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Mishra P, Jiongming L, Jianhe L, Kewei F, Yongming J, Wang G, Pei L, Tongxing Y. Prostate Cancer among Patients Undergoing Radical Cystoprostatectomy for Bladder Cancer in the Department of Urology in a Tertiary Care Centre. JNMA J Nepal Med Assoc 2023; 61:782-786. [PMID: 38289768 PMCID: PMC10579766 DOI: 10.31729/jnma.8309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Indexed: 02/01/2024] Open
Abstract
Introduction Prostate cancer is the most common malignancy in men and remains one of the most prevalent and least understood of all human malignancies. Bladder cancer is the most frequently diagnosed cancer in China. Radical cystectomy remains the gold standard for muscle-invasive, recurrent and multiple bladder cancer. All male patients undergoing radical cystoprostatectomy must be evaluated for prostate cancer before planning surgery. The aim of this study was to find out the prevalence of prostate cancer among patients undergoing radical cystoprostatectomy undergoing surgery for bladder cancer. Methods A descriptive cross-sectional study was conducted in a tertiary care centre from 1 August 2023 to 30 August 2023 where data from 1 January 2015 to 30 December 2017 was taken from medical records after obtaining ethical approval from the Ethical Review Board. All patients who underwent radical cystoprostatectomy were included in the study. Whole radical cystoprostatectomy specimens were cut transversely at 3 mm intervals and examined in the same pathological centre. Clinically significant prostate cancer was defined as a tumour with a Gleason pattern ≥4, prostate tumour with clinical stage ≥pT3, lymph node. involvement, positive surgical margin or multifocality of three or more lesions. A convenience sampling method was used. The point estimate was calculated at a 95% Confidence Interval. Results Among 210 patients, 52 (24.76%) (18.92-30.60, 95% Confidence Interval) had incidental prostate cancer. The average age of patients with incidental prostate cancer was 65.88±9.54 years. Conclusions The prevalence of incidental prostate cancer was found to be lower than the study conducted in a similar setting. Keywords bladder cancer; incidental findings; prostate cancer.
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Affiliation(s)
- Prashant Mishra
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
| | - Li Jiongming
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
| | - Liu Jianhe
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
| | - Fang Kewei
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
| | - Jiang Yongming
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
| | - Guang Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
| | - Li Pei
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
| | - Yang Tongxing
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, Yunnan, People's Republic of China
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Korpás KL, Beke L, Varga D, Bidiga L, Méhes G, Molnár S. Grade Group accuracy is improved by extensive prostate biopsy sampling, but unrelated to prostatectomy specimen sampling or use of immunohistochemistry. Pathol Oncol Res 2023; 29:1611157. [PMID: 37415848 PMCID: PMC10319996 DOI: 10.3389/pore.2023.1611157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
Assessing the accurate Grade Group of a prostate needle biopsy specimen is essential for choosing the adequate therapeutic modality for prostate cancer patients. However, it is well-known that biopsy Grade Group tends to up- or downgrade significantly at radical prostatectomy. We aimed to investigate the correlation between accuracy and biopsy core number, performed immunohistochemical staining (IHC) or prostatectomy specimen sampling, with the latest also being correlated with higher detection rates of adverse pathological features, e.g., positive surgical margins, higher pathological stage or presence of perineural invasion (PnI status). The study cohort consisted of 315 consecutive patients diagnosed with prostate adenocarcinoma via transrectal ultrasound-guided needle biopsy who later underwent radical prostatectomy. We grouped and compared patients based on Grade Group accuracy, presence of IHC on biopsy, margin status, pathological stage, and PnI status. Inter-observer reproducibility was also calculated. Statistical analyzes included ANOVA, Tukey's multiple comparisons post hoc test, Chi-squared test, and Fleiss kappa statistics. Undergraded cases harboured a significantly lower number of biopsy cores (p < 0.05), than accurately graded cases. Using IHC did not affect grading accuracy significantly, nor did the number of slides from prostatectomy specimens. The mean number of slides was virtually identical when margin status, pathological stage and PnI status of prostatectomy specimens were compared. Inter-observer reproducibility at our institute was calculated as fair (overall kappa = 0.29). Grade Group accuracy is significantly improved by obtaining more cores at biopsy but is unrelated to performed IHC. The extent of sampling prostatectomy specimens, however, did not affect accuracy and failed to significantly improve detection of adverse pathological features.
