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Abstract
Despite the wealth of information obtained by conventional histology, long-term studies are needed to provide novel information on the correlation of pathologic findings with prognosis. Findings need to be correlated not only with PSA progression but with the more clinically important parameters of distant metastases and survival. Although conventional histology still will have a role in the evaluation of prostate cancer at radical prostatectomy and its correlation with outcome, it undoubtedly will be augmented by newer techniques. These developments must be approached critically and rationally to determine whether they provide additional prognostic information beyond that currently available using more conventional parameters.
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Affiliation(s)
- J I Epstein
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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52
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Straub B, Müller M, Krause H, Goessl C, Schrader M, Heicappell R, Miller K. Reverse transcriptase-polymerase chain reaction for prostate-specific antigen in the molecular staging of pelvic surgical margins after radical prostatectomy. Urology 2001; 57:1006-11. [PMID: 11337316 DOI: 10.1016/s0090-4295(00)01123-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To examine the application of reverse transcriptase-polymerase chain reaction (RT-PCR) to assist in prostate-specific antigen (PSA) detection in the surgical margins after radical prostatectomy (RP). The risk of local recurrence increases considerably in the presence of extracapsular tumor growth and/or positive surgical margins at RP. Although this makes it possible to identify patients with an increased risk of local recurrence, precise predictions cannot be made. A more precise assessment is desirable mainly for early planning of adjuvant therapy. METHODS Ninety-five patients with clinically organ-confined prostate cancer (CaP) underwent RP. After removing the gland, biopsies were obtained from four defined areas of the prostatic fossa and processed for RT-PCR for PSA detection. Sixteen patients with muscle-invasive bladder carcinoma who underwent radical cystoprostatectomy served as controls. RESULTS Thirty-two of 95 patients with CaP (35%) had at least one positive molecular margin indicating an expression for PSA; 19 of 48 (39%) of these had an organ-confined tumor stage according to conventional histology and 13 of 47 (28%) had tumor growth beyond the prostate. A statistically significant correlation between the frequency of positive molecular margins and clinical data was only observed in the group with disease greater than Stage pT2. All controls had negative molecular margins (P = 0.012). CONCLUSIONS On the basis of the results obtained, molecular diagnostic RT-PCR for PSA detection in the surgical margins after RP seems to be an interesting supplementary tool for monitoring the course and establishing the prognosis. Long-term follow-up of these patients is needed to demonstrate the clinical value of molecular diagnostics of surgical margins during RP.
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Affiliation(s)
- B Straub
- Department of Urology, Klinikum Benjamin Franklin, Freie Universität Berlin, Berlin, Germany
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53
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Vis AN, Hoedemaeker RF, van der Kwast TH, Schröder FH. Defining the window of opportunity in screening for prostate cancer: validation of a predictive tumor classification model. Prostate 2001; 46:154-62. [PMID: 11170143 DOI: 10.1002/1097-0045(20010201)46:2<154::aid-pros1019>3.0.co;2-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Subdividing cancers according to the natural course of disease, both at the time of diagnosis and after radical prostatectomy, may influence management decisions of patients with prostate cancer. We investigated whether categorization of prostate cancers into different prognostic subgroups is feasible. METHODS In 218 screened participants of a randomized study, conventional post-operative tumor features were assessed for their accuracy in predicting PSA relapse after radical prostatectomy using Cox regression analysis. Independent prognostic tumor features were combined to identify subsets of cancers with similar biological potential. A cancer was defined that may be curable after its detection by screening tests, though is destined to progress to clinically manifest disease and cancer-related mortality in the absence of screening. RESULTS After a median follow-up of 33.0 months, pathological stage (P = 0.03), tumor volume (P = 0.04), and margin status (P = 0.01) each independently predicted PSA relapse after surgery. The proportion of poorly differentiated cancer proved highly superior to the Gleason score and most strongly predicted PSA relapse (P < 0.0001). Based on combined independent prognostic tumor features, a tumor classification model powerfully predicted PSA relapse. CONCLUSIONS Based on tumor characteristics, possibly harmless, and conversely, possibly non-curable disease, may be distinguished from cancers that are likely to show clinical progression in the absence of screening and treatment. Prediction of these subclasses prior to treatment may eventually lead to proper patient management.
