Localized prostate cancer. Local treatment and what place for lymphadenectomy

The pretreatment PSA level, the Gleason score, the presence of lymph-node metastases, the status of surgical positive margins are poor pathological risk factors for patients who have a pathologic stage T3 prostate cancer. The increase in PSA level during the year prior to diagnostic is associated with the risk of death due to prostate cancer following radical prostatectomy or external beam radiation therapy. The assessment of Locoregional extension is indicated for such patients. The extended pelvic lymphadenectomy remains the most accurate procedure for a correct staging of the detection of nodal involvement in these patients with high-risk localized prostate cancer. For such patients with a high-risk of progression and, whose the life expectancy is greater than 10 years, treatment must be a combined modality therapy since radical prostatectomy alone correlates with a poor clinical outcome. Adjuvant hormonal therapy following local curative treatment by prostatectomy (or radiotherapy) needs to be often considered. Collegial decision-making is by far the most appropriate setting for the discussion among medical specialists of these complex clinical cases for patients often having associated medical conditions and whose adjuvant treatment will have a significant impact of their future quality of life.     

Localized prostate cancer and 30 years of follow-up in a population-based setting

Some patients with a histopathological diagnosis of prostate cancer have a tumour that behaves benignly during long-term follow-up. The proportion of patients with such a tumour is unknown, as is the fraction who die of prostate cancer between 10 and 20 y of follow-up. All men aged 45-84 y obtaining a diagnosis of prostate cancer between 1965 and 1993 and being reported to the Finnish Cancer Registry were observed. Death was recorded as caused by prostate cancer or not. We identified 11,500 men with localized prostate cancer and in this group the disease-specific survival rate reached a plateau at approximately 30% after 23 y of follow-up. In the same cohort, 5% of the patients died of prostate cancer during years 11-20 of follow-up. During the observation period, somewhat less than half of the patients with localized prostate cancer who died, died of the disease. This proportion decreased with duration of follow-up. In conclusion, early aggressive therapy for localized prostate cancer is unnecessary, in terms of survival, for those with a benignly behaving tumour (about 30% in this series) or who die of intercurrent disease (about 50% in this series). Such therapy may, however, prolong life for the patients and may cure the patients that die of prostate cancer after more than 10 y follow-up. Prostate Cancer and Prostatic Diseases (2000) 3, 37-42     

Localized prostate cancer treatment in renal transplant patient with high intensity focalized ultrasound (HIFU)

We report a 62 years old kidney transplant (KT) patient who was diagnosed of localized prostatic cancer (PC) after 6 years of the implant. Transrectal prostatic High Intensity Focused Ultrasound (HIFU) was applied. Results have been satisfactory, achieving pathologic and biochemical success. The discharge was completed at 24 hs, the morbidity was minimal. We have not found any reference in the literature on the appliance of HIFU in PC KT patients. We think that HIFU may represent a good alternative for these patients.     

Bone and prostate cancer cell interactions in metastatic prostate cancer

The interplay in prostate cancer bone metastases between the 'seed' (the prostate cancer cells) and the 'soil' (the bone microenvironment) has been increasingly recognized as integral to the remarkable tropism for bone shown by prostate cancer. Increasing research into this area is elucidating the mechanisms involved in this complex 'cross-talk'. Recent developments, including the use of bisphosphonates in metastatic disease, highlight the important role of bone cells in the development and progression of metastatic prostate cancer. We review the current reports emphasising these possible mechanisms and indicating possible factors for future treatment directions.     

Advanced prostate cancer

Both the definition and therapy of advanced prostate cancer is challenging. The advanced prostate cancer session at "The 8th International Prostate Cancer Update" had discussions which tried to answer the questions of management of these patients who either present with advanced disease or fail any form of therapy for clinically confined prostate cancer. This article provides an overview of therapeutic options: monotherapy and minimal androgen blockade options versus maximal androgen blockade, adjuvant therapy, intermittent therapy and timing of therapy as well as chemotherapy when all these measures fail. The impact of these therapies on progression as well as quality of life is reviewed.     

