Biomedical subjects

P Hammerer

Publications and source records attributed to P Hammerer.

At least 37 records · Page 2Linked to original sources

PubMed2000

Advanced prostate cancer is associated with a decrease in serum luteinizing hormone.

OBJECTIVE: Depletion of serum LH by LHRH agonists is used as a therapeutic treatment in hormone-sensitive prostate cancer (PCa). However, little information on serum LH in different patient groups is available. METHODS: Patients with biopsy-proven PCa, men with BPH (biopsy-proven absence of PCa), two subgroups (serum PSA <4 ng/ml; PCa and BPH), and a PCa cohort before and after radical prostatectomy were analyzed for serum LH, testosterone (T), dihydrotestosterone (DHT), total and free PSA by immunological procedures. RESULTS: PCa patients with cancer volumes >10 cm(3), or with advanced Gleason scores, had significantly lower LH values than men in a cancer-free control group (PSA <4 ng/ml). Eight weeks after radical prostatectomy, LH levels had returned to the level of the control group (p<0.0001). These alterations were not accompanied by corresponding changes of serum androgens. Introduction of a PSA/LH ratio appeared to increase the differences between BPH and PCA groups ranked according to Gleason scores, versus PSA or LH alone. However, the calculation of ROC curves indicated that PSA/LH ratios may not improve the discrimination of malignant and benign forms of the disease, compared to presently used parameters. CONCLUSIONS: A significant reduction of circulating LH is observed in the most advanced forms of PCa. The effect does not come about by T- or DHT-mediated feedback inhibition. Since LH values after prostatectomy returned to practically the same levels as seen in the control group (BPH with <4 ng/ml PSA), it appears that the healthy prostate has no marked influence on serum LH while advanced PCa induces a decrease in serum LH.

Adult↗

PubMed1999

Allelic losses at 8p, 10q, 11p, 13q, 16q, 17p, and 18q in prostatic carcinomas: The impact of zonal location, Gleason grade, and tumour multifocality.

Molecular genetic investigations have made it clear that the development and progression of prostate cancer is associated with losses of genetic material in certain chromosomal arms. However, there are only few data about the question of whether the zonal location, a higher Gleason grade, or multifocality of the tumour have any influence on the pattern of allelic losses. In the present study, 48 tumour foci from 32 radical prostatectomy specimens were investigated for allelic losses at chromosomes 8p, 10q, 11p, 13q, 16q, 17p, and 18q with a set of 20 microsatellite markers. The results were analysed for the zonal location of the tumour foci and the presence of a Gleason grade 4 differentiation. Overall, focal allelic losses at 8p, 10q, 11p, 13q, 16q, 17p, and 18q were observed in 62.5%, 17.2%,. 3.2%, 18.8%, 40%, 9.7%, and 22.6% of the 32 cases, respectively. Comparing the frequencies of allelic losses with the zonal location or the Gleason grade, no highly significant correlations were found at any chromosomal locus investigated. However, the observation of different patterns of allelic losses in 12 of 14 cases containing more than one tumour focus indicates a high rate of genetic heterogeneity. We conclude that allelic losses at the chromosomal loci investigated are not strongly associated with a specific zonal location or a higher Gleason grade of prostatic carcinoma. Genetic heterogeneity of multiple tumour foci within one gland might contribute to the difficulties in predicting the prognosis for this common malignancy.

Journal Article↗

PubMed1999

Early prostate-specific antigen relapse after radical retropubic prostatectomy: prediction on the basis of preoperative and postoperative tumor characteristics.

