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Numbere N, Teramoto Y, Gurung PMS, Goto T, Yang Z, Miyamoto H. The Clinical Impact of pT3a Lesions in Patients With pT3b Prostate Cancer Undergoing Radical Prostatectomy. Arch Pathol Lab Med 2022; 146:619-625. [PMID: 34979562 DOI: 10.5858/arpa.2021-0069-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/24/2022]
Abstract
CONTEXT.— Seminal vesicle invasion (SVI) by prostate cancer (pT3b disease) has been considered as a key prognostic factor. OBJECTIVE.— To assess the clinical impact of T3a lesions (ie, extraprostatic extension other than bladder neck invasion [BNI] or SVI [EPE], microscopic bladder neck invasion [mBNI]) in pT3b disease. DESIGN.— We compared radical prostatectomy findings and long-term oncologic outcomes in 248 patients with pT3b disease, with versus without EPE/mBNI. RESULTS.— Extraprostatic extension/mBNI was found in 219 (88.3%)/48 (19.4%) cases, respectively. Extraprostatic extension was significantly associated with higher preoperative prostate-specific antigen (PSA) level, higher rates of positive surgical margin (pSM) and lymphovascular invasion (LVI), and larger tumor volume. Similarly, mBNI was significantly associated with higher PSA level, higher rates of Grade Group(s) 4-5 or 5, pSM, LVI, and pN1, and larger tumor volume. Significant differences in all of these clinicopathologic features (except lymph node metastasis) between EPE-/mBNI+ or EPE+/mBNI- and EPE+/mBNI+ cases were also observed. Outcome analysis revealed that patients with EPE (P < .001) or mBNI (P < .001) had a significantly higher risk of disease progression than respective controls. Notably, there were significant differences in progression-free survival between EPE-/mBNI+ or EPE+/mBNI- cases and EPE-/mBNI- (P = .001) or EPE+/mBNI+ (P < .001) cases. In multivariate analysis, EPE (hazard ratio [HR] = 6.53, P = .009) and mBNI (HR = 2.33, P = .003), as well as EPE-/mBNI+ or EPE+/mBNI- (HR = 11.7, P = .01) and EPE+/mBNI+ (HR = 25.9, P = .002) (versus EPE-/mBNI-), showed significance for progression. CONCLUSIONS.— From these significant findings, we propose a novel pT3b subclassification: pT3b1 (SVI alone without EPE or mBNI), pT3b2 (SVI with either EPE or mBNI), and pT3b3 (SVI with both EPE and mBNI).
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Affiliation(s)
- Numbereye Numbere
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Goto, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Yuki Teramoto
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Goto, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.,James P. Wilmot Cancer Institute (Teramoto, Goto, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Pratik M S Gurung
- The Department of Urology (Gurung, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Takuro Goto
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Goto, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.,James P. Wilmot Cancer Institute (Teramoto, Goto, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Zhiming Yang
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Goto, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York
| | - Hiroshi Miyamoto
- From the Department of Pathology & Laboratory Medicine (Numbere, Teramoto, Goto, Yang, Miyamoto), University of Rochester Medical Center, Rochester, New York.,James P. Wilmot Cancer Institute (Teramoto, Goto, Miyamoto), University of Rochester Medical Center, Rochester, New York.,The Department of Urology (Gurung, Miyamoto), University of Rochester Medical Center, Rochester, New York
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Cheraghlou S, Yu PK, Otremba MD, Mehra S, Yarbrough WG, Judson BL. Extracapsular extension is not a significant prognostic indicator in non-squamous cancers of the major salivary glands. CANCERS OF THE HEAD & NECK 2018; 3:5. [PMID: 31093358 PMCID: PMC6460801 DOI: 10.1186/s41199-018-0032-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 05/29/2018] [Indexed: 01/03/2023]
Abstract
