血清PSA值与穿刺标本Gleason评分预测前列腺癌病理分级

目的 探讨准确有效预测前列腺癌病理分级的方法.方法 分析75例前列腺癌患者术前血清PSA水平、穿刺活检标本和前列腺癌根治术后标本Gleason评分资料,对血清PSA水平与根治术后标本Gleason评分进行等级相关分析,对穿刺活检标本与根治术后标本Gleason评分进行配对秩和检验.结果 75例患者术前血清PSA值4～230 ng/ml,平均33.5 ng/ml;穿刺活检标本Gleason评分2～9分,平均(4.4±2.3)分;根治术后标本Gleason评分2～10分,平均(4.8±2.5)分.术前血清PSA水平与根治术后标本Gleason评分呈正相关(rs=0.279,P=0.015),穿刺活检标本与根治术后标本Gleason评分差异有统计学意义(P=0.011).结论 前列腺癌患者术前血清PSA水平越高,根治术后标本Gleason评分也越高;穿刺标本Gleason评分有低估的缺点,必要时应行病理分级后再评估.     

Gleason10分前列腺癌患者的临床特点分析

目的 观察Gleason 10分前列腺癌患者的临床诊疗及疾病变化过程,总结该类前列腺癌患者的临床特点及预后影响因素. 方法 2005年1月至2010年5月,21例初诊为前列腺癌、Gleason 10分、行手术去势加抗雄激素治疗的患者纳入本研究.初诊年龄56～85岁,平均73岁.PSA 8.9～261.0 ng/ml,平均60.8 ng/ml,其中6例PSA≤20 ng/ml.行核素骨扫描发现骨转移16例.予双侧睾丸切除术加氟他胺或比卡鲁胺全雄激素阻断治疗.术后1个月复查PSA,以后每3个月随访PSA.治疗后6个月为单纯内分泌治疗观察终点.6个月内PSA未降至＜4 ng/ml且无远处转移者加用局部外放射治疗,伴骨转移者使用基于多西他赛与泼尼松的全身化疗.患者死亡为研究终点.结果 15例初诊PSA＞ 20 ng/ml患者中,5例治疗后6个月内血清PSA未降至正常水平,其中4例伴骨转移.该4例子全身化疗后PSA均未降至正常水平,3例1年内死亡,1例诊断后19个月死亡,1例疾病局限患者予外放射治疗,PSA下降至正常水平8个月后出现肿瘤进展,诊断后11个月死亡.10例治疗后6个月内血清PSA降至正常水平,其中3例分别于诊断后第19、28、36个月死于肿瘤,7例存活.6例初诊时PSA≤20 ng/ml患者中3例治疗后6个月内PSA未降至正常水平,其中2例伴骨转移予化疗后于1年内死亡;1例PSA下降至正常水平但仍出现肿瘤进展,全身多发骨转移,化疗无效,1年内死亡;1例4年后因前列腺癌死亡;1例随访6个月,PSA降至0.07 ng/ml. 结论 Gleason 10分前列腺癌肿瘤进展迅速,抗雄激素治疗疗效不佳,行伞雄激素阻断后6个月内PSA无法下降至正常水平患者病情进展凶险.初诊PSA≤20 ng/ml且病理证实Gleason 10分者可能预示预后不佳.     

