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Lee W, Lim B, Kyung YS, Kim CS. Comparative oncological outcomes after radical prostatectomy or external beam radiation therapy plus androgen deprivation therapy in men with clinical T3b prostate cancer. Int J Urol 2022; 29:414-420. [PMID: 35133691 DOI: 10.1111/iju.14799] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 01/04/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To compare oncological outcomes in men with clinical T3b prostate cancer who underwent radical prostatectomy or a combination of radiation therapy plus androgen deprivation therapy. METHODS Men with clinical T3b prostate cancer who underwent radical prostatectomy or radiation therapy plus androgen deprivation therapy between 2007 and 2014 were evaluated. All patients were relatively healthy, with Eastern Cooperative Oncology Group performance status of 0 or 1 without nodal or distant metastasis. Cancer-specific survival was analyzed. Age, Charlson Comorbidity Index, biopsy Gleason score and pretreatment prostate-specific antigen were adjusted by propensity score matching. The Cox proportional hazards model was used to assess factors prognostic of cancer-specific survival. RESULTS Of the 152 patients with clinical T3b prostate cancer, 45 underwent radical prostatectomy, and 107 underwent radiation therapy plus androgen deprivation therapy between 2007 and 2014. The mean cancer-specific survival was significantly longer in the radical prostatectomy than in the radiation therapy plus androgen deprivation therapy group (P = 0.029). Age, Charlson Comorbidity Index and pretreatment prostate-specific antigen were significantly higher in the radiation therapy plus androgen deprivation therapy group. In the propensity score matched population of 24 patients each, the median cancer-specific survival remained significantly longer in the radical prostatectomy than in the radiation therapy plus androgen deprivation therapy group (not reached vs 112.93 ± 11.94 months, P = 0.026). Multivariate analysis showed that undergoing radiation therapy plus androgen deprivation therapy was the only significant poor prognostic factor for cancer-specific survival (hazard ratio 6.694, 95% confidence interval 1.642-27.592, P = 0.008). CONCLUSION Cancer-specific survival was significantly longer in men with clinical T3b prostate cancer who underwent radical prostatectomy than radiation therapy plus androgen deprivation therapy, suggesting that radical prostatectomy can be a better treatment option for the initial definitive treatment for these patients.
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Affiliation(s)
- Wonchul Lee
- Department of Urology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
| | - Bumjin Lim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Soo Kyung
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Sjoberg HT, Philippou Y, Magnussen AL, Tullis IDC, Bridges E, Chatrian A, Lefebvre J, Tam KH, Murphy EA, Rittscher J, Preise D, Agemy L, Yechezkel T, Smart SC, Kinchesh P, Gilchrist S, Allen DP, Scheiblin DA, Lockett SJ, Wink DA, Lamb AD, Mills IG, Harris A, Muschel RJ, Vojnovic B, Scherz A, Hamdy FC, Bryant RJ. Tumour irradiation combined with vascular-targeted photodynamic therapy enhances antitumour effects in pre-clinical prostate cancer. Br J Cancer 2021; 125:534-546. [PMID: 34155340 PMCID: PMC8367986 DOI: 10.1038/s41416-021-01450-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/29/2021] [Accepted: 05/25/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND There is a need to improve the treatment of prostate cancer (PCa) and reduce treatment side effects. Vascular-targeted photodynamic therapy (VTP) is a focal therapy for low-risk low-volume localised PCa, which rapidly disrupts targeted tumour vessels. There is interest in expanding the use of VTP to higher-risk disease. Tumour vasculature is characterised by vessel immaturity, increased permeability, aberrant branching and inefficient flow. FRT alters the tumour microenvironment and promotes transient 'vascular normalisation'. We hypothesised that multimodality therapy combining fractionated radiotherapy (FRT) and VTP could improve PCa tumour control compared against monotherapy with FRT or VTP. METHODS We investigated whether sequential delivery of FRT followed by VTP 7 days later improves flank TRAMP-C1 PCa tumour allograft control compared to monotherapy with FRT or VTP. RESULTS FRT induced 'vascular normalisation' changes in PCa flank tumour allografts, improving vascular function as demonstrated using dynamic contrast-enhanced magnetic resonance imaging. FRT followed by VTP significantly delayed tumour growth in flank PCa allograft pre-clinical models, compared with monotherapy with FRT or VTP, and improved overall survival. CONCLUSION Combining FRT and VTP may be a promising multimodal approach in PCa therapy. This provides proof-of-concept for this multimodality treatment to inform early phase clinical trials.
