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PubMed2001

Discrepancies between Gleason scores of needle biopsy and radical prostatectomy specimens.

The purpose of this study was to determine the accuracy of Gleason scores in prostate needle biopsy diagnosis and to investigate factors affecting the accuracy of the tumor grade. A single pathologist reviewed 116 sets of prostate cancer biopsies and radical prostatectomy specimens. The following factors were examined to determine their effect on the accuracy of the biopsy Gleason scores: (i) relative tumor differentiation; (ii) pathological stage; (iii) amount of tissue in the biopsy specimen; (iv) amount of cancer tissue in the biopsy specimen; (v) tumor heterogeneity; (vi) clinical findings (prostate specific antigen value and digital rectal examination); and (vii) interobserver variability. In 53 cases the Gleason score of biopsy specimens was identical to the score of prostatectomy specimens (45.7%). Fifty-four cases (46.6%) of biopsy specimens were undergraded. The most common discrepancy was diagnosis of well-differentiated carcinoma in the biopsy but diagnosis of moderately differentiated tumor in the corresponding prostatectomy specimen. This discrepancy occurred when the amount of tumor in the biopsy was 3 mm or less. Biopsy and prostatectomy results showed less agreement when the original biopsy tumor grade rendered by nine different pathologists was used, suggesting that interobserver variability can adversely affect the accuracy of tumor grade. Clarifying the histologic criteria for distinguishing each grade, especially between Gleason grades 2 and 3, is important for accurate grading.

Adenocarcinoma↗
PubMedDate not supplied

Change in International Prostate Symptom Score after transurethral prostatectomy in Taiwanese men with benign prostate hyperplasia: use of these changes to predict the outcome.

To investigate whether the pre- and postoperative International Prostate Symptom Score (IPSS) change predicts the outcome of transurethral prostatectomy in a Taiwanese population, 99 patients (transurethral prostatectomy candidates) were assessed with the IPSS before and 6-12 months after surgery. All symptoms improved significantly postoperatively. Patients with a greater preoperative IPSS benefited the most. Improvements in preoperative obstructive symptoms (incomplete emptying, intermittency, straining, and weak stream) were greater than those in irritable symptoms (urgency, frequency, and nocturia). A significant correlation was found between IPSS and quality of life (QOL) before and after transurethral prostatectomy. A change of 1 unit on the IPSS scale was found to decrease the QOL score 0.282 units. The positive predictive value of a >or=7-IPSS point decrease depended on the predictive IPSS criteria applied. When the preoperative IPSS was more than 17, the sensitivity was 83.5% and specificity was 30%. Postoperative improvement did not differ significantly between acute urinary retention (AUR) and non-AUR patients. Change in IPSS of more than 7 points predicted symptomatic improvement with high sensitivity. The predictive value depends on the definition of significant improvement (magnitude of IPSS change) and on the level of IPSS symptoms (sufficient to warrant transurethral prostatectomy).

Aged↗
PubMed1999

Accuracy and cost of intraoperative lymph node frozen sections at radical prostatectomy.

AIM: To assess the value of intraoperative diagnostic examination of frozen sections of lymph nodes removed during radical prostatectomy. METHODS: Pelvic lymph nodes from patients with prostatic carcinoma were obtained (1) as frozen sections during radical prostatectomy, to exclude patients from non-curative surgery, and (2) as paraffin sections postoperatively from lymphadenectomy performed at radical prostatectomy, to stage the tumour and assess need for adjuvant treatment. Findings from the two approaches were used to assess the accuracy and cost of frozen section diagnosis, and to judge the results of omitting intraoperative diagnosis. RESULTS: In 82 patients frozen section revealed metastasis in six (7.3%), and metastases were found in a further four (4.9%) on paraffin sections (false negatives). Of the 195 patients undergoing staging lymphadenectomy (without frozen section), metastatic cancer was seen in nine cases (4.6%). The frozen section cost of metastatic cancer detection per patient was calculated as 7516 Pounds (550 Pounds x 82/6), with an associated false negative rate of 33%. CONCLUSIONS: Frozen section diagnosis of metastatic carcinoma in pelvic lymph nodes before radical prostatectomy has a high false negative rate and is costly. It may not be justified with the observed low incidence of lymph node metastasis.

