Outcomes of locally advanced prostate cancer： a single institution study of 209 patients in Japan

Aim:To investigate the outcomes for Asian populations with locally advanced/clinical stage Ⅲ prostate cancer(PCa)treated with currently prevailing modalities.Methods:We reviewed the record of 209 patients with clinical stage ⅢPCa,who were treated at Niigata Cancer Center Hospital between 1992 and 2003.Treatment options included hor-mone therapy-combined radical prostatectomy(RP HT),hormone therapy-combined external beam irradiation(EBRT HT)and primary hormone therapy(PHT).Results:The 5-and 10-year overall survival rates were 80.3%and 46.1% in all cohorts,respectively.The survival rates were 87.3% and 66.5% in the RP HT group,94.9% and70.0% in the EBRT HT group and 66.1% and 17.2% in the PHT group,respectively.A significant survival advantagewas found in the EBRT HT group compared with that in the PHT group(P<0.0001).Also,the RP HT group hadbetter survival than the PHT group(P=0.0107).The 5-and 10-year disease-specific survival rates for all cases were92.5% and 80.0%,respectively.They were 93.8% and 71.4% in the RP HT group,96.6% and 93.6% in theEBRT HT group and 88.6% and 62.3% in the PHT group,respectively.A survival advantage was found in theEBRT HT group compared with the PHT group(P=0.029).No significant difference was found in disease-specificsurvival between the EBRT HT and RP HT groups or between the RP HT and PHT groups.Conclusion:Althoughour findings indicate that radiotherapy plus HT has a survival advantage in this stage of PCa,we recommend therapiesthat take into account the patients'social and medical conditions for Asian men with clinical stage Ⅲ PCa.(Asian JAndrol 2006 Sep;8:555-561)     

A retrospective study of the treatment of locally advanced prostate cancer by six institutions in eastern and north-eastern Japan

OBJECTIVE: To investigate patients with locally advanced prostate cancer treated at six academic institutions in eastern and north-eastern Japan from 1988 to 2000, to facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer. PATIENTS AND METHODS: The study included 391 eligible patients with locally advanced prostate cancer who were treated by radical prostatectomy (RP), radiotherapy and/or primary hormone therapy. Disease-specific survival rates for these patients were assessed in relation to their clinicopathological characteristics and the types of treatment they received. The Mann-Whitney U-test, Kruskal-Wallis, chi-square and log-rank test were used for statistical analysis, as appropriate. RESULTS: In all, 128 patient with lower prostate-specific antigen levels (P = 0.023) and/or better performance status (P = 0.001) had RP. Neoadjuvant hormone therapy before RP was the treatment in 68 (53%) of these 128 patients; 66 (52%) received immediate adjuvant hormone therapy. Of 87 patients treated with radiotherapy, 75 (86%) had external beam radiotherapy (EBRT) as the primary treatment with no brachytherapy, and 12 (14%) had brachytherapy as the primary method. Neoadjuvant hormone therapy was given to 56 of the 87 patients (64%); 48 (55%) received immediate adjuvant hormone therapy. Of the 176 patients treated with primary hormone therapy alone, combined androgen blockade and surgical or medical castration was the treatment in 76 (43%) and 85 (48%), respectively. Disease-specific survival rates at 5 years for patients treated with RP, EBRT and primary hormone therapy were 90%, 98%, and 89%, respectively. CONCLUSION: The treatments provided by the participating institutions did not differ significantly from those set out in European and American guidelines, and short-term disease-specific survival rates for each treatment did not differ significantly from those of historical controls. Further investigation may facilitate the establishment of Japanese guidelines for the diagnosis and treatment of locally advanced prostate cancer.     