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Affiliation(s)
| | - Lívia Beke
- Department of Pathology, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Dániel Varga
- Department of Urology, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - László Bidiga
- Department of Pathology, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Gábor Méhes
- Department of Pathology, Clinical Centre, University of Debrecen, Debrecen, Hungary
| | - Sarolta Molnár
- Department of Pathology, Clinical Centre, University of Debrecen, Debrecen, Hungary
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Collette ERP, den Bakker MA, Klaver SO, Vis AN, Kliffen M. Partial versus complete prostatectomy specimen sampling: prospective non-inferiority study for pT3a tumours and surgical margin involvement. BMJ Open 2019; 9:e024524. [PMID: 30975668 PMCID: PMC6500235 DOI: 10.1136/bmjopen-2018-024524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
AIMS The importance of additional information gained by complete versus partial sampling or prostatectomy specimens is uncertain. There is sparse data on the value of complete versus partial sampling and numbers of inclusions in studies are small and retrospective. We present the results of a prospective non-inferiority study to examine if partial sampling is inferior to complete sampling in terms of pathology outcomes and clinical relevance. METHODS 564 robot-assisted prostatectomy (RARP) specimens with prospective registration and analysis were collected over a 2-year period. All patients underwent RARP between January 2014 and February 2016 in our hospital after a diagnosis of clinically localised prostate cancer. For each patient, tumour stage and surgical margin status was recorded after partial and after complete sampling. Upstaging from pT2 to pT3a and upgrading from a negative-to-positive surgical margin was analysed. RESULTS In 12 of 564 patients (2.1%), complete sampling yielded new information. In eight patients (1.4%), the surgical margin converted to positive after complete sampling. Upstaging from initial pT2 tumour in partial sampling to pT3a tumour after complete sampling was documented in five patients (0.9%). In the follow-up period (mean 35 months), a biochemical recurrence occurred in one patient. CONCLUSIONS Complete sampling provides new information in only 2.1% of cases, compared with partial sampling. We conclude that the additional information gained by complete sampling in terms of stage and surgical margin detection is statistically insignificant compared with partial sampling. Furthermore, partial sampling compared with complete sampling does not change postoperative clinical management.
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Affiliation(s)
- Eelco R P Collette
- Urology, VU medisch centrum School of Medical Sciences, Amsterdam, The Netherlands
| | | | | | - André N Vis
- Urology, VU medisch centrum School of Medical Sciences, Amsterdam, The Netherlands
| | - Mike Kliffen
- Pathology, Maasstad Ziekenhuis, Rotterdam, The Netherlands
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Kaelberer JB, O'Donnell MA, Mitchell DL, Snow AN, Mott SL, Buatti JM, Smith MC, Watkins JM. Incidental prostate cancer diagnosed at radical cystoprostatectomy for bladder cancer: disease-specific outcomes and survival. Prostate Int 2016; 4:107-12. [PMID: 27689068 PMCID: PMC5031900 DOI: 10.1016/j.prnil.2016.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/05/2022] Open
Abstract
Background The current standard of care for men with muscle-invasive bladder cancer is radical cystoprostatectomy (RCP). One-third of RCP specimens demonstrate incidental prostate cancer, primarily reported in small series with limited follow-up. The aim of this study is to report mature outcomes, including patterns of failure and disease-specific recurrence rates, and survival, for a large cohort of men with incidental prostate cancer at RCP performed at a tertiary referral center. Methods This retrospective study describes cancer control and survival rates for men who underwent RCP for bladder cancer and were found incidentally to have prostate cancer. Analysis of patient-, tumor-, and treatment-specific factors were analyzed for association with disease control and survival endpoints. Results Between 2002 and 2010, 94 patients with incidental discovery of prostate cancer postRCP were identified for inclusion in this study. Forty-five patients (45%) underwent RCP for recurrent (rather than initial presentation of) bladder carcinoma. At a median follow-up of 40.3 months (71.2 months for survivors; range, 8.9–155.5 months), 42 patients were alive without recurrence and 52 patients had died (25 associated with disease). The estimated 5-year bladder cancer disease-free, urinary tract malignancy disease-free, and prostate specific antigen (PSA) relapse-free survivals were 76% [95% confidence interval (CI), 65–84%], 64% (52–74%), and 97% (79–100%), respectively. The estimated 5-year urinary tract malignancy-specific and overall survivals were 61% (49–71%) and 52% (41–62%), respectively. Univariate analysis demonstrated associations between pathologic T/N-stage and nodal ratio with bladder cancer disease-free, urinary tract malignancy disease-specific, and overall survivals, with patient age at diagnosis as an additional adverse factor associated with overall survival. Multivariate analysis confirmed pN-stage and age as independently associated with worse survival. Conclusion For men undergoing RCP for bladder cancer, the present study suggests that incidentally discovered prostate cancers, irrespective of pathologic stage, Gleason score, or clinical significance, do not impact 5-year disease control or survival outcomes.