Cost-Benefit Analysis↗
PubMedDate not supplied

[Subtotal transurethral prostatectomy in the treatment of patients with prostatic cancer].

The results are given of subtotal transurethral resection (subtotal TUR) in 21 patients with prostatic cancer (PC) operated in 1998-2004. The patients had contraindications to radical treatment. The aim of the surgical intervention was maximal possible removal of the prostatic tissue to the prostatic capsule that improves results of adjuvant hormonal and radiotherapy. Postoperative follow-up lasted from 6 months to 6 years. The control groups consisted of 20 patients subjected to palliative prostatic TUR and 24 PC patients given only hormonal or radiotherapy. Subtotal transurethral prostatectomy and TUR of the prostate were successfully made in all the patients. The number of postoperative complications and reoperations was less in patients after subtotal transurethral prostatectomy than in those after palliative TUR. The treatment reduced blood PSA levels in all the groups but the progress of this reduction depended on the treatment method. The group after subtotal transurethral prostatectomy achieved maximal PSA lowering after 2 months after surgery. The follow-up registered distant metastases in 19.04% patients of the study group and 20 and 29.4% in the control groups. One-year survival was 80.95, 80, 83.3%, respectively; 3-year survival was 80, 45.5 and 77.8%, respectively. Thus, combined treatment of prostatic cancer (subtotal transurethral prostatectomy and maximal androgenic blockade) rapidly corrects urination without deterioration of survival parameters compared to hormonal therapy alone.

Combined Modality Therapy↗
PubMed2005

Advances in the Management of Post-Radical Prostatectomy Erectile Dysfunction: Treatment Strategies When PDE-5 Inhibitors Don't Work.

Phosphodiesterase type-5 (PDE-5) inhibitors have revolutionized the treatment of post-radical prostatectomy erectile dysfunction. For those patients who undergo a non-nerve-sparing radical prostatectomy or whose condition fails to respond to PDE-5 inhibitors, alternative treatment with intracavernous injection therapy, transurethral alprostadil, vacuum erection devices, and recently described combination therapy is available. The goals of therapy are to provide the patient with a means of obtaining an erection so that the patient and his partner may resume sexual relations as soon as possible following radical prostatectomy. There is evidence that early institution of treatment may promote improvement in the return of spontaneous erections in patients who have undergone nerve preservation. In patients who undergo non-nerve-sparing procedures, therapy may improve penile rigidity. Intracavernous injection therapy, transurethral alprostadil, and vacuum devices are highly effective in the management of post-prostatectomy erectile dysfunction. High dropout rates, which are not related to adverse effects, have been described with all 3 modalities. Pre- and postoperative counseling may improve patient and partner satisfaction.

Journal Article↗
PubMed2007

Laser prostatectomy versus transurethral resection of prostate in the treatment of benign prostatic hyperplasia.

OBJECTIVE: To assess the effectiveness of laser-prostatectomy compared with transurethral resection of prostate (TURP). METHODS: This randomized clinical trial with one year follow-up, was conducted on 87 patients with benign prostatic hyperplasia (BPH) at Shohada-e-Tajrish Hospital, Tehran, Iran, from 1999 to 2003. Fifty-two patients underwent TURP and 35 patients were treated by non-contact laser prostatectomy using ND: YAG laser at 40-60 watt power and 13000-29000 jules energy settings. RESULTS: Comparing variables of urinary maximum flow and residue, changes of urine volume and severity of symptoms during consequent periods of 3, 6 and 12 months after the operation in 3 groups revealed that differences in maximum urinary flow changes were significant only in the sixth month (p<0.05). Also, changes in the severity of symptoms before and after the operation showed more decrease in the TURP group during all 3 periods of follow-up (p=0.01). In the laser prostatectomy group duration of operation (p=0.01), amount of fluid used during the operation (p<0.001) and duration of bed rest (p<0.001) were less than those of the TURP group. CONCLUSION: Laser prostatectomy can decrease duration of operation, duration of bed rest and pathogenesis following the operation in patients. Although changes in the severity of symptoms are more pronounced in TURP patients, changes in urodynamic indexes are similar in both groups.