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Affiliation(s)
- A N Vis
- Department of Pathology, Josephine Nefkens Institute, Erasmus University, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands.
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54
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Babaian RJ, Troncoso P, Bhadkamkar VA, Johnston DA. Analysis of clinicopathologic factors predicting outcome after radical prostatectomy. Cancer 2001. [DOI: 10.1002/1097-0142(20010415)91:8<1414::aid-cncr1147>3.0.co;2-g] [Citation(s) in RCA: 128] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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55
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Blute ML, Bergstralh EJ, Iocca A, Scherer B, Zincke H. Use of Gleason score, prostate specific antigen, seminal vesicle and margin status to predict biochemical failure after radical prostatectomy. J Urol 2001; 165:119-25. [PMID: 11125379 DOI: 10.1097/00005392-200101000-00030] [Citation(s) in RCA: 220] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We determine the importance of clinical and pathological variables for predicting biochemical progression in patients after surgery for specimen confined prostate cancer. We developed a simple scoring algorithm for biochemical progression in node negative cases and tested the algorithm performance on an independent group. MATERIALS AND METHODS Our study included 2,518 patients with pT2N0 or pT3N0 disease treated between 1990 and 1993. Gleason score, preoperative prostate specific antigen (PSA), margin status, extraprostatic extension, seminal vesicle involvement, DNA ploidy and adjuvant treatment were primary variables analyzed univariately. The Cox proportional hazards model was used on 2,000 randomly selected patients to develop a multivariate scoring algorithm for the aforementioned factors to predict biochemical progression-free survival. The final model included Gleason score, preoperative PSA, margin status, seminal vesicle involvement and adjuvant treatment. The prognostic score derived from this model was validated by applying it to the remaining 518 patients. Harrell's measure of concordance (C) was used to compare competing models. RESULTS For patients who did not receive adjuvant therapy the derived score based on the Cox model coefficient was Gleason +1 (PSA 4 to 10), +2 (PSA 10.1 to 20), +3 (PSA greater than 20), +2 (positive seminal vesicle) and +2 (positive margin). The score was reduced by 4 if adjuvant hormonal therapy was given and by 2 for only adjuvant radiotherapy. The 5-year progression-free survival was 94% for scores less than 5, 60% for 10 and 32% for greater than 12 (C = 0. 718). Applying the score to the independent validation data set (518) resulted in 5-year progression-free survival of 96% for scores less than 5, 53% for 10 and 30% for greater than 12 (C = 0.759). CONCLUSIONS Progression-free survival determined by the model score group identified a wide range of risk levels for patients with specimen confined prostate cancer. This simple predictive model allows identification of patients at high risk for cancer progression with specimen confined disease who may be targeted for closer surveillance and adjuvant therapy, while those at lower risk may be simply observed.
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Affiliation(s)
- M L Blute
- Department of Urology and Section of Biostatistics, Mayo Clinic, Rochester, Minnesota 55905, USA
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56
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Schulman CC, Altwein JE, Zlotta AR. Treatment options after failure of local curative treatments in prostate cancer: a controversial issue. BJU Int 2000; 86:1014-22. [PMID: 11119094 DOI: 10.1046/j.1464-410x.2000.00941.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- C C Schulman
- Department of Urology, Erasme Hospital, University Clinics of Brussels, Brussels, Belgium.