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Affiliation(s)
- Hanna T Sjoberg
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Anette L Magnussen
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Esther Bridges
- Department of Oncology, University of Oxford, Oxford, UK
| | - Andrea Chatrian
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Joel Lefebvre
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Ka Ho Tam
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Emma A Murphy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Oncology, University of Oxford, Oxford, UK
| | - Jens Rittscher
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
- Ludwig Institute for Cancer Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Target Discovery Institute, NDM Research Building, University of Oxford, Headington, UK
| | - Dina Preise
- Department of Core Facilities, The Weizmann Institute of Science, Rehovot, Israel
| | - Lilach Agemy
- Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Tamar Yechezkel
- Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Sean C Smart
- Department of Oncology, University of Oxford, Oxford, UK
| | - Paul Kinchesh
- Department of Oncology, University of Oxford, Oxford, UK
| | | | - Danny P Allen
- Department of Oncology, University of Oxford, Oxford, UK
| | - David A Scheiblin
- Optical Microscopy and Analysis Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc. for the National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Stephen J Lockett
- Optical Microscopy and Analysis Laboratory, Frederick National Laboratory for Cancer Research, Leidos Biomedical Research Inc. for the National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - David A Wink
- Cancer and Inflammation Program, Centre for Cancer Research, National Cancer Institute, National Institutes of Health, Frederick, MD, USA
| | - Alastair D Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Ian G Mills
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Adrian Harris
- Department of Oncology, University of Oxford, Oxford, UK
| | - Ruth J Muschel
- Department of Oncology, University of Oxford, Oxford, UK
| | - Boris Vojnovic
- Department of Oncology, University of Oxford, Oxford, UK
| | - Avigdor Scherz
- Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
- Department of Oncology, University of Oxford, Oxford, UK.
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3
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Wang Y, Wu G, Fan L, Pan J, Gong Y, Fei X, Du X, Zhu Y, Xue W. The prognostic nomogram including MRI for locally advanced prostate cancer treated by radical prostatectomy. Prostate 2021; 81:463-468. [PMID: 33822399 DOI: 10.1002/pros.24126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To establish the prognostic nomogram for locally advanced prostate cancer (LAPC) patients treated by radical prostatectomy (RP) based on clinical and multiparametric-MRI (mp-MRI) metrics. METHODS One hundred and twenty-one patients diagnosed with LAPC were included in this study. They were all examined by mp-MRI within one week before surgery and treated by RP (36 with RP alone, 48 with neoadjuvant hormonal therapy (NHT) and 37 with neoadjuvant chemohormonal therapy (NCHT)). The biochemical progression-free survival (bPFS) was analyzed by Kaplan-Meier method. Univariate and multivariate analysis were used to determine prognostic factors that were related with bPFS. The prognostic nomogram was established by factors that were significant in multivariate analyses. RESULTS The median bPFS had significant difference in the subgroup of treatment (RP alone: 2 [0.00-5.04] vs. NHT: 9.3 [6.746-11.854] vs. NCHT: 11.17 [0.000-25.075] months [Log rank p < .001]), the subgroup of hyperintensity within prostate in DWI (negative: 15.97 [11.202-20.731] vs. positive: 5.2 [2.952-7.448] months [Log rank p < .001]) and the subgroup of pelvic lymph node metastasis (negative: 10.2 [8.404-11.996] vs. unilateral: 4.43 [0.000-11.086] vs. Bilateral: 1.83 [0.636~3.031] [Log rank p < .001]). The method of treatment (hazards ratio [HR], 0.566; 95% confidence interval [CI], 0.356-0.899; p = .016), hyperintensity within prostate in DWI (HR, 2.539; 95% CI, 1.349-4.779; p = .004) and the metastasis burden of pelvic lymph node (HR, 2.492; 95% CI, 1.645-3.777; p < .001) were identified as independent predictors with significance in multivariable Cox regression analysis. The nomogram was established based on these three factors. CONCLUSION We established a nomogram based on three significant prognosis factors including the neoadjuvant therapeutic schedule, hyperintensity within prostate in DWI and the metastasis burden of pelvic lymph nodes, which were associated with the clinical outcomes in LAPC patients after surgery.