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Affiliation(s)
- Joshua B Kaelberer
- Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Michael A O'Donnell
- Department of Urology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Darrion L Mitchell
- Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Anthony N Snow
- Department of Pathology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Sarah L Mott
- Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA, USA
| | - John M Buatti
- Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - Mark C Smith
- Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
| | - John M Watkins
- Department of Radiation Oncology, University of Iowa, Carver College of Medicine, Iowa City, IA, USA
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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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Optimizing prostate specimen handling for diagnosis and prognosis. Methods Mol Biol 2014; 1180:337-52. [PMID: 25015158 DOI: 10.1007/978-1-4939-1050-2_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Optimal processing, handling, and sampling of prostatic biopsies, transurethral resections, and radical prostatectomy specimens ensure accurate diagnosis and staging. Prognostic factors derived from careful examination of tissue samples are critical for patient management, including cancer volume, extraprostatic extension, surgical margins, vascular/lymphatic invasion, and perineural invasion. This chapter addresses these important issues, including recent recommendations of a consensus panel of the International Society of Urologic Pathologists.
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Watkins JM, Laszewski M, Watkins PL, Dufan TA, Adducci C. Margin involvement at prostatectomy for clinically localized prostate cancer: does a low-risk group exist? Pract Radiat Oncol 2014; 5:e31-6. [PMID: 25413418 DOI: 10.1016/j.prro.2014.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 04/29/2014] [Accepted: 04/29/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To determine whether additional pathology details may provide risk stratification for patients with involved surgical margins at radical prostatectomy (RP). METHODS AND MATERIALS Eligible patients underwent RP between 2003 and 2010. Patients with preoperative prostate-specific antigen (PSA) ≥20, follow-up <12 months, lymph node or seminal vesicle involvement, or who received radiation therapy or hormone therapy prior to PSA relapse were excluded. Surgical specimens were reviewed by a study pathologist, blinded to outcomes. Survival analysis methods were employed to assess disease control and survival rates, as well as association of patient-, tumor-, and treatment-specific factors for endpoints. RESULTS Of 355 RP cases, 279 patients were eligible for the present analysis. At a median follow-up of 53 months (range, 16-127), 31/114 (27%) of patients with involved surgical margins experienced PSA relapse, as compared with 7/165 (4%) for negative margins (hazard ratio, 4.997; 95% confidence interval, 2.425-10.296; P < .0001). Detailed pathology review demonstrated associations between PSA relapse and Gleason score at RP, extent of margin involvement (width), capsule penetration, and perineural invasion. Subgroup analysis identified low risk (4%) of 5-year PSA relapse for patients with Gleason ≤6 mm and margin width ≤4 mm (single maximal or cumulative). All subgroups with higher Gleason score or wider margin were associated with >20% risk of PSA relapse at 5 years. CONCLUSIONS Within the present study, Gleason score, 6 patients with margin width ≤4 mm appear to have low rates of early PSA relapse following RP. Low-grade cases with larger extent of margin involvement or higher risk Gleason score patients with any margin involvement have high rates of early PSA relapse.