雄激素全阻断治疗对前列腺体积的影响及相关因素分析

目的 探讨前列腺癌近距离治疗前雄激素全阻断治疗对前列腺体积变化的影响及与临床病理因素的相关性。方法 前列腺癌患者74例。年龄54～84岁，平均71岁。均经会阴前列腺穿刺活检证实。血清PSA值2．8～71．2ng／ml；TNM分期T1cN0M0～T3aN0M0；Gleason评分5～9分65例，不确定9例；前列腺体积14～83ml，其中〈50ml42例，〉50ml32例。前列腺体积经三维治疗计划系统测量。采用手术去势加雄激素阻断（比卡鲁胺50ms／a或氟他胺250mg3次／d）31例，药物去势（戈舍瑞林3．6mg或亮丙瑞林3．75mg次／28d）加雄激素阻断治疗43例，时间2．1～5．6个月，平均2．8个月。观察前列腺体积变化与治疗前患者血清PSA值、Gleason评分、TNM分期、活检阳性区数及治疗方式的关系。结果 雄激素全阻断治疗后74例患者平均前列腺体积缩小37％。前列腺体积〉50ml者前列腺缩小程度大于体积〈50ml者（P=0．004）。前列腺体积缩小比率与治疗前体积大小呈正相关（r=0．321，P=0．006），而与治疗前血清PSA值、Gleason评分、TNM分期、活检阳性区数及雄激素全阻断治疗方式无关。结论 雄激素全阻断治疗可以缩小前列腺体积，使之适合粒子植入，治疗前前列腺体积越大，体积缩小越明显。     

腹腔镜前列腺癌根治术治疗高危前列腺癌的临床体会

目的：探讨腹腔镜前列腺癌根治术在高危前列腺癌治疗中的价值。方法回顾性分析2012年3月～2014年11月本院腹腔镜前列腺癌根治术治疗26例高危前列腺癌的临床资料。患者平均年龄65．2岁,术前检查单独PSA≥20ng／mL者9例;兼具PSA≥20ng／mL并Gleason评分≥8分者17例;术前诊断T3 b和T4期各1例。3例患者因前列腺体积过大术前分别行3～6个月新辅助内分泌治疗。手术方式均采用经腹膜外路径腹腔镜前列腺癌根治术,同时行盆腔淋巴结清扫。结果26例手术均获成功,平均手术时间152min,平均出血量85mL,无输血病例。所有患者均于术后两周拔除导尿管,8例拔管后尿失禁,经盆底训练后于1周至3个月恢复控尿。术后病理T2a～T2b,Gleason评分≤7分者10例;T2c～T4,Gleason评分≥8分者16例。术中清扫淋巴结数目平均5．5个,淋巴结阳性3例;切缘阳性4例,术后控尿恢复后予局部放射治疗。19例获访3～30个月,所有患者均控尿良好,PSA≤0．2ng／mL。结论对高危前列腺癌患者采用以根治性前列腺癌切除术为核心的综合治疗策略安全有效,可使患者获益。     

前列腺癌患者去势术后的睾酮水平

目的 探讨进展期前列腺癌患者去势术后平均睾酮水平，以指导内分泌治疗。方法 进展期前列腺癌患者40例，去势术后，未用任何抗雄激素药物，分别于术前、术后1周及1、3、6、9、12个月，观察血清总睾酮和PSA变化。结果 去势术后6个月，40例患者血清睾酮平均水平〈1．9nmol／L（95％可信区间1．2～1．9nmol／L）；13例患者睾酮〉1．9nmol／L，平均Gleason评分为6．8分。术后6个月，36例患者PSA〈1ng／ml，平均Gleason评分为6．3分；4例患者PSA〉1ng／ml，平均Glcason评分为8．0分。结论 前列腺癌患者去势术后，平均血清睾酮水平〈1．9nmol／L，部分患者需继续抗雄激素药物治疗。术后PSA逐渐下降，6个月降至最低值。     

雄激素剥夺治疗时间对前列腺癌根治术后放疗的预后影响

为了明确持续的雄激素剥夺治疗是否影响前列腺癌根治术后患者接受放疗的临床预后，对1986年至2010年间某三级医疗机构收治的680例接受辅助放疗或接受挽救性放疗的患者的临床资料进行回顾性分析并进行随访.共有144例患者在前列腺癌根治术后接受雄激素剥夺治疗，且有以下高危因素，包括 Gleason 评分8~10、精囊侵犯或放疗前 PSA＞1 ng/ml.发现接受雄激素剥夺治疗时间小于12个月的患者比治疗时间大于12个月的患者更容易发生化疗失败(HR：2．27；P ＝0．003)或者远处转移(HR：2．48；P ＝0.03).研究结果表明，对于前列腺癌根治术后接受放疗的高危患者，放疗后的持续的雄激素剥夺治疗与患者的预后相关，因此推荐此类患者进行至少12个月的持续雄激素剥夺治疗，将使患者获得更好的预后。     