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Affiliation(s)
- Yan Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guangyu Wu
- Department of Imaging, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Liancheng Fan
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jiahua Pan
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiming Gong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaochen Fei
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinxing Du
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yinjie Zhu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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van Poppel H, Everaerts W, Tosco L, Joniau S. Open and robotic radical prostatectomy. Asian J Urol 2018; 6:125-128. [PMID: 31061797 PMCID: PMC6488736 DOI: 10.1016/j.ajur.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022] Open
Abstract
Open retropubic radical prostatectomy has been the "gold standard" treatment for locally confined prostate cancer (PCa) but in recent years minimal invasive techniques as laparoscopy and robot-assisted prostatectomy have become widely available. The trifecta of the surgical treatment of PCa is cancer control, the preservation of continence, and erectile potency. Over the years the complication rates of radical prostatectomy have become very limited with improved cancer control and better functional results. We review the indications and the surgical technique of radical prostatectomy, be it open or laparoscopic, eventually robot-assisted as well as the pre- and postoperative measures and the surgery-related consequences.
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Affiliation(s)
- Hendrik van Poppel
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Lorenzo Tosco
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
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5
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Survival after radical prostatectomy or radiotherapy for locally advanced (cT3) prostate cancer. World J Urol 2018; 36:1399-1407. [DOI: 10.1007/s00345-018-2310-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/24/2018] [Indexed: 10/17/2022] Open
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Hsu CY, Chen PR, Chen HJ, Liang JA. Association between radical prostatectomy and risk of herpes zoster. Eur J Clin Microbiol Infect Dis 2016; 36:337-342. [PMID: 27752790 DOI: 10.1007/s10096-016-2806-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/26/2016] [Indexed: 12/22/2022]
Abstract
The present study investigated the association between radical prostatectomy (RP) and the risk of herpes zoster (HZ). Male patients aged ≥ 40 years and diagnosed with prostate cancer (PCa) between 2000 and 2005 were included in this study. Patients who underwent RP for the first time during 2000-2006 were included in the RP group. Randomly selected individuals from among the remaining patients with PCa who did not undergo RP were included in the non-RP group. Univariate and multivariate Cox regression models were used to analyze the association between PCa and HZ. In addition, the association between RP and the risk of HZ in different subgroups was evaluated after stratification by age, comorbidities, and hormone therapy (HoT) status. Furthermore, the combined effect of RP and HoT on the risk of HZ was evaluated. This study included 1,380 patients with PCa who newly underwent RP and 1,371 patients with PCa who did not undergo RP. During follow-up, 96 and 104 patients in the RP and non-RP groups, respectively, developed HZ. Patients who underwent both RP and HoT showed a significantly reduced risk of HZ, compared with patients who did not undergo both RP and HoT. RP is not associated with an increased risk of HZ. However, prostate-specific antigen levels should be monitored routinely during follow-up to detect PCa recurrence.
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Affiliation(s)
- C-Y Hsu
- Department of Family Medicine, Puli Christian Hospital, Puli, Taiwan.,Department of Medical Education and Research, Puli Christian Hospital, Puli, Taiwan.,Center for General Education, National Chi Nan University, Puli, Taiwan.,Department of Optometry, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Center for General Education, National Taichung University of Science and Technology, Taichung, Taiwan.,Center for General Education, Feng Chia University, Taichung, Taiwan.,Department of General Education, National Chin-Yi University of Technology, Taichung, Taiwan.,The General Education Center, Chaoyang University of Technology, Taichung, Taiwan
| | - P-R Chen
- Department of Surgery, Division of Thoracic Surgery, China Medical University Hospital, Taichung, Taiwan
| | - H-J Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - J-A Liang
- Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine, China Medical University, No. 2, Yuh-Der Road, Taichung, 40447, Taiwan. .,Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan.
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7
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Nazim SM, Abbas F. Role of Surgery in locally advanced prostate cancer. Pak J Med Sci 2015; 31:710-6. [PMID: 26150873 PMCID: PMC4485300 DOI: 10.12669/pjms.313.7103] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/09/2015] [Accepted: 03/28/2015] [Indexed: 11/30/2022] Open
Abstract
A significant proportion of patients present with locally advanced prostate cancer with inherent higher risk of local recurrence and systemic relapse after initial treatment. Recent literature favors combination of radiation therapy and extended hormonal therapy for this subset of patients. The effectiveness of Radical prostatectomy (RP) alone for locally advanced prostate cancer is controversial and is a focus of debate. However, it can decrease the tumor burden and allows the accurate and precise pathological staging with the need for subsequent treatment. Comparison of RP and other treatment modalities is difficult and incorrect because of inherent selection bias. RP as a part of multi-modality treatment (with neo-adjuvant hormonal therapy (HT) and with adjuvant or salvage radiation therapy (RT)/HT) can provide long term overall and cancer specific survival. Surgical treatment (such as transurethral resection (TUR), JJ stenting and percutaneous nephrostomy (PCN) placement etc.) can also provide symptomatic improvement and palliative care to improve quality of life of patients with advanced prostate cancer.