Intermittent androgen suppression in patients with prostate cancer

OBJECTIVES: To evaluate intermittent androgen suppression (IAS) in patients with prostate cancer and to try to define predictive factors for biochemical progression. PATIENTS AND METHODS: From 1989 to 2001, 146 patients received IAS as a primary treatment for localized, advanced or metastatic prostate cancer (72 men) or as a treatment for prostate-specific antigen (PSA) recurrence after radical prostatectomy (RP) and/or radiation therapy (74 men). Androgen-deprivation treatment (ADT) was continued up to 6 months after PSA became undetectable or a nadir PSA level was reached. ADT was then re-instituted when the PSA level was> 4 ng/mL for patients who had RP or> 10 ng/mL for the others. RESULTS: After a mean (range) follow-up of 45.6 (12-196.9) months, 24 patients had biochemical progression. These patients were younger than those with no biochemical progression (67 vs 72 years, P = 0.004) and had a statistically higher Gleason score (7.21 vs 6.52, P = 0.01) and PSA level (111.1 vs 32.1 ng/mL, P = 0.05), and a shorter first phase without treatment (7.6 vs 11.2 months, P = 0.05). Overall 5-year metastatic disease free survival of 91.3%. The overall 5-year biochemical recurrence-free survival was 68%. Using multivariate analysis, a Gleason score of >or= 8 (P = 0.021), first-phase duration with no treatment of < 1 year (P = 0.044), positive lymph nodes or metastatic disease at the time of starting IAS (P = 0.023) and age < 70 years (P = 0.037) were the strongest predictors of biochemical progression. CONCLUSION: IAS appeared to be a feasible treatment; the best candidates being those aged> 70 years with localized prostate cancer and a Gleason score of 相似文献   

Radical prostatectomy vs radiation therapy and androgen-suppression therapy in high-risk prostate cancer

Study Type – Therapy (retrospective cohort analysis) Level of Evidence 2b What's known on the subject? and What does the study add? Prostate cancer is generally considered to be high risk when the prostate‐specific antigen (PSA) concentration is >20 ng/mL, the Gleason score is ≥8 or the American Joint Commission on Cancer (AJCC) tumour (T) category is ≥2c. There is no consensus on the best treatment for men with prostate cancer that includes these high‐risk features. Options include external beam radiation therapy (EBRT) with androgen suppression therapy (AST), treatment with a combination of brachytherapy, EBRT and AST termed combined‐modality therapy (CMT) or radical prostatectomy (RP) followed by adjuvant RT in cases where there are unfavourable pathological features, e.g. positive surgical margin, extracapsular extension and seminal vesicle invasion. While outcomes for both approaches have been published independently these treatments have not been compared in the setting of a prospective RCT where confounding factors related to patient selection for RP or CMT would be minimised. These factors include age, known prostate cancer prognostic factors and comorbidity. RCTs that compare RP to radiation‐based regimens have been attempted but failed to accrue.

OBJECTIVE

• ? To assess the risk of prostate cancer‐specific mortality after therapy with radical prostatectomy (RP) or combined‐modality therapy (CMT) with brachytherapy, external beam radiation therapy (EBRT) and androgen‐suppression therapy (AST) in men with Gleason score 8–10 prostate cancer.

PATIENTS AND METHODS

• ? Men with localised high‐risk prostate cancer based on a Gleason score of 8–10 were selected for study from Duke University (285 men), treated between January 1988 and October 2008 with RP or from the Chicago Prostate Cancer Center or within the 21st Century Oncology establishment (372) treated between August 1991 and November 2005 with CMT.
• ? Fine and Gray multivariable regression was used to assess whether the risk of prostate cancer‐specific mortality differed after RP as compared with CMT adjusting for age, cardiac comorbidity and year of treatment, and known prostate cancer prognostic factors.

RESULTS

• ? As of January 2009, with a median (interquartile range) follow‐up of 4.62 (2.4–8.2) years, there were 21 prostate cancer‐specific deaths.
• ? Treatment with RP was not associated with an increased risk of prostate cancer‐specific mortality compared with CMT (adjusted hazard ratio [HR] 1.8, 95% confidence interval [CI] 0.6–5.6, P= 0.3).
• ? Factors associated with an increased risk of prostate cancer‐specific mortality were a PSA concentration of <4 ng/mL (adjusted HR 6.1, 95% CI 2.3–16, P < 0.001) as compared with ≥4 ng/mL, and clinical category T2b, c (adjusted HR 2.9; 95% CI 1.1–7.2; P= 0.03) as compared with T1c, 2a.