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Doherty AP, Bower M, Smith GL, Miano R, Mannion EM, Mitchell H, Christmas TJ. Undetectable ultrasensitive PSA after radical prostatectomy for prostate cancer predicts relapse-free survival. Br J Cancer 2000; 83:1432-6. [PMID: 11076649 PMCID: PMC2363433 DOI: 10.1054/bjoc.2000.1474] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Radical retropubic prostatectomy is considered by many centres to be the treatment of choice for men aged less than 70 years with localized prostate cancer. A rise in serum prostate-specific antigen after radical prostatectomy occurs in 10-40% of cases. This study evaluates the usefulness of novel ultrasensitive PSA assays in the early detection of biochemical relapse. 200 patients of mean age 61. 2 years underwent radical retropubic prostatectomy. Levels < or = 0.01 ng ml-1 were considered undetectable. Mean pre-operative prostate-specific antigen was 13.3 ng ml-1. Biochemical relapse was defined as 3 consecutive rises. The 2-year biochemical disease-free survival for the 134 patients with evaluable prostate-specific antigen nadir data was 61.1% (95% CI: 51.6-70.6%). Only 2 patients with an undetectable prostate-specific antigen after radical retropubic prostatectomy biochemically relapsed (3%), compared to 47 relapses out of 61 patients (75%) who did not reach this level. Cox multivariate analysis confirms prostate-specific antigen nadir < or = 0.01 ng ml-1 to be a superb independent variable predicting a favourable biochemical disease-free survival (P < 0.0001). Early diagnosis of biochemical relapse is feasible with sensitive prostate-specific antigen assays. These assays more accurately measure the prostate-specific antigen nadir, which is an excellent predictor of biochemical disease-free survival. Thus, sensitive prostate-specific antigen assays offer accurate prognostic information and expedite decision-making regarding the use of salvage prostate-bed radiotherapy or hormone therapy.
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Affiliation(s)
- A P Doherty
- Department of Urology, Charing Cross Hospital, Fulham Palace Road, London
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58
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HOLLENBECK BRENTK, BASSILY NADER, WEI JOHNT, MONTIE JAMESE, HAYASAKA SATORU, TAYLOR JEREMYM, RUBIN MARKA. WHOLE MOUNTED RADICAL PROSTATECTOMY SPECIMENS DO NOT INCREASE DETECTION OF ADVERSE PATHOLOGICAL FEATURES. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67033-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- BRENT K. HOLLENBECK
- From the Departments of Surgery, Section of Urology, Pathology and Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - NADER BASSILY
- From the Departments of Surgery, Section of Urology, Pathology and Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - JOHN T. WEI
- From the Departments of Surgery, Section of Urology, Pathology and Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - JAMES E. MONTIE
- From the Departments of Surgery, Section of Urology, Pathology and Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - SATORU HAYASAKA
- From the Departments of Surgery, Section of Urology, Pathology and Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - JEREMY M.G. TAYLOR
- From the Departments of Surgery, Section of Urology, Pathology and Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan
| | - MARK A. RUBIN
- From the Departments of Surgery, Section of Urology, Pathology and Biostatistics, University of Michigan Medical Center, Ann Arbor, Michigan
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60
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WHOLE MOUNTED RADICAL PROSTATECTOMY SPECIMENS DO NOT INCREASE DETECTION OF ADVERSE PATHOLOGICAL FEATURES. J Urol 2000. [DOI: 10.1097/00005392-200011000-00028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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SCOLIERI MICHAELJ, ALTMAN ANDREW, RESNICK MARTINI. NEOADJUVANT HORMONAL ABLATIVE THERAPY BEFORE RADICAL PROSTATECTOMY: A REVIEW. IS IT INDICATED? J Urol 2000. [DOI: 10.1016/s0022-5347(05)67008-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- MICHAEL J. SCOLIERI
- From the Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - ANDREW ALTMAN
- From the Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, Ohio
| | - MARTIN I. RESNICK
- From the Department of Urology, Case Western Reserve University, School of Medicine, Cleveland, Ohio