OBJECTIVES: This study was undertaken to distinguish between patients who will and will not benefit from a retropubic radical prostatectomy (RRP) for clinically localized prostatic carcinoma (PCa) on the basis of preoperative and postoperative tumor characteristics. METHODS: Data of 318 consecutive patients who underwent RRP for clinically localized PCa were reviewed. Preoperative characteristics used included clinical stage, findings on transrectal ultrasonography, prostate-specific antigen (PSA) values, Gleason grade, number of positive biopsies, number of biopsies containing any Gleason grade 4 and/or 5 cancer, and number of biopsies with predominant (>50% of cancerous tissue) Gleason grade 4 and/or 5 cancer. Postoperative characteristics included pathologic stage, Gleason grade, margin status, cancer volume, and volume of Gleason grade 4 and/or 5 cancer. The impact on biochemical relapse after RRP were calculated by Cox regression and CART (classification and regression tree) analysis to establish low, intermediate, and high risk of recurrence. RESULTS: Of patients who underwent RRP, 66% showed no evidence of relapse after a follow-up of 42 months. All preoperative and postoperative characteristics showed a significant association with biochemical relapse. Cox regression of preoperative characteristics showed the number of positive biopsies with predominant Gleason grade 4 and/or 5 cancer to be the most accurate predictor of failure (p < 0.0001), followed by the number of positive biopsies and PSA. CART analysis distinguished between four risk groups on the basis of the same characteristics as in the Cox regression. The low-risk group consisted of 232 patients (75.1%) and the high-risk group of 17 patients (5.5%); corresponding Kaplan-Meier curves showed a 2-year PSA-free survival rate of 97% for the low-risk group and 20% for the high-risk group. Cox regression of postoperative characteristics recognized the volume of Gleason grade 4 and/or 5 as the characteristic with the strongest association with biochemical failure. CART analysis distinguished between four risk groups, using the volume of high-grade cancer as the most influential characteristic. The corresponding Kaplan-Meier curves showed for the low-risk group (n = 79; 29.6%) a PSA-free survival rate of 96% after 42 months and for the high-risk group (n = 47; 17.6%) a 21% PSA-free survival rate after 42 months. CONCLUSION: For preoperative and postoperative estimation of biochemical recurrence after RRP, a quantitative analysis of high-grade cancer, expressed by the number of preoperative biopsy cores containing high-grade cancer and the volume of cancer, proved to be the best predictor of relapse. CART analysis might be useful in advising patients for their best therapy options. However, defined characteristics of risk groups should be evaluated with new prospective data before they are used routinely.

Adenocarcinoma↗

PubMed1999

Molecular heterogeneity of free PSA in sera of patients with benign and malignant prostate tumors.

OBJECTIVE: To analyze free prostate-specific antigen (f-PSA) in sera from patients with prostate cancer (PCa) and benign prostatic hyperplasia (BPH), and to detect possible differences in subtypes as potential diagnostic parameters. MATERIALS AND METHODS: PSA was purified from sera by an immunoaffinity procedure developed on the basis of oriented antibody immobilization, and subjected to size exclusion chromatography (SEC), Western blotting, and N-terminal amino acid sequencing. RESULTS: The novel procedure allowed the purification of PSA with high yield from sera containing PSA <10 ng/ml. SEC under nonreducing conditions as well as Western blots demonstrated the presence of several molecular forms of f-PSA. Three of the smaller polypeptides exhibited the N-terminal sequence of PSA while one represented the C-terminal fragment Lys(146)-Pro(237). Shortening of some polypeptides by the N-terminal amino acid Ile(1) suggestive of aminopeptidase action was also observed. No propeptide sequence could be detected, and none of the bands from patient sera reacted with antibodies raised against propeptide antigens. BPH sera expressed higher proportions of smaller PSA fragments per unit p33, and contained significant amounts of fragments <14,000 which appeared to be very low or absent from most PCa sera. CONCLUSIONS: f-PSA as obtained from BPH and PCa sera represents a heterogeneous fraction. The major component (p33) is not in the nicked form and does not contain proPSA. Diagnostic potential could arise from the quantitative differences of the smaller PSA derivatives seen between PCa and BPH sera.

Amino Acid Sequence↗

PubMed1999

Ultrasensitive detection of prostate specific antigen in the followup of 422 patients after radical prostatectomy.