CONCLUSION

• ? Initial treatment with RP as compared with CMT was not associated with an increased risk of prostate cancer‐specific mortality in men with Gleason score 8–10 prostate cancer.

     

Adjuvant versus salvage radiation therapy for prostate cancer and the risk of death

Study Type – Therapy (case series)
Level of Evidence 4

OBJECTIVE

To investigate whether salvage radiation therapy (RT) for prostate‐specific antigen (PSA) failure can provide the same result as adjuvant RT, which decreases the risk of all‐cause mortality (ACM) for men with positive margins (R1), or extra‐capsular or seminal vesicle extension (pT3).

METHODS

We studied 1638 men at Duke University who underwent radical prostatectomy for unfavourable‐risk prostate cancer and whose postoperative PSA was undetectable. Cox regression was used to evaluate whether salvage vs adjuvant RT in men with a rapid (<10 months) or slow (≥10 months) PSA doubling time (DT) was associated with the risk of ACM, adjusting for adverse features (pT3, R1, Gleason score 8–10), age, preoperative PSA level, comorbidity and hormonal therapy use.

RESULTS

Despite fewer men with two or more adverse features (61 vs 82%; P = 0.016), salvage for a rapid PSA DT vs adjuvant RT increased the risk of ACM [adjusted hazard ratio (AHR) = 3.42; 95% confidence interval (CI) = 1.27–9.20; P = 0.015]. There was no difference (AHR = 1.39; 95% CI = 0.50–3.90; P = 0.53) in the risk of ACM among men who received salvage for a slow PSA DT or adjuvant RT. Nearly all (90%) men with a slow PSA DT had Gleason score ≤7 and the majority (59%) had at most pT3 or R1 disease.

CONCLUSION

Radiation therapy after PSA failure as compared with adjuvant RT was not associated with an increased risk of ACM in men with Gleason score ≤7 and pT3R0 or pT2R1 disease.     

Endocrine therapy with or without radical prostatectomy for T1b-T3N0M0 prostate cancer

BACKGROUND: We retrospectively compared the 5-year survival rates of T1b-T3N0M0 prostate cancer patients treated either by endocrine therapy plus radical prostatectomy or endocrine therapy alone. METHODS: Clinical T1b-T3N0M0 prostate cancer patients were enrolled at 104 institutions in Japan. They were assigned to study 1 (n = 176), if they were indicated to prostatectomy, if not indicated, they were assigned to study 2 (n = 151). The indication of prostatectomy was based on the clinical judgement of physicians and/or patients. Those assigned to study 1 underwent prostatectomy and adjuvant endocrine therapy with or without preoperative androgen deprivation. Those assigned to study 2 were treated with leuprorelin acetate with or without chlormadinone acetate. They were followed-up every 3 months until death or for 5 years and over. RESULTS: Those assigned to study 1 were younger (mean age 67.2 vs 75.7 years), less advanced in clinical stage, and had lower prostate specific antigen levels (mean 43.8 vs 103.6 ng/mL). Death for any reason was observed less frequently in study 1 (n = 29, 16%) than study 2 (n = 50, 33%), and the 5-year overall survival rate was higher in study 1 (87 vs. 68%). However, prostate cancer deaths were comparatively seldom (9% in study 1 and 7% in study 2), resulting in the identical 5-year cause specific survival rate in both study groups (91%). In both study groups the overall survival was almost equal to the natural survival of age-matched men. CONCLUSIONS: Endocrine therapy offers a reasonable survival rate in T1b-T3 prostate cancer patients within a 5-year follow-up. Observation will be extended to determine 10-year outcomes.     

