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Masui K, Katayama N, Yorozu A, Kikuchi T, Higashide S, Kojima S, Saito S. The prognosis of patients with prostate cancer receiving permanent seed implantation stratified by prostate volume: Should we be reluctant to treat with brachytherapy because of a very small prostate (<15 cc)? Radiother Oncol 2023; 188:109855. [PMID: 37597804 DOI: 10.1016/j.radonc.2023.109855] [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: 06/02/2023] [Revised: 08/05/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE We evaluated the treatment outcomes of different prostate volumes (PVs), <15 cc, 15-20 cc, and > 20 cc, in patients with prostate cancer who underwent permanent seed implantation (PI) ± external beam radiation therapy ± hormone therapy in a national Japanese prospective cohort study (J-POPS). METHODS AND MATERIALS Of the 6721 patients in J-POPS from 2005 to 2011, 6652 were included in the analysis population. We categorized the patients into the following three PV groups: <15 cc, 15-20 cc, and > 20 cc. We evaluated the effect of PV on biochemical freedom from failure (bFFF), prostate cancer-specific mortality (PCSM), and all-cause mortality (ACM) using the Phoenix definition and Cox proportional hazard models. RESULTS The median follow-up period was 60.0 months. Patients in each PV group was 491 (7.4%), 1118 (16.8%), and 5043 (75.8%), respectively. No difference was observed in bFFF (94.7%, 96.2%, and 95.7%, p = 0.407), PCSM (99.8%, 99.7%, and 99.8%, p = 0.682), and ACM (98.2%, 96.7%, and 97.2%, p = 0.119) at 5 years for each PV group. In univariate and multivariate analyses, PV was not associated with bFFF, PCSM, ACM, or grade 2 toxicity. The percentage of positive biopsies was the single most significant predictor for all treatment outcomes. CONCLUSIONS Our results obtained by analyzing a very large Japanese prospective database showed no difference in treatment outcomes according to PV (<15 cc, 15-20 cc, and ˃20 cc). Our study confirmed that PI in small prostates (even < 15 cc) remains an effective treatment option.
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Affiliation(s)
- Koji Masui
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Norihisa Katayama
- Department of Radiology, Kagawa Prefectural Central Hospital, Kagawa, Japan
| | - Atsunori Yorozu
- Department of Radiation Oncology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | | | | | | | - Shiro Saito
- Department of Urology, Ofuna Chuo Hospital, Kanagawa, Japan
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Zhang Y, Fu Y. Comprehensive Analysis and Identification of an Immune-Related Gene Signature with Prognostic Value for Prostate Cancer. Int J Gen Med 2021; 14:2931-2942. [PMID: 34234523 PMCID: PMC8254424 DOI: 10.2147/ijgm.s321319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/14/2021] [Indexed: 12/27/2022] Open
Abstract
Background The tumor microenvironment (TME) has recently been proven to play a crucial role in the development and prognosis of tumors. However, the current knowledge on the potential of the TME in prostate cancer (PCa) remains scarce. Purpose This study aims to elucidate the value of TME-related genes for PCa prognosis by integrative bioinformatics analysis. Materials and Methods We downloaded the immune and stromal scores of PCa samples via the ESTIMATE and correlated these scores to clinicopathological characteristics and recurrence-free survival (RFS) of patients. Based on these scores, the TME-related differentially expressed genes were identified for functional enrichment analysis. Cox regression analyses were performed to identify prognostic genes and establish a predictive risk model. Moreover, gene set enrichment analysis (GSEA) was performed to evaluate the relationship between risk score and immune pathway. Results The stromal and immune scores were associated with clinicopathological characteristics and RFS in PCa patients. In total, 238 intersecting differentially expressed genes were identified. Functional enrichment analysis further revealed that these genes dramatically participated in the immune-related pathways. The immune-related risk model was built with C-type lectin domain containing 7A (CLEC7A) and collagen type XI alpha 1 chain (COL11A1) using Cox regression analyses. Kaplan–Meier survival analysis showed that the expression levels of CLEC7A and COL11A1 were significantly associated with the RFS. Further, the RFS time in high-risk group was significantly shorter than that in low-risk group. The areas under the curve for the risk model in predicting 3- and 5-year RFS rates were 0.694 and 0.731, respectively. GSEA suggested that immunosuppression existed in high-risk PCa patients. Conclusion CLEC7A and COL11A1 were selected to build a predictive risk model, which may help clinicians to assess the prognosis of PCa patients and select appropriate targets for immunotherapy.