PURPOSE: We validated our ultrasensitive prostate specific antigen (PSA) assay based on lyophilization and 4-fold concentration of patient sera with the clinical long-term followup and according to histopathological characteristics of 422 patients treated with radical retropubic prostatectomy for prostate cancer. MATERIALS AND METHODS: Each serum sample was divided into 2 aliquots for standard and 4-fold concentrated (ultrasensitive) detection. Samples were analyzed by the same unmodified DPC-Immulite PSA assay. Biochemical relapse was defined as an increase of at least 0.10 ng./ml. in native serum (equivalent to 0.025 ng./ml. in concentrated serum). Mean followup was 449 days (range 29 to 2,057). Kaplan-Meier analysis of standard and ultrasensitive detection results was done, and findings were correlated with pathological stage, Gleason grade, total cancer volume, Gleason grade 4 cancer volume and margin status. Significance of earlier detection in ultrasensitive versus standard detection was calculated with the log rank (Mantel-Cox) test with p <0.05 considered significant. RESULTS: Of 442 patients 88 (20.8%) experienced biochemical recurrence. Of this cohort 28 (31%) demonstrated early failure on the ultrasensitive assay which was later confirmed on the standard assay, 37 (42%) had failure simultaneously on both assays and 23 (26%) had failure on the ultrasensitive but remained disease-free on the standard assay. Average time for ultrasensitive assay detection of recurrence was 288 days (standard 555). Kaplan-Meier analysis revealed significant advantages in earlier detection of recurrence with the ultrasensitive assay, and close correlation with pathological stage, Gleason grade, margin status and Gleason grade 4 cancer volume. Time advantages of ultrasensitive versus standard detection were greater for advanced cancers (pT3a/b or greater, Gleason 3 + 4 or greater) than for small, low grade tumors. All patients who had positive results on the standard assay had a previous (28) or simultaneous (37) positive ultrasensitive result. With standard detection 25% of all relapses were evident within the first year of surgery and with ultrasensitive detection the percentage increased to 85.7%. On both assays 334 patients remained free of biochemical recurrence. CONCLUSIONS: Our ultrasensitive PSA assay is useful for early detection of biochemical relapse after radical retropubic prostatectomy. It not only provides the same accuracy as conventional PSA assays but also offers the advantage of detecting recurrence about 300 days earlier. Thus, long-term results of radical retropubic prostatectomy series can be calculated sooner. The clinical impact of this assay will be obvious once curative treatment options are available if applied at the earliest time of evident tumor recurrence.

Follow-Up Studies↗

PubMed1998

Interphase cytogenetic study of preoperative core biopsies for the prediction of early serum prostate specific antigen recurrence after radical prostatectomy of clinically localized prostate carcinoma.

BACKGROUND: Current clinical and pathologic methods are imprecise in predicting the extent of prostate carcinoma progression. This study was conducted to evaluate the role of interphase cytogenetics (ICG) with chromosome enumeration probes relative to the role of conventional pathologic characteristics in the preoperative prediction of postoperative tumor classification and recurrence of elevated serum concentrations of prostate specific antigen (PSA). METHODS: The authors performed ICG with enumeration probes for chromosomes 7, 17, and X on 6-microm sections of core biopsies from 75 patients with clinically localized adenocarcinoma of the prostate. Results were compared with pathologic findings (tumor classification, volume, and status of surgical margins) of the corresponding radical prostatectomy specimens and data on serum PSA measurements taken for 72 patients during a follow-up period of up to 42 months (mean, 19.8 months). In addition to ICG, biopsies were reviewed for primary, secondary, highest, and combined Gleason grades, number and bilaterality of positive biopsies, amount of carcinoma (percentage and core length of infiltration), amount of high grade carcinoma, and perineural invasion. RESULTS: Chromosome categories were unevenly distributed among pathologic tumor classification groups (P = 0.0008) and between groups with positive and negative surgical margins (P = 0.0116). Tumors with aneusomic chromosome numbers had larger volumes than those with eusomy and tetrasomy (P = 0.0022). Kaplan-Meier analysis demonstrated that PSA recurrences (> or = 0.4 ng/mL) were more frequent and observed earlier in patients with detected chromosomal aneusomies than in those with eusomic and tetrasomic chromosome numbers (P < 0.0001). Cox regression analysis indicated that ICG was the most valuable independent factor in predicting PSA recurrences. CONCLUSIONS: The detection of numeric chromosomal aberrations in preoperative core biopsies is an adverse prognostic sign. Grading based on the quantification of genetic changes might prove useful in the prognostic stratification of patients with clinically localized prostate carcinoma.