Understanding the pathological features of focality, grade and tumour volume of early-stage prostate cancer as a foundation for parenchyma-sparing prostate cancer therapies: active surveillance and focal targeted therapy

What's known on the subject? and What does the study add? The recent shift of pathological stage migration towards earlier forms suggested great potential for the introduction of focal therapy into urological practice. A body of the literature showed increasing frequency of unilateral and unifocal lesions that can be efficiently treated with tumour ablative techniques. The internal panel of experts has done a comprehensive review of the largest mostly single institution studies and their own trials with the aim of evaluating a value of main pathological features of early stage prostate cancer as a background to developing a concept of focal therapy. Analysis data including latest developments will help to better understand the purpose, meaning and patient selection of different kinds of focal targeted ablation of prostate cancer.

OBJECTIVE

? To better understand the biology and incidence of the cancer foci within the prostate through a comprehensive literature review and a review of our own data, to establish the current level of knowledge regarding the pathological foundation for active surveillance (AS) or focal therapy (FT).

PATIENTS AND METHODS

? A systematic review of the literature was performed, searching PubMed® from January 1994 to July 2009. ? Electronic searches were limited to the English language using the keywords ‘prostate cancer’, ‘histopathology’, ‘radical prostatectomy’, ‘pathological stage’ and ‘focal therapy’. ? The authors’ own data were also analysed and are presented.

RESULTS

? Recent data have shown a significant pathological stage migration towards earlier disease comprising unilateral pT2a/b prostate cancer (PCa). ? The cancer volume of the clinically significant tumour (index lesion) has been proposed as a driving force of PCa progression and therefore should be identified and treated at an early stage. ? In general, most satellite lesions do not appear to be life‐threatening. ? Other pathological features, such as Gleason score, extraprostatic extension and the spatial distribution of PCa within the prostate, remain important selective criteria for AS or FT.

CONCLUSION

? The present study reviews the current knowledge of cancer focality, aggression and tumour volume. Further research is needed to better understand the biologic behaviour of each of the tumour foci within a cancerous prostate, and to employ this information to selected patients for no therapy (AS), parenchyma‐preserving approaches (FT) or whole gland radical therapy.     

腹腔镜下根治性前列腺切除术治疗TURP术后偶发前列腺癌的配对分析

目的探讨经尿道前列腺切除术(TURP)后偶发前列腺癌行腹腔镜根治性前列腺切除术(LRP)在外科手术、肿瘤学及尿控等方面的影响。方法回顾性分析自2012年1月至2017年12月北部战区总医院泌尿外科285例接受了LRP治疗的男性患者的临床资料。其中37例患者术前已接受过TURP治疗(TURP组),另外选取37例没有接受过TURP的患者与之配对(对照组)。运用相关统计学方法比较两组患者在围手术期并发症、外科手术、肿瘤及尿控等方面的差异。结果两组患者在年龄、体质指数、血清前列腺特异性抗原(PSA)水平以及术前和术后Gleason评分等方面无统计学差异。TURP组与对照组相比患者出血量较多[(555.4±238.4)vs.(237±111.3)mL,P<0.05]、手术时间较长[(256.7±65.3)vs.(215.2±62.3)min,P<0.05]、输血概率大(5.4%vs.0.0%,P<0.05)、并发症发生率较高(43.2%vs.13.5%,P<0.05)。TURP组的手术阳性切缘率与对照组相比(35.1%vs.24.3%)差异无统计学意义(P=0.353)。手术后12个月的尿控率两组相似,但在3个月时TURP组的尿控率较低(40.5%vs.70.2%)。在平均随访36.5个月后,TURP组和对照组分别有10.8%和8.1%的患者出现生化复发,差异无统计学意义。结论TURP后LRP需要更长的手术时间、失血更多、并发症发生率更高和更差的短期尿控,但两组患者远期肿瘤切除效果及远期尿控没有差异,所以TURP后行LRP的疗效是安全可靠的。     