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Bostwick DG, Grignon DJ, Hammond ME, Amin MB, Cohen M, Crawford D, Gospadarowicz M, Kaplan RS, Miller DS, Montironi R, Pajak TF, Pollack A, Srigley JR, Yarbro JW. Prognostic factors in prostate cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000; 124:995-1000. [PMID: 10888774 DOI: 10.5858/2000-124-0995-pfipc] [Citation(s) in RCA: 214] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Under the auspices of the College of American Pathologists, a multidisciplinary group of clinicians, pathologists, and statisticians considered prognostic and predictive factors in prostate cancer and stratified them into categories reflecting the strength of published evidence and taking into account the expert opinions of the Prostate Working Group members. MATERIALS AND METHODS Factors were ranked according to the previous College of American Pathologists categorical rankings: category I, factors proven to be of prognostic importance and useful in clinical patient management; category II, factors that have been extensively studied biologically and clinically but whose importance remains to be validated in statistically robust studies; and category III, all other factors not sufficiently studied to demonstrate their prognostic value. Factors in categories I and II were considered with respect to variations in methods of analysis, interpretation of findings, reporting of data, and statistical evaluation. For each factor, detailed recommendations for improvement were made. Recommendations were based on the following aims: (1) increasing uniformity and completeness of pathologic evaluation of tumor specimens, (2) enhancing the quality of data collected pertaining to existing prognostic factors, and (3) improving patient care. RESULTS AND CONCLUSIONS Factors ranked in category I included preoperative serum prostate-specific antigen level, TNM stage grouping, histologic grade as Gleason score, and surgical margin status. Category II factors included tumor volume, histologic type, and DNA ploidy. Factors in category III included perineural invasion, neuroendocrine differentiation, microvessel density, nuclear roundness, chromatin texture, other karyometric factors, proliferation markers, prostate-specific antigen derivatives, and other factors (oncogenes, tumor suppressor genes, apoptosis genes, etc).
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63
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Shekarriz B, Tiguert R, Upadhyay J, Gheiler E, Powell IJ, Pontes JE, Grignon DJ, Sakr W, Wood DP. Impact of location and multifocality of positive surgical margins on disease-free survival following radical prostatectomy: a comparison between African-American and white men. Urology 2000; 55:899-903. [PMID: 10840105 DOI: 10.1016/s0090-4295(00)00463-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES Although the rate of positive surgical margins is higher in African-American men (AAM) than in white men (WM), the impact of this difference on survival is not clear. Furthermore, it is unknown whether there are racial differences in the distribution of the positive surgical margins after radical retropubic prostatectomy (RRP). We investigated the differences between AAM and WM in terms of the site and multifocality of the positive surgical margins and their effect on disease-free survival (DFS) following RRP. METHODS Between January 1991 and December 1995, 493 patients (288 WM and 205 AAM) were treated with RRP as monotherapy. Positive surgical margins were observed in 179 patients (86 WM and 93 AAM). Patients were divided in two groups: group 1 = WM and group 2 = AAM. The incidence and location of the positive surgical margins and their correlation with DFS were determined and compared. RESULTS Overall, AAM had a higher rate of positive surgical margins than WM (48% versus 33%, respectively, P = 0.001). There was no significant difference in the frequency of multifocality of the positive margins (P = 0.4). Positive surgical margins were located significantly more often at the base in AAM (P = 0.015); however, the location of the positive surgical margins did not impact on DFS between groups. In those with multifocal positive surgical margins, AAM had a worse DFS compared with WM (P = 0.03). CONCLUSIONS Race is an independent prognostic factor for DFS in patients with positive surgical margins. There were no differences in DFS between WM and AAM based on the margin location. In WM, prognostic factors for DFS in those with positive surgical margins were preoperative serum prostate-specific antigen, Gleason score, and pathologic stage. Conversely, in AAM none of these parameters were significant predictors of failure.