Adenocarcinoma↗

PubMed1998

[Development of tumor selection based on pathological stage in clinically localized prostate carcinoma].

Four hundred and eighty-eight radical retropubic prostatectomies (RRP) were performed on clinically localized prostate cancer at one institution within 5 years (1992-1996). These were then analyzed regarding the migration of pathological tumor stages towards more localized stages. Within the observation period, the annual rate of RRP increased by 81% from 69 to 125 cases. The authors noted a decline in the occurrence of advanced tumor stages (65.0% to 39.2%) and small cancers (< 0.5 cc: 7.2% to 1.6%) and an increase in pathological T2 tumors (30.4% to 55.2%). The rate of positive surgical margins declined from 34.7% to 12.8% (for all pathological stages). These data confirm trends which were observed in the USA with increasing detection and treatment of localized prostate cancer.

Biomarkers, Tumor↗

PubMed1998

[Plasma TGF-beta1 concentrations in patients with prostate carcinoma or benign prostatic hyperplasia].

Transforming growth factor-beta 1 (TGF-beta 1) is a pleiotrophic growth factor in carcinogenesis and regulars multiple cell functions. We wanted to evaluate the diagnostic meaning of TGF-beta 1 plasma levels in patients with a biopsy proven prostate cancer. The TGF-beta 1 blood level was analysed in 394 patients. In 242 patients (group I) the blood was taken before any prostate manipulation and biopsy. The TGF-beta 1 plasma concentrations were almost similar in the group of patients with a prostate cancer (n = 157) and patients with a benign prostate hyperplasia (n = 85; 14,258 pg/ml versus 14,658 pg/ml, SD 10,516 pg/ml). In 152 patients the blood was taken 6-12 months after radical prostatectomy (group II). There was no significant difference between the patients with a PSA-progress and without PSA-progress after. Our results suggest that TGF-beta 1 plasma levels can not be used to distinguish between patients with prostate cancer and benign prostate hyperplasia.

Biomarkers, Tumor↗

PubMed1998

The value of the ratio of free-to-total prostate specific antigen for staging purposes in previously untreated prostate cancer.

PURPOSE: We analyzed the use of the ratio of free-to-total prostate specific antigen (PSA), also termed percentage of free PSA, for predicting tumor stage, volume and grade in patients with clinically localized prostate cancer. MATERIALS AND METHODS: A total of 515 consecutive patients underwent further prostate evaluation due to elevated PSA (greater than 4.0 ng./ml.) or abnormal digital rectal examination. Prostate cancer was diagnosed in 307 patients (59.6%), including 170 (55.4%) who underwent radical retropubic prostatectomy. Data on pathological stage, Gleason grade, and total and Gleason grade 4 cancer volume were available in all patients. In the remaining 208 men (40.4%) benign prostate hyperplasia was diagnosed. Total and free PSA was measured in preoperative serum. RESULTS: Total PSA was significantly higher (p <0.0001) in the 71 men with stage pT3 tumors than in the 91 with pT2 disease. Eight patients had stage pT4 tumors. Cancer volume correlated well with advancing pathological stage (p <0.0001) and total PSA (p <0.0001). The free-to-total PSA ratio was not significantly different (p = 0.93) in stages pT2 and pT3 tumors, and it did not correlate with total (p = 0.71) or pure Gleason grade 4 (p = 0.94) cancer volume. However, the ratio of free-to-total PSA tended to decrease (p = 0.07) in tumors of increasing Gleason grade. CONCLUSIONS: The ratio of free-to-total PSA does not help in the preoperative prediction of final tumor stage and volume. However, disease grading may alter the free-to-total PSA ratio.

