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PubMed1998

Efficacy and safety of transurethral alprostadil in patients with erectile dysfunction following radical prostatectomy.

PURPOSE: A retrospective analysis of the MUSE clinical trial was performed to evaluate the efficacy and safety of transurethral alprostadil in patients with erectile dysfunction after radical prostatectomy. MATERIALS AND METHODS: Patients received doses of transurethral alprostadil in the clinic and those for whom a suitable dose was determined were treated at home with active drug or placebo for 3 months. Patients had undergone radical prostatectomy no less than 3 months before study entry. RESULTS: Of the 384 patients in whom radical prostatectomy was identified as a cause of erectile dysfunction 70.3% had an erection believed sufficient for intercourse in the clinic and 57.1% on active medication had sexual intercourse at least once at home. The product of clinic and home success rates (70.3 x 57.1%) was an overall success rate (the likelihood of active treatment to lead to intercourse at home) of 40.1%. The frequency of most adverse effects of radical prostatectomy was comparable to that of other organic etiologies of erectile dysfunction (1,127 patients). The percentage of patients with hypotension in the clinic was lower after radical prostatectomy compared to other erectile dysfunction etiologies (0.8 versus 4.2%, p < 0.001) but the percentage of patients with urethral pain/burning was higher (18.3 versus 10.4%, p = 0.027). No urinary tract infection, fibrosis or priapism occurred in the post-radical prostatectomy patients. CONCLUSIONS: Transurethral alprostadil is a well tolerated and efficacious method of treating erectile dysfunction after radical prostatectomy, although psychological changes associated with cancer and surgery may limit home response. The severe neurovascular deficit associated with prostatectomy neither limits the efficacy of transurethral alprostadil nor increases the risks.

Adult↗
PubMed2005

Open versus laparoscopic radical prostatectomy.

Expert laparoscopic surgeons have demonstrated that laparoscopic radical prostatectomy with or without robotic assistance can be performed with excellent results. There is no evidence that laparoscopic radical prostatectomy with or without robotic assistance offers any clinically relevant advantage over open radical prostatectomy. Laparoscopic radical prostatectomy with or without robotic assistance requires a significant learning curve, is a longer surgical procedure, carries greater costs, and requires an expanded operating room team. The literature suggests that laparoscopic radical prostatectomy is associated with more intraoperative complications and higher positive surgical margins. The lesser amount of postoperative bleeding associated with laparoscopic radical prostatectomy is not clinically relevant. Laparoscopic radical prostatectomy is not associated with less pain and does not facilitate earlier urinary catheter removal. The best way to improve overall outcomes after radical prostatectomy is to direct patients to expert open or laparoscopic surgeons.

Journal Article↗
PubMed1986

Gleason histologic grading of prostatic carcinoma. Correlations between biopsy and prostatectomy specimens.

The Gleason histologic score of prostatic adenocarcinoma in biopsy specimens (needle cores or transurethral chips) was compared with the Gleason score of corresponding radical prostatectomy specimens from 53 patients with localized prostatic carcinoma. The Gleason score assigned to the biopsy specimen was identical to that of the prostatectomy specimen in 51% of cases, was greater than that of the prostatectomy specimen in 4%, and was less than that of the prostatectomy specimen in 45%. The magnitude of discrepancy between the scores of the biopsy specimen and the prostatectomy specimen was directly related to the quantity of neoplastic tissue in the biopsy specimen. Discrepancies between the Gleason score of biopsy material and prostatectomy specimens were greater among biopsy specimens with low Gleason scores as compared with biopsy specimens with high Gleason scores. Given the small number of cases, these differences were not statistically significant. Clinical understaging of the primary tumor did not correlate with histologic undergrading of the prostatectomy specimen. It was concluded that prostatic biopsy should be repeated when the initial diagnosis of adenocarcinoma is based on only limited quantities of neoplastic tissue with a low Gleason score and management decisions may be influenced by the true Gleason score of the tumor.

