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PubMed1995

Laser coagulation prostatectomy: evolution of clinical practice and treatment parameters.

Laser coagulation prostatectomy has evolved into an accepted option for the management of bladder outlet obstruction secondary to benign prostatic hyperplasia. Clinical results document the safety and efficacy of this operation. Rapidly expanding clinical experience and basic research efforts in recent years have provided a scientific foundation and an improved qualitative understanding of the laser-tissue interactions during Nd:YAG laser coagulation of the prostate. Today, truly quantitative laser dosimetry is becoming available to guide the operative approaches to laser prostatectomy with the increasing variety of Nd:YAG delivery systems. The development of laser coagulation prostatectomy is traced to the present, and accumulated clinical experience and laboratory data are incorporated into a rational approach to operative and perioperative patient management utilizing this technology.

Clinical Trials as Topic↗
PubMed1996

Holmium:YAG laser prostatectomy: results of U.S. pilot study.

The holmium:YAG (Ho:YAG) laser wavelength's ability to vaporize and incise soft tissue offers potential advantages for prostatectomy compared with the Nd:YAG laser, which primarily produces tissue coagulation. In this initial U.S. trial, Ho:YAG laser prostatectomy was performed in 20 men, including 2 men treated immediately prior to radical prostatectomy to assess Ho:YAG laser tissue effects in the prostate. A total of 18 men were treated for clinically symptomatic bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). Estimated excess BPH tissue averaged 24 g (range 5-50 g). A mean of 129 kJ of Ho:YAG laser energy was delivered, combined with a mean of 11 kJ of Nd:YAG energy to provide supplemental coagulation for hemostasis. The mean operative time was 1 hour 34 minutes. No significant intraoperative changes in hematocrit or serum electrolytes were documented. No perioperative or late complications occurred. The mean postoperative catheterization time was 1.4 days. Of the 18 patients, 16 (90%) underwent a successful voiding trial on the first postoperative morning. Immediate improvement in voiding, comparable to that seen after transurethral electrocautery resection of the prostate (TURP), was reported by all patients. Ho:YAG laser resection of the prostate appears to be a useful surgical technique associated with minimal morbidity and immediate improvement in voiding.

Aged↗
PubMed1998

Urolase v ultraline fibers in laser prostatectomy: 3-year follow-up of a randomized study.

Recently, laser treatment of the prostate has been added to the urologist's armamentarium for the treatment of bladder outlet obstruction secondary to benign prostatic hyperplasia (BPH). Until now, limited data on long-term outcome are available notwithstanding the fact that such information is crucial in determining the ultimate role of laser prostatectomy in the treatment of BPH. We now have 3-year data of a comparative study using the Urolase and Ultraline fiber in Nd:YAG sidefiring laser prostatectomy. The study was performed to compare laser prostatectomy using a pure coagulation (Urolase fiber) and a combination of a coagulation and vaporization (Ultraline fiber). In a period of 15 months, 93 men were randomized for laser treatment with the Ultraline fiber (N = 44) or the Urolase fiber (N = 49). Symptom scores, maximal uroflow, postvoiding residual volume, and sexual history were noted over a 3-year period. Adverse events and retreatments were also recorded. The mean postoperative catheterization time was 18 days, without significant difference between the two groups. After 3 years, we demonstrated a durable improvement in maximal flow rate, from 7.8 to 13.9 mL/sec in the Urolase group and from 7.9 to 13.6 mL/sec in the Ultraline group. In both groups, however, a considerable decrease in the maximal flow rate was noted after 3 years compared with 3 months after treatment, from 18.7 to 13.9 mL/sec in the Urolase group and from 20.0 to 13.6 mL/sec in the Ultraline group. The symptom scores showed marked and lasting improvement. The postvoiding residual urine volume became very low in the early postoperative period but did significantly increase after 3 years; nevertheless, it was still only 50% of the preoperative value. Although after 3 years, the maximal uroflow rate was still significantly improved compared with baseline, a considerable decrease was noted when compared with the early postoperative value. The same considerable and lasting improvement in subjective outcome (symptom scores) was seen in both groups. Although the Ultraline fiber also causes vaporization of prostatic tissue, no differences could be noted in the clinical outcome obtained with the two fibers.