临床局限性前列腺癌行前列腺癌根治术后生化复发的可能性预测

作者回顾性分析了一组临床局限性前列腺癌行经耻骨后前列腺癌根治术的患者 ,以确定预测前列腺癌生化复发的临床和病理危险因素。 1982年至 1999年 ,2 0 91例临床局限性前列腺癌患者(临床分期为T1c或T2 期 ,Gleason评分≥ 5分 )行经耻骨后前列腺癌根治术和淋巴结切除术 ,前列腺癌根治术后PSA升高≥ 0 .2ng/ml诊断为生化复发。通过统计学分析建立两个模型 ,第 1个模型只考虑术前因素 ,第 2个模型考虑所有可能的因素。结果显示 :随访中位时间 5 .9年 (1～ 17年 ) ,36 0例患者 (17% )生化复发。 5、10及 15年无生化复发的生存率分别为 84 %、…     

前列腺根治术后是否需要立即给予内分泌治疗值得商榷

前列腺癌根治术后生化复发患者的治疗选择目前还有一些争议,可供选择的治疗方法包括：等待观察、挽救性放疗、内分泌治疗（包括全雄激素阻断、间歇性内分泌治疗、抗雄激素药物单药治疗、抗雄激素药物联合5a-还原酶抑制剂等）。经过对患者全面评估后,首先应该判断患者是肿瘤局部复发还是远处转移。局部复发可能性大者可选用等待观察或挽救性放疗,远处转移可能性大者可选用内分泌治疗。     

原发性前列腺印戒细胞癌诊疗分析

目的 提高对原发性前列腺印戒细胞癌临床特点的认识和诊治水平. 方法 原发性前列腺印戒细胞癌患者23例.年龄57～90岁,平均74岁.有排尿症状者18例,体检偶然发现PSA升高者5例.实验室检查PSA平均45.3(7.4～126.8)ng/ml.MRI多示外周带有异常区呈T1w低信号、T2W高信号,增强后明显强化,中央带见增生结节,呈混杂信号.其中行前列腺癌根治术7例,2例切缘阳性者术后辅以全雄激素阻断治疗及体外放射治疗,16例行全雄激素阻断治疗,其中11例因存在下尿路梗阻而行前列腺绿激光汽化术,3例行体外放射治疗.23例均行消化道内镜或钡餐检查排除转移性印戒细胞癌. 结果 23例均经病理证实为印戒细胞癌,其中纯印戒细胞癌6例,混有典型前列腺癌成分17例,其中典型癌成分均为Gleason评分7～10分的高级别低分化前列腺癌.免疫标记PSA、前列腺酸性磷酸酶均为阳性,AB/PAS阴性,CEA阴性21例.TNM临床分期Ⅱ期7例,Ⅲ期10例,Ⅳ期6例.20例平均随访24(6～56)个月,8例生存6～42个月后因肿瘤转移死亡,5例12～21个月后出现生化复发,失访3例. 结论 原发性前列腺印戒细胞癌侵袭性强、转移快且累及前列腺外各种脏器、复发早,早期诊断及综合治疗或能提高远期生存率.     