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Affiliation(s)
- John M Watkins
- Department of Radiation Oncology, Carver School of Medicine, University of Iowa, Iowa City, Iowa; Bismarck Cancer Center, Bismarck, North Dakota.
| | - Michael Laszewski
- Department of Pathology, St. Alexius Medical Center, Bismarck, North Dakota
| | - Patricia L Watkins
- Bismarck Cancer Center, Bismarck, North Dakota; Department of Pediatrics, Carver School of Medicine, University of Iowa, Iowa City, Iowa
| | | | - Christopher Adducci
- Department of Urology, Prairie Lakes Specialty Clinic, Watertown, South Dakota
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9
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Iremashvili V, Lokeshwar SD, Jorda M, Pelaez L, Soloway MS. Prognostic Implications of Partial Sampling of Radical Prostatectomy Specimens: Comparison of 3 Methods. J Urol 2013; 190:84-90. [DOI: 10.1016/j.juro.2012.12.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 12/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Viacheslav Iremashvili
- Departments of Urology and Pathology (MJ, LP), Miller School of Medicine, University of Miami, Miami, Florida
| | - Soum D. Lokeshwar
- Departments of Urology and Pathology (MJ, LP), Miller School of Medicine, University of Miami, Miami, Florida
| | - Merce Jorda
- Departments of Urology and Pathology (MJ, LP), Miller School of Medicine, University of Miami, Miami, Florida
| | - Liset Pelaez
- Departments of Urology and Pathology (MJ, LP), Miller School of Medicine, University of Miami, Miami, Florida
| | - Mark S. Soloway
- Departments of Urology and Pathology (MJ, LP), Miller School of Medicine, University of Miami, Miami, Florida
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Andino L, Davis JW, Wei W, Prokhorova IN, Troncoso P, Matin SF. Correlation of histomorphologic findings and partial neurovascular bundle preservation during laparoscopic and robotic radical prostatectomy. J Robot Surg 2013; 7:1-8. [PMID: 27000885 DOI: 10.1007/s11701-011-0323-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Accepted: 10/23/2011] [Indexed: 10/15/2022]
Abstract
The objective of this work was to compare the amount of residual periprostatic tissue for radical prostatectomy performed by the partial NS (PNS) technique with that performed by the nerve-sparing (NS) or wide-resection (WR) techniques. Retrospective histomorphologic evaluation of radical prostatectomy specimens (RPSs) from patients undergoing laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) was performed. The posterolateral regions corresponding to the neurovascular bundle in RPSs from 48 patients who had undergone NS, PNS, or WR during LRP (n = 30) or RARP (n = 18) were examined by two pathologists unaware of the technique used. The RPSs were evaluated at the base, mid-gland, and apex. The amount of periprostatic tissue at each site was recorded. Measurements were analyzed by use of a linear mixed model. For both LRP and RARP, each gradation of nerve-preservation was associated with periprostatic tissue, except PNS and WR did not differ for LRP at the apex and base or for RARP at the apex, mid-gland, and base. For LRP, a greater amount of tissue was on the left side of the prostate than on the right at the mid-gland level (P = 0.004) whereas for RARP the opposite was found (P = 0.024). Of 18 separate analyses, 13 were significantly associated. The study is limited by its retrospective design. The amount of periprostatic tissue in the neurovascular bundle area correlates well with the nerve-preservation approach used during LRP and RARP, providing anatomic evidence supporting the PNS approach. We also describe a novel finding of laterality bias at the mid-gland level in LRP and RARP specimens.
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Affiliation(s)
- Lizmarie Andino
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA
| | - Wei Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ina N Prokhorova
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Patricia Troncoso
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Surena F Matin
- Department of Urology, Unit 1373, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX, 77030, USA.