Aged↗
PubMed2000

Radical prostatectomy versus brachytherapy for early-stage prostate cancer.

BACKGROUND AND PURPOSE: The considerations in choosing a treatment for prostate cancer are potential for cure, acute toxicity, long-term morbidity, quality of life, and direct and indirect costs. The classic options are radical prostatectomy, external-beam radiation, and watchful waiting. During the last decade, technological advances have fostered another: brachytherapy. METHODS: This article compares brachytherapy and radical prostatectomy in terms of cancer control, complications, and cost using series from medical centers that have pioneered and advocated particular procedures. RESULTS: In the surgical series from Johns Hopkins, the 7-year success rate (no PSA >0.2 ng/mL) of anatomic radical prostatectomy was 97.8% in patients with stage T(2c) or lower disease and a Gleason score of < or =6. In the brachytherapy series from Seattle, the 7-year success rate (PSA < or =0.5 ng/mL) was 79%. Postoperatively, 68% of the patients who were potent preoperatively maintained erectile function, and 92% were fully continent. Urethral toxicity is slightly more common in patients treated by brachytherapy, but in the authors' series, no patient remained incontinent after 6 months. Some patients became impotent during follow-up. The cost of brachytherapy ($16,200) is less than that of ($27,000), although the difference may be reduced by the use of neoadjuvant hormonal therapy with the former. CONCLUSION: Patients receiving brachytherapy appear to have a slightly higher rate of disease progression. The side effects generally are acceptable and may be less severe than those of surgery. Further follow-up data are needed to define the roles of these two treatments for early-stage prostate cancer.

Brachytherapy↗
PubMed2004

Extraperitoneal standard laparoscopic radical prostatectomy.

PURPOSE: To describe our preliminary experience with the extraperitoneal approach for laparoscopic radical prostatectomy. PATIENTS AND METHODS: Between February and December 2002, we performed 100 laparoscopic radical prostatectomies by an extraperitoneal approach. RESULTS: Of the procedures, 98 were completed as planned, while conversion to a transperitoneal approach was necessary in 2 patients with previous mesh hernia repair. The mean operative time was 163 minutes. The mean operative blood loss was 375 mL. The transfusion rate was 3%. No rectal, bowel, ureteral, or nervous injury was observed. There were no major complications. There were nine minor complications (four anastomotic leakages, one rectus muscle hematoma, four cases of acute urinary retention). The mean hospital stay was 6.1 days. Mean catheterization lasted 6 days. The pathologic stage was T2a, T2b, T2c, T3a, and T3b in 17%, 22%, 39%, 12%, and 10%, respectively. The mean Gleason score was 7. The margins were positive in 15% of the pT2 and in 35% of the pT3 tumors; 48% of the positive margins occurred in the first 25 cases. The median follow-up was 12 months; 93% of the patients had a serum prostate specific antigen concentration <0.2 ng/mL. No patient has presented with clinical port-site metastasis. All the patients were evaluated by questionnaire sent by mail before and after the surgery. With a median follow-up of 12 months, 86% of the patients were continent (no pads), 7% of the patients used 1 precaution pad, and 7% had need for 1 pad routinely. With a median follow-up of 6 months, among the preoperatively potent patients (IIEF5 >20), the postoperative erection and intercourse rate was 64% and 43% in patients with bilateral and unilateral nerve-bundle preservation, respectively. CONCLUSION: The extraperitoneal technique is a reliable approach for laparoscopic radical prostatectomy. The choice between a transperitoneal or an extraperitoneal approach depends on the surgeon's experience.

Erectile Dysfunction↗
PubMed2006

Nerve-sparing endoscopic extraperitoneal radical prostatectomy: University of Leipzig technique.