放射性粒子植入术治疗高分级前列腺癌的远期随访研究

目的:探讨应用I125放射性粒子植入术治疗高分级非转移性前列腺癌的远期疗效和安全性。方法:回顾性分析2007年1月~2017年3月经病理确诊为前列腺癌且Gleason评分≥8分的高分级前列腺癌患者67例,年龄61~83岁,平均(74.2±4.8)岁;穿刺前PSA 5.6~117.0ng/ml,平均(27.6±22.8)ng/ml;穿刺Gleason评分8分者35例(52.2%),9~10分者32例(47.8%);临床分期T2期42例(62.7%),T3期25例(37.3%),所有患者均接受I125前列腺放射性粒子植入术作为初始治疗,术后均行辅助内分泌治疗,内分泌治疗时间为6~12个月,为激素全阻断疗法。生化进展定义为PSA大于治疗后最低值2ng/ml,随访患者无生化进展生存率、肿瘤特异性生存率和总体生存率。结果:所有高分级前列腺癌患者粒子植入手术均顺利完成,术后随访12~121个月,平均56.1个月。在随访过程中,33例(49.3%)高分级前列腺癌患者出现生化进展,平均生化进展时间为28.8个月;13例(19.4%)患者在随访过程中死亡,其中7例(10.1%)患者因前列腺癌进展死亡。本组患者3年无生化进展生存率、肿瘤特异性生存率和总体生存率分别为59.7%、94.9%和89.8%,5年无生化进展生存率、肿瘤特异性生存率和总体生存率分别为42.6%、91.5%和83.1%。Gleason评分8分与9~10分的高分级前列腺癌患者经粒子植入治疗后的无生化进展生存率Kaplan-Meier生存曲线比较差异有统计学意义(P0.05)。结论:应用I125放射性粒子植入术治疗高分级前列腺癌患者安全、有效,值得推广,但应注意Gleason评分≥9分患者,临床进展更为迅速,在临床工作中应予以重视。     

Nondissection of pelvic lymph nodes does not influence the results of perineal radical prostatectomy in selected patients

OBJECTIVES: Retrospective studies have shown that pelvic lymph node dissection can be dispensed with in selected men undergoing radical prostatectomy. We prospectively evaluated the influence of nondissection of pelvic lymph nodes on tumor progression in our first 100 perineal prostatectomies. METHODS: From October 1992 to February 1998, 100 patients underwent radical perineal prostatectomy for localized prostate cancer. Preoperative PSA, the Gleason score of positive biopsies and age at surgery were noted. Forty-three of the 100 patients (group 1) did not undergo pelvic lymph node dissection because their preoperative PSA level was below 10 ng/ml (Hybritech assay, normal value 4 ng/ml) and the Gleason score of their positive biopsies was below 7. These 43 patients were compared with 25 of the 114 patients operated on during the same period by the retropubic approach and who had pelvic node dissection and the same preoperative criteria (PSA <10 ng/ml and a Gleason score of positive biopsies <7; group 2). All prostatectomy specimens were processed according to the Stanford protocol: prostate weight, Gleason score, capsular, seminal vesicle, lymph node and surgical margin status, and tumor volume were studied. Postoperative followup was based on routine serum PSA assays after 1 and 3 months and then half-yearly. Biological progression was defined as PSA level which was detectable postoperatively (>/=0.2 ng/ml). Kaplan-Meier analysis was used to evaluate the likelihood of biochemical recurrence. Results were compared by using Fisher's test, the Mann-Whitney test and the log-rank test. Differences were considered significant when the p value was <0.05. RESULTS: No differences in preoperative characteristics were observed; in groups 1 and 2, mean age was 65.9 and 64.7 years, PSA was 6.7 and 5.11 ng/ml, and the Gleason biopsy score was 5.7 vs. 5.0, respectively. In groups 1 and 2, specimen weight was 44.5 and 54.3 g (p = 0.04), the Gleason score was 6.2 and 5.6, tumor volume was 0.91 and 0.8 ml, 81.4 and 84% of patients were in stage pT2, 13.9 and 12% had extracapsular disease, 4.6 and 0% had seminal vesicle invasion, and 13.9 and 16% had positive surgical margins, respectively. The mean follow-up was 2.74 years (0.27-5.59 years). The actuarial 5-year recurrence-free rate was 78% in group 1 and 80% in group 2 (p>0.05). CONCLUSION: The lack of pelvic lymph node dissection does not influence the intermediate term results of perineal radical prostatectomy in selected patients (preoperative PSA <10 ng/ml and Gleason score for positive biopsies <7).     

根治性前列腺切除术后生化复发的危险因素分析

目的:探讨根治性前列腺切除术后生化复发的危险因素。方法:回顾性分析2010年1月至2020年12月空军军医大学第一附属医院收治的558例根治性前列腺切除术患者的临床资料。年龄平均67.9(40~87)岁,体质指数平均24.56(15.12~35.94) kg/m 2。前列腺特异性抗原(PSA)平均41.07...     