Biomarkers, Tumor↗

PubMed1998

Incidence of positive surgical margins after biopsy-selected nerve-sparing radical prostatectomy.

OBJECTIVES: The selection criteria for a nerve-sparing radical prostatectomy (NSRP) are not thoroughly investigated and are based mainly on preoperative digital rectal examinations and intraoperative findings. At our institution NSRP is performed only on patients whose preoperative systematic sextant biopsy of the prostate showed only unilateral cancer. To prove the safety of these criteria, we analyzed the incidence of positive surgical margins and tumor progression rate in patients who were selected for an NSRP only by the result of the biopsy. METHODS: Preoperative systematic sextant biopsies revealed unilateral cancer in 69 preoperatively potent men of 289 consecutive prostatic cancer patients (23.9%); contralateral NSRP was performed on these 69 patients. The prostate specimens were investigated by using a 3-mm step-section technique to identify positive surgical margins. Tumor progression was defined as a prostate-specific antigen (PSA) level greater than 0.4 ng/mL in the native and greater than 0.025 ng/mL in the suprasensitive postoperative blood test. Mean follow-up was 15 months (range 6 to 24). RESULTS: In 69 patients who underwent NSRP, 11 positive margins (15.9%) were found. Only 3 patients (4.3%) had a positive margin on the nerve-sparing side. In 220 patients who underwent non-NSRP 59 positive margins (26.8%) were detected. PSA recurrence rate after 12 months was similar in patients with NSRP and non-NSRP. Analysis of systematic sextant biopsies gives safe selection criteria because in approximately 95% the surgical margin on the nerve-sparing side will be negative. CONCLUSIONS: Basing the indication for an NSRP on the results of preoperative systematic biopsies was safe according to margin status and postoperative PSA, when all patients with tumor in one of the three biopsy cores of each side of the prostate were excluded from an NS technique on that side. Such a strict approach will exclude approximately 30% of patients from NSRP unnecessarily because of tumor findings on a prostate side where the cancer is still organ-confined. Less strict criteria, including patients with only well-differentiated cancer and a maximum of one positive biopsy on the evaluated side, seem to be as safe as the described selection. However, data on these patients need further evaluation.

Aged↗

PubMed1998

Thromboembolic complication rate after radical retropubic prostatectomy. Impact of routine ultrasonography for the detection of pelvic lymphoceles and hematomas.

OBJECTIVES: The impact of routine ultrasonography for diagnosis and rapid treatment of pelvic lymphoceles and hematomas on the rate of thromboembolic complications was studied. METHODS: From June 1987 to December 1995, 508 patients underwent radical retropubic prostatectomy with low-dose heparin prophylaxis at our medical institution. Beginning with patient 321, routine pelvic ultrasonography was started on each patient on postoperative day 1 for diagnosis of lymphoceles and hematomas. The rate of thromboembolic complications in patients 321-508 was compared with that in patients 1-320 (without routine ultrasonography). RESULTS: In patients 1-320, a total of 20 (6.2%) symptomatic thromboembolic complications occurred: five (1.6%) pulmonary emboli and 15 (4.7%) cases of deep venous thrombosis. In patients 321-508, the total rate of thromboembolic complications was significantly reduced (p = 0.049): only 4 patients (2.1%) had thromboembolic events (1 pulmonary embolism and 3 cases of deep venous thrombosis): all but 1 of the complications were associated with small hematomas, which were first negative on routine pelvic ultrasonography but positive on CT scan only done when clinical suspicion of symptoms occurred or during open surgery and showed compression of the iliac vein. CONCLUSIONS: Pelvic lymphoceles and hematomas seem to be important cofactors in the pathophysiology of thromboembolic complications after radical retropubic prostatectomy. Most lymphoceles and hematomas can be diagnosed with pelvic ultrasonography although small hematomas can be overseen with pelvic ultrasonography Surgeons should become more aware of these postoperative complications particularly in patients on heparin prophylaxis.