PURPOSE: To describe the various operative steps as well as the functional and oncologic results of nerve-sparing endoscopic extraperitoneal radical prostatectomy (nsEERP). PATIENTS AND METHODS: One hundred twenty preoperatively potent patients have been treated with bilateral nsEERPE in our department. The average age of the patients was 60.3 years (range 41-74 years), and the mean prostate weight was 48.6 g (range 24-117 g). RESULTS: The mean operative time was 136 minutes (range 75-210 minutes). No conversions to open surgery were necessary. The mean catheterization time was 5.7 days (range 4-20 days). Lymphadenectomy was performed in 26 patients. The pathologic stages were pT2 in 78 and pT3 in 42 patients. Positive margins were detected in 7.7% (N = 6) and 19% (N = 8) of the patients with pT2 and pT3 disease, respectively. Erections sufficient for intercourse were reported in interviews with 58 patients (48.3%) during the 6-month follow-up period. Follow-up of at least 1 year is deemed necessary to draw more definite conclusions about erectile function. One week postoperatively, 32 patients (26.7%) required a maximum of 1 pad, 59 patients (49.2%) 2 or 3 pads, and 29 patients (24.2%) more than 3 pads per day because of incontinence, whereas 3 and 6 months after the procedure, 98 (82%) and 106 (88%) of the patients required a maximum of 1 pad, respectively. CONCLUSION: Our results demonstrate that nsEERPE can be performed with equal efficacy and preliminary results similar to those of standard open radical prostatectomy as well as transperitoneal laparoscopic prostatectomy while completely avoiding intraperitoneal complications.

Adult↗
PubMed1996

Laparoscopic radical prostatectomy in the canine model.

The purpose of this study was to determine the feasibility of performing laparoscopic radical prostatectomy in a canine model. Laparoscopic radical prostatectomy was performed on six adult male canines. A new endoscopic needle driver was used to construct a secure vesicourethral anastomosis. Average operative time required to complete the procedure was 304 min (range 270-345 min). Dissection of the prostate gland took an average of 67 min (range 35-90 min), and construction of the vesicourethral anastomosis took 154 min (rage 80-240 min). There were no intraoperative complications and only one postoperative complication (anastomotic leak). Five of the six animals recovered uneventfully from the procedure, and their foley catheters were removed 10-14 days postoperatively after a retrograde cystourethrogram demonstrated an intact vesicourethral anastomosis. Four (80%) of the surviving animals were clinically continent within 10 days after catheter removal. Post mortem examination confirmed that the vesicourethral anastomosis was intact with no evidence of urine extravasation. These data demonstrate the feasibility of laparoscopic radical prostatectomy in a canine model, and suggest that additional work with this technique should be continued to develop its potential clinical application.

Animals↗
PubMed1998

Correlation of gross morphologic features with histologic features in radical prostatectomy specimens.

The gross features of prostatic adenocarcinoma can be subtle. While these gross features have been described, the histologic correlates have not been detailed. This study involved examination of 211 consecutive radical prostatectomy specimens between January 1995 and December 1996. The gross findings were correlated with histologic examination. No gross lesion was apparent in 47 cases (22.3%), a subtle lesion was present in 78 (37.0%), and a definite lesion suggestive of carcinoma, in 86 (40.8%). Tumor was identified grossly and confirmed histologically in 50 (64%) of 78 subtle lesions, 83 (96%) of 86 definite lesions, and in 63% of all prostatectomy specimens. Prostatectomy specimens with definite lesions were significantly more likely to contain tumors that were stage T3 or higher (37%) than those with a subtle lesion (20%), were higher grade (mean Gleason score, 6.8 vs 6.36), and had larger tumor diameters (mean, 1.3 cm vs 1.0 cm). Specimens with subtle lesions were more likely to contain tumors that were stage T3 or higher compared with specimens with no apparent gross lesions (20% vs 4%), but did not differ significantly in mean Gleason score (6.36 vs 6.26) or tumor size (1.0 cm vs 0.95 cm). Ninety-two percent of all tumors stage T3 or higher, 81% of all tumors Gleason score 8 or higher, and 72% of all tumors greater than 1.0 cm in diameter were grossly identified and confirmed histologically. However, the site of extraprostatic extension and positive margins were present in the histologic sample of the grossly identified lesion in only 27 (54%) of 50 cases and 20 (46%) of 43 cases, respectively. Prostatic adenocarcinomas can be accurately identified by gross inspection in 63% of cases; the false-positive rate for gross inspection was 19%. The presence of an identifiable gross lesion is correlated with increased tumor stage, grade, and size.