Prostate specific antigen recurrence rates are low after radical retropubic prostatectomy and positive margins

PURPOSE: Treatment in patients with a positive surgical margin after radical retropubic prostatectomy is controversial. Options are observation, radiation therapy and early hormone therapy. Making the appropriate choice should be based on an understanding of the risk of recurrence without treatment. MATERIALS AND METHODS: We reviewed the records of 1,383 patients after radical retropubic prostatectomy was performed by a single surgeon. All specimens were analyzed by a single pathologist. Of the patients 936 met criteria for analysis. RESULTS: Mean followup in these 936 patients was 45.8 months (minimum 12). The overall PSA biochemical recurrence rate was 11.5% (108 of 936 cases). Of the 936 patients 350 (37%) had tumor at an inked margin. These patients had a recurrence rate of 19% (67 of 350), while patients with negative margins had a recurrence rate of 7% (41 of 586). This difference was statistically significant (p <0.01). Multivariate HR analysis revealed that significant risk factors for recurrence in the 936 patients were PSA greater than 20 ng/ml, clinical stage T2 or greater, Gleason 7 or greater, seminal vesicle involvement, extraprostatic extension, a visual estimate of prostate cancer volume of greater than 9.1% and positive surgical margins. Statistically significant risk factors for recurrence in patients with a positive margin on multivariate HR analysis were PSA greater than 20 ng/ml, Gleason score 7 or greater and seminal vesicle involvement. CONCLUSIONS: Although the positive margin rate in this series was 37%, the recurrence rate in these patients was only 19%. It is important to consider other factors, such as PSA, Gleason score, seminal vesicle involvement and extraprostatic extension, when making treatment decisions.     

Improved risk stratification for biochemical recurrence after radical prostatectomy using a novel risk group system based on prostate specific antigen density and biopsy Gleason score

PURPOSE: Previous studies have suggested that prostate specific antigen (PSA) density is a significant independent predictor of biochemical failure after primary therapy. We determined whether pathological PSA density using surgical weight of the radical prostatectomy specimen was an independent predictor of adverse pathological features or biochemical recurrence after radical prostatectomy. We also examined whether combining pathological PSA density with biopsy Gleason score improved risk stratification compared with serum PSA and biopsy Gleason score for predicting PSA recurrence after prostatectomy. MATERIALS AND METHODS: Multivariate analysis was used to determine whether pathological PSA density was an independent predictor of adverse pathology or PSA recurrence after radical prostatectomy in 325 patients treated at a Veterans Affairs medical center. Cutoff points of pathological PSA density were generated to identify patients at various risks for biochemical recurrence. These cutoffs were combined with biopsy Gleason cutoff points 2 to 6, 7 and 8 to 10 to generate a risk stratification system that was compared with a previous risk stratification system using PSA and biopsy Gleason score cutoff points. The validity of the risk stratification system using pathological PSA density and biopsy Gleason score was evaluated in another cohort of 490 patients treated with radical prostatectomy at a tertiary care medical center. RESULTS: Pathological PSA density was an independent predictor of positive surgical margins (p <0.001), nonorgan confined disease (p <0.001), seminal vesicle invasion (p = 0.003) and biochemical recurrence after radical prostatectomy (p <0.001). The cutoff points for pathological PSA density of less than 0.3, 0.3 to 0.7 and greater than 0.7 ng./ml./gm. separated patients into 3 distinct groups at increasing risk for biochemical failure after radical prostatectomy (p <0.001). Pathological PSA density cutoffs combined with biopsy Gleason score cutoffs 2 to 6, 7 and 8 to 10 provided better risk stratification for biochemical failure than cutoffs based on a combination of PSA and biopsy Gleason score in patients treated at the Veterans Affairs (hazards ratio 3.04, confidence interval 2.25 to 4.11, p <0.001) and tertiary care (hazards ratio 2.38, confidence interval 1.78 to 3.18, p <0.001) medical centers. CONCLUSIONS: Pathological PSA density was a strong predictor of advanced pathology and biochemical failure after radical prostatectomy. Pathological PSA density combined with biopsy Gleason score defined a novel risk group system that improved risk stratification compared with a combination of PSA and biopsy Gleason score. These results were validated in another cohort of patients treated with radical prostatectomy at a tertiary care medical center. Further studies are required using PSA density values calculated from preoperative transrectal ultrasound measurements to determine whether a combination of PSA density and biopsy Gleason score provides significant pretreatment risk stratification.     