Adenocarcinoma↗
PubMed2000

Visual estimate of the percentage of carcinoma is an independent predictor of prostate carcinoma recurrence after radical prostatectomy.

BACKGROUND: The importance of tumor size measurements as predictors of disease recurrence after radical prostatectomy in patients with prostate carcinoma remains somewhat controversial, and many pathologists do not report these measurements routinely. The authors studied the correlation between the visual estimate of the percentage of carcinoma in prostatic tissue from radical prostatectomy specimens and prostate carcinoma recurrence rates in a series of 595 patients who underwent radical prostatectomy. METHODS: A total of 595 men with clinically localized prostate carcinoma were treated by the same surgeon (W.J.C.) from 1993 through 1997. The percentage of carcinoma in radical prostatectomy specimens from these patients was assessed microscopically through visual estimate. The authors used Kaplan-Meier product limit estimates, log-rank statistics, and the Cox proportional hazards model to evaluate the percentage of carcinoma in the pathologic specimens as predictors of recurrence free survival. RESULTS: Of the 595 patients, 46 (8%) had evidence of tumor recurrence. The mean percentage of carcinoma in the prostatectomy specimen was 11.3% in the group of patients who did not have disease recurrence and 23.8% in the group of patients who did experience disease recurrence. The percentage of carcinoma, preoperative prostate specific antigen levels, tumor differentiation (histologic Gleason grade), and pathologic stage all were significant predictors of disease recurrence according to the Kaplan-Meier method (all log-rank P values < 0.0001). Using the Cox proportional hazards model, controlling for all of these variables, only pathologic tumor stage, Gleason score, and percentage of carcinoma proved to be independent predictors of disease recurrence. In the final model, which included pathologic stage, Gleason score, and percentage of carcinoma, for each 5% increase in the percentage of carcinoma in the surgical specimen, there was an 11% incremental increase in the chance of tumor recurrence. CONCLUSIONS: The visual estimate of the percentage of carcinoma in prostatic tissue specimens from patients who undergo radical prostatectomy is a practical, simple, and inexpensive method that provides important prognostic information after radical prostatectomy.

Adult↗
PubMed2005

Correlation of abdominal leak point pressure with objective incontinence severity in men with post-radical prostatectomy stress incontinence.

AIMS: To determine if the abdominal leak point pressure (ALPP) correlates with objective incontinence severity in patients suffering from post-prostatectomy stress incontinence. METHODS: Twenty-nine men were evaluated for urinary incontinence after radical prostatectomy with videourodynamics and a 24-hr pad test. ALPP was determined with and without a 7-French urodynamics catheter and the lowest value was accepted. Six patients with urgency incontinence associated with detrusor overactivity or decreased bladder compliance were excluded leaving 23 patients for analysis. The relationship between the variables of ALPP, 24-hr pad weight, age and time from prostatectomy were examined with Pearson correlation. RESULTS: The mean age was 66.4 years (SD +/- 7.9, range: 45-81) and the median time from radical prostatectomy was 23 months (IQR = 14-64, range: 9-204). The mean ALPP was 92.8 cm H(2)O (SD +/- 42.4 cm H(2)O) and the mean pad weight was 279.1 g (SD +/- 238.3 g). There was only a weak inverse correlation between ALPP and 24-hr pad weight which was not statistically significant (r = - 0.191, P = 0.38). Age and time from prostatectomy did not significantly correlate with ALPP (r = - 0.122, P = 0.58 and r = - 0.23, P = 0.29, respectively). CONCLUSIONS: ALPP did not correlate significantly with the 24-hr pad test in patients with post-prostatectomy stress incontinence. This suggests that in this patient subset, the ALPP is a relatively poor predictor of incontinence severity and, therefore, has limited clinical value in the urodynamic evaluation of post-prostatectomy incontinence. The urodynamic assessment of these patients should focus on the presence or absence of stress incontinence and on the presence of associated bladder dysfunction.