The role of surgery in high-risk localised prostate cancer

? The optimal management of high-risk localised prostate cancer is a major challenge for urologists and oncologists. It is clear that multimodal therapy including radical local treatment is needed in these men to achieve the best outcomes. ? External beam radiotherapy (EBRT) is an essential component of therapy either as a primary or adjuvant treatment. However, the role of radical prostatectomy (RP) is more controversial. Both methods are currently valid therapy options. ? There have been many individual studies of EBRT and RP in high-risk disease, but no good quality large prospective randomized trials. ? In EBRT, combination with neoadjuvant plus long-term adjuvant androgen-deprivation therapy (ADT) has been conclusively shown to improve outcomes and is widely considered the standard of care. ? However, the role of RP has achieved recent prominence with several important studies. Published data from prospective randomized trials in patients after RP have shown that in men with adverse pathological features at surgery, the addition of adjuvant RT improves biochemical-free and progression-free survival. ? More recently, studies from large-volume centres comparing EBRT and RP have provided intriguing suggestions of better outcomes with RP as the primary treatment. ? An important question therefore, is which of the two methods provides the best outcome in men with localised high-risk disease. Crucially, does the combination of RP and selective adjuvant EBRT provide clinically significant better outcomes compared with EBRT alone? ? In this review we discuss the current evidence for the role of RP for high-risk localised prostate cancer and define the parameters and urgent need for a prospective trial to test the role of surgery for this group of patients.     

A long-term study of the efficacy of treatment of localized prostate cancer

This paper presents a retrospective comparison of patients undergoing treatment for clinically localized prostate cancer. We reviewed the age, grade, and stage at diagnosis as well as the survival and recurrence rates of 222 patients treated for carcinoma of the prostate with either radical prostatectomy (RP) or radiotherapy (XRT) at four Army medical centers. Mean follow-up was 8.02 years (range 0.026–32.5 years). Stage and grade were similar in patients receiving either RP or XRT. Kaplan-Meier estimates showed that patients who underwent RP had a significantly greater disease-specific survival (p = 0.0001) and a significantly lower rate of distant metastases (p = 0.006) than did those who received XRT. There was no significant difference in the rate of local progression (p = 0.276) or in the mean time to local progression (XRT = 3.5, RP = 4.0 years) or to distant metastases (XRT = 3.79, RP = 4.52 years). Cox proportional hazards model incorporating age, stage, grade, and treatment type demonstrated that those patients who received XRT had more than two times the risk of dying of their disease than did those who underwent RP (risk ratio = 2.37; 95% confidence interval = 1.49–3.76). These data in similar groups of patients suggest that metastasis-free survival is improved in those who receive RP compared with XRT and that this translates into an enhanced survival advantage. Further study of larger groups of patients stratified by risk factors in randomized, prospective trials with longer follow-up will improve our ability to determine the best treatment for clinically localized prostate cancer.     

腹腔镜下经腹膜外前列腺癌根治术(附25例报告)

目的 探讨经腹膜外途径腹腔镜下前列腺癌根治术在治疗前列腺癌中的价值。方法 2003年6月至2006年1月我院共收治前列腺癌患者25例，年龄62-78岁（平均68．5岁），病史2周-6年，所有患者均接受腹腔镜下前列腺癌根治术。结果 所有手术均顺利完成，手术时间210-380min，半均245min，术中出血量500-1200mL，（平均850mL，），所有患者均于术后2周拔除导尿管。3例出现尿漏，于拔管前消失；3例术后出现轻度尿失禁，经辅助治疗后好转，术后PSA0-0．08μg／L，随访1-10月，未见肿瘤复发。结论 腹腔镜下经腹膜外前列腺癌根治术是一种安全有效的治疗方法，术中视野清晰、止血可靠、创伤小、腹腔并发症少、患者住院时间短、恢复快，值得临床推广。     

High surgical volume is associated with a lower rate of secondary therapy after radical prostatectomy for localized prostate cancer

OBJECTIVE

To assess the relationship between surgical volume (SV), defined as the number of radical prostatectomies (RPs) within a calendar year, and the time to secondary therapy (ST) after RP, as this might represent an important determinant of cancer control.

PATIENTS AND METHODS

The study included 7937 men treated with RP by 130 urologists between 1989 and 2000. Radiotherapy or any form of hormonal manipulation represented ST. Univariable and multivariable Cox regression analyses was used to evaluate the time to ST after RP.

RESULTS

SV was an independent (P = 0.02) predictor of ST‐free survival after RP, and the multivariable rate of ST sharply decreased with increasing SV.