Biochemical and pathological predictors of the recurrence of prostatic adenocarcinoma with seminal vesicle invasion

PURPOSE: We assessed biochemical and pathological factors as predictors of recurrence in men with seminal vesicle invasion. MATERIALS AND METHODS: A consecutive series of 812 men who underwent radical retropubic prostatectomy between 1992 and 2000 included 106 (13%) with seminal vesicle invasion. Disease recurrence was defined as prostate specific antigen (PSA) 0.4 ng./ml. or greater. Patients with less than 12 months of followup, salvage radical retropubic prostatectomy, lymph node metastases and adjuvant therapy were excluded from study. Data on the remaining 66 cases were analyzed using the chi-square test, bivariate logistic regression, Kaplan-Meier analyses and Cox proportional regression. Variables included demographics, recurrence, time from surgery to recurrence, positive margins, capsular invasion, extracapsular extension, Gleason score (2 to 6, 7 and 8 to 10), and dichotomized values of preoperative PSA (10 or less versus 10 ng./ml.) and tumor volume (20% or less versus greater than 20%). RESULTS: Mean patient age was 62 years (range 48 to 74). At an average followup of 47.7 months (range 13 to 109) 53% of the patients were free of biochemical recurrence. Mean time to recurrence was 18.6 months (range 1.7 to 51.6). Univariate analyses revealed a statistical significant increased risk of recurrence in patients with PSA greater than 10 ng./ml. (p <0.0001), capsular invasion (p = 0.01) and age (p = 0.036). When adjusting for potential covariates, Cox proportional regression analysis indicated that higher PSA (hazard ratio 7.33, 95% CI 2.57 to 20.95), larger tumor volume (hazard ratio 5.64, 95% CI 1.97 to 16.19) and higher age (hazard ratio 1.13, 95% CI 1.04 to 1.22) were significantly associated with shorter time to recurrence. CONCLUSIONS: PSA greater than 10 ng./ml., tumor volume greater than 20% and age are significant predictors of recurrence after radical retropubic prostatectomy in patients with prostate cancer and seminal vesicle invasion. Hopefully future randomized trials may show a survival benefit of adjuvant therapy in patients at high risk.     

Prediction of Capsular Perforation and Seminal Vesicle Invasion in Prostate Cancer

Purpose

Capsular perforation and seminal vesicle invasion are unfavorable, prognostic factors in prostate cancer. Accurate preoperative prediction of these factors would be clinically useful for planning treatment, especially in patients being considered for radiation therapy, nerve sparing radical prostatectomy and watchful waiting. However, current methods are imprecise at predicting the presence and extent of these factors. We determined which combination of commonly available preoperative variables provides the best prediction of capsular perforation and seminal vesicle invasion in patients with clinically localized prostate cancer.

Materials and Methods

We reviewed the preoperative medical records and biopsy findings from 314 patients with clinical stages T1cN0M0 to T2cN0M0 cancer who underwent radical retropubic prostatectomy and bilateral pelvic lymphadenectomy between September 1991 and June 1993. Radical prostatectomy specimens were embedded and evaluated by whole mount sections.

Results

Capsular perforation was observed in 104 patients (33.1 percent) and seminal vesicle invasion was noted in 46 (14.6 percent). Preoperative variables predictive of capsular perforation and seminal vesicle invasion on univariate analysis were serum prostate specific antigen (PSA) concentration, clinical stage, Gleason primary and secondary patterns, Gleason score, nuclear grade, perineural invasion and percent cancer in the biopsy specimens. On multivariate analysis independent prognostic factors for capsular perforation and seminal vesicle invasion were PSA, Gleason score and percent cancer in the biopsy specimens.