Background Extracapsular extension (ECE) is a well-established prognostic feature in squamous cell cancers of the head and neck. Although some extrapolate data from mucosal head and neck cancer to include ECE as a high-risk feature in salivary gland cancers, data is lacking about ECE’s prognostic value for these malignancies. We investigate whether ECE is a significant prognostic indicator in pathologic node-positive cancers of the major salivary glands. Methods A retrospective study of adult salivary gland cancer cases diagnosed from 2004 to 2013 in the NCDB was conducted. Demographic, tumor, treatment, and survival variables were included in the study. Univariate Kaplan-Meier analyses, as well as multivariate Cox survival regressions were performed. Results Positive ECE status was associated with significantly worse survival in salivary SCC (HR 1.687; p = 0.002) but not non-squamous salivary cancers (HR 1.000; p = 0.998) on multivariate analysis. While post-operative radiotherapy was not associated with improved survival for patients without high-risk adverse features (high grade or positive surgical margins), its use was associated with better survival for ECE-positive salivary SCC patients without one of these additional adverse features (HR 0.064; p = 0.010). Conclusions Although ECE is a significant prognostic indicator in salivary SCC, its prognostic significance for non-squamous salivary cancers may be limited. Radiotherapy may improve survival in cases with at least one high-risk adverse feature: high grade; positive surgical margins; and for salivary SCC specifically, positive ECE status.
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Affiliation(s)
- Shayan Cheraghlou
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA
| | - Phoebe K Yu
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA
| | - Michael D Otremba
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA
| | - Saral Mehra
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA
| | - Wendell G Yarbrough
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA.,3Department of Pathology, Yale School of Medicine, New Haven, CT USA
| | - Benjamin L Judson
- 1Division of Otolaryngology, Department of Surgery, Yale School of Medicine, 800 Howard Ave., YPB 425, New Haven, CT 06519 USA.,2Yale Cancer Center, New Haven, CT USA
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Badani KK, Reddy BN, Moskowitz EJ, Paulucci DJ, Beksac AT, Martini A, Whalen MJ, Skarecky DW, Huynh LM, Ahlering TE. Lymph node yield during radical prostatectomy does not impact rate of biochemical recurrence in patients with seminal vesicle invasion and node-negative disease. Urol Oncol 2018; 36:310.e1-310.e6. [PMID: 29625782 DOI: 10.1016/j.urolonc.2018.03.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/05/2018] [Accepted: 03/05/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Seminal vesicle invasion (SVI) is a risk factor for poor oncologic outcome in patients with prostate cancer. Modifications to the pelvic lymph node dissection (PLND) during radical prostatectomy (RP) have been reported to have a therapeutic benefit. The present study is the first to determine if lymph node yield (LNY) is associated with a lower risk of biochemical recurrence (BCR) for men with SVI. METHODS A total of 220 patients from 2 high-volume institutions who underwent RP without adjuvant treatment between 1990 and 2015 and had prostate cancer with SVI (i.e., pT3b) were identified, and 21 patients did not undergo lymph node dissection. BCR was defined as a postoperative PSA>0.2ng/mL, or use of salvage androgen deprivation therapy (ADT) or radiation. Multivariable Cox proportional hazards models were used to determine whether LNY was predictive of BCR, controlling for PSA, pathologic Gleason Score, pathologic lymph node status, NCCN risk category, etc. The Kaplan-Meier method was used to determine 3-year freedom from BCR. RESULTS Median number of lymph nodes sampled were 7 (IQR: 3-12; range: 0-35) and 90.5% underwent PLND. The estimated 3-year BCR rate was 43.9%. Results from multivariable analysis demonstrated that LNY was not significantly associated with risk of BCR overall (HR = 1.00, 95% CI: 0.98-1.03; P = 0.848) for pN0 (HR = 0.99, 95% CI: 0.97-1.03; P = 0.916) or pN1 patients (HR = 0.96, 95% CI: 0.88-1.06; P = 0.468). Overall, PSA (HR = 1.02, P<0.001) and biopsy Gleason sum ≥ 8 (HR = 1.81, P = 0.001) were associated with an increased risk of BCR, and increasing LNY increased the likelihood of detecting>2 positive lymph nodes (OR = 1.27, 95% CI: 1.06-1.65, P = 0.023). CONCLUSION Seminal vesicle invasion is associated with an increased risk of BCR at 3 years, primarily due to pathologic Gleason score and PSA. Although greater lymph node yield is diagnostic and facilitates more accurate pathologic staging, our data do not show a therapeutic benefit in reducing BCR.