Adult↗

PubMed1997

Surgical therapy for localized prostatic carcinoma.

The intraoperative, immediate postoperative, and late postoperative morbidity and prostate-specific antigen (PSA) levels in 511 consecutive patients with clinical T1b, T1c, and T2 tumors, who underwent anatomical radical retropubic prostatectomy, have been discussed. Between 1988 and 1995, prostatic cancer was diagnosed in 511 patients on the basis of PSA and prostate biopsy, when life expectancy was more than 10 years and frozen sections of obturator lymph nodes were negative. All specimens were cut into 3 mm sections by the step-section technique, after the surgical margin had been inked with formalin-resistant dye to identify the margin status. The mean age of the 511 patients was 63.4 years. Blood loss during the operation decreased to 986 ml in the last 2 years. Of the patients, 4.3% had intraoperative rectal perforation; only 5 required a second operation, which was done with a simple rectal approach. Ureteral injury occurred in 1.4% and this was repaired during the operation; 11% had prolonged lymphocele; all were treated conservatively. Deep-venous thromboses were seen in 3.7%; 5 patients (1%) had pulmonary embolism, which was lethal in 3 patients (0.6% of the whole group). There were no intraoperative deaths. No patient death was observed in the last 3 years, when all lymphoceles were diagnosed with thorough ultrasonographic evaluation and drained immediately. Complete continence after 1 year was achieved in 92% of the patients; 5.8% of the patients had anastomotic stricture; most were treated with a single calibration. Twelve months after the operation, 80% of the patients had no measurable PSA. There was a clear correlation of PSA negativity to tumor stage. Anatomical radical prostatectomy is safe and can cure about 70% of patients with clinical T1b, T1c, and T2 prostatic tumors.

Adult↗

PubMed1997

[Urodynamic changes after radical prostatectomy].

Urodynamic examinations were performed in 82 patients with clinically localized prostate cancer before and after radical prostatectomy. A significant decrease in bladder capacity (396 ml to 331.9 ml), urethral closure pressure (89.6 cm H2O to 65.2 cm H2O) and functional profile length (61 mm to 25.9 mm) was noted. The continence rate after radical prostatectomy was 33.4% after 1 month, 69.4% after 3 months, 84.7% after 6 months, and 90.9% after 12 months, respectively. A correlation was found between urethral closure pressure and functional profile length and continence. A second urodynamic examination was performed 6 months after radical prostatectomy. Functional profile length and urethral closure pressure increased. These data suggest that restoration of continence is based on sphincteric parameters.

Adult↗

PubMed1997

Prostatic volume and ratio of free-to-total prostate specific antigen in patients with prostatic cancer or benign prostatic hyperplasia.