Aged↗
PubMed1996

Holmium: YAG laser prostatectomy canine feasibility study.

BACKGROUND AND OBJECTIVE: Laser coagulation prostatectomy performed with the Neodymium: Yttrium-Aluminum-Garnet laser has emerged as a viable alternative for the treatment of benign prostatic hyperplasia. Laser vaporization prostatectomy, if feasible, has the potential to reduce postoperative catheterization time and achievement time of maximum voiding outcomes. The objective of this study was to determine the ability of the Holmium: Yttrium-Aluminum-Garnet laser wavelength to vaporize prostatic tissue and create an immediate prostatectomy defect. STUDY DESIGN/MATERIALS AND METHODS: The Holmium: Yttrium-Aluminum-Garnet laser was applied in vivo in a canine prostate model. Laser energy was delivered endoscopically via quartz laser fibers circumferentially to each prostatic fossa. High energies, up to 2.8 joules per pulse and 60 watts total power, were utilized. All prostates were surgically removed immediately following laser applications to determine acute laser effects. RESULTS: Immediate tissue ablation or vaporization with this laser wavelength was found to be both feasible and relatively efficient. The mean transverse dimension of the prostatic defects produced was 19 mm, with a maximum transverse dimension of 27 mm. In one prostate a cavity of 27 (transverse) by 29 (anterior-posterior) by 43 (length) mm was created, with an estimated tissue removal of approximately 20 cc. Hemostasis with the Holmium laser was adequate in this canine prostate model. In addition to the acute tissue cavity created, a 1-2 mm rim of surrounding tissue coagulation was observed in each specimen. CONCLUSION: The Holmium: Yttrium-Aluminum-Garnet laser wavelength is capable of acute prostatic tissue vaporization and deserves ongoing study with potential application in the surgical treatment of benign prostatic hyperplasia in men.

Animals↗
PubMed1999

High-intensity focused ultrasound (HIFU) followed after one to two weeks by radical retropubic prostatectomy: results of a prospective study.

BACKGROUND: High-intensity focused ultrasound (HIFU) consists of focused ultrasound waves emitted from a transducer that are capable of inducing tissue damage. Experimental studies have shown clear damage of malignant tissue exposed to HIFU, but knowledge of in vivo effects is limited. We studied the safety and efficacy of HIFU in patients with a T1-2 N0) M0 prostate carcinoma. METHODS: HIFU treatment was performed under general anesthesia with the Ablatherm device (Technomed Medical Systems, Lyon, France), 7-12 days prior to radical prostatectomy. Only the lobe in which carcinoma was confirmed was treated. The radical prostatectomy specimen was examined histopathologically, and the changes were compared with treatment goals. RESULTS: So far, 9 patients have been treated. On histology, a sharp delineation was noted between areas treated with HIFU and untreated areas. On the dorsal border, however, incomplete destruction of tissue was noted, and in 2 cases a small residual tumor was seen in this region. In all cases complete necrosis was seen in the treated region. CONCLUSIONS: Histology reports of radical prostatectomy specimens of patients operated 7-12 days after HIFU treatment showed marked and complete necrosis in the treated area. Due to incomplete tissue destruction at the dorsal side, however, a small focus of residual vital tumor was found in 2 of 9 patients.

Aged↗
PubMed1999

Correlation between preoperative predictors and pathologic features in radical prostatectomy specimens in PSA-based screening.