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Affiliation(s)
- Ketan K Badani
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Balaji N Reddy
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Eric J Moskowitz
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - David J Paulucci
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Alp Tuna Beksac
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Alberto Martini
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | - Michael J Whalen
- Department of Urology, Icahn School of Medicine, Mount Sinai, New York, NY
| | | | - Linda My Huynh
- Department of Urology, University of California-Irvine, Orange, CA
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Greco C, Castiglioni S, Fodor A, De Cobelli O, Longaretti N, Rocco B, Vavassori A, Orecchia R. Benefit on Biochemical Control of Adjuvant Radiation Therapy in Patients with Pathologically Involved Seminal Vesicles after Radical Prostatectomy. TUMORI JOURNAL 2018; 93:445-51. [DOI: 10.1177/030089160709300507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background To determine whether there is a benefit for biochemical control with adjuvant radiation therapy to the surgical bed following radical prostatectomy in patients with seminal vesicle invasion and pathologically negative pelvic lymph nodes (pT3b-pT4 pN0). Methods We retrospectively reviewed the clinical records of radical prostatectomy patients treated between 1995 and 2002. A total of 66 patients with seminal vesicle invasion were identified: 45 of these patients received adjuvant radiation therapy and 21 were observed. Radiation therapy was initiated within 4 months of prostatectomy. Median dose was 66 Gy (range, 60–70 Gy). Median follow-up from the day of surgery was 40.6 months (mean, 41.5; range, 12–99). Biochemical recurrence was defined as the first value ≥0.2 ng/ml. Results At two years, the proportion of patients free from biochemical recurrence was 80% in patients who received adjuvant radiation therapy versus 54% for those not given radiation therapy (P = 0.036). Actuarial biochemical recurrence at 5 years was 59% vs 41% for the radiation therapy and no radiation therapy groups, respectively. On univariate Cox regression model, the hazard of biochemical failure was also associated with a detectable (≥0.2 ng/ml) postsurgical prostate-specific antigen (P = 0.02) prior to radiation therapy. Pathological T stage (pT3b vs pT4), Gleason score, primary Gleason pattern and positive surgical margins were not significantly associated with biochemical recurrence. The hazard of biochemical failure was around 85% lower in the radiation therapy group than in the observation group (P = 0.002). Conclusions Data from the present series suggest that adjuvant radiation therapy for patients with seminal vesicle invasion and undetectable (≤0.2 ng/ml) postoperative prostate-specific antigen significantly reduces the likelihood of biochemical failure.