PURPOSE: We correlated prostatic volume with the ratio of free-to-total prostate specific antigen (PSA) in serum from patients with prostatic cancer or benign prostatic hyperplasia (BPH) to evaluate how prostatic volume influences the ratio. MATERIALS AND METHODS: We evaluated sera from 395 patients (mean age 65 years, range 45 to 88) with prostate cancer (239) or BPH (156) for total PSA, free PSA and ratio of free-to-total PSA. For detection of total and free PSA we used an Immulite free and total PSA assay. Prostatic volume was determined with transrectal ultrasonography. Prostatic volume in BPH and prostate cancer patients was divided into 10 ml. groups, and mean ratio of free-to-total PSA was calculated for each volume group and both diseases. For statistical analysis Mann-Whitney U and Kruskal-Wallis tests were performed in addition to calculation of sensitivity and specificity, and receiver operator curves for prostates 60 ml. or less and greater than 60 ml. RESULTS: For BPH patients the mean ratio of free-to-total PSA was 14.64 to 25.14% without a close relation to prostatic volume. In prostate cancer patients a proportional increase from 8.45 to 19.37% in the ratio of free-to-total PSA with volume was found. Mann-Whitney U analysis revealed significant differences in prostate cancer versus BPH only in patients with prostates of 60 ml. or smaller (p = 0.0008 to 0.029). No significant differences were seen when prostate cancer and BPH patients with prostates larger than 60 ml. were compared (p = 0.082 to 0.868). Kruskal-Wallis test confirmed independence of the ratio of free-to-total PSA from prostatic volume in BPH patients (p = 0.285) but dependence in prostate cancer patients (p <0.0001). Sensitivity was higher in patients with prostates 60 ml. or smaller (86.72%) than in patients with prostates larger than 60 ml. (66%), and specificity was lower at 45.78 and 56.16%, respectively. CONCLUSIONS: We have shown that the ratio of free-to-total PSA is influenced by prostatic volume in patients with prostate cancer. The ratio of free-to-total PSA provides useful information for differentiate BPH from prostate cancer in patients with small prostates but it is less useful in patients with larger prostates, probably because of the larger proportion of benign hypertrophic tissue.

Aged↗

PubMed1997

Early complication of anatomical radical retropubic prostatectomy: lessons from a single-center experience.

OBJECTIVES: The purpose of this study is to report the rate of early complications in 316 of 600 patients who underwent anatomical radical retropubic prostatectomy for localized prostatic cancer from June 1988 to July 1996 and to measure the effect of increasing experience in a single institution. METHODS: From January 1992 to August 1995, 316 patients with prostatic cancer underwent anatomical radical retropubic prostatectomy at our medical institution. Early complications were recorded prospectively and the rate of complications of the first 166 patients was compared with the rate in the next 150 patients. RESULTS: Comparison of the 2 groups showed a significant decrease in blood loss with time (mean 1,397 vs. 967 cm3, p = 0.0011). The rates of anastomotic urinary leakage (21.7 vs. 10%, p = 0.0056), lymphoceles (22.3 vs. 2%, p < 0.0001), rectal injury (7.8 vs. 2%, p = 0.02), reoperation (10.2 vs. 4%, p = 0.049), and thromboembolic complications (7.8 vs. 2.7%, p = 0.0479) also decreased significantly. Only ureteral transsection showed an increase in the later group (0 vs. 4.7%, p = 0.005). CONCLUSIONS: The low percentage of early complications suggests that anatomical retropubic radical prostatectomy is a safe approach. Our single-center study showed a learning pattern that appears unavoidable when this operation is as radical as possible so as to keep the percentage of positive margins low especially in patients with advanced tumors (> pT2).

Adult↗

PubMed1997

Urodynamic evaluation of changes in urinary control after radical retropubic prostatectomy.

PURPOSE: Urodynamic evaluations were done in patients before and after radical prostatectomy to obtain more information about the factors that affect continence. MATERIALS AND METHODS: Urodynamic testing was done in 82 patients before, and 6 to 8 weeks and 6 months (9 cases) after radical prostatectomy. Evaluation included measurement of cystometric bladder capacity, compliance, functional profile length, maximal urethral closure pressure, maximal urethral closure pressure during voluntary contraction of the external sphincter, residual urine, maximal flow rate and bladder instability. RESULTS: The continence rate was 33.4, 69.4, 84.7 and 90.9% at 1, 3, 6 and 12 months after radical prostatectomy, respectively. Mean functional urethral length decreased from 61 mm. preoperatively to 25.9 mm. postoperatively, maximal urethral pressure from 89.6 to 65.2 cm. water and bladder capacity from 338.7 to 278.8 ml. Bladder instability was found in 17 and 41% of cases before and directly after radical prostatectomy, respectively. There was a statistically significant difference in maximal urethral closure pressure (68.1 versus 53.1 cm. water) as well as functional urethral length (27.6 versus 20.5 mm.) in continent versus incontinent patients, respectively. Urodynamic examination 6 months after prostatectomy showed an increase in functional profile length and maximal urethral pressure, while bladder measurements did not change significantly. CONCLUSIONS: After radical prostatectomy significant changes in bladder and sphincter measurements are noted. Urethral closure pressure, functional urethral length and bladder stability are significant urodynamic factors that influence continence after radical prostatectomy.