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Next-generation prostate cancer biobanking: toward a processing protocol amenable for the International Cancer Genome Consortium. ACTA ACUST UNITED AC 2012; 21:61-8. [PMID: 22555088 DOI: 10.1097/pdm.0b013e31823b6da6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Next-generation DNA and RNA sequencing requires intact nucleic acids from high-quality human tissue samples to better elucidate the molecular basis of cancer. We have developed a prostate biobanking protocol to acquire suitable samples for sequencing without compromising the accuracy of clinical diagnosis. To assess the clinical implications of implementing this protocol, we evaluated 105 consecutive radical prostatectomy specimens from November 2008 to February 2009. Alternating levels of prostate samples were submitted to Surgical Pathology as formalin-fixed, paraffin-embedded blocks and to the institutional biobank as frozen blocks. Differences in reported pathologic characteristics between clinical and procured specimens were compared. Clinical staging and grading were not affected by the biobank protocol. Tumor foci on frozen hematoxylin and eosin slides were identified and high-density tumor foci were scored and processed for DNA and RNA extractions for sequencing. Both DNA and RNA were extracted from 22 cases of 44 with high-density tumor foci. Eighty-two percent (18/22) of the samples passed rigorous quality control steps for DNA and RNA sequencing. To date, DNA extracted from 7 cases has undergone whole-genome sequencing, and RNA from 18 cases has been RNA sequenced. This protocol provides prostate tissue for high-throughput biomedical research and confirms the feasibility of actively integrating prostate cancer into The Cancer Genome Atlas Program, a member of the International Cancer Genome Consortium.
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Ali A, Furusato B, Ts'o POP, Lum ZP, Elsamanoudi S, Mohamed A, Srivastava S, Moul JW, Brassell SA, Sesterhenn IA, McLeod DG. Assessment of circulating tumor cells (CTCs) in prostate cancer patients with low-volume tumors. Pathol Int 2011; 60:667-72. [PMID: 20846264 DOI: 10.1111/j.1440-1827.2010.02584.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study was to assess the incidence of circulating tumor cells (CTCs) in prostate cancer patients with low-volume tumors (less than 0.5 cc) after radical prostatectomy (RP). Blood samples were collected from 64 RP patients to assess the incidence of CTCs following RP. The specimens were processed by whole-mount section. Clinicopathological data (e.g. patient age, race, specimen weight, tumor volume, grade, stage and surgical margin status) and follow-up PSA data were compared to CTC status. Of the 64 RP patients, nine had 'low-volume prostate cancer'. Seven of these patients had detectable levels of CTCs. In two of the seven patients with detectable CTCs, PSA elevation was also observed. Isolation and detection of circulating epithelial cells is possible in low-volume prostate cancer patients. In the setting of low-volume prostate cancer, CTCs may be associated with the presence of detectable PSA levels. However, the detection of CTCs did not predict PSA failure.
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Affiliation(s)
- Amina Ali
- Urology Service, Walter Reed Army Medical Center, Washington, DC 20307, USA
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Sharma NL, Papadopoulos A, Lee D, McLoughlin J, Vowler SL, Baumert H, Warren AY, Patil V, Shah N, Neal DE. First 500 cases of robotic-assisted laparoscopic radical prostatectomy from a single UK centre: learning curves of two surgeons. BJU Int 2010; 108:739-47. [DOI: 10.1111/j.1464-410x.2010.09941.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Comparative Analysis of Whole Mount Processing and Systematic Sampling of Radical Prostatectomy Specimens: Pathological Outcomes and Risk of Biochemical Recurrence. J Urol 2010; 184:1334-40. [DOI: 10.1016/j.juro.2010.06.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Indexed: 11/19/2022]
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Abstract
Prostate cancer remains a significant health problem worldwide and is the second highest cause of cancer-related death in men. While there is uncertainty over which men will benefit from radical treatment, considerable efforts are being made to reduce treatment related side-effects and in optimising outcomes. This article reviews the development and introduction of robotic-assisted laparoscopic radical prostatectomy (RALP), the results to date, and the possible future directions of RALP.