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Affiliation(s)
- Syed Muhammad Nazim
- Syed Muhammad Nazim, Section of Urology, Department of surgery, The Aga Khan University, Karachi Pakistan
| | - Farhat Abbas
- Farhat Abbas, Section of Urology, Department of surgery, The Aga Khan University, Karachi Pakistan
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9
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Treatment of locally advanced prostate cancer: a case report and narrative review. Case Rep Urol 2012; 2012:402513. [PMID: 23346453 PMCID: PMC3533609 DOI: 10.1155/2012/402513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Accepted: 11/29/2012] [Indexed: 11/18/2022] Open
Abstract
Introduction. Treatment of locally advanced prostate cancer is under discussion. Differences between clinical and pathological staging and risk factors such as positive surgical margins and seminal vesicle involvement challenge the individual treatment decisions. Case Presentation. Clinical tumor stage before treatment was assessed to be T2. After radical prostatectomy, pathological examination revealed the stage pT3b N0 M0 including positive surgical margin and seminal vesicle involvement. Early adjuvant androgen deprivation therapy and late adjuvant radiation therapy were added in response to the pathological risk factors. No evidence of disease was observed for 15 years after the treatment. The unexpected pathological findings were not explained by the physicians in charge. Discussion. A narrative review of the recent literature showed that multiple treatment modalities including adjuvant radiotherapy following radical prostatectomy are consistent with current recommendations. The multimodal approach has possibly cured a high-risk patient and may also work successfully in other patients. An alternative treatment option with better preservation of health-related quality of life might have also achieved a similar good overall survival.
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10
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Joniau S, Hsu CY, Gontero P, Spahn M, Van Poppel H. Radical prostatectomy in very high-risk localized prostate cancer: long-term outcomes and outcome predictors. ACTA ACUST UNITED AC 2012; 46:164-71. [PMID: 22364377 DOI: 10.3109/00365599.2011.637956] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to present the long-term outcomes and determine outcome predictors in very high-risk (cT3b-T4) prostate cancer (PCa) after radical prostatectomy (RP). MATERIAL AND METHODS Between January 1989 and December 2004, 51 patients with cT3b-T4 PCa underwent RP. Kaplan-Meier survival analysis was used to calculate the biochemical progression-free survival (BPFS), clinical progression-free survival (CPFS), cancer-specific survival (CSS) and overall survival (OS) rate. Multivariate Cox proportional hazard models were used to determine the predictive power of clinical and pathological variables in BPFS and CPFS. RESULTS Median follow-up was 108 months [interquartile range (IQR) 73.5-144.5]. The median serum prostate-specific antigen (PSA) was 16.9 ng/ml (IQR 7-37.2). Median biopsy and pathological Gleason (pGS) score were both scored as 7 (range 4-10 and 5-9, respectively). Overstaging was frequent (37.2%); four patients (7.8%) had organ-confined stage pT2, while 15 (29.4%) had extracapsular extension only (pT3a). Another 23 (45.1%) were confirmed with seminal vesicle invasion (pT3b) and nine (17.7%) had adjacent structure invasion (pT4). Eleven patients (21.6%) had lymph-node involvement. Thirty-two patients (62.7%) had positive surgical margins. The BPFS, CPFS, CSS and OS at 5 and 10 years were 52.7%, 45.8%;78.0%, 72.5%; 91.9%, 91.9% and 88.0%, 70.7%. In the multivariate Cox proportional hazard models, pathological stage was an independent predictor of BPFS while preoperative PSA and pGS was an independent predictor of CPFS. CONCLUSIONS The management of cT3b-T4 PCa typically consists of a multimodality treatment in which RP is a valuable first step. Overstaging was frequent (37.2%), and almost one-quarter of the patients remained free of additional treatments. Long-term cancer-related outcomes were very satisfactory.
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Affiliation(s)
- Steven Joniau
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.