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Affiliation(s)
- Carlo Greco
- Division of Radiation Oncology, University of Magna Graecia, Catanzaro
- Division of Radiation Oncology, European Institute of Oncology, Milan
| | | | - Andrei Fodor
- Division of Radiation Oncology, European Institute of Oncology, Milan
| | | | | | - Bernardo Rocco
- Division of Urology, European Institute of Oncology, Milan
| | - Andrea Vavassori
- Division of Radiation Oncology, European Institute of Oncology, Milan
| | - Roberto Orecchia
- Division of Radiation Oncology, European Institute of Oncology, Milan
- Chair of Radiation Oncology, University of Milan, Italy
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5
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Lee HJ, Han JH, Lee DH, Nam JK, Kim TN, Chung MK, Park SW. Does bilateral seminal vesicle invasion at radical prostatectomy predict worse prognosis than unilateral invasion among patients with pT3b prostate cancers? Int J Urol 2016; 23:758-63. [DOI: 10.1111/iju.13144] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/19/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Hyun Jung Lee
- Department of Pathology; Pusan National University Yangsan Hospital; Yangsan Korea
| | - Jun-Hee Han
- Research Institute for Convergence of Biomedical Science and Technology; Pusan National University Yangsan Hospital; Yangsan Korea
| | - Dong Hoon Lee
- Department of Urology; Pusan National University Yangsan Hospital; Yangsan Korea
| | - Jong Kil Nam
- Department of Urology; Pusan National University Yangsan Hospital; Yangsan Korea
| | - Tae Nam Kim
- Department of Urology; Pusan National University Hospital; Busan Korea
| | - Moon Kee Chung
- Department of Urology; Pusan National University Yangsan Hospital; Yangsan Korea
| | - Sung-Woo Park
- Research Institute for Convergence of Biomedical Science and Technology; Pusan National University Yangsan Hospital; Yangsan Korea
- Department of Urology; Pusan National University Yangsan Hospital; Yangsan Korea
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Pagano MJ, Whalen MJ, Paulucci DJ, Reddy BN, Matulay JT, Rothberg M, Scarberry K, Patel T, Shapiro EY, RoyChoudhury A, McKiernan J, Benson MC, Badani KK. Predictors of biochemical recurrence in pT3b prostate cancer after radical prostatectomy without adjuvant radiotherapy. Prostate 2016; 76:226-34. [PMID: 26481325 DOI: 10.1002/pros.23114] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/06/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND Men with pathologic evidence of seminal vesicle invasion (SVI) at radical prostatectomy (RP) have higher rates of biochemical recurrence (BCR) and mortality. Adjuvant radiotherapy (XRT) has been shown to increase freedom from BCR, but its impact on overall survival is controversial and it may represent overtreatment for some. The present study, therefore, sought to identify men with SVI at higher risk for BCR after RP in the absence of adjuvant XRT. METHODS We identified 180 patients in our institutional database who underwent RP from 1990 to 2011 who had pT3bN0-1 disease. The Kaplan-Meier method was used to estimate freedom from BCR for the overall cohort and substratified by Gleason score, PSA, surgical margin status, and lymph node positivity. Cox Proportional Hazards models were used to determine demographic and histopathological factors predictive of BCR. Time-dependent ROC curve analysis was conducted to assess the ability of the UCSF-CAPRA score to predict BCR. RESULTS Median age was 64 years, and 52.8% of patients were preoperative D'Amico high risk. At RP, 41.4% had a positive surgical margin (PSM), and 12.2% had positive lymph nodes (LN). The most common sites of PSM were the peripheral zone (56.8%) and the apex (32.4%). Positive bladder neck margin (HR = 7.01, P = 0.035) and PSA 10-20 versus ≤10 (HR = 1.63, P = 0.047) predicted higher BCR in multivariable analyses. Median follow-up was 26 months, and 2-, 3-, and 5-year BCR-free rates were 56.1%, 49.0%, and 39.5%. Log rank tests showed that freedom from BCR was significantly less for Gleason 9-10, PSA >20, PSM, and N1 patients. The area under curve (AUC) for CAPRA in predicting BCR was 0.713 at 2 years, 0.692 at 3 years, and 0.641 at 5 years. Increasing CAPRA score was associated with an increased risk of BCR (HR = 1.33, P < 0.001). CONCLUSIONS pT3b prostate cancer is a heterogeneous disease commonly associated with several high-risk features. Stratifying men with SVI by prognostic features (i.e., Gleason, PSA, node status, surgical margin status) and using these features to augment the CAPRA score will improve identification of those at higher risk for BCR that should be strongly considered for adjuvant XRT.