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Affiliation(s)
- N L Sharma
- Department of Urology, Cambridge Research Institute, Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, UK
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Mouraviev V, Madden JF, Broadwater G, Mayes JM, Burchette JL, Schneider F, Smith J, Tsivian M, Wong T, Polascik TJ. Use of
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In-Capromab Pendetide Immunoscintigraphy to Image Localized Prostate Cancer Foci Within the Prostate Gland. J Urol 2009; 182:938-47. [DOI: 10.1016/j.juro.2009.05.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2009] [Indexed: 01/10/2023]
Affiliation(s)
- Vladimir Mouraviev
- Duke Prostate Center and Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - John F. Madden
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Gloria Broadwater
- Cancer Center Biostatistics, Duke University Medical Center, Durham, North Carolina
| | - Janice M. Mayes
- Cancer Center Biostatistics, Duke University Medical Center, Durham, North Carolina
| | - James L. Burchette
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Frank Schneider
- Department of Pathology, Duke University Medical Center, Durham, North Carolina
| | - Jill Smith
- Duke Prostate Center and Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Matvey Tsivian
- Duke Prostate Center and Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Terence Wong
- Department of Radiology/Nuclear Medicine, Duke University Medical Center, Durham, North Carolina
| | - Thomas J. Polascik
- Duke Prostate Center and Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina
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Abstract
Obtaining high quality fresh or frozen prostate tissue in gram amounts promotes the research of prostate cancer. Due to the inability to effectively recognize prostate cancer upon the cut section of a fresh prostate many pathology departments perform whole organ processing precluding the procurement of prostate tissue. Some sites randomly procure tissue, while others perform specialized procedures that can be difficult to duplicate. Neither of these types of procurement consistently results in gram quantities of tissue procured from each prostate with a high percentage of samples yielding tissue corresponding to cancer. In this study, we present a simplified model of prostate tissue procurement that has no impact on Gleason grade, tumor stage or margin status, requires minimal specialized processing, and obtains gram amounts of fresh tissue from each radical prostatectomy specimen with a high percentage yielding cancer tissue.
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Affiliation(s)
- Carl Morrison
- Department of Pathology and Laboratory Medicine, Roswell Park Cancer Institute, Buffalo, New York 14263, USA.
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Moul JW. Post-radical prostatectomy management options for positive surgical margins: Argument for observation. Urol Oncol 2009; 27:92-6. [DOI: 10.1016/j.urolonc.2008.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 04/03/2008] [Accepted: 04/08/2008] [Indexed: 11/16/2022]
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19
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Furusato B, Rosner IL, Osborn D, Ali A, Srivastava S, Davis CJ, Sesterhenn IA, McLeod DG. Do patients with low volume prostate cancer have prostate specific antigen recurrence following radical prostatectomy? J Clin Pathol 2008; 61:1038-40. [DOI: 10.1136/jcp.2008.057794] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Aims:The objective of this study was to determine the incidence of prostate specific antigen (PSA) relapse in patients with low volume prostate cancer following radical prostatectomy.Methods:Between 1993 and 2001, 50 of 717 patients had total tumour volumes of less than 0.5 cm3 following radical prostatectomy. Biochemical recurrence was defined as two consecutive values of serum PSA levels of 0.2 ng/ml or greater.Results:Median follow-up of the 50 patients was 58 months. In five of the 50 patients (10%), PSA recurrence was observed. All of these five cases had Gleason score of 3+3 (well and/or moderately differentiated), organ confined and surgical margin negative tumours. In three of the five cases, capsular incision resulted in benign glands extending into the surgical margin.Conclusions:Five of 50 cases had PSA failure. In three of the five patients, benign glands located in the margin could explain the “PSA recurrence”. However, in the other two patients, none of the pathological parameters correlated with measurable PSA levels. The explanation for their PSA failure is unclear.
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Sung MT, Davidson DD, Montironi R, Lopez-Beltran A, Cheng L. Radical prostatectomy specimen processing: A critical appraisal of sampling methods. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.cdip.2007.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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21
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Walz J, Graefen M, Huland H. Offene, laparoskopische und roboterassistierte radikale Prostatektomie im Vergleich. DER ONKOLOGE 2007. [DOI: 10.1007/s00761-007-1226-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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22
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Molinié V. [Pathological interpretation of radical prostatectomy]. ACTA ACUST UNITED AC 2007; 40 Suppl 2:S32-4. [PMID: 17361917 DOI: 10.1016/s0003-4401(06)80017-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The examination by the pathologist of the whole prostate gland after radical prostatectomy allows close inspection of the tissue in order to determine the presence or absence of important prognostic pathological parameters, such as the histological grade, extracapsular extension, seminal vesicle invasion, positive surgical margins. Only complete embedding and multiple close steps sectioning of the whole prostate gland allows the more accurate assessment of the margin status. Specimens not sectioned from the whole organ carry the likelihood of missing important adverse pathologic features. The vast majority of departments of pathology in French institutions are used to study radical prostatectomy specimens obtained from the entire prostate gland.