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11
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Barry Delongchamps N, Peyromaure M, Kpatcha F, Beuvon F, Legrand G, Zerbib M. [pT3N0 prostate cancer treated with radical prostatectomy as sole treatment: Oncological results and predictive factors of recurrence]. Prog Urol 2011; 22:100-5. [PMID: 22284594 DOI: 10.1016/j.purol.2011.08.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/29/2011] [Accepted: 08/30/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate biological free survival in patients with locally advanced prostate cancer treated with radical prostatectomy (RP) as sole treatment, and to analyse predictive factors of recurrence. PATIENTS AND METHOD We retrospectively studied patients treated between 1996 and 2006 for a pT3N0 prostate cancer with RP without any adjuvant treatment. The main endpoint was PSA relapse, defined as two successive elevations of PSA>0.2 ng/mL. An association between PSA free survival and PSA, Gleason score, pathological stage and surgical margins status was statistically assessed. RESULTS A total of 147 patients were included. Median preoperative PSA was of 10 ng/mL. Pathological stage was pT3b in 30% of the cases and surgical margins showed cancer involvement in 63% of the cases. Gleason score was ≥3+4 in 74% of the cases. Postoperative PSA was undetectable in 121 (82%) patients. Median follow up following RP was of 5 years. The 5-year-PSA free survival was of 48%. Multivariate analysis showed that preoperative and postoperative PSA, as well as Gleason score were predictors of PSA relapse (P<0.05). In patients with undetectable postoperative PSA, 5-year-PSA free survival was of 56%. Seminal vesicle involvement and Gleason score ≥3+4 were the only independent predictors of PSA relapse. CONCLUSIONS After RP for pT3N0 prostate cancer, the only predictive factors of recurrence were postoperative PSA and Gleason score. In case of undetectable postoperative PSA, surveillance seems acceptable if Gleason score is <3+4 and in the absence of seminal vesicle involvement.
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Affiliation(s)
- N Barry Delongchamps
- Department of urology, Cochin hospital, Paris Descartes University, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
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12
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Frequency of positive surgical margin at prostatectomy and its effect on patient outcome. Prostate Cancer 2011; 2011:673021. [PMID: 22110996 PMCID: PMC3200270 DOI: 10.1155/2011/673021] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 03/27/2011] [Indexed: 11/17/2022] Open
Abstract
A positive surgical margin at prostatectomy is defined as tumor cells touching the inked edge of the specimen. This finding is reported in 8.8% to 42% of cases (median about 20%) in various studies. It is one of the main determinants of eventual biochemical (PSA) failure, generally associated with a doubled or tripled risk of failure. The effect of a positive margin on outcome can be modified by stage or grade and the length, number and location of positive margins, as well as by technical operative approach and duration of operator experience. This paper tabulates data from the past decade of studies on margin status.
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13
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A population-based study on the utilisation rate of primary radiotherapy for prostate cancer in 4 regions in the Netherlands, 1997–2008. Radiother Oncol 2011; 99:207-13. [DOI: 10.1016/j.radonc.2011.05.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 04/18/2011] [Accepted: 05/03/2011] [Indexed: 11/21/2022]
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14
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Current world literature. Curr Opin Urol 2011; 21:257-64. [PMID: 21455039 DOI: 10.1097/mou.0b013e3283462c0f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Schreiber D, Rineer J, Sura S, Teper E, Nabhani T, Han P, Schwartz D, Choi K, Rotman M. Radical prostatectomy for cT3-4 disease: an evaluation of the pathological outcomes and patterns of care for adjuvant radiation in a national cohort. BJU Int 2010; 108:360-5. [PMID: 21087395 DOI: 10.1111/j.1464-410x.2010.09875.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Schreiber
- Department of Radiation Oncology, State University of New York-Downstate, Brooklyn, NY 11209, USA.
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16
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Boormans JL, Korsten H, Ziel-van der Made ACJ, van Leenders GJLH, Verhagen PCMS, Trapman J. E17K substitution in AKT1 in prostate cancer. Br J Cancer 2010; 102:1491-4. [PMID: 20407443 PMCID: PMC2869172 DOI: 10.1038/sj.bjc.6605673] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The phosphatidylinositol 3-kinase (PI3K)–AKT pathway is activated in many cancers. Mutational hotspots in AKT1 and in the regulatory and catalytic subunits of PI3K have been detected in multiple tumour types. In AKT1, the E17K substitution leads to a PI3K-independent activation of AKT1. Methods: A mutational profiling of AKT1 and of the mutational hotspots in PIK3CA and PIK3R1 was carried out in samples from primary and recurrent prostate tumours. Results: We show that, in prostate cancer, AKT1(E17K) had a prevalence of 1.4%. The mutation seemed to be associated with a favourable clinical course but it was not associated with a specific tumour growth pattern. Activating mutations in PIK3CA or PIK3R1 were not found in prostate cancer. Conclusion: The E17K substitution in AKT1 is rare in prostate cancer. It seems associated with a favourable clinical outcome but not with a specific histology of the tumour.
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Affiliation(s)
- J L Boormans
- Department of Urology, Erasmus University Medical Centre, 3000 CA, Rotterdam, The Netherlands.
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