Conclusions

The combination of serum PSA concentration, Gleason score and percent cancer in the biopsy specimens provides the best prediction of capsular perforation and seminal vesicle invasion. Models based on this combination of factors may be clinically useful to stratify patients for nonoperative treatment.     

Prognostic indicators for long term outcome following radical retropubic prostatectomy for prostate cancer involving the seminal vesicles

Seminal vesicle involvement at the time of radical prostatectomy (RP) for prostate cancer has been equated with metastatic disease. We review our biochemical freedom from disease results following RP in patients with seminal vesicle involvement with particular attention to identifying variables that may be predictive of disease recurrence. We retrospectively reviewed our surgical database and identified patients with pT3b (2002 AJCC) prostate cancer at RP [corrected]. There were 70 cases without lymph node involvement and with available clinical follow-up identified. Any patient receiving androgen deprivation therapy, radiation therapy, or with a sustained PSA elevation greater than 0.2 ng/mL was considered a biochemical failure. Results were calculated using the Kaplan-Meier method. Mean age was 63.4 (range 45.7-79.5) years, mean preoperative PSA was 11.3 ng/mL (range 2-60), mean biopsy Gleason score was 7.2 (range 4-9), mean RP Gleason score was 7.5 (range 5-9), and median follow-up time was 61.5 months (range 2.3-160.6). Overall, 33/70 (47%) patients were without evidence of disease without further therapy. For patients with pT3bN0Mx prostate cancer, margin status, capsular invasion, and PSA were not statistically significant risk factors for disease progression. Gleason score and major Gleason grade were the only statistically significant variables that predicted disease progression. A specimen Gleason score of greater than 7 and major Gleason grades greater than 3 were associated with an increased rate of disease progression in this patient group.     

Is seminal vesicle ablation mandatory for all patients undergoing radical prostatectomy? A multivariate analysis on 1283 patients

OBJECTIVE: With a shift in prostate cancer stage and a majority of patients operated nowadays with PSA levels <10 ng/ml, rates of seminal vesicle (SV) invasion found on radical prostatectomy specimens have decreased as compared to historical data. Since SV-sparing surgery may possibly have an influence on post-operative erectile dysfunction and urinary recovery, we tried to determine which patients could be safely spared SV excision during radical prostatectomy. MATERIAL AND METHODS: We used preoperative data from 1283 patients operated by radical retropubic prostatectomy--777 with serum PSA <10.0 ng/ml--to predict SV invasion on final pathological examination. Variables analyzed included age, digital rectal examination, serum PSA, biopsy Gleason score and percentage of biopsy cores invaded by prostate cancer. Statistical analysis included univariate, multivariate logistic regression analysis and receiver operating characteristic (ROC) curves. RESULTS: Out of 1283 patients, 137 (10.6%) had SV involvement, 41/777 (5.2%) with PSA <10.0 ng/ml, 16.1% in the 10-20 ng/ml range and 26.2% when PSA was >20 ng/ml. Percentage of biopsies affected by prostate cancer and biopsy Gleason score were significant predictors of SV invasion in multivariate analysis, both in the entire population and in the subset of patients with PSA <10.0 ng/ml (p < 0.0001). Probability graphs created for patients with PSA <10 ng/ml indicate a risk of seminal invasion <5% when Gleason score on biopsy is <7 or when the percentage of biopsies affected by cancer is <50%. CONCLUSIONS: Resection of SV might not be "oncologically" necessary in all patients undergoing RP when PSA levels are below 10 ng/ml except when biopsy Gleason score is > or =7 or when more than 50% of prostate biopsy cores show cancer involvement. SV-sparing surgery could be prospectively compared to standard retropubic prostatectomy in selected individuals analyzing potential benefits on erectile function and urinary continence.     