Adenocarcinoma↗
PubMed1999

Maximum diameter of prostatic carcinoma is a simple, inexpensive, and independent predictor of prostate-specific antigen failure in radical prostatectomy specimens. Validation in a cohort of 434 patients.

The amount of tumor in radical prostatectomy specimens can be determined with several techniques. Maximum tumor diameter correlates well with total tumor volume and can readily be obtained in incompletely submitted specimens. Initial results in a small series suggested that this measure also may predict for prostate-specific antigen (PSA) failure. We studied whether maximum tumor diameter was an independent predictor of PSA failure in a series of 434 men who underwent radical prostatectomy because of prostatic adenocarcinoma; 118 (27.2%) had PSA failure. Preoperative PSA, Gleason score, pathologic stage, margin status, and largest tumor diameter were determined, and multivariate logistic modeling was performed on the outcome of PSA failure. Maximum tumor diameter was an independent risk factor for PSA failure, along with preoperative serum PSA level, and Gleason score > or = 8. Only 15% of men with tumor with maximum diameter < 1 cm had PSA failure, compared with 73% of men with tumor with maximum diameter > 2. Maximum tumor diameter of prostatic carcinoma is a simple, inexpensive, and independent predictor of PSA failure that can be obtained readily from partially submitted radical prostatectomy specimens.

Adenocarcinoma↗
PubMed1999

Acute normovolaemic haemodilution vs controlled hypotension for reducing the use of allogeneic blood in patients undergoing radical prostatectomy.

Blood loss in patients undergoing radical prostatectomy may be substantial. In a randomized, prospective study, we assessed two methods of reducing the need for allogeneic blood transfusion with regard to efficacy and costs. Sixty patients undergoing retropubic radical prostatectomy were allocated randomly to one of three groups. In group 1 (n = 20), acute normovolaemic haemodilution (ANH) was initiated after induction of anaesthesia; autologous blood 15 ml kg-1 was withdrawn and replaced by colloid solutions (gelatin) to maintain haemodynamic stability. In group 2 (n = 20), controlled hypotension was established using sodium nitroprusside (target mean arterial pressure (MAP) approximately 50 mm Hg). Group 3 (n = 20), without manipulations, served as a control group. Troponin T (TnT), a sensitive marker for myocardial ischaemia, and various coagulation variables were measured in the perioperative period. Packed red blood cells (PRBC) were given when haemoglobin concentration was less than 7 g dl-1. Cost calculations did not include hospital overhead costs or staff costs. In the ANH group, mean 1278 (SD 150) ml of autologous blood were withdrawn. Significantly more volume was infused in the ANH patients (gelatin 2450 (550) ml) than in the two other groups. Coagulation data (platelet count, activated partial thromboplastin time (aPTT), fibrinogen, antithrombin III (AT III), D-dimers) did not differ significantly between the three groups. The hypotension group had significantly lower blood loss (1260 (570) ml), whereas the ANH (1820 (680) ml) and control group (1920 (590) ml) did not differ significantly. Patients in the hypotension group needed significantly less PRBC (total 14 units; 75% of patients did not need PRBC) than the ANH (total 21 units; 55% of patients did not need PRBC) or control patients (total 28 units; 40% of patients did not need PRBC). Total costs were lowest in the hypotension group (41% less than in the control patients) (P < 0.05). We conclude that the use of hypotension during radical prostatectomy resulted in approximately 40% reduction in total transfusion costs. ANH was less effective and more costly than controlled hypotension.