CONCLUSIONS

The use of ST is inversely proportional to SV of up to 24 RPs per year. A higher annual SV might be indicative of less restrictive use of RP in high‐risk patients who eventually require combined treatments.     

Impact of adjuvant androgen deprivation therapy after radical prostatectomy on the survival of patients with pathological T3b prostate cancer

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? Adjuvant hormonal therapy is known to improve cancer specific survival in prostate cancer patients with lymph node positive disease. This study suggests that surgically treated prostate cancer patients with seminal vesical invasion (pT3b) may have improved cancer specific survival if treated with adjuvant androgen deprivation therapy, similar to lymph node positive patients.

OBJECTIVE

To determine the impact of adjuvant androgen deprivation therapy (ADT) on survival in patients with seminal vesicle invasion (pT3b) at radical prostatectomy.

PATIENTS AND METHODS

We reviewed 12 115 patients who underwent radical prostatectomy between 1987 and 2002 to identify patients with pT3bN0 prostate cancer who received adjuvant ADT (n= 191). These patients were matched by clinical and pathological variables to a group of patients with pT3b prostate cancer who did not receive adjuvant ADT. Median postoperative follow‐up was 10 years. Clinical endpoints included biochemical progression‐free survival (BPFS), local recurrence‐free survival (LRFS), systemic progression‐free survival (SPFS), cancer‐specific survival (CSS) and overall survival.

RESULTS

Patients who underwent adjuvant ADT experienced improved 10‐year BPFS (60% vs 16%, P < 0.001), LRFS (87% vs 76%, P= 0.002), SPFS (91% vs 78%, P= 0.004) and CSS (94% vs 87%, P= 0.037). Overall survival was not significantly different between groups (75% vs 69%, P= 0.12). Both luteinizing hormone‐releasing hormone agonists (hazard ratio, 0.26; 95% CI, 0.15–0.46; P < 0.001) and bilateral orchiectomy (hazard ratio, 0.13; 95% CI, 0.06–0.31; P < 0.001) improved BPFS. When stratified by type of ADT (hormonal therapy vs orchiectomy), there was no difference in survival outcomes.

CONCLUSIONS

Adjuvant ADT improves local, and systemic control after radical prostatectomy for pT3b prostate cancer. There is no difference in survival between patients receiving medical hormonal therapy vs patients undergoing orchiectomy. Given the lack of improvement in overall survival, continued investigation is needed to identify the cohort of pT3b patients at highest risk for cancer progression and therefore most likely to benefit from a multimodal treatment approach.     

机器人辅助腹腔镜前列腺癌根治术联合新辅助内分泌治疗高危前列腺癌的临床研究

目的:探讨术前机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radical prostatectomy,RALP)联合新辅助内分泌治疗(Neoadjuvant hormone therapy,NHT)治疗高危前列腺癌患者的临床疗效。方法:回顾性分析甘肃省人民医院泌尿外科自2018年6月-2020年12月前通过PSA、穿刺活检及MRI确诊的35例高危前列腺癌患者临床资料,其中术前行RALP+NHT治疗组25例,年龄为56~81(70.28±7.07)岁;RALP治疗组10例,年龄为49~86(69.20±8.77)岁。比较两组患者的手术时间、术中出血量、术后住院时间、术后切缘阳性率及术中和术后并发症等情况。结果:所有患者手术均获成功,无中转开放及二次手术。与RALP治疗组相比,RALP+NHT治疗组在手术时间[237.88±68.99d Vs (277±76.69)d,P=0.541]、术中出血量[(149.60±149.84)ml Vs (225±268.56)ml,P=0.266]、术后住院时间[(11±4.31) d Vs(11.7±4.86) d,P=0.402]、术后留置尿管时间[(28±6.81) d Vs (28±6.81) d,P=0.464]和术前PSA值[(49.97±32.22)ng/ml Vs (47.41±23.14)ng/ml,P=0.089]等方面差异均无统计学意义;RALP+NHT治疗组在总住院时间[(18.08±4.44)d Vs (25.5±10.82)d,P<0.005]和术后留置引流管时间[(10.12±3.36)d Vs(11.10±5.17)d,P=0.014]明显低于RALP组,差异具有统计学意义;RALP+NHT治疗组在Gleason评分(24%Vs10%)、肿瘤切缘阳性(12%Vs 20%)及并发症(4%Vs 10%)等方面下降明显。结论:术前RALP联合NHT可降低高危前列腺癌切缘阳性、改善病理分级,使高危患者受益。     