Abdomen↗
PubMed2004

Anatomic variations due to radical prostatectomy. Impact on target volume definition and dose-volume parameters of rectum and bladder.

BACKGROUND AND PURPOSE: A quantitative estimate of the impact of prostatectomy on pelvic anatomy is unavailable, even if it would be an important prerequisite for a precise definition of clinical target volume (CTV) in post-prostatectomy radiotherapy. The purpose of this study was to investigate the impact of prostatectomy on the definition of CTV, on the position of bladder and rectum and their implications for three-dimensional conformal radiotherapy (3-D CRT). PATIENTS AND METHODS: Six patients eligible for radical retropubic prostatectomy were considered. Each patient underwent a planning CT between 1 week and 1 month before surgery (CTpre), and then CT was repeated in the same positioning 1-2 months after surgery (CTpost). For each patient the CT(pre/post) scans were matched; rectum, bladder and CTV were contoured on both CT scans for each patient by one observer. Two different CTVs were contoured: CTV1: prostate + seminal vesicles in CTpre; prostate + seminal vesicles surgical bed in CTpost; CTV2: prostate in CTpre; prostate surgical bed in CT(post). After image registration, the contours of rectum, bladder and CTV1/2 drawn on CTpost were transferred on CTpre. The corresponding planning target volumes (PTVs) were generated, and for each PTV, a conformal four field technique using 18-MV X-rays was planned. The volumes of CTV1, CTV2, PTV1, PTV2, rectum and bladder pre- and post-surgery were compared. Differences in 3-D position of these structures before and after surgery were analyzed by beam's eye view (BEV) images. Pre- and post-surgery dose-volume histograms (DVHs) of rectum and bladder were compared together with the fraction of rectum/bladder receiving at least 95% of the ICRU dose (V95), the treated volume (TV, body included in the 95% isodose) and the irradiated volume (IV, body included in the 50% isodose). RESULTS: For both CTV1 and CTV2, the volumes were significantly reduced after prostatectomy (average reduction around 30 cm3 for both; range 0-60 cm3). This reduction was mainly due to a more caudal definition of the cranial edge of CTV after prostatectomy (average difference for CTV2: 1.5 cm; range 0-2.5 cm). Concerning the bladder, a systematic posterior shift of the bladder base (average: 1.5 cm) was found and was correlated with a significant reduction of V95 for bladder (around 10 cm3; p = 0.03). V95 of the rectum, TV and IV also resulted to be significantly lower after surgery. The average reduction of V95 for the rectum was relatively small (2.5 cm3 of rectal wall). CONCLUSION: The impact of prostatectomy on CTV definition is high. A significant reduction of CTV, PTV, TV and IV may be expected after surgery with a consequent reduction of the portions of rectum/bladder irradiated with adjuvant radiotherapy.

Aged↗
PubMed1999

[Lymph node positive prostate carcinoma. A case for radical prostatectomy].

Lymph node positive carcinoma of the prostate (stage pN +/D1) is generally considered to be systemic disease that cannot be cured by radical prostatectomy. Treatment options in these minimally metastasized tumors are the wait and watch strategy, hormonal therapy, radiotherapy and radical prostatectomy alone or in combination. At present, there are no prospective randomized trials available regarding the value of these treatment modalities. In retrospective studies, the results of radical prostatectomy seem to be superior to conservative management. In several studies comparing radical prostatectomy vs. pelvic lymphadenectomy alone, a higher tumor burden in the lymphadenectomy alone groups is present. In general, radical prostatectomy reduces local complications of prostate carcinoma and improves quality of life. In conclusion, patients with single or low volume lymph node metastases as well as patients with low tumor grade or favorable Gleason score and diploid tumors seem to benefit from radical prostatectomy. However, the definitive role for radical prostatectomy has to be stated as uncertain.