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Affiliation(s)
- Matthew J Pagano
- Department of Urology, Columbia University Medical Center, New York City, New York
| | - Michael J Whalen
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York
| | - David J Paulucci
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York
| | - Balaji N Reddy
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York
| | - Justin T Matulay
- Department of Urology, Columbia University Medical Center, New York City, New York
| | - Michael Rothberg
- Department of Urology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
| | - Kyle Scarberry
- Department of Urology, Columbia University Medical Center, New York City, New York
| | - Trushar Patel
- Department of Urology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Edan Y Shapiro
- Department of Urology, Columbia University College of Physicians and Surgeons, New York City, New York
| | - Arindam RoyChoudhury
- Department of Biostatistics, Columbia University Medical Center, New York City, New York
| | - James McKiernan
- Department of Urology, Columbia University Medical Center, New York City, New York
| | - Mitchell C Benson
- Department of Urology, Columbia University Medical Center, New York City, New York
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York City, New York
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7
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Mitchell DL, Tracy CR, Buatti JM, Smith MC, Snow AN, Henry MD, Vaena DA, Tewfik HH, Watkins JM. Individualization of Adjuvant Therapy After Radical Prostatectomy for Clinically Localized Prostate Cancer: Current Status and Future Directions. Clin Genitourin Cancer 2016; 14:12-21. [PMID: 26341039 DOI: 10.1016/j.clgc.2015.07.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Accepted: 07/30/2015] [Indexed: 11/20/2022]
Abstract
Radiation therapy indications in the postprostatectomy setting are evolving. Several retrospective series have identified a number of "high-risk" pathologic features associated with an elevated risk of disease recurrence after radical prostatectomy. More recently, several randomized phase III trials demonstrated superior biochemical relapse-free survival for adjuvant radiation therapy after prostatectomy for patients with these high-risk pathologic features, including positive margin status, extraprostatic extension, and/or seminal vesicle invasion. These series further suggested improvement in distant metastasis control and overall survival after 15 years. However, not all patients with high-risk features experience disease recurrence after surgery alone, and some subsets of patients experience suboptimal disease control and survival despite immediate postoperative radiotherapy. Furthermore, some patients without high-risk features will develop recurrence. The present review discusses the current data and potential future directions to improve individualization of therapy after prostatectomy.
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Affiliation(s)
- Darrion L Mitchell
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Chad R Tracy
- Department of Urology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Mark C Smith
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Anthony N Snow
- Department of Pathology, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Michael D Henry
- Department of Molecular Physiology and Biophysics and Holden Comprehensive Cancer Center, University of Iowa Carver School of Medicine, Iowa City, IA
| | - Daniel A Vaena
- Department of Hematology and Oncology, University of Iowa Carver School of Medicine, Iowa City, IA
| | | | - John M Watkins
- Department of Radiation Oncology, University of Iowa Carver School of Medicine, Iowa City, IA.
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8
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Ün S, Türk H, Koca O, Divrik RT, Zorlu F. Factors determining biochemical recurrence in low-risk prostate cancer patients who underwent radical prostatectomy. Turk J Urol 2015; 41:61-6. [PMID: 26328203 DOI: 10.5152/tud.2015.65624] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/10/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study was conducted to research the factors determining biochemical recurrence (BCR) in low-risk localized prostate cancer patients who underwent radical prostatectomy (RP). MATERIALS AND METHODS We retrospectively analyzed the data of 504 patients who had undergone RP between 2003 and 2013 at our clinic. One hundred and fifty-two patients who underwent RP for low-risk prostate cancer were included in the study. RESULTS The mean follow-up period for patients was 58.7 (21-229) months. The mean age of the patients was 63.7±7.2 years (49-79). The mean prostate specific antigen (PSA) value was 5.25±4.22 ng/mL (3.58-9.45). The BCR rate after the operation was 25% (38/152). In the univariate analysis, recurrence determining factors were shown to include extracapsular involvement (ECI) (p=0.004), capsular invasion (CI) (p=0.001), age (p=0.014), and tumor size (p=0.006). However, only CI was found to be significant in multivariate analysis (p=0.001). CONCLUSION Capsular invasion is an independent risk factor in low-risk prostate cancer patients who underwent RP for BCR.