BACKGROUND: Measurement of percent free prostate-specific antigen (PSA), PSA density, and PSA-transition zone density (PSA-TZ density) in addition to total PSA is known to improve the specificity of PSA-based prostate cancer screening. We evaluated the ability of total PSA, percent free PSA, PSA density, and PSA-TZ density to predict pathologic features in radical prostatectomy specimens. METHODS: The levels of total PSA, percent free PSA, PSA density, and PSA-TZ density assessed prior to the diagnosis of prostate cancer were correlated with the pathologic findings in 102 prostate glands with cancer obtained at radical prostatectomy. The entire organs were examined histologically; Pearson correlation coefficients were used for statistical analysis. RESULTS: High levels of total PSA, PSA density, and PSA-TZ density correlated significantly with capsular penetration, high Gleason scores, and large cancer volumes in the prostatectomy specimens. Free PSA was found to correlate well with high Gleason scores, high percentages of cancer, and large cancer volumes, but not with capsular penetration. The four parameters were evaluated by means of logistic regression, which showed that only percent free PSA and total PSA were significant predictors of Gleason scores > or =7 and cancer volumes > or =0.5 cc. With regard to clinically insignificant cancers, only percent free PSA and the Gleason score obtained at biopsy were significant predictors. CONCLUSIONS: In men whose prostate cancers are detected by PSA-based screening, high total PSA levels in combination with low percent free PSA levels are suggestive of a potentially more aggressive type of prostate cancer. This may help both patient and clinician in selecting the most appropriate therapeutic approach.

Adult↗
PubMed2001

Expression of p21 predicts PSA failure in locally advanced prostate cancer treated by prostatectomy.

The management of prostate cancer is based on several clinicopathological criteria. The ability to determine the tumor's biological potential is one goal of tumor markers in order to identify patients who may require more intensive treatment strategies. The purpose of our study was to determine if p21/(WAF1/CIP1) expression can predict biochemical failure in patients with locally advanced prostate cancer treated by radical retropubic prostatectomy (RRP). We used immunohistochemistry to analyze patterns of p21 expression in a population of 296 patients with locally advanced (pT3) prostate cancer treated by RRP. Results were correlated with clinicopathological parameters and time to PSA failure. For the entire cohort of 296 patients, after adjustment for prognostic factors, p21 expression was associated with an increased risk of PSA failure (relative risk [RR] = 1.48) of statistical significance at a median follow-up of 54.5 months. Other parameters that independently predicted the risk of PSA failure included lymph node metastasis and seminal vesicle involvement. Because neoadjuvant hormonal therapy (NHT) is known to lead to involutional changes in prostatic carcinoma, we performed multivariate analyses after stratifying for NHT prior to surgery. Among the 172 patients treated by RRP alone, p21 expression was an independent predictor of PSA failure (RR = 2.30), as were lymph node metastases (RR = 3.19) and pathological grade 5-7 and 8-10 (RR = 2.87 and 3.50, respectively). p21 over-expression is an independent predictor of PSA failure in pT3 patients treated by radical prostatectomy, especially if they did not receive NHT. This tumor marker may help clinicians identify patients who may require adjuvant treatment strategies following radical prostatectomy.

Aged↗
PubMed2002

The impact of androgen deprivation on quality of life after radical prostatectomy for prostate carcinoma.

BACKGROUND: Androgen deprivation is commonly prescribed for men with a rising prostate specific antigen level after radical prostatectomy, despite scant evidence regarding its efficacy and side effects. In the current study, the authors compared measures of health-related quality of life (HRQOL) in men who were treated with androgen deprivation after radical prostatectomy with those for men who underwent surgery but were not treated with androgen deprivation. METHODS: Medicare Provider and Analysis and Review (MedPAR) files were used to identify men who had undergone radical prostatectomies between 1991-1992. Medicare Part B data then were used to select two samples: men who subsequently were androgen deprived and those who were not. In 1999, a mail survey was administered that addressed a range of disease-related and treatment-related issues, including HRQOL. Age-adjusted comparisons of responses to seven multiitem measures of HRQOL were performed. RESULTS: The overall response rate was 82%. On all seven HRQOL measures (impact of cancer and treatment, concern regarding body image, mental health, general health, activity, worries about cancer and dying, and energy), there were statistically significant decrements associated with androgen deprivation. CONCLUSIONS: Patients and physicians must weigh the price patients pay with regard to HRQOL against the uncertain benefits of early androgen deprivation.