Aged↗
PubMed1996

Two-dimensional outcome analysis as a guide for quality assurance of prostatectomy.

PURPOSE: To find outlier centers in different aspects of quality of care by comparing two different outcomes and adjusting to case mix in benign prostatic hypertrophy (BPH) patients undergoing prostatectomy. MATERIALS AND METHODS: An observational study including 537 consecutive patients undergoing prostatectomy for BPH in three medical centers in Israel between 1991 and 1992. Data were collected from medical charts and by a structured interview. Outcomes examined included immediate surgical complications and postoperative symptom effect level. Regression analysis was employed to adjust for case mix and to determine the additional contribution of medical centers. RESULTS: We found significant variability among centers in crude symptom effect, but not after case mix adjustment. An outlier was detected in both the crude and case mix-adjusted urological complications. CONCLUSIONS: Centers may differ with various outcomes. This may reflect variability in different levels of performance within different aspects of the process of care in prostatectomy procedures.

Aged↗
PubMed2002

Preoperative prediction of extracapsular tumor extension at radical retropubic prostatectomy in Taiwanese patients with T1c prostate cancer.

BACKGROUND: To find a predictor for extracapsular tumor extension at radical retropubic prostatectomy (RRP) in Taiwanese patients with stage T1c prostate cancer (PC), preoperative transrectal sonoguiding prostate biopsy outcomes and clinicopathological data obtained from these patients were reviewed. METHODS: Fifty-five consecutive men who underwent radical retropubic prostatectomy for stage T1c PC were included. Preoperative sextant needle biopsies of the prostate were performed and whole-mount prostatectomy specimens were processed. The pathological end point was tumor capsular perforation extending entirely through the prostate capsule. Preoperative prostate-specific antigen (PSA), free-to-total PSA ratio, prostate volume, PSA density, Gleason score, number of positive biopsy cores, percentage cancer of sextant biopsies, percentage cancer of one lobe and percentage cancer of one core were analyzed for their ability to predict extracapsular tumor extension at RRP. RESULTS: Eighteen of the 55 specimens showed evidence of tumor capsular perforation. Those with extracapsular tumor extension (ECE) had higher PSA than organ-confined disease (OCD) (18.4 vs 8.3 ng/ml, P < 0.01). The ECE had a higher PSA density than OCD (0.556 vs 0.226, P < 0.01). The percentage of cancer in biopsies, percentage cancer of one lobe and percentage cancer of one core were all higher in ECE than OCD (P < 0.05). The ECE had a higher biopsy Gleason score than OCD (5.6 vs 4.5, P < 0.01). CONCLUSIONS: The four strongest predictors for extracapsular tumor extension of patients with T1c PC were PSA density >or=0.35, biopsy Gleason score >or=6, >or=20% cancer in biopsies and PSA >or=10 ng/ml.

Aged↗
PubMed2003

Radical prostatectomy for prostate cancer patients with prostate-specific antigen >20 ng/ml.

OBJECTIVE: Prostate cancer patients with prostate-specific antigen (PSA) >20 ng/ml are at high risk of progression after radical prostatectomy. Comparison has seldom been made between the outcomes of patients with PSA 20.1-50 ng/ml and those with PSA >50 ng/ml after radical prostatectomy. We retrospectively analyzed the outcomes of these two groups. METHODS: From 1993 to 2002, 60 prostate cancer patients receiving radical prostatectomy were enrolled in this study. Thirty-seven patients with PSA 20.1-50 ng/ml were assigned to Group I. Twenty-three patients with PSA >50 ng/ml were assigned to Group II. Preoperatively, Group II had greater PSA and PSA density than Group I (P < 0.0001). Group II had higher biopsy Gleason score and clinical stage than Group I (P < 0.05). Pathological categories and outcomes of both groups were compared. RESULTS: Group II had higher Gleason score and tumor volume than Group I (P < 0.05). The incidence of organ-confined diseases was 29.7% in Group I and 0% in Group II (P < 0.05). Group II had higher incidence of extracapsular tumor extension, positive surgical margin and lymph node involvement than Group I (P < 0.05). The incidence of postoperative PSA >0.01 ng/ml and PSA failure were higher in Group II than Group I (P < 0.05). Need for adjuvant treatment and death from prostate cancer was similar in both groups. CONCLUSION: Patients with PSA >50 ng/ml had a poorer prognosis than patients with PSA 20.1-50 ng/ml. Those with PSA >50 ng/ml had shorter freedom from PSA failure survivals than those with PSA 20.1-50 ng/ml (P = 0.004). Classification of high-risk prostate patients into two sub-groups with PSA 20.1-50 ng/ml and PSA >50 ng/ml should be considered.

