methylation changes at either allele. GSTP1 CG island methylation changes were present in each of the five homozygous samples. Hypermethylation of the 5'-regulatory region of the GSTP1 gene may serve as an important molecular genetic biomarker for both prostate cancer and PIN. The finding of frequent GSTP1 methylation changes in PIN and prostate cancer supports a role for PIN lesions as a prostate cancer precursor and may provide insight to the molecular pathogenesis of prostate cancer.

Adenocarcinoma↗
PubMed1998

Influence of radical prostatectomy on serum hormone levels.

PURPOSE: The influence of radical prostatectomy on the hypothalamic pituitary axis has not been well studied. It is also unclear how alterations in serum androgen levels that result from surgical removal of the prostate might influence the recovery of libido and sexual function following radical prostatectomy. We determined the influence of radical prostatectomy on the hypothalamic pituitary testicular axis of 63 men with clinically localized prostate cancer treated only with radical prostatectomy. MATERIALS AND METHODS: A total of 63 healthy men 43 to 67 years old were enrolled in this prospective study. Phlebotomy was performed immediately before and 1 year following radical retropubic prostatectomy. Sera were stored frozen and analyzed as a group at the end of the study. We measured serum testosterone, percent free testosterone, dihydrotestosterone (DHT), estradiol, luteinizing hormone (LH), follicle-stimulating hormone (FSH), sex hormone binding globulin and prolactin. RESULTS: Following radical prostatectomy there was a statistically significant increase in serum testosterone, free testosterone, estradiol, LH and FSH (p <0.0001), and statistically significant decrease in serum DHT (p <0.0001). No difference was noted in serum sex hormone binding globulin or prolactin levels. There was no statistically significant correlation between any serum hormone and sample storage time, patient age or prostate volume that could limit potential bias in study design. Serum hormone changes did not correlate with pathological stage or histological grade for this group of patients. CONCLUSIONS: Radical prostatectomy influences the hypothalamic pituitary axis by increasing serum testosterone, percent free testosterone, estradiol, LH and FSH while decreasing serum DHT levels. These findings suggest that the sexual dysfunction associated with radical prostatectomy cannot be explained by androgen deficiency alone. These data further suggest that the normal prostate and/or prostate neoplasm could secrete a substance or substances that give negative feedback control to pituitary gonadotropin secretion. Further investigation is warranted to identify this substance or substances.

Adult↗
PubMed1998

The role of perineural invasion and other biopsy characteristics as prognostic markers for localized prostate cancer.

The presence of perineural invasion and the finding of Gleason score 7 cancer on three cores in this case signifies a high likelihood of extraprostatic extension. However, the presence of perineural invasion on prostate biopsy does not independently influence the likelihood of prostate-specific antigen recurrence following radical prostatectomy when matched for preoperative Gleason score, prostate-specific antigen, and clinical stage. This is because cases with perineural invasion on needle biopsy are often associated with other adverse preoperative features such as high biopsy Gleason score, multiple cores involved, and high serum prostate-specific antigen levels. The finding of perineural invasion on needle biopsy may aid urologists in deciding whether to resect the neurovascular bundle on the side of perineural invasion. Excising the neurovascular bundle in cases with perineural invasion will reduce the incidence of positive margins by 17.5% of cases. The remaining cases not benefiting from neurovascular bundle excision are equally divided between extremely aggressive tumors with positive margins outside the neurovascular bundle region or positive seminal vesicles and lymph nodes, and less aggressive tumors that are either organ-confined or have very limited extraprostatic extension.

Biopsy, Needle↗
PubMed1998

Nonpalpable stage T1c prostate cancer: prediction of insignificant disease using free/total prostate specific antigen levels and needle biopsy findings.