Aged↗
PubMed2002

Factors affecting recurrence rates after prostatectomy or radiotherapy in localized prostate carcinoma patients with biopsy Gleason score 8 or above.

BACKGROUND: To review the biochemical recurrence-free survival (bRFS) rates of treatment with either external beam radiotherapy or radical prostatectomy in patients with biopsy Gleason score 8 or above in the prostate specific antigen (PSA) era. METHODS: A total of 297 localized prostate carcinoma patients diagnosed with biopsy Gleason score 8 or above were treated between 1987 and 2000 at the Cleveland Clinic with either prostatectomy or radiotherapy (RT). All patients had pretreatment PSA (iPSA) levels. Androgen deprivation was given as part of the initial treatment in 154 patients (52%). Radical prostatectomy (RP) was the primary treatment in 115 patients (39%) and 182 patients (61%) received RT. The median radiation dose was 70.2 Gy (range, 60.0-78.0 Gy). The median follow-up time was 42 months (range, 1-153 months). RESULTS: For the 297 patients, the 5 and 8-year bRFS rates were 45% (95% confidence interval [CI] 38-52%) and 31% (95% CI 20-42%), respectively. The 5-year bRFS rates for iPSA 10 or less versus. iPSA above10 were 66% (95% CI 54-78%) versus 31% (95% CI 22-40%), respectively (P < 0.001). The 5-year bRFS rates for use of androgen deprivation versus no androgen deprivation were 62% (95% CI 52-72%) versus 35% (95% CI 27-42%), respectively (P < 0.001). The 5-year bRFS rates for RT patients versus RP patients were 47% (95% CI 38-57%) versus 42% (95% CI 31-53%), respectively (P = 0.051). For RT patients, the 5-year bRFS rates for use of androgen deprivation versus no androgen deprivation were 71% versus 29%, respectively (P < 0.001). For RP patients, the 5-year bRFS rates for use of androgen deprivation versus no androgen deprivation were 39% versus 43%, respectively (P = 0.90). Multivariate time-to-failure analysis using the proportional hazards model showed iPSA level (P < 0.001) and the use of androgen deprivation (P = 0.001) to be the only independent predictors of biochemical recurrence. Age (P = 0.44), race (P = 0.80), clinical T stage (P = 0.10), biopsy Gleason scores (P = 0.39), and treatment modality (P = 0.13) were not independent predictors of biochemical failure. A total of 104 patients had Stage T1 or T2 disease, low iPSA levels (</= 10 ng/mL), and a high Gleason score (>/= 8). For all 104 patients, the 5-year bRFS rate was 64%. For 52 of the 104 patients who received 6 months of androgen deprivation or less, the 5-year bRFS rate was 78%. CONCLUSION: Patients with localized prostate carcinoma with a biopsy Gleason score 8 or less have lower recurrence rates if iPSA levels are 10 or less. Biochemical control rates were encouraging for patients with biopsy Gleason score 8 or above, clinical Stage T1-T2, and iPSA levels less than or equal to 10 ng/mL treated with adjuvant androgen deprivation given only for 6 months or less. If longer follow-up confirms these findings, these patients might not need prolonged androgen deprivation for periods exceeding 6 months following local therapy.

Adult↗
PubMed2006

Multiinstitutional validation of the UCSF cancer of the prostate risk assessment for prediction of recurrence after radical prostatectomy.