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Affiliation(s)
- B Shekarriz
- Department of Urology, Wayne State University School of Medicine and Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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65
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IMPACT OF POSITIVE SURGICAL MARGINS ON PROSTATE CANCER RECURRENCE AND THE USE OF SECONDARY CANCER TREATMENT:. J Urol 2000. [DOI: 10.1097/00005392-200004000-00023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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GROSSFELD GARYD, CHANG JAMESJ, BROERING JEANETTEM, MILLER DAVEP, YU JENNY, FLANDERS SCOTTC, HENNING JAMESM, STIER DAVIDM, CARROLL PETERR. IMPACT OF POSITIVE SURGICAL MARGINS ON PROSTATE CANCER RECURRENCE AND THE USE OF SECONDARY CANCER TREATMENT: DATA FROM THE CAPSURE DATABASE. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67716-6] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- GARY D. GROSSFELD
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - JAMES J. CHANG
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - JEANETTE M. BROERING
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - DAVE P. MILLER
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - JENNY YU
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - SCOTT C. FLANDERS
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - JAMES M. HENNING
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - DAVID M. STIER
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
| | - PETER R. CARROLL
- From the Department of Urology, University of California San Francisco Urology Outcomes Research Group and University of California San Francisco-Mount Zion Cancer Center, University of California San Francisco and Lewin-TAG, Inc., San Francisco, California, and TAP Holdings, Inc., Deerfield, Illinois
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Cheng L, Darson MF, Bergstralh EJ, Slezak J, Myers RP, Bostwick DG. Correlation of margin status and extraprostatic extension with progression of prostate carcinoma. Cancer 1999; 86:1775-82. [PMID: 10547551 DOI: 10.1002/(sici)1097-0142(19991101)86:9<1775::aid-cncr20>3.0.co;2-l] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The correlation of surgical margins and extraprostatic extension (EPE) with progression is uncertain with regard to prostate carcinoma patients treated by radical prostatectomy. The objective of this study was to define factors predictive of cancer progression; emphasis was placed on surgical margins and their relation to extraprostatic extension. METHODS The study group consisted of 377 patients who were treated by radical retropubic prostatectomy and bilateral pelvic lymphadenectomy at the Mayo Clinic between 1986 and 1993. All specimens were totally embedded and whole-mounted. Patients ranged in age from 41 to 79 years (mean, 65 years). Those with seminal vesicle invasion or lymph node metastasis and those treated preoperatively with radiation or androgen deprivation were excluded. Final pathologic T classifications were pT2a (41 patients), pT2b (237), and pT3a (99). Progression was defined as biochemical failure (prostate specific antigen [PSA] >0.2 ng/mL), clinical or biopsy-proven local recurrence, or distant metastasis. The mean follow-up was 5.8 years (range, 0.2-11.4 years). Seventy-nine patients who received adjuvant treatment within 3 months after surgery were excluded from survival analysis. RESULTS The overall margin positivity rate was 29%. Seventy-two patients (19%) had only positive surgical margins without evidence of EPE ("surgical incision"), 53 (14%) had only EPE, 37 (10%) had both, and 215 (57%) had neither. Positive margins were correlated with the finding of EPE (P = 0.003). Progression free survival rates at 5 and 10 years were 88% and 67%, respectively. In univariate analysis, preoperative PSA concentration, positive surgical margins, Gleason grade, cancer volume, and DNA ploidy were significant in predicting progression (P values, <0.001, <0.001, 0.01, 0.007, and <0.001, respectively). In multivariate analysis, margin status and DNA ploidy were independent predictors of progression (relative risk for margin status, 1.9; 95% confidence interval [CI], 1.1-3.4; P = 0.03; relative risk for DNA ploidy, 5.1; 95% CI, 2.4-10.9; P<0.001). Among patients with positive margins, 5-year progression free survival was 78% for those with negative EPE and 55% for those with positive EPE. CONCLUSIONS Surgical margin status and DNA ploidy were independent predictors of progression after radical prostatectomy. To improve cancer control, adjuvant therapy may be considered for patients with positive surgical margins or nondiploid cancer.