PURPOSE: Approximately 25% of radical prostatectomies performed for stage T1c disease show potentially insignificant prostate cancer. We previously reported the use of serum prostate specific antigen (PSA) density and needle biopsy findings to predict potentially insignificant cancer. We now evaluate whether using free/total serum PSA levels along with needle biopsy findings can better predict tumor significance. MATERIALS AND METHODS: We studied 163 radical prostatectomy specimens of stage T1c prostate cancer in which free/total serum PSA levels were determined. Free/total serum PSA levels were measured with Tandem-MP PSA assays. Insignificant prostate cancers were organ confined with tumor volumes less than 0.5 cc and Gleason score less than 7. Advanced tumors were either Gleason score 7 or greater, established extraprostatic extension with positive margins, or positive seminal vesicles or lymph nodes. Other cases were considered as moderate tumor. Moderate and advanced tumors were considered significant. RESULTS: Of the tumors 30.7% were insignificant, 49.7% moderate and 19.6% advanced. The best model to predict preoperatively insignificant tumor was a free/total PSA of 0.15 or greater and favorable needle biopsy findings (less than 3 cores involved, none of the cores with greater than 50% tumor involvement and Gleason score less than 7). Using this model of the 18 tumors predicted to be insignificant 17 were insignificant for a positive predictive value of 94.4%. Of the 145 cases that were predicted to be significant 112 were correctly predicted for a negative predictive value of 77.2%. There was only 1 tumor predicted to be insignificant which was classified as moderate. No tumor predicted to be insignificant was advanced. CONCLUSIONS: In conjunction with needle biopsy findings, free/total PSA levels accurately predict insignificant tumor in stage T1c disease.

Biopsy, Needle↗
PubMed1997

Recommended prostate-specific antigen testing intervals for the detection of curable prostate cancer.

OBJECTIVE: To evaluate prostate-specific antigen (PSA) testing intervals that maintain the detection of curable cancer and reduce unnecessary testing. DESIGN AND PATIENTS: Historical prospective study of serial PSA measurements at 2- and 4-year intervals from frozen serum samples of 40 men who eventually developed prostate cancer and 272 men without prostate cancer who were participants in a prospective aging study (Gerontology Research Center of the National Institute on Aging, the Baltimore Longitudinal Study of Aging) and the case series of 389 consecutive men treated surgically for nonpalpable prostate cancer. MAIN OUTCOME MEASURES: Probability of a PSA conversion to 4.1 to 5.0 ng/mL and to greater than 5.0 ng/mL at 2 and 4 years and probability of detecting curable prostate cancer by age and PSA level. RESULTS: When the pretreatment PSA level was less than or equal to 4.0 ng/mL, nonpalpable prostate cancers were highly likely (34/36, 94%) to be curable (organ-confined or capsular penetration with Gleason score < 7 and negative margins), and the majority (25/36, 69%) were small cancers (confined tumor < or = 0.5 cm3 with no Gleason pattern 4 or 5). When the pretreatment PSA level was greater than 4.0 ng/mL and less than or equal to 5.0 ng/mL, cancers were highly likely to be curable (32/36, 89%), and a minority were small cancers (12/36, 33%). When the pretreatment PSA level was greater than 5.0 ng/mL, 96 (30%) of 317 cancers were noncurable. The PSA conversion (for cancer cases) to a level at which cure is less likely (> 5.0 ng/mL) is rare (0%) after 2 or 4 years when the initial PSA is less than 2.0 ng/mL. PSA conversion to a range at which cancers are likely to be curable and less likely to be small (4.1-5.0 ng/mL) is rare after 2 years (0%-4%) when the baseline PSA level is less than 2.0 ng/mL but common when the baseline PSA level is between 2.1 and 3.0 ng/mL (27%) or 3.1 and 4.0 ng/mL (36%). CONCLUSIONS: These data suggest that for men with no cancer suspected on digital rectal examination, a PSA level of 4.0 to 5.0 ng/mL is an acceptable range for maintaining the detection of curable prostate cancer and a 2-year PSA testing interval is not likely to miss a curable prostate cancer when the initial PSA level is less than 2.0 ng/mL. Recognizing that 70% of a screened population between the ages of 50 years and 70 years have PSA levels less than 2.0 ng/mL, elimination of annual PSA testing for these men would result in large health care cost savings.