BACKGROUND: The University of California, San Francisco (UCSF) Cancer of the Prostate Risk Assessment (CAPRA) is a novel preoperative index which predicts the risk of biochemical recurrence after radical prostatectomy. The performance of the index is at least as good as the best available instruments based on clinical variables, and the 0 to 10 score is simple to calculate for both clinical and research purposes. This study used a large external dataset to validate CAPRA. METHODS: Data were abstracted from the Shared Equal Access Regional Cancer Hospital (SEARCH) database, a registry of men who underwent radical prostatectomy at 4 Veterans Affairs and 1 active military medical center. Of 2096 men in the database, 1346 (64%) had full data available to calculate the CAPRA score. Performance of the CAPRA score was assessed with proportional hazards regression, survival analysis, and the concordance (c) index. RESULTS: Of the studied patients, 41% were non-Caucasian, and their mean age was 62 years. Twenty-six percent suffered recurrence; median follow-up among patients who did not recur was 34 months. The hazard ratio (HR) for each 1-point increase in CAPRA was 1.39 (95% CI [confidence interval], 1.31-1.46). The 5-year recurrence-free survival rate ranged from 86% for CAPRA 0-1 patients to 21% for CAPRA 7-10 patients. Increasing CAPRA scores were significantly associated with increasing risk of adverse pathologic outcomes. The c-index for CAPRA for the validation set was 0.68, compared with 0.66 for the original development set. CONCLUSIONS: The UCSF-CAPRA accurately predicted both biochemical and pathologic outcomes after radical prostatectomy among a large, diverse, cohort of men. These results validated the effectiveness of this powerful and straightforward instrument.

Adult↗
PubMed1992

Cancer detected incidental to simple prostatectomy (stage A1).

The incidence of stage A (incidental) adenocarcinoma of the prostate in transurethral resection (TUR) specimens is approximately 16%. This paper discusses the criteria for differentiating stage A1 versus stage A2 tumor, based on tumor volume and grade. Both the short-term (4 year) and long-term (8-10 year) natural history of untreated stage A1 prostate cancer are examined. Options to follow patients expectantly are presented. These include digital rectal examination and transrectal ultrasound. Specific problems relating to analyzing transrectal ultrasounds in patients who have had a prior TUR are addressed. Also, the unique aspects of transrectal ultrasound for stage A1 disease as it relates to the location of the lesion are expanded upon. The third option in the management of stage A1 disease is to monitor serum prostate specific antigen (PSA) levels. Areas covered include the sensitivity and specificity of PSA in general, and, in specific, serum PSA levels following TUR for stage A1 disease as a predictor of residual tumor. New data on a small group of patients who underwent delayed radical prostatectomy following diagnosis of stage A1 disease, where PSA data was available, are presented. The rationale for following patients with stage A1 disease by monitoring their serum PSA levels is supported by data from a group of men with normally sized prostates, benign prostatic hyperplasia, or cancer where longitudinal serum PSA levels were available. Finally, the option of radical prostatectomy for stage A1 disease is put forth. Data include a study of a large group of radical prostatectomy specimens performed for stage A1 disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed2004

Thromboprophylaxis for radical prostatectomy: a comparative analysis of present practice between the USA, the UK, and Ireland.

BACKGROUND: A clinical dilemma exists in the management of patients undergoing radical prostatectomy (RP) whereby measures taken to reduce the risk of thrombotic events may adversely affect efforts to limit blood loss. No consensus exists in the literature on the ideal management of thromboprophylaxis in these patients. Our aim is to examine and compare current thromboprophylactic policy and practice between the centres involved in performing RP. METHODS: A questionnaire was forwarded to all urology residency programmes in Ireland, the United Kingdom, and the United States, regarding their current practice with respect to thromboprophylaxis in RP. Completed questionnaire were returned by fax and the data entered into a computer database. RESULTS: An overall response rate of 60% was achieved. The questionnaires demonstrated a significant difference in clinical practice between Urologists in the United States and the United Kingdom. Just 24% of American Urologists use pharmacological thromboprophylaxis in contrast to 100% of British Urologists. There was no difference in the use of non-pharmacological thromboprophylaxis. Pharmacological thromboprophylaxis is mainly administered by units, mostly in the United Kingdom, doing fewer radical prostatectomies. CONCLUSIONS: While there have been studies advocating the use of pharmacological thromboprophylaxis in patients undergoing major pelvic surgery, there is no consensus on it is use in urological practice. This study has demonstrated significant differences in the management of thromboprophylaxis between the USA and the UK/Ireland. Units performing the largest number of radical prostatectomies, mostly in the USA, do not use pharmacological thromboprophylaxis and most do not use compression boots.