Race is not an independent predictor of biochemical recurrence after radical prostatectomy in an equal access medical center

OBJECTIVES: To compare the racial differences in clinical and pathologic features between black and white men who underwent radical prostatectomy (RP) in an equal access health care center and to determine whether race is an independent predictor of biochemical recurrence. METHODS: A retrospective survey of 273 patients (125 black, 148 white) who underwent RP at the West Los Angeles Veterans Affairs Medical Center between 1991 and 1999 was undertaken. Patients were analyzed for racial differences in age at diagnosis, clinical stage, preoperative serum prostate-specific antigen (PSA), and Gleason score of the prostate biopsy specimens. Surgical specimens were studied to determine pathologic stage, Gleason score, incidence of seminal vesicle invasion, positive surgical margins, capsular penetration, and pelvic lymph node involvement. Patients were followed for PSA recurrence (greater than 0.2 ng/mL). Multivariate analysis was used to determine the clinical and pathologic variables that were significant in predicting biochemical recurrence after RP and to determine whether race was an independent predictor of biochemical failure. RESULTS: No significant differences were found between black and white men in the preoperative factors (clinical stage, age at diagnosis, biopsy Gleason score, and serum PSA) or in the pathologic features of the RP specimens (Gleason score, pathologic stage, incidence of positive surgical margins, capsular penetration, seminal vesicle invasion, or lymph node involvement). In addition, no differences were found between black and white men in the PSA recurrence rates after RP using Kaplan-Meier survival curves (P = 0.651). Multivariate analysis revealed that serum PSA (P = 0.010), biopsy Gleason score (P = 0. 003), younger age (P = 0.010), surgical Gleason score (P = 0.005), and lymph node involvement (P = 0.022) were all independent predictors of biochemical recurrence. Race was not a significant predictor of biochemical failure in multivariate analysis (P = 0. 199). CONCLUSIONS: In an equal access medical care facility, no differences were evident between black and white men in the preoperative clinical factors or the pathologic features of the RP specimens. In addition, no differences were observed in the PSA recurrence rates after RP. Serum PSA, biopsy Gleason score, younger age, surgical Gleason score, and lymph node involvement were all independent predictors of biochemical recurrence. Race was not an independent predictor of biochemical recurrence.     

Histological characteristics and clinical significance of Japanese prostate cancer with low levels of prostate specific antigen of 4.0 ng/ml or lower]

PURPOSE: They set a normal limit of prostate specific antigen (PSA) to 4.0 ng/ml in Tandem R assay at most institutions. We investigated clinical and histological characteristics of prostate cancer based on whole mount step-section histology of radical prostatectomy specimens, and taking notice of Japanese prostate cancer whose levels of PSA are less than 4.0 ng/ml in normal levels. MATERIALS AND METHODS: One hundred and twenty-two patients underwent radical prostatectomy for clinically resectable prostate cancer at University Hospital from February 1992 to April 1997. Clinicopathological findings were stratified according to the preoperative PSA levels in 111 patients without preoperative endocrine therapy. Immunohistochemical study for PSA was conducted in 7 randomly selected patients. RESULTS: Of the patients 22 (19.8%) had normal (4.0 ng/ml or lower) preoperative serum PSA. Mean tumor volume in this PSA range was 1.5 cm3 with one pT 0 case included. Pathologically organ confined, potentially curable disease (< pT 3) was found in 17 (77.3%) patients and extracapsular extension and seminal vesicle invasion in 5 (23.8%), respectively. No patients had positive pelvic lymph nodes. Well differentiated tumors of Gleason scores 2-4 were found in 9 (40.9%) of the patients, moderately differentiated tumors (Gleason scores 5, 6) in 5 (22.7%) and poorly differentiated histology (Gleason scores 7-10) in 7 (31.8%). Sixteen (72.7%) patients had clinically significant tumors (> 0.5 cm3, Gleason score > or = 7). All 7 patients had positive staining for PSA, but its intensity did not correlate with serum PSA levels. CONCLUSIONS: Many prostate cancers found in surgical specimens were clinically significant despite the low levels of PSA and potentially curable by definitive treatment. Age, co-morbidity and other clinicopathological variables as well as PSA levels should all be taken into account when treatment options are discussed.