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Affiliation(s)
- Sıtkı Ün
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Hakan Türk
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Osman Koca
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Rauf Taner Divrik
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Ferruh Zorlu
- Clinic of Urology, Tepecik Training and Research Hospital, İzmir, Turkey
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9
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Mikel Hubanks J, Boorjian SA, Frank I, Gettman MT, Houston Thompson R, Rangel LJ, Bergstralh EJ, Jeffrey Karnes R. The presence of extracapsular extension is associated with an increased risk of death from prostate cancer after radical prostatectomy for patients with seminal vesicle invasion and negative lymph nodes. Urol Oncol 2014; 32:26.e1-7. [DOI: 10.1016/j.urolonc.2012.09.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 08/21/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
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10
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Song C, Kim YS, Hong JH, Kim CS, Ahn H. Treatment failure and clinical progression after salvage therapy in men with biochemical recurrence after radical prostatectomy: radiotherapy vs androgen deprivation. BJU Int 2009; 106:188-93. [PMID: 20002666 DOI: 10.1111/j.1464-410x.2009.09136.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the outcomes between salvage radiotherapy (RT) and androgen-deprivation therapy (ADT), to investigate factors determining clinical progression (CP) in men with prostate cancer. PATIENTS AND METHODS The study comprised 121 patients with biochemical recurrence while on follow-up by prostate-specific antigen (PSA) measurement, without adjuvant therapy after radical prostatectomy, received RT (45) or ADT (76). Failure after salvage therapy was defined as a PSA level of >0.2 ng/mL. Clinical, pathological and treatment factors were analysed. RESULTS The clinicopathological characteristics were similar between the RT and ADT groups except that men in the RT group were younger (61.4 vs 65.4 years). After ADT, salvage failed in 10 (13%) after a mean (sd) of 18.5 (4.5) months of treatment, and 6.7 months after salvage failed all patients progressed clinically. After RT, salvage failed in 22 (49%) after 30.7 (5.2) months of response. Upon RT failure, all patients received ADT, after which in three (14%) patients the treatment failed again after 20.1 months of treatment and progressed to CP after 6.5 months, while in the remaining 19 (86%) patients the PSA level remained undetectable for 37.6 (7.7) months. On multivariate analysis, pathological stage (> or =T3b) and Gleason grade 5 disease were independently prognostic of CP. CONCLUSION Salvage RT alone and combined with subsequent ADT provided PSA control in most patients, significantly increasing CP-free survival compared with initial ADT. Patients with a short PSA doubling time (<3 months) are at high risk of failed salvage treatment after RT, and initial ADT might be considered. Regardless of salvage method, advanced pathological stage and Gleason grade 5 were factors prognostic of CP.
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Affiliation(s)
- Cheryn Song
- Department of Urology and Radiation Oncology, University of Ulsan College of Medicine, Seoul, Korea
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11
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Foley CL, Feneley MR. The clinical significance and therapeutic implications of extraprostatic invasion. Surg Oncol 2009; 18:203-12. [PMID: 19398328 DOI: 10.1016/j.suronc.2009.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Invasion of the prostatic margin by cancer establishes a higher risk of disease progression and treatment failure depending upon its extent and other clinical factors. Pathological stage is the most important single prognostic indicator, but determined reliably only in patients having radical prostatectomy. Tumour beyond the prostatic margin or its invasion into the seminal vesicle defines the local stage category as T3, and when confirmed by pathological examination the extent of prostatic margin involvement has prognostic significance. Prediction of extraprostatic invasion may influence therapeutic decisions, but can be difficult to determine for the individual patient prior to treatment. In some individuals having radical prostatectomy, the finding of extraprostatic invasion is unsuspected, and fortunately for the majority of these men the treatment remains curative. On the other hand, when extraprostatic invasion is suspected prior to or at surgery, wide excision may be necessary to achieve negative surgical margins, with other factors contributing independently to the likelihood of subsequent progression. Radiotherapy is an effective alternative treatment for clinical stage T3 and high-risk clinically localized cancer. Recent technological advances and use of combination modality treatment with radiation and hormone manipulation have improved survival outcomes and reduced side-effects. Radiation also has its place as adjuvant treatment following radical prostatectomy in high-risk disease, or as salvage following PSA recurrence, with ongoing trials evaluating potential benefit and toxicity. For clinically localised stage T3 prostate cancer, treatment with surgery or radiotherapy may be highly effective, but multimodality interventions are increasingly being used for primary treatment where clinical assessment indicates that there would otherwise be a high risk for disease progression and therapeutic failure.