Adult↗

PubMed1997

Numerical chromosomal aberrations in transition-zone carcinomas of the prostate.

PURPOSE: Prostatic carcinomas arising in the transition zone (TZ) are thought to differ from the more frequent cancers of the peripheral zone (PZ) with regard to morphology and biologic behavior. It is unclear, however, whether the differences are reflected in genetic alterations. MATERIALS AND METHODS: We assessed numerical aberrations of chromosomes 7, 8, 10, 17, and X with interphase cytogenetics in 10 radical-prostatectomy specimens containing exclusively TZ cancers larger than 0.5 cm.3 and in 10 additional specimens containing both TZ and PZ cancers larger than 0.5 cm.3 each. RESULTS: Of the 20 TZ carcinomas, 9 were completely disomic, 5 were at least focally tetrasomic but not aneusomic, and 6 were focally aneusomic. Ploidy correlated well with tumor volume (p = 0.0083), grade (p = 0.0064) and surgical margins (p = 0.0141) but not with preoperative prostate-specific antigen. A strong correlation was observed between the presence of low grade tumor (Gleason grade 4 or 5) and a nondiploid chromosomal status (p = 0.0001). In 10 cases there were also foci of PZ cancer larger than 0.5 cm.3, of which 4 were disomic, 3 were tetrasomic at the most, and 3 were aneusomic. The mean tumor volumes of disomic and aneusomic cancers differed significantly between TZ and PZ carcinomas (p = 0.0336 and 0.0476, respectively). CONCLUSIONS: Numerical chromosomal instability parallels tumor progression in TZ carcinomas of the prostate. However, our results indicate that PZ and TZ cancers differ in that the latter can reach larger volumes before histological dedifferentiation and aneusomy occur.

Aged↗

PubMed1996

Preoperative prediction of tumor heterogeneity and recurrence after radical prostatectomy for localized prostatic carcinoma with digital rectal, examination prostate specific antigen and the results of 6 systematic biopsies.

PURPOSE: Digital rectal examination, preoperative serum prostate specific antigen (PSA) concentration and results of 6 ultrasound guided systematic sextant biopsies in 257 consecutive patients with clinical stages T2 and T1c prostatic carcinoma were evaluated for their use in predicting pathological stage and tumor recurrence. MATERIALS AND METHODS: Each of the 257 consecutive specimens was examined using the 3 mm. step section technique. Results of preoperative digital rectal examination, PSA and 6 systematic sextant biopsies were correlated with pathological stage, margin status and postoperative PSA during a mean followup of 2 years. Patients were considered to have disease progression based on elevated PSA level by a supersensitive assay. RESULTS: Digital rectal examination could not predict pathological stage and tumor recurrence. Preoperative PSA concentration, number of positive biopsies and tumor grade in the biopsy specimens correlated well with pathological stage. The best predictor of tumor recurrence was the biopsy result. However, a precise prediction of outcome (87% probability of being PSA negative versus 0%) was possible only in a third of the patients if the biopsy results were used. Use of preoperative PSA concentration did not improve this probability. CONCLUSIONS: Preoperative PSA concentration and/or biopsy results correlate significantly with pathological stage and margin status. Precise prediction of tumor recurrence is possible in only approximately a third of the patients with clinical stage T2 prostatic carcinoma.

Aged↗