Combined Modality Therapy↗
PubMed2004

Laparoscopic radical prostatectomy: review and assessment of an emerging technique.

BACKGROUND: Several recent reports have affirmed the feasibility of the laparoscopic approach for radical prostatectomy. In this review, we discuss the morbidities associated with this technique and compare outcomes and convalescence with standard open radical prostatectomy. METHODS: We reviewed all currently published data on laparoscopic radical prostatectomy and our series of 45 robotic-assisted radical prostatectomies and compared them to several landmark series of open retropubic and perineal radical prostatectomies. RESULTS: Although the initial series reported long operating times, these times have been significantly reduced in more recent series. Data on blood loss, convalescence, impotence, and incontinence rates have also been promising. CONCLUSIONS: Although follow-up has been short thus far, laparoscopic radical prostatectomy has been shown to be similar to open radical prostatectomy in several areas.

Humans↗
PubMed2006

Totally extraperitoneal (TEP) hernia repair after radical prostatectomy or previous lower abdominal surgery: is it safe? A prospective study.

BACKGROUND: Many practicing surgeons claim that hernias after previous lower abdominal surgery should be treated by transabdominal preperitoneal repair (TAPP). Moreover, previous radical prostatectomy contraindicates the laparoscopic approach for hernia repair. This prospective study was designed to examine the feasibility and to evaluate the surgical outcome of laparoscopic totally extraperitoneal (TEP) hernia repair in patients who had undergone previous lower abdominal surgery or radical prostatectomy, and to compare this group to all patients who underwent laparoscopic TEP without previous surgery during the study period. METHODS: Patients undergoing elective inguinal hernia repair, by one staff surgeon, in the Department of Abdominal Surgery at the Institute of Laparoscopic Surgery (ILS, Bordeaux) between September 2003 and December 2004 were prospectively enrolled to this study. Three groups were defined--patients with previous radical prostatectomy, patients with previous lower abdominal surgery, and patients without previous surgery--and their data were analyzed and compared. RESULTS: A total of 256 laparoscopic inguinal hernia repairs were performed in 202 patients. Of these, 148 patients had unilateral hernia (143 right and 113 left) and 54 patients had bilateral hernias. There were 166 male patients and 36 female patients with a mean age of 61 +/- 16 years. Of these, 10 patients had inguinal hernia after prostatectomy and 15 patients had inguinal hernia after previous lower abdominal surgery. The mean operative time was significantly longer in the patients with previous prostatectomy than in the two other groups. Two patients after prostatectomy were converted to TAPP due to surgical difficulties. There were no major intraoperative complications in all patients except for three cases of bleeding arising from the inferior epigastric artery: two in the postprostatectomy group and one in a patient without previous surgery. Both ambulation and hospital stay were similar for all groups. Only one patient without previous surgery had postoperative bleeding and was reoperated on several hours after the hernia repair. During the follow-up period of 8 +/- 4 months, there was no recurrence of the hernia in any group. CONCLUSIONS: Laparoscopic TEP for inguinal hernia repair in patients after previous low abdominal surgery has good results, similar to those in patients without previous surgery. Despite a longer operative time, TEP repairs can be performed efficiently and safely in patients after prostatectomy by skilled and experienced laparoscopic surgeons.

Aged↗
PubMed2004

High incidence of inguinal hernia after radical retropubic prostatectomy.