Aged↗
PubMed2005

Predictor of response to salvage radiotherapy in patients with PSA recurrence after radical prostatectomy: the usefulness of PSA doubling time.

BACKGROUND: We assessed predictors of response to salvage radiotherapy (sRT) in patients with prostate-specific antigen (PSA) recurrence after radical prostatectomy. METHODS: A total of 21 patients receiving sRT for PSA recurrence without systemic progression after radical prostatectomy had medical records available for retrospective review. We defined sRT as external beam radiotherapy for patients with a continuous increase in PSA level > or =0.2 ng/ml after radical prostatectomy. Response was defined as achievement of a PSA nadir of < or =0.1 ng/ml. Various pre-treatment parameters were evaluated retrospectively. RESULTS: The median follow-up period after sRT was 38 months. Of the 21 patients, 15 were good responders (71%). The only predictive factor was PSA doubling time (PSADT). Age and PSA level at diagnosis, Gleason score and surgical margin status were not significant predictors of response. The median PSADT in responders was 6.2 months versus 1.9 months in non-responders (P = 0.019). The patients with a PSADT of > or =5 months were all responders. CONCLUSION: PSADT appears to be a good predictor of response to sRT. sRT was especially effective when PSADT was > or =5 months.

Aged↗
PubMed2006

A randomized trial comparing radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy for locally advanced prostate cancer: results at median follow-up of 102 months.

BACKGROUND: To investigate the optimal treatment of locally advanced prostate cancer, a prospective randomized trial was conducted to compare radical prostatectomy plus endocrine therapy versus external beam radiotherapy plus endocrine therapy. METHODS: One hundred patients with T2b-3N0M0 prostate cancer were enrolled and 95 were evaluated. Of 95 cases, 46 underwent radical prostatectomy with pelvic lymph node dissection and 49 were treated with external beam radiation by linear accelerator with 40-50 Gy to the whole pelvis and 20-Gy boost to the prostatic area. For all patients, endocrine therapy was initiated 8 weeks before surgery or radiotherapy and continued thereafter. The long-term outcome and morbidity were examined. RESULTS: Median follow-up period was 102 months. At 10 years overall survival rates in the surgery group were better than the radiation group (76.2% versus 71.1% for biochemical progression-free rates; P=0.25, 83.5% versus 66.1% for clinical progression-free rates; P=0.14, 85.7% versus 77.1% for cause-specific survival rates; P=0.06, and 67.9% versus 60.9% for overall survival rates; P=0.30), although none of them reached statistical significance. Erectile dysfunction was recognized in almost all patients as a result of continuous endocrine therapy. Incontinence requiring more than one pad per day was observed more frequently in the surgery group than the radiation group (P<0.01). CONCLUSIONS: For the treatment of patients with locally advanced prostate cancer, when combined with endocrine therapy, either radical prostatectomy or external beam radiotherapy demonstrated favorable long-term outcomes. The radiation dose of 60-70 Gy might not be enough for the local treatment of locally advanced prostate cancer.

Adenocarcinoma↗
PubMed1998

A preoperative nomogram for disease recurrence following radical prostatectomy for prostate cancer.