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Affiliation(s)
- V Molinié
- Service d'anatomie et de cytologie pathologiques, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex, France.
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Baccala A, Reuther AM, Bianco FJ, Scardino PT, Kattan MW, Klein EA. Complete Resection of Seminal Vesicles at Radical Prostatectomy Results in Substantial Long-Term Disease-Free Survival: Multi-institutional Study of 6740 Patients. Urology 2007; 69:536-40. [PMID: 17382160 DOI: 10.1016/j.urology.2006.12.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 09/19/2006] [Accepted: 12/12/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To estimate the disease-specific survival of patients with complete removal of the seminal vesicles (SVs) at radical prostatectomy and to develop a nomogram for the prediction of SV invasion (SVI). METHODS An analysis of 6740 patients from three institutions was performed. The primary outcome was biochemical failure analyzed according to the presence or absence of SVI using the Kaplan-Meier method and Cox proportional hazards model. The variables analyzed included age, biopsy Gleason score, clinical T stage, margin status, extracapsular extension, SVI, surgical Gleason score, initial prostate-specific antigen level, and institution. Logistic regression analysis was used to determine the preoperative factors predicting for SVI and create the model for the nomogram. RESULTS Of the 6740 patients, 566 (8.4%) had positive SVs. The median follow-up was 33.4 months (range 1 to 239). The 5 and 10-year biochemical relapse-free survival rate was 38.0% and 25.6%, respectively, for patients with positive SVs and 85.7% and 77.2%, respectively, for patients with negative SVs (P <0.0001). In the multivariate model, all variables, except for biopsy Gleason score and T stage, were significant predictors of biochemical failure (P <0.05), and all variables, except for age, were predictors of SVI. The nomogram achieved an area under the curve of 0.80. CONCLUSIONS These results have demonstrated that a substantial number of patients with SVI are disease free at 5 and 10 years after complete excision without adjuvant therapy. These findings suggest the therapeutic efficacy of complete SV excision and can identify those with a nomogram-predicted increased risk of SVI who might benefit from complete excision.
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Affiliation(s)
- Angelo Baccala
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44122, USA.
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Wittekindt C, Sittel C, Kvasnicka HM, Eckel HE. Immunohistochemistry of whole-organ sections of advanced human laryngeal cancer. Eur Arch Otorhinolaryngol 2006; 263:741-6. [PMID: 16683119 DOI: 10.1007/s00405-006-0055-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2005] [Accepted: 02/09/2006] [Indexed: 10/24/2022]
Abstract
Whole-mount sections have been in the interest of laryngologists for long time. The aim of this study was to demonstrate the technical aspects of processing horizontal whole-mount sections of advanced laryngeal cancer specimens after total laryngectomy. Those sections may provide new insights in the biology of laryngeal cancer. Six excised human larynges were block-embedded in paraffine. Serial sections were obtained as thin as 9 mum. Sections were stained by Giemsa and standard immunohistochemistry protocols with commercial antibodies against Cytokeratine5/6, Ki-67, Topoisomerase IIalpha, and p53. Four high-power fields were selected randomly in each section of a surface grid and the percentage of positive tumor cells was noted for each antibody in the respective field. Morphometric surface maps of protein expression were generated for each parameter. The tissues remained intact without major artifacts. Specific characteristics of the tumors were identified after evaluation of the whole-mount sections. Staining of cytokeratine was homogenous, whereas nuclear markers showed a distinct heterogeneity in the respective staining patterns. By analyzation of color-coded fusion images the spatial expression of the respective antibodies could be visualized.
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Affiliation(s)
- Claus Wittekindt
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Kerpener Str. 62, 50924, Cologne, Germany.