OBJECTIVES: To assess the incidence of, and risk factors for, inguinal hernia after retropubic radical prostatectomy compared with after pelvic lymph node dissection and total cystectomy. METHODS: A total of 155 radical prostatectomies, 35 pelvic lymph node dissections, and 56 total cystectomies were included in this study. We reviewed the charts retrospectively and evaluated the incidence of, and risk factors for, inguinal hernia after surgery using Kaplan-Meier plots and a Cox proportional hazard model. RESULTS: Of 155 patients in the radical prostatectomy group, 35 patients in the pelvic lymph node dissection group, and 56 patients in the cystectomy group, 33 (21.3%), 4 (11.4%), and 3 (5.4%), respectively, developed inguinal hernias during follow-up. In the radical prostatectomy group, 27 (81.8%) of the 33 patients developed inguinal hernia within 2 years postoperatively. Multivariate Cox proportional hazard analysis revealed that prostatectomy group, past history of inguinal hernia, and body mass index of less than 23 were significant risk factors for postoperative inguinal hernia. CONCLUSIONS: The incidence of inguinal hernia after radical prostatectomy is not low. Urologists should realize that inguinal hernia is one of the major complications of radical prostatectomy and examine the groin preoperatively and postoperatively.

Aged↗
PubMed2004

Characterization of minute adenocarcinomas of prostate at radical prostatectomy.

OBJECTIVES: To characterize minute prostate cancer seen at radical prostatectomy. With aggressive screening and more extensive biopsy sampling, we have increasingly seen these cancers at radical prostatectomy. METHODS: We examined radical prostatectomy specimens submitted in total for minute cancer. RESULTS: During the past 1.5 years, 78 prostates (5.2%) had either no cancer (2 cases) or contained between one and six foci of organ-confined carcinoma (76 cases) measuring 6 mm or less, with a Gleason score of 6 or less. The mean prebiopsy serum prostate-specific antigen level was 5.8 ng/mL, and 84.6% of the patients had undergone biopsy because of an elevated prostate-specific antigen level. Of these patients, 40% had had either benign or atypical diagnoses on prior biopsies, and 43% had only minute (0.5 mm or less) foci of carcinoma on biopsy. The radical prostatectomy specimens had a mean of two cancer foci measuring, on average, 3 mm in the greatest dimension. In 85% of the cases, the side of the positive biopsy matched the side of the carcinoma found at radical prostatectomy; 81.5% of cases had high-grade prostatic intraepithelial neoplasia immediately adjacent to the cancer. CONCLUSIONS: The incidence of minute carcinoma of the prostate has increased from 0.5% in 1988 to 5.2% in the current study. The patients often had moderately increased prostate-specific antigen levels and minute foci of carcinoma on biopsy. These small tumors at radical prostatectomy are usually discovered by fortuitous biopsy that is often preceded by other biopsies with noncancerous diagnoses. Patients with the above clinical and biopsy findings should be counseled about the possibility of finding only minute foci of carcinoma at radical prostatectomy and may want to consider watchful waiting.

Adenocarcinoma↗
PubMed2006

Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy).

OBJECTIVES: To report the long-term survival probability in more than 3000 men with localized prostate cancer treated either conservatively or by definitive treatment (radiotherapy or radical prostatectomy). METHODS: We studied 3159 men with biopsy-confirmed, clinically localized prostate cancer diagnosed from 1980 to 1997. We restricted our analysis to men 75 years of age or younger. The extent of comorbid disease was measured using the Charlson score. The Cox proportional hazards regression model was used to compare long-term survival in patients who were treated conservatively versus survival in patients treated with either radiotherapy or radical prostatectomy. RESULTS: After adjusting for age, race, tumor grade, comorbid disease, income status, and year of diagnosis, the overall survival rate at 15 years was 35% for conservative management, 50% for radiotherapy, and 65% for radical prostatectomy. The corresponding prostate cancer-specific survival rates were 79%, 87%, and 92%. Patients undergoing radiotherapy or radical prostatectomy had lower overall mortality than patients undergoing conservative management (adjusted relative risk 0.67 for radiotherapy and 0.41 for prostatectomy; P <0.001). The increase in the survival duration was 4.6 years with radiotherapy and 8.6 years with radical prostatectomy. CONCLUSIONS: The results of this study have shown that compared with conservative management, both radiotherapy and radical prostatectomy increase survival for men with localized prostate cancer.