BACKGROUND: Few published studies have combined clinical prognostic factors into risk profiles that can be used to predict the likelihood of recurrence or metastatic progression in patients following treatment of prostate cancer. We developed a nomogram that allows prediction of disease recurrence through use of preoperative clinical factors for patients with clinically localized prostate cancer who are candidates for treatment with a radical prostatectomy. METHODS: By use of Cox proportional hazards regression analysis, we modeled the clinical data and disease follow-up for 983 men with clinically localized prostate cancer whom we intended to treat with a radical prostatectomy. Clinical data included pretreatment serum prostate-specific antigen levels, biopsy Gleason scores, and clinical stage. Treatment failure was recorded when there was clinical evidence of disease recurrence, a rising serum prostate-specific antigen level (two measurements of 0.4 ng/mL or greater and rising), or initiation of adjuvant therapy. Validation was performed on a separate sample of 168 men, also from our institution. RESULTS: Treatment failure (i.e., cancer recurrence) was noted in 196 of the 983 men, and the patients without failure had a median follow-up of 30 months (range, 1-146 months). The 5-year probability of freedom from failure for the cohort was 73% (95% confidence interval = 69%-76%). The predictions from the nomogram appeared accurate and discriminating, with a validation sample area under the receiver operating characteristic curve (i.e., comparison of the predicted probability with the actual outcome) of 0.79. CONCLUSIONS: A nomogram has been developed that can be used to predict the 5-year probability of treatment failure among men with clinically localized prostate cancer treated with radical prostatectomy.

Adult↗
PubMed1995

Prostate bed massage as a means to determine the source of a rising prostate specific antigen after radical prostatectomy.

PURPOSE: To determine the value of prostate bed massage as a means to determine whether a rising prostate specific antigen (PSA) after radical prostatectomy is due to local recurrence or distant metastases. METHODS AND MATERIALS: Eighteen patients referred for pelvic radiotherapy because of a rising PSA after radical prostatectomy had PSA levels measured immediately before and 5 minutes after a vigorous 30-second massage of the prostate bed. RESULTS: Only one of the 18 (5%) patients experienced a rise in their PSA following vigorous prostate bed massage. Fifteen of the 18 (83%) patients' PSA levels declined after radiotherapy, suggesting that recurrent prostate cancer had been present in the prostate bed at the time of prostate massage in these patients. Only 1 of these 15 patients (7%) had a rise in their PSA after massage. CONCLUSION: Prostate bed massage, as performed in this study, was not helpful to determine whether a rise in PSA after radical prostatectomy was due to local or distant recurrence.

Humans↗
PubMed1992

Evaluation of radical prostatectomy specimens. A comparative analysis of sampling methods.

We evaluated 104 radical prostatectomies for clinical stage B (n = 93) and stage A (n = 11) prostate cancer. Seven (8%) stage B cases had no gross cancer. By submitting only gross stage B cancer along with standard sections of proximal and distal margins, base of seminal vesicles, and most apical section (next to distal margin), we identified 91% of capsular penetration and 96% of positive margins as compared with identification by complete microscopic examination. Although this method identified 100% capsular penetration and positive margins in stage A cases, 28% of all the cases were grossly normal. Stage A tumor was often difficult to identify because of its heterogeneous location, its gross similarity to nodular hyperplasia, and the confounding presence of post-transurethral resection scarring. In 98% of all stages B and A cases, this method identified to within 1, the Gleason sum of the totally embedded radical prostatectomy. Using this sampling method, key pathologic parameters were identified with an average of 13 blocks (range 7-36) as compared with totally embedding the prostate, using an average of 42 blocks (range 21-81). Based on our study and our understanding of stages A and B disease, we recommend that in grossly normal glands, alternate posterior sections (stage B) and alternate entire sections (stage A) be submitted. Use of this sampling method will achieve a greater uniformity in the processing of specimens and a more accurate pathologic analysis of radical prostatectomy specimens.

Adenocarcinoma↗