A review of high-risk prostate cancer and the role of neo-adjuvant and adjuvant therapies

Hsa_circRNA_100146 Promotes Prostate Cancer Progression by Upregulating TRIP13 via Sponging miR-615-5p

Objective: This study was conducted for investigating the functions of circular RNA circRNA_100146 (circRNA_100146) in the development of prostate cancer (PCa) and identifying the underlying mechanisms of the circRNA_100146/miR-615-5p/TRIP13 axis. Materials and Methods: Under the support of RT-PCR, the expression of circRNA_100146 in PCa cells was examined. Cell Counting Kit-8 (CCK-8) assays and clone formation assays were applied to the assessment of cell proliferation. We then determined cell invasion and migration through transwell assays and wound healing assays. RNA pull-down assays and luciferase reporter assays were performed for the exploration of the regulatory effects of potential molecules on the expressions of the targeting genes. In addition, a nude mouse xenograft model was applied to demonstrate the oncogenic roles of circRNA_100146 in PCa. Results: CircRNA_100146 expression was distinctly upregulated in PCa cells. Silencing of circRNA_100146 suppressed PCa cells' invasion, migration, and proliferation. CircRNA_100146 sponged miR-615-5p to suppress its expressions, while miR-615-5p targeted the 3'-UTR of TRIP13 to repress the expression of TRIP13. In addition, we observed that knockdown of miR-615-5p reversed the suppression of circRNA_100146 silence on the proliferation and invasion of PCa cells. In addition, the tumor growth was also suppressed by silencing circRNA_100146 in vivo. Conclusion: CircRNA_100146 is a tumor promoter in PCa, which promoted progression by mediating the miR-615-5p/TRIP13. CircRNA_100146 can be a potential candidate for targeted therapy of PCa.

Robotic radical prostatectomy in high-risk prostate cancer: current perspectives

Around 20%–30% of patients diagnosed with prostate cancer (PCa) still have high-risk PCa disease (HRPC) that requires aggressive treatment. Treatment of HRPC is controversial, and multimodality therapy combining surgery, radiation therapy, and androgen deprivation therapy have been suggested. There has been a trend toward performing radical prostatectomy (RP) in HRPC and currently, robot-assisted laparoscopic RP (RARP) has become the most common approach. Number of publications related to robotic surgery in HRPC is limited in the literature. Tissue and Tumor characteristics might be different in HRPC patients compared to low-risk group and increased surgical experience for RARP is needed. Due to the current literature, RARP seems to have similar oncologic outcomes including surgical margin positivity, biochemical recurrence and recurrence-free survival rates, additional cancer therapy needs and lymph node (LN) yields with similar complication rates compared to open surgery in HRPC. In addition, decreased blood loss, lower rates of blood transfusion and shorter duration of hospital stay seem to be the advantages of robotic surgery in this particular patient group. RARP in HRPC patients seems to be safe and technically feasible with good intermediate-term oncologic results, acceptable morbidities, excellent short-term surgical and pathological outcomes and satisfactory functional results.

Comparison of positive surgical margin rates in high risk prostate cancer: open versus minimally invasive radical prostatectomy

OBJECTIVE

We compared positive surgical margin (PSM) rates for patients with high risk prostate cancer (HRCaP) who underwent open radical retropubic (RRP), robotic (RALP), and laparoscopic (LRP) prostatectomy at a single institution.

MATERIALS AND METHODS

We performed a retrospective review of our prospectively maintained IRB approved database identifying prostate cancer patients who underwent RRP, RALP, or LRP between January 2000 and March 2010. Patients were considered to have HRCaP if they had biopsy or final pathologic Gleason score ≥ 8, or preoperative PSA ≥ 20, or pathologic stage ≥ T3a. A positive surgical margin (PSM) was defined by the presence of tumor at the inked surface of the specimen. Patients who received neoadjuvant hormonal therapy and those who underwent a perineal prostatectomy were excluded from the study.

RESULTS

Of the 445 patients in this study, surgical technique for prostatectomy included RRP (n = 153), RALP (n = 152), and LRP (n = 140). PSM rate for the three groups were not different: 52.9% RRP, 50% RALP, and 41.4% LRP, (p = 0.13). The PSM rate did not differ when comparing RRP to a combined group of RALP and LRP (p = 0.16). Among patients with a PSM, there was no statistical difference between the three groups in terms of the number of patients with a pathologic stage of T3 or higher (p = 0.83). On univariate analysis, a higher preoperative PSA value was associated with a positive margin (p = 0.04).