Aged↗
PubMed1997

Radical prostatectomy: is the perineal approach more difficult to learn?

PURPOSE: We assessed the relative difficulty with which radical perineal and retropubic prostatectomy operations are learned. MATERIALS AND METHODS: The first 10 radical perineal and retropubic prostatectomies performed by 6 graduating urology residents were reviewed for patient and tumor characteristics, duration of surgery and hospitalization, and complication rates. RESULTS: A total of 120 patients was reviewed. Mean hospital stay was 2.5 days less after radical perineal prostatectomy, and estimated blood loss, number of transfusions and complication rates were also less for this procedure. All parameters used to estimate the outcome of the procedure indicated that radical perineal prostatectomy was learned more quickly than radical retropubic prostatectomy. CONCLUSIONS: In a residency training program radical perineal prostatectomy was learned at least as easily as retropubic prostatectomy. Due to expanding indications for this procedure, these findings should encourage urological surgeons to develop their skill with this approach.

General Surgery↗
PubMed2002

Cancer control with radical prostatectomy alone in 1,000 consecutive patients.

PURPOSE: We analyzed the long-term progression-free probability after radical retropubic prostatectomy in a consecutive series of patients with localized prostate cancer. MATERIALS AND METHODS: From 1983 to 1998, 1,000 patients (median age 62.9 years, range 37.7 to 81.4) with clinical stage T1 to T2 prostate cancer were treated with radical retropubic prostatectomy and pelvic lymphadenectomy, without other cancer related therapy before recurrence. Mean followup was 53.2 months (median 46.9, range 1 to 170). RESULTS: Ten years after radical retropubic prostatectomy the mean probability +/- 2 standard errors that patients remained free of progression and of any further treatment was 75.0% +/- 3.7% and of metastasis 84.2% +/- 4.4%. Mean actuarial cancer specific survival rate +/- 2 standard error was 97.6% +/- 1.7%. In a multivariate analysis pretreatment prostate specific antigen level (p <0.0001), biopsy Gleason sum (p <0.0001) and clinical stage (p=0.0071) were independent prognostic factors for progression. After prostatectomy independent risk factors were Gleason sum in the prostatectomy specimen (p=0.0008), extracapsular extension (p=0.0019), seminal vesical involvement (p <0.0001), lymph node metastasis (p <0.0001) and surgical margin status (p <0.0001). Margins were positive in 12.8% of cases. At 10 years postoperatively radical retropubic prostatectomy was effective for cancer confined to the prostate (92.2% progression-free probability) and also not confined (52.8%), including 71.4% progression-free probability for patients with only extracapsular extension and 37.4% with seminal vesicle invasion without lymph node metastasis. CONCLUSIONS: Radical retropubic prostatectomy provided long-term cancer control in 75% of patients with clinically localized prostate cancer and was effective in the majority of those with high risk cancer, including T2c or biopsy Gleason sum 8 to 10, or PSA greater than 20 ng./ml. Further research should address identifying patients who can safely avoid aggressive therapy.

Adult↗
PubMed2002

A centralized comparison of radical perineal and retropubic prostatectomy specimens: is there a difference according to the surgical approach?