Perioperative complications of radical retropubic prostatectomy in patients with locally advanced prostate cancer: a comparison with clinically localized prostate cancer

Radical prostatectomy (RP) continues to be an effective surgical therapy for prostate carcinoma, particularly for organ-confined prostate cancer (PCa). Recently, RP has also been used in the treatment of locally advanced prostate cancer. However, little research has been performed to elucidate the perioperative complications associated with RP in patients with clinically localized or locally advanced PCa. We sought to analyse the incidence of complications in these two groups after radical retropubic prostatectomy (RRP). From June 2002 to July 2010, we reviewed 379 PCa patients who underwent RRP in our hospital. Among these cases, 196 had clinically localized PCa (T_1a–T_2c: group 1), and 183 had locally advanced PCa (≥T_3a: group 2). The overall complication incidence was 21.9%, which was lower than other studies have reported. Perioperative complications in patients with locally advanced PCa mirror those in patients with clinically localized PCa (26.2% vs. 17.8%, P=0.91). Our results showed that perioperative complications could not be regarded as a factor to consider in regarding RP in patients with cT₃ or greater.     

The androgen receptor in hormone-refractory prostate cancer

Advanced prostate cancer is responsive to hormone therapy that interferes with androgen receptor （AR） signalling. However, the effect is short-lived, as nearly all tumours progress to a hormone-refractory （HR） state, a lethal stage of the disease. Intuitively, the AR should not be involved because hormone therapy that blocks or reduces AR activity is not effective in treating HR tumours. However, there is still a consensus that AR plays an essential role in HR prostate cancer （HRPC） because AR signalling is still functional in HR tumours. AR signalling can be activated in HR tumours through several mechanisms. First, activation of intracellular signal transduction pathways can sensitize the AR to castrate levels of androgens. Also, mutations in the AR can change AR ligand specificity, thereby allowing it to be activated by non-steroids or anti-androgens. Finally, overexpression of the wild-type AR sensitizes itself to low concentrations of androgens. Therefore, drugs targeting AR signalling could still be effective in treating HRPC.     

Comparison of stage migration patterns between Europe and the USA: an analysis of 11 350 men treated with radical prostatectomy for prostate cancer

OBJECTIVE

To examine the stage migration patterns in patients treated with radical prostatectomy (RP) for prostate cancer in Europe and in the USA in the last 20 years.

PATIENTS AND METHODS

Between 1988 and 2005, RP was performed in 11 350 men: 5739 from Europe and 5611 from the USA. Independent‐samples t‐test and the chi‐square test were, respectively, used for comparisons of means and proportions. The trend test was used to test the statistical significance of trends in proportions over time.

RESULTS

Temporal patterns in patients’ age, stage and PSA level at presentation were similar on both continents. Conversely, temporal patterns in Gleason sum distribution differed. In the USA, the rate of biopsy Gleason sums of 2–5 decreased from 32.8% to 0.2% (P < 0.001), while the rate of Gleason sums of 7 and 8–10 increased (P < 0.001). Conversely, in Europe the rate of Gleason sums of 6 increased from 40% to 64% (P < 0.001) at the expense of all other Gleason sums. At RP, the rate of Gleason sums of 2–5 decreased on both continents and the rate of a Gleason sum of 7 increased in the USA. Moreover, no important differences in pathological stage trends (organ confinement, extracapsular extension and seminal vesicle invasion) distinguished either population. Finally, the rate of lymph node involvement increased in the USA but remained stable in Europe.

CONCLUSIONS

Stage and grade migration affected the USA and Europe to different extents. These differences should be accounted for when prediction tools or comparisons between the USA and Europe are considered.