CONCLUSION

In this HRCaP series, the PSM rate did not differ based on the surgical approach. On univariate analysis, patients with a higher preoperative PSA value were more likely to have a PSM.

[Diagnostics of radical prostatectomy specimens. Results of the 2009 consensus conference of the International Society of Urological Pathology]

The 2009 consensus conference of the International Society of Urological Pathology (ISUP) made recommendations for standardization of handling and staging of radical prostatectomy specimens. The conference topics were preparation of specimens, the T2 subclassification, prostate cancer volume, extraprostatic tumor extent, lymphovascular invasion, seminal vesicle infiltration, lymph node metastases and surgical margins. This review article presents the essential results and recommendations of this conference.

International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens: rationale and organization

The 2009 International Society of Urological Pathology consensus conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. The activities of the conference were coordinated through five workgroups. The results are presented in five separate reports covering (1) specimen handling, (2) T2 substaging and prostate cancer volume, (3) extraprostatic extension, lymphovascular invasion and locally advanced disease, (4) seminal vesicles and lymph node metastases and (5) surgical margins. In this introductory article we describe some novel features of the organization of the consensus process. Following the completion of a pre-meeting survey conference, participants discussed and voted on 43 specific issues of contention relating to the pathological reporting of radical prostatectomy specimens. Consensus, defined as agreement by at least 65% of participants present, was achieved for 30 questions.

Matrix metalloproteinase 9 is associated with Gleason score in prostate cancer but not with prognosis

Prostate cancer is the most common cancer in North American men. Among men diagnosed with prostate cancer in more than three cores or with high grade prostate cancer, many experience long disease-free survival. However, these patients still undergo radical treatment while they could benefit from active surveillance with complementary therapy. Matrix metalloproteinase 9 degrades type IV collagen and activates tumorigenic factors and is thus a potential prognostic factor and therapeutic target. This study was thus aimed at investigating the role of matrix metalloproteinase 9 on prostate cancer progression. We correlated matrix metalloproteinase 9 immunohistochemical expression by cancer, stromal and benign epithelial cells with prostate cancer disease-free survival among a cohort composed of 187 pT3NxM0 prostate cancer patients. Median follow-up was 4.63 years and a recurrence occurred in 67 men (35.3%). Matrix metalloproteinase 9 immunostaining was cytoplasmic and expressed at different levels in cancer (94.1%), stromal (87.7%) and benign epithelial cells (94.1%). High levels (>50% of cells) of matrix metalloproteinase 9 expression by prostate cancer cells was strongly associated with high Gleason score (P = .0009). In stromal cells and in benign epithelial cells, high matrix metalloproteinase 9 expression levels were respectively associated with low pT3 substage (P = .046) and with low initial serum prostate-specific antigen levels (P = .006). Matrix metalloproteinase 9 expression level by any cell type was not associated with prostate cancer disease-free survival. These results show that matrix metalloproteinase 9 is overexpressed by cancer cells in high grade tumors and by stromal and benign epithelial cells in lower substage tumors.

A multidisciplinary approach to the management of urologic malignancies: does it influence diagnostic and treatment decisions?

OBJECTIVE

It is recognized that multidisciplinary teams may improve management decisions for patients with malignancies. We prospectively studied the effect of such a multidisciplinary approach on the diagnosis and treatment decisions of patients newly presenting with urologic malignancies.

METHODS

Two hundred sixty-nine consecutive new patients presenting to our institution with an outside diagnosis of a urologic malignancy for diagnostic or treatment considerations (2007-2008). All cases were reviewed and discussed at a tumor board with all members of the different subspecialties present. Reevaluation of the outside diagnostic and treatment plan was undertaken. Based on this team review and approach, patients were classified based on changes in diagnosis and/or treatment.

RESULTS

Cohort was comprised of patients with the diagnosis of cancer of the prostate (34%), bladder (23%), kidney (35%), testicle (5%), and other (1%). Only 35% of patients had no changes in diagnosis or treatment, 38% had a change in diagnosis or treatment, 10% required further analysis (i.e., "other"), and 17% were N/A. Changes in diagnosis were most common in bladder (23%) and renal (17%) cancers. Changes in treatment were most common in bladder cancer (44%), followed by kidney (36%), testicular (29%), then prostate (22%) cancers. A stage effect on diagnostic and treatment considerations was also noted, especially for bladder cancer.

CONCLUSIONS

A multidisciplinary team approach affects the diagnostic and management decisions in a significant number patients with a newly diagnosed urologic malignancy, and thereby seems to have a clinical impact for many of our patients with urologic cancers.