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12
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The prognostic impact of seminal vesicle involvement found at prostatectomy and the effects of adjuvant radiation: data from Southwest Oncology Group 8794. J Urol 2008; 180:2453-7; discussion 2458. [PMID: 18930488 DOI: 10.1016/j.juro.2008.08.037] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Indexed: 11/23/2022]
Abstract
PURPOSE From the randomized study Southwest Oncology Group 8794 we evaluated the effect of seminal vesicle involvement on outcomes and whether those patients benefited from post-prostatectomy adjuvant radiation therapy. MATERIALS AND METHODS Southwest Oncology Group study 8794 randomized high risk patients (with seminal vesicle positive disease and/or capsular penetration and/or positive margins) to radiation vs observation after prostatectomy. A total of 431 subjects with pathologically advanced prostate cancer were randomized. RESULTS Median followup was 12.2 years. Of the patients 139 had seminal vesicle involvement with or without capsular penetration and/or positive margins. Compared to the 286 patients with seminal vesicle negative disease there was poorer 10-year biochemical failure-free survival (33% for seminal vesicle negative and 22% for seminal vesicle positive, p = 0.04), metastasis-free survival (70% and 56%, respectively, p = 0.005) and overall survival (10-year overall survival 74% and 61%, respectively, p = 0.02) for those with seminal vesicle positive disease. Patients with seminal vesicle positive disease who received adjuvant radiation compared to observation realized an improvement in 10-year biochemical failure-free survival from 12% to 36% (p = 0.001), in 10-year overall survival from 51% to 71% (p = 0.08) and in metastasis-free survival from 47% to 66% (p = 0.09), respectively. CONCLUSIONS Although seminal vesicle involvement is a negative prognostic factor, long-term control is possible especially if patients are given adjuvant radiation therapy. This therapy appears to be effective in patients with seminal vesicle involvement.
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Song C, Kang T, Lee MS, Ro JY, Lee SE, Lee E, Choi HY, Han DH, Hong SJ, Chung BH, Kim CS, Ahn H. Clinico-pathological Characteristics of Prostate Cancer in Korean Men and Nomograms for the Prediction of the Pathological Stage of the Clinically Localized Prostate Cancer: A Multi-institutional Update. Korean J Urol 2007. [DOI: 10.4111/kju.2007.48.2.125] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Taejin Kang
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Moo-song Lee
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Y. Ro
- Department of Pathology, University of Ulsan, Seoul, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University, Seoul, Korea
| | - Eunsik Lee
- Department of Urology, Seoul National University, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Sungkyunkwan University, Seoul, Korea
| | - Deok Hyun Han
- Department of Urology, Sungkyunkwan University, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Ha Chung
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, University of Ulsan, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan, Seoul, Korea
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Krupski TL, Saigal CS, Hanley J, Schonlau M, Litwin MS. Patterns of care for men with prostate cancer after failure of primary treatment. Cancer 2006; 107:258-65. [PMID: 16783816 DOI: 10.1002/cncr.21981] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND This study sought to determine trends in patterns of care after failure of primary prostate cancer treatment and to determine whether nonclinical factors influenced the receipt of secondary treatment. METHODS The authors identified individuals treated for nonmetastatic prostate cancer in the years 1991-1999 from the linked databases of Medicare and the National Cancer Institute's Surveillance, Epidemiology, and End Results registry. The outcome of interest was receipt of secondary therapy. They performed Cox proportional hazard analyses to investigate the link between demographic and clinical characteristics and the likelihood of receiving secondary treatment after either surgery or radiation. RESULTS Of 65,716 subjects who met our inclusion criteria, 10,200 (15%) received some form of secondary therapy. For men undergoing initial surgical or radiation therapy, tumor grade, year of diagnosis, and geographic region were associated with secondary therapy. No socioeconomic factors such as education, ethnicity, or income level were associated with secondary therapy. CONCLUSIONS Patterns of care after primary prostate cancer therapy continue to vary regionally. Standardized clinical algorithms and utilization of prostate-specific antigen testing appear to have influenced secondary therapy rates.