Anticoagulants↗
PubMed2005

Obtaining fresh prostate cancer tissue for research: a novel biopsy needle and sampling technique for radical prostatectomy specimens.

BACKGROUND: Fresh or fresh-frozen tissue samples are preferred for molecular profiling as formalin fixation degrades intracellular nucleic acids. Radical prostatectomy (RP) specimens are a valuable source of prostate cancer tissue, but the reliance on whole-organ pathological processing for prognostication limits sampling opportunities. Few studies have addressed specific harvesting techniques using prostatectomy specimens. MATERIALS AND METHODS: Ex vivo biopsies were performed on 23 consecutive fresh RP specimens using a purpose-designed needle. A standard sextant approach was used with an additional lateral biopsy on each side. Cores from each lobe were snap-frozen together and sections assessed by a pathologist blinded to the RP and pre-operative biopsy pathology. Comparison with pre-operative biopsies was performed using the t-test and chi(2) statistical tests. Eleven randomly selected RP specimens were further evaluated for the effects of needle tracks and margin perforation. RESULTS: Cancer was detected in 19 of 23 specimens, giving a sensitivity of 83.6%. The average tumor involvement was 28.3% per section compared with 15.6% for pre-operative biopsies (P < 0.02). There was no statistically significant difference between the groups for either Gleason sum score concordance or tumor location concordance. In 3 of 11 cases, needle margin perforation was identified; in none of the cases did it compromise pathological assessment, although in one case a deeper block resection was required. CONCLUSIONS: Ex vivo biopsy is a useful technique for retrieving fresh tissue whilst preserving organ morphology in RP specimens. The purpose-designed needle and harvesting technique provide good yields of cancer tissue from a high proportion of sampled prostatectomy specimens.

Biopsy, Needle↗
PubMed1986

Early complications of combined pelvic lymphadenectomy and radical prostatectomy versus lymphadenectomy alone.

A comparison of the early morbidity of pelvic lymphadenectomy plus radical prostatectomy versus lymphadenectomy alone is reported. Fifty-one patients underwent the combined procedure; 26 had lymphadenectomy alone. Incidence of early complications was 35% in patients undergoing prostatectomy and node dissection and 27% in patients undergoing lymph node dissection only, a difference which is not statistically significant. Thrombophlebitis and pulmonary embolus occurred after the combined procedure. There was one postoperative death in the combined surgery group. The results of this study suggest that lymph node dissection may be performed at the time of radical prostatectomy rather than as a staging procedure, and emphasize the importance of pelvic lymph node dissection in the evaluation and treatment of clinically localized prostate cancer.

Adenocarcinoma↗
PubMedDate not supplied

Radical prostatectomy or deferred treatment?

Screening for prostate cancer has intensified, due both to increased patient and physician awareness and to the availability of new, more sensitive diagnostic tools (prostate-specific antigen [PSA], rectal ultrasound, etc.). Consequently, the number of newly diagnosed cases of prostatic cancer is rising rapidly, whereas the frequency of death due to prostate cancer remains almost stable. It must therefore be assumed that the number of patients in whom a diagnosed prostate cancer will not be fatal is also increasing. Consequently, not every prostatic carcinoma requires radical treatment when diagnosed. Also, it must be concluded that not every man who is a long-term survivor after radical prostatectomy owes his survival to the treatment. Long-term survival may reflect the relatively benign biological potential of this disease in an individual patient. Therefore there is an inherent risk of overtreating patients and this must be weighed against the costs, the postoperative morbidity, and the mortality, albeit low, of a radical prostatectomy. Nevertheless, as long as we do not have diagnostic tools which, at an early stage of prostatic cancer, enable us to determine whether a carcinoma will ultimately have a fatal outcome, we are obliged to offer a radical prostatectomy to younger patients (who have a life expectancy of more than 10 years) as long as they have organ-confined disease.

Follow-Up Studies↗