Local-regional prostate cancer

Historically, locally advanced prostate cancer was defined clinically with the digital rectal exam (DRE). With the introduction of screening prostate specific antigen (PSA), further pretreatment stratification of locally advanced prostate cancer was possible. Tables and nomograms have been developed to predict pathologic staging prior to therapy. By combining DRE, PSA, Gleason score, and clinical staging, a patient's probability of treatment failure is estimated, thereby stratifying the risk of locally advanced disease. Pretreatment PSA velocity (PSAV) and PSA doubling time (PSADT) will likely continue to play a role in defining locally advanced prostate cancer. Imaging studies, especially high-field strength pelvic MRI, may provide additional information regarding the presence of locally advanced prostate cancer. In the future, molecular or genetic testing may permit further stratification of patients with locally advanced disease, who are at variable risk for recurrence and death after treatment. Future trials will need to assess the utility of multimodality treatments for patients in the diverse classification of locally advanced prostate cancer.     

Metastatic prostate cancer

Summary For decades the palliation of prostate cancer has centered around hormonal manipulation using orchiectomy or estrogen administration. Newer modalities, such as LHRH agonists and nonsteroidal antiandrogens, are now available. Patients receiving combination therapy enjoy superior progression-free and median survival rates.     

Hormone-refractory prostate cancer

Hormone-refractory prostate cancer is an advanced stage of the metastatic disease; it has a poor prognosis and a short median survival, about 9 to 18 months. The current article is based on a literature review regarding the prognostic factors and medical treatments, with a focus on recent advances in chemotherapy. With the use of docetaxel that increases the median survival of this disease and improves the symptoms, new clinical protocols have been developed, with promising results; these protocols propose a combination with calcitriol or antiangiogenic agents. Supportive care is also an important part of the treatment due to the high level of bone involvement and its consequences. Such recent advances constitute a real progress in the management of prostate cancer, namely the pharmacological combinations with a promising efficacy and little toxicity.     

Localized prostate cancer and robot-assisted laparoscopic radical prostatectomy: a retrospective,comparative study between pre- and post-operative Gleason scores

Introduction: To compare the pre- and post-operative Gleason scores (GS) in patients with localized prostate cancer treated with robot-assisted laparoscopic radical prostatectomy.

Materials and methods: A single center, retrospective comparison between pre- and post-operative GS. Age, prostate volume, PSA, number of biopsies, number of positive cores, biopsy GS, cTNM, final pathology GS and pTNM of 286 patients were retrieved. They were divided into risk groups.

Results: A total of 286 patients with a mean age at surgery of 64.64?±?7.81 y and mean PSA-value of 9.35?±?8.38?ng/mL. Mean prostate volume was 55.09?±?24.93?mL, mean number of biopsies was 11.90?±?4.63. Mean percentage of positive cores was 36.90?±?22.42%. A GS of <7 was seen in 23.4%, 66.8% had a GS of 7 and 9.7% of >7 in final pathology. Of the total, 38.1% were pre-operative low risk, 58.7% of them had an upgrade in GS on final pathology, 45.1% were in the intermediate risk group, 5.4% showed a downgrade, 64.3% remained stable and 30.2% had an upgrade in GS. Also, 16.8% were high risk patients of which 35.4% had a downgrade, 39.6% remained stable and 25% showed an upgrade of the GS.

Conclusions: We found a substantial underestimation of the GS in the pre-operative setting when compared to the GS in final pathology.     

Defining prostate cancer risk before prostate biopsy

Prostate cancer is the most commonly diagnosed cancer in men. At present, patients are selected for prostate biopsy on the basis of age, serum prostate specific antigen (PSA), and prostatic digital rectal examination (DRE) findings. However, due to limitations in the use of PSA and DRE, many patients undergo unnecessary prostate biopsy. A further problem arises as many patients are diagnosed and treated for indolent disease. This review of the literature highlights the strengths and weaknesses of existing methods of prebiopsy risk stratification and evaluates promising serum, urine, and radiologic prostate cancer biomarkers, which may improve risk stratification for prostate biopsy in the future.     

miRNA在前列腺癌中的研究进展

前列腺癌(PCa)是男性泌尿系最常见的恶性肿瘤之一,微小RNA(miRNA)是一类内源性的非编码小RNA,研究发现miRNA与PCa的发生和发展密切相关,多种miRNA在PCa中表达异常。本文通过描述miRNA在PCa中表达差异及其与预后的相关性,进一步分析miRNA与放化疗、雄激素受体,以及PCa转移的相关性,来阐明miRNA在PCa发生发展中的的作用。