PURPOSE: We performed a central review of pathology specimens from radical perineal and radical retropubic prostatectomies performed by a single surgeon. We determined whether differences exist in the 2 approaches in regard to the ability to obtain adequate surgical margins around the tumor and adequate extracapsular tissue around the prostate, and avoid inadvertent capsular incision. MATERIALS AND METHODS: The review included whole mount prostates from 60 patients who underwent radical retropubic prostatectomy and 40 who underwent radical perineal prostatectomy. The pathologist (N. S. G.) was blinded to the surgical approach. All prostatectomies were consecutive and performed by the same surgeon (H. J. K.). To ensure consistency of the pathological measurements patients were excluded from analysis if they had undergone preoperative androgen ablation or a nerve sparing procedure, leaving 45 retropubic and 27 perineal prostatectomy specimens for further evaluation. Pertinent clinical parameters were assessed and a detailed pathological analysis of each specimen was performed. RESULTS: In the retropubic and perineal groups 78% of the tumors were organ confined (stage pT2) with extracapsular extension (stage pT3) in the majority of the remaining patients. There was no significant difference in the positive margin rate for the retropubic and perineal procedures (16% and 22%, p = 0.53) or for Gleason 6 and 7 tumors only in the 2 groups (10% and 17%, respectively, p = 0.47). The capsular incision rate was 4% in each group. The distance of the tumor from the posterolateral margins and the amount of extracapsular tissue excised were equivalent in each group. Subgroups of patients with a prostate of less than 50 gm. and containing only low grade, low stage neoplasms were also analyzed. Subgroup analysis showed no difference in any variable. CONCLUSIONS: Radical perineal prostatectomy is comparable to radical retropubic prostatectomy for obtaining adequate surgical margins, avoiding inadvertent capsular incisions and excising adequate extracapsular tissue around tumor foci. Additional patient accrual and prostate specific antigen followup would further help validate the similar efficacy of the 2 surgical approaches as treatment for prostate cancer.

Adult↗
PubMed2000

Prostate cancer is highly predictable: a prognostic equation based on all morphological variables in radical prostatectomy specimens.

PURPOSE: We determine whether biochemical prostate specific antigen (PSA) failure can be accurately predicted from preoperative serum PSA combined with 6 morphological variables from radical retropubic prostatectomy specimens in men with peripheral zone cancers. The unexpected limitation imposed by preoperative serum PSA on biochemical failure led us to compare peripheral zone to transition zone cancers. MATERIALS AND METHODS: A total of 326 peripheral zone and 46 transition zone cancers treated only with radical retropubic prostatectomy were followed for a minimum of 3 years (mean and median greater than 5). All prostates were sectioned at 3 mm. intervals and morphological variables were quantitated using the Stanford technique. Biochemical failure was defined as serum PSA 0.07 ng./ml. or greater and increasing. Multivariate logistic regression was used to identify variables with the most independent influence on biochemical failure and derive a clinical equation to predict failure in peripheral zone cancers. The validity of the predictive equation was assessed by out of sample validation and cross validation techniques. The 46 transition zone cancers were compared to the 326 peripheral zone cancers by Student's t and Wilcoxon tests. RESULTS: Of the peripheral zone failures 60% occurred in the first year after radical retropubic prostatectomy and 95% had occurred by the end of year 4. The highest preoperative serum PSA was 23 ng./ml. among the 181 men biochemically free of disease. Only 15.8% of 57 men with PSA greater than 15 ng./ml. were biochemically disease-free. For the 48 transition zone cancers cure rates were independent of serum PSA with 6 men having PSA greater than 50 ng./ml. Biochemical disease-free status was noted in 80% of transition zone compared to 56% of peripheral zone cancers (p = 0.0009). The most important variables predicting biochemical disease-free status for peripheral zone cancers were percent Gleason grade 4/5, cancer volume, serum PSA and prostate weight. Foci of vascular invasion, intraductal cancer and lymph nodes were less significant variables, and capsular penetration, positive surgical margins and seminal vesical invasion were insignificant. The multivariate logistic equation for predicting failure in peripheral zone cancers was highly accurate and requires only 2 to 3 minutes with a simple calculator. CONCLUSIONS: Failure of radical retropubic prostatectomy to cure peripheral zone prostate cancer is highly predictable based on 6 morphological variables from the prostatectomy specimen and serum PSA. The level of serum PSA profoundly limits biochemical cure rates in peripheral zone cancers. Transition zone cancers have a high cure rate, despite high serum PSA and adverse morphological variables. Men with serum PSA greater than 15 and perhaps even greater than 10 ng./ml. have such a low cure rate for peripheral zone cancer that re-biopsy attempts appear indicated to prove a transition zone location or else therapy other than radical retropubic prostatectomy should be sought. Pathologists should indicate whether the primary (largest) cancer is in the peripheral or transition zone to prevent overoptimistic reports of cure with radical prostatectomy procedures, as 85% of all tumors are in the peripheral zone.