Aged↗
PubMed1997

Tumor angiogenesis correlates with progression after radical prostatectomy but not with pathologic stage in Gleason sum 5 to 7 adenocarcinoma of the prostate.

BACKGROUND: Prior studies have suggested that tumor angiogenesis (microvessel density [MVD]) may be of prognostic significance in patients with prostate carcinoma. METHODS: The authors examined the relationship of MVD in intermediate grade prostate carcinomas with stage at radical prostatectomy (RP) and progression after RP. For the former group, 109 RP specimens with Gleason sums of 6 and 7 were studied: 34 organ-confined tumors, 37 with capsular penetration, 21 with seminal vesicle involvement, and 17 with pelvic lymph node metastasis. For the latter group, 87 RP specimens were studied that had a Gleason sum of 5 to 7 for which the patients underwent follow-up of at least 7 years or until progression. Thirty-seven patients (43%) progressed at a mean of 3.5 years (range, 1-8 years). Representative sections of each tumor were stained for CD31 and "hot spot" microvessels were quantitated in a 3.14-mm2 area. RESULTS: In the first arm, there was no relationship between MVD and stage at RP. In the second arm, the mean MVD in tumors that progressed was significantly higher than in nonprogressors (43.0 +/- 26.1 vs. 29.0 +/- 13.1; P < 0.0001 by Wilcoxon-Gehan statistic). MVD and Gleason sum were independent statistically significant predictors of progression (MVD, P < 0.0001; Gleason sum, P < 0.0001 by Cox proportional hazards model). CONCLUSIONS: MVD is an independent significant predictor of progression after RP for tumors with a Gleason sum of 5 to 7. Because these comprise the majority of RP specimens, it is this group for which discrimination of biologic potential is most needed. Angiogenesis may be useful in the prognostic stratification of patients beyond that possible using stage and grade alone.

Adenocarcinoma↗
PubMed1997

Prediction of significant cancer in men with stage T1c adenocarcinoma of the prostate.

Widespread prostate specific antigen (PSA) testing results in detection of prostate cancer 4-6 years earlier than possible with digital rectal examination. Twenty to thirty percent of prostate cancers detected with PSA testing (non-palpable disease) are small tumors (< 0.5cc) that may be unimportant in some men. Pre-treatment criteria that include PSA density and prostate biopsy findings provide the means to assess the significance of prostate cancer after diagnosis. This information is useful when counseling men regarding management options for non-palpable, PSA detected prostate cancer.

Adenocarcinoma↗
PubMed1997

Radical prostatectomy as treatment for prostate-specific antigen-detected stage T1c prostate cancer.

The use of serum prostate-specific antigen (PSA) measurement as a method for early detection of prostate cancer has increased the detection of clinically and pathologically localized prostate cancer. Clinical stage T1c was introduced to describe cancers discovered on prostate biopsy as a result of an abnormal serum PSA level without a palpable prostatic abnormality on digital rectal examination. The majority of men with stage T1c tumors have significant disease warranting treatment. We report the results of anatomic radical retropubic prostatectomy as therapy for PSA-detected stage T1c prostate cancer in 340 men treated at a single institution. In all, 17 men (5%) have had a recurrence with 2.3 +/- 1.2 years of follow-up, 15 of whom have experienced an isolated biochemical PSA recurrence only. The overall actuarial biochemical PSA recurrence-free rate at 6 years is 87%, with pathologic stage being the best single indicator of the likelihood of progression. Although a longer period of follow-up is needed, this interim report suggests that these men can be cured by surgery at rates equal to or better than those of previously reported radical prostatectomy series.

Actuarial Analysis↗