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Affiliation(s)
- Tracey L Krupski
- Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
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15
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Sodee DB, Nelson AD, Faulhaber PF, Maclennan GT, Resnick MI, Bakale G. Update on fused capromab pendetide imaging of prostate cancer. ACTA ACUST UNITED AC 2005; 3:230-8. [PMID: 15882479 DOI: 10.3816/cgc.2005.n.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The primary objective of this overview is to apprise clinical urologists and oncologists of the current state of fused multimodality imaging of prostate cancer, which can be applied to optimize treatment by ensuring that a patient's disease is characterized as well as current imaging technology permits. The focus of this study is the monoclonal antibody capromab pendetide, which targets prostate specific membrane antigen (PSMA), a type II membrane glycoprotein strongly associated with prostate cancer. Identifying where capromab pendetide uptake occurs can be done accurately if this functional imaging modality is combined with a modality that provides anatomic detail, such as computed tomography (CT) or magnetic resonance imaging (MRI). Image fusion, or coregistration, which is overlaying the functional images of capromab pendetide uptake on the anatomic CT or MRI images, provides a detailed map of cancer localization inside and outside the prostate gland. This same principle of fusing functional images on anatomic images is the basis for enormous growth of positron emission tomography with CT during the past 2 years. Positron emission tomography imaging has a different functionality base than does capromab pendetide, and thus the 2 modalities should be complementary. However, the key to both functional imaging modalities is accurate fusion with anatomic images, which is illustrated in our case reports. The cases cited demonstrate the need to optimize every phase of imaging from patient preparation to reading and reporting increased PSMA concentration seen on the fused images. Reference is also made to applying capromab pendetide/CT fused imaging to radiation therapy planning.
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Affiliation(s)
- D Bruce Sodee
- Department of Radiology, Division of Nuclear Medicine, University Hospitals of Cleveland/Case University School of Medicine, OH 44106, USA.
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Krupski TL, Kwan L, Litwin MS. Sociodemographic factors associated with postprostatectomy radiotherapy. Prostate Cancer Prostatic Dis 2005; 8:184-8. [PMID: 15809671 DOI: 10.1038/sj.pcan.4500791] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE To determine if nonclinical factors affect the use of adjuvant radiation therapy after surgical resection of the prostate gland. METHODS Using the National Cancer Institute's Surveillance Epidemiology and End Results (SEER) public use data files, we identified men with localized/regional prostate cancer who underwent postprostatectomy radiotherapy within 4 months of surgery. We used 2000 Census information to ascribe a median education and income level to these men based on the county of residence and ethnicity. RESULTS Of 34,763 men who underwent surgical resection, 1549 received postprostatectomy radiotherapy. Those with higher tumor grade and from certain geographic regions (Seattle and Hawaii) had significantly higher rates of radiotherapy while being older and from other geographic regions (Detroit, Utah, and New Mexico) was protective. The use of additional radiation therapy was not affected by ethnicity, income level, or educational attainment. CONCLUSIONS We found no socioeconomic or demographic disparities in the receipt of postprostatectomy radiotherapy. Geographic variation in postprostatectomy radiotherapy may be explained by limited evidence supporting its use in clinical practice.
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Affiliation(s)
- T L Krupski
- Department of Urology, David Geffen School of Medicine, School of Public Health, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California 90095-1738, USA.
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