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Affiliation(s)
- L Cheng
- Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA
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69
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Blute ML, Zincke H. RE: PATHOLOGICAL FEATURES AND PROGNOSTIC SIGNIFICANCE OF PROSTATE CANCER IN THE APICAL SECTION DETERMINED BY WHOLE MOUNT HISTOLOGY. J Urol 1999. [DOI: 10.1016/s0022-5347(05)68314-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael L. Blute
- Department of Urology; Mayo Clinic; Mayo Medical School; 200 First St. S. W.; Rochester, Minnesota 55905
| | - Horst Zincke
- Department of Urology; Mayo Clinic; Mayo Medical School; 200 First St. S. W.; Rochester, Minnesota 55905
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Sakr WA, Grignon DJ. Prostate. Practice parameters, pathologic staging, and handling radical prostatectomy specimens. Urol Clin North Am 1999; 26:453-63, v. [PMID: 10494284 DOI: 10.1016/s0094-0143(05)70194-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article addresses the handling, processing, and reporting of radical prostatectomy specimens with the goal of providing general guidelines and practical suggestions for the surgical pathologist. During the last decade, pathologists in academic and community institutions have witnessed a surge in the number of radical prostatectomy specimens evaluated in their departments. Unlike the relative familiarity most pathologists have with other major oncologic resections, radical prostatectomy specimens present an interesting and occasionally frustrating challenge with respect to gross evaluation, sampling, and reporting.
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Affiliation(s)
- W A Sakr
- Department of Pathology, Harper Hospital, Wayne State University, Detroit, Michigan, USA
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THE COMBINATION OF PREOPERATIVE PROSTATE SPECIFIC ANTIGEN AND POSTOPERATIVE PATHOLOGICAL FINDINGS TO PREDICT PROSTATE SPECIFIC ANTIGEN OUTCOME IN CLINICALLY LOCALIZED PROSTATE CANCER. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62251-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Tiguert R, Hurley PM, Gheiler EL, Tefilli MV, Gudziak MR, Dhabuwala CB, Pontes JE, Wood DP. Treatment outcome after radical prostatectomy is not adversely affected by a pre-existing penile prosthesis. Urology 1998; 52:1030-3. [PMID: 9836550 DOI: 10.1016/s0090-4295(98)00372-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To report on the safety of radical retropubic prostatectomy (RRP) in patients with a penile prosthesis presenting with clinically localized prostate cancer. METHODS From January 1990 to December 1997, 8 consecutive men with a penile prosthesis underwent RRP for clinically localized prostate cancer. Retrospective data regarding patient population, operating time, estimated blood loss, length of hospital stay, and clinical outcome were evaluated. RESULTS Mean patient age was 65.4 years (range 57 to 70) at the time of RRP, with a mean preoperative serum prostate-specific antigen level of 11.5 ng/mL. Mean duration of RRP surgery was 183.9 minutes, and the mean estimated blood loss was 1281.8 mL. No complication requiring penile prosthesis removal occurred. In 1 case, the reservoir tubing was punctured during closure of the abdominal fascia wall. This was immediately recognized and fixed. All patients had a functioning penile prosthesis after RRP. CONCLUSIONS RRP can be safely and expeditiously performed in patients with a pre-existing penile prosthesis. The risk of prosthesis malfunction after RRP is very low. Patients with a penile prosthesis and prostate cancer should not be denied the option of undergoing RRP.
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Affiliation(s)
- R Tiguert
- Department of Urology, Wayne State University, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan, USA
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SITE SPECIFIC PREDICTORS OF POSITIVE MARGINS AT RADICAL PROSTATECTOMY: AN ARGUMENT FOR RISK BASED MODIFICATION OF TECHNIQUE. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62394-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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WIEDER JEFFA, SOLOWAY MARKS. INCIDENCE, ETIOLOGY, LOCATION, PREVENTION AND TREATMENT OF POSITIVE SURGICAL MARGINS AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER. J Urol 1998. [DOI: 10.1016/s0022-5347(01)62881-7] [Citation(s) in RCA: 289] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- JEFF A. WIEDER
- Department of Urology, University of Miami School of Medicine, Miami, Florida
| | - MARK S. SOLOWAY
- Department of Urology, University of Miami School of Medicine, Miami, Florida
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