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25
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Gaston SM, Upton MP. Tissue print micropeel: a new technique for mapping tumor invasion in prostate cancer. Curr Urol Rep 2006; 7:50-6. [PMID: 16480669 DOI: 10.1007/s11934-006-0038-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Because of widely adopted screening programs for early detection of prostate cancers, many patients who undergo radical prostatectomy have tumors that are not grossly evident, and the extent and distribution of the cancer in the gland can only be determined by a microscopic examination of the surgical specimen. Historically, one of the most important predictors of the quality of cancer control following surgical resection of a solid tumor is the absence of cancer at the surgical margins. Although the clinical significance of cancer at the margins of a radical prostatectomy specimen has been a source of controversy in recent years, surgical pathology assessment of radical prostatectomy margins remains an important part of prostate cancer clinical care. However, a comprehensive histopathologic review of every radical prostatectomy specimen is beyond the resources of most hospitals. Tissue print micropeel technologies, combined with appropriate markers, provide a new strategy that combines a relatively simple technique for sampling specimen margins with a method for obtaining molecular information about the cancer that can add to the macroscopic and microscopic anatomical findings. This new tissue printing approach for incorporating molecular markers into the assessment of radical prostatectomy margins is reviewed in this article.
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Affiliation(s)
- Sandra M Gaston
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
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Brassell SA, Kao TC, Sun L, Moul JW. Prostate-specific antigen versus prostate-specific antigen density as predictor of tumor volume, margin status, pathologic stage, and biochemical recurrence of prostate cancer. Urology 2006; 66:1229-33. [PMID: 16360448 DOI: 10.1016/j.urology.2005.06.106] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2005] [Revised: 05/27/2005] [Accepted: 06/22/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To compare prostate-specific antigen (PSA) and PSA density (PSAD) calculated by transrectal ultrasound (TRUS) volume (TRUS PSAD), pathologic volume (Path PSAD), and weight (Weight PSAD) for their ability to predict pathologic characteristics and biochemical recurrence of prostate cancer. We also compared all PSAD derivatives to determine consistency. METHODS Between 1993 and 2002, 306 patients were retrospectively identified who had had PSAD determined preoperatively by TRUS and subsequently underwent radical prostatectomy with whole mounting and close step sectioning. The determination of stage, margin status, tumor number, individual tumor volume, and total tumor volume was obtained from the pathologic evaluation. Clinical follow-up was available for 265 patients. RESULTS The mean patient age was 62 years, the median Gleason score was 7, the median PSA level was 5.80 ng/mL, and the median TRUS PSAD was 0.16. The percentages of concordance for PSA, TRUS PSAD, Path PSAD, and Weight PSAD were similar in predicting margin status and extracapsular extension. Using linear regression analysis, PSA was more efficacious than TRUS PSAD, Path PSAD, or Weight PSAD in predicting the total tumor volume (R2 0.11, 0.08, 0.04, and 0.06, respectively). A significant positive correlation was found among TRUS PSAD, Path PSAD, and Weight PSAD. PSA was significantly better in predicting biochemical recurrence than TRUS, Path, or Weight PSAD (concordance 75.5%, 66.6%, 66.5%, and 70.4%, respectively). CONCLUSIONS PSA and TRUS PSAD are significant and equivalent predictors of margin status and extracapsular extension. A marked difference may exist between PSA and TRUS PSAD in predicting the total tumor volume and biochemical recurrence.
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Affiliation(s)
- Stephen A Brassell
- Center for Prostate Disease Research, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.
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Montironi R, van der Kwast T, Boccon-Gibod L, Bono AV, Boccon-Gibod L. Handling and Pathology Reporting of Radical Prostatectomy Specimens. Eur Urol 2003; 44:626-36. [PMID: 14644113 DOI: 10.1016/s0302-2838(03)00381-6] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Proper examination of radical prostatectomy (RP) specimens by the pathologists is critical in accurately determining the prediction of patient outcome. The pathology report should include relevant clinical information as well as provide prognostically useful data derived from the evaluation of the RP specimen.
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Affiliation(s)
- Rodolfo Montironi
- Institute of Pathological Anatomy, Polytechnic University of the Marche Region (Ancona), Umberto 1 degrees Hospital, I-60020 Torrette, Ancona, Italy.
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