Aged↗
PubMed1999

Can ploidy of prostate carcinoma diagnosed on needle biopsy predict radical prostatectomy stage and grade?

PURPOSE: Deoxyribonucleic acid ploidy correlates with the biological behavior of prostate carcinoma. However, the usefulness of ploidy on needle biopsies that show prostate cancer has not been established to our knowledge. MATERIALS AND METHODS: We retrospectively determined ploidy on needle biopsies of 159 men with prostate carcinoma treated surgically at Johns Hopkins Hospital. Ploidy was determined by image analysis of Feulgen stained slides. Needle ploidy and Gleason score were compared as prognostic tools in the prediction of grade and stage of subsequent prostatectomy. RESULTS: Of the 159 cases 98 (62%) were diploid, 16 (10%) tetraploid and 45 (28%) aneuploid. Of the diploid, tetraploid and aneuploid tumors 69, 50 and 44%, respectively, proved to be organ confined. Tetraploid and aneuploid tumors were grouped for the remaining analysis. Needle ploidy correlated significantly with pathological stage (p = 0.003). However, needle Gleason score correlated even more strongly (p <0.001), and on multivariate analysis ploidy was not further predictive of pathological stage once Gleason score was considered. Needle ploidy and Gleason score were predictive of prostatectomy Gleason score (6 or less versus 7 or greater), and on multivariate analysis ploidy was an independently significant predictor of this parameter (p = 0.04). In 13 cases (8%) there was an important grading discrepancy, in which needle ploidy would have accurately predicted prostatectomy grade. However, in 33 cases (21%) needle and prostatectomy Gleason scores were congruent, and needle ploidy did not accurately predict prostatectomy Gleason score. CONCLUSIONS: With accurate needle Gleason grading, ploidy is not helpful in predicting prostatectomy findings. However, ploidy correlates with prostatectomy stage and grade, and may be useful if accurate Gleason grading is a concern.

Aged↗
PubMed1999

p53 and bcl-2 immunohistochemistry in pretreatment prostate needle biopsies to predict recurrence of prostate cancer after radical prostatectomy.

PURPOSE: Immunohistochemical staining of radical prostatectomy specimens for p53 and bcl-2 proteins has been shown to correlate with prostate specific antigen (PSA) recurrence in a series of patients at our institution. We analyzed the relationship between staining of diagnostic prostate needle biopsies for p53 and bcl-2, and PSA recurrence. MATERIALS AND METHODS: From 1986 to 1993, 335 radical prostatectomies were performed at our hospital. Of the prostatectomy specimens 199 had been evaluated for p53 and bcl-2 proteins in a prior series. Of 139 patients with biopsy material available for analysis 129 had enough for evaluation of 1 or both markers. Prospectively obtained clinical followup data were available, with a mean followup of 6 years. Commercially available antibodies were used for immunohistochemical staining. RESULTS: The overall PSA recurrence rate was 37.6% for 199 radical prostatectomy cases and 37.9% for 129 with biopsy immunohistochemical staining. Staining of prostatectomies correlated well with PSA recurrence for p53 (p = 0.004) and bcl-2 (p = 0.001). However, biopsy staining did not correlate with prostatectomy staining or PSA recurrence for either marker. CONCLUSIONS: The p53 and bcl-2 biomarkers appear to be important to predict recurrence of prostate cancer when prostatectomy specimens are analyzed but this usefulness is not apparent with immunohistochemical staining of prostate biopsies. This difference may reflect sampling error and/or the heterogeneous nature of prostate cancers, and deserves further study.

Aged↗