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Affiliation(s)
- Yongrui Zhang
- Department of Urology, The First Hospital of Jilin University, Changchun, 130021, Jilin, People's Republic of China
| | - Yaowen Fu
- Department of Urology, The First Hospital of Jilin University, Changchun, 130021, Jilin, People's Republic of China
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68Ga-prostate-specific membrane antigen PETCT-based response to androgen deprivation therapy in patients with prostate cancer. Nucl Med Commun 2019; 40:1283-1288. [DOI: 10.1097/mnm.0000000000001105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Liu H, Zhou H, Yan L, Ye T, Lu H, Sun X, Ye Z, Xu H. Prognostic significance of six clinicopathological features for biochemical recurrence after radical prostatectomy: a systematic review and meta-analysis. Oncotarget 2017; 9:32238-32249. [PMID: 30181813 PMCID: PMC6114957 DOI: 10.18632/oncotarget.22459] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 10/11/2017] [Indexed: 11/25/2022] Open
Abstract
Identifying patients with high risk of biochemical recurrence after radical prostatectomy is of immense value in clinical practice. Assessment of prognostic significance of specific clinicopathological features plays an important role in surgical management after prostatectomy. The purpose of our meta-analysis was to investigate the association between the six pathological characteristics and the prognosis of prostate cancer. We carried out a systematic document retrieval in electronic databases to sort out appropriate studies. Outcomes of interest were gathered from studies comparing biochemical recurrence-free survival (BCFS) in patients with the six pathological traits. Studies results were pooled, and hazard ratios (HRs) combined with corresponding 95% confidence intervals (CIs) for survival were used to estimate the effect size. 29 studies (21,683 patients) were enrolled in our meta-analysis. All the six predictors were statistically significant for BCFS with regard to seminal vesicle invasion (HR = 1.97, 95% CI = 1.79–2.18, p < 0.00001), positive surgical margin (HR = 1.79, 95% CI = 1.56–2.06, p < 0.00001), extracapsular extension (HR = 2.03, 95% CI = 1.65–2.50, p < 0.0001), lymphovascular invasion (HR = 1.85, 95% CI = 1.54–2.22, p < 0.00001), lymph node involvement (HR = 1.88, 95% CI = 1.37–2.60, p = 0.0001) and perineural invasion (HR = 1.59, 95% CI = 1.33–1.91, p < 0.00001). Subgroup analysis showed that all the six predictors had significantly relationship with poor BCFS. The pooled results demonstrated that the six clinical findings indicated a worse prognosis in patients with prostate cancer. In conclusion, our results show several clinicopathological characteristics can predict the risk of biochemical recurrence after radical prostatectomy. Prospective studies are needed to further confirm the predictive value of these features for the prognosis of prostate cancer patients after radical prostatectomy.
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Affiliation(s)
- Haoran Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hui Zhou
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Libin Yan
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Tao Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hongyan Lu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Xifeng Sun
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Institute of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China
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5
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Hwang EC, Yu SH, Jo YH, Jung SI, Kang TW, Kwon DD, Choi C, Heo SH, Hwang JE, Jung SH, Jung TY. Effect of serum testosterone and percent tumor volume on extra-prostatic extension and biochemical recurrence after laparoscopic radical prostatectomy. Asian J Androl 2016; 18:54-9. [PMID: 25966628 PMCID: PMC4736357 DOI: 10.4103/1008-682x.154317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several studies have revealed that the preoperative serum testosterone and percent tumor volume (PTV) predict extra-prostatic extension (EPE) and biochemical recurrence (BCR) after radical prostatectomy. This study investigated the prognostic significance of serum testosterone and PTV in relation to EPE and BCR after laparoscopic radical prostatectomy (LRP). We reviewed 520 patients who underwent LRP between 2004 and 2012. PTV was determined as the sum of all visually estimated tumor foci in every section. BCR was defined as two consecutive increases in the postoperative prostate-specific antigen (PSA) >0.2 ng ml-1 . The threshold for serum total testosterone was 3.0 ng ml-1 . Multivariate logistic regression was used to define the effect of variables on the risk of EPE and BCR. A low serum testosterone (<3.0 ng ml-1 ) was associated with a high serum PSA, Gleason score, positive core percentage of the prostate biopsy, PTV, and all pathological variables. On multivariate analysis, similar to previous studies, the serum PSA, biopsy positive core percentage, Gleason score, and pathological variables predicted EPE and BCR. In addition, low serum testosterone (<3.0 ng ml-1 , adjusted OR, 8.52; 95% CI, 5.04-14.4, P= 0.001) predicted EPE and PTV (adjusted OR, 1.02; 95% CI, 1.01-1.05, P= 0.046) predicted BCR. In addition to previous predictors of EPE and BCR, low serum testosterone and PTV are valuable predictors of EPE and BCR after LRP.
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Affiliation(s)
| | | | | | | | | | - Dong Deuk Kwon
- Department of Urology, Chonnam National University Medical School, Gwangju, Republic of Korea
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Kim SH, Park WS, Kim SH, Park B, Joo J, Lee GK, Joung JY, Seo HK, Chung J, Lee KH. Prostate Stem Cell Antigen Expression in Radical Prostatectomy Specimens Predicts Early Biochemical Recurrence in Patients with High Risk Prostate Cancer Receiving Neoadjuvant Hormonal Therapy. PLoS One 2016; 11:e0151646. [PMID: 26982980 PMCID: PMC4794240 DOI: 10.1371/journal.pone.0151646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 03/02/2016] [Indexed: 12/31/2022] Open
Abstract
We aimed to identify tissue biomarkers that predict early biochemical recurrence (BCR) in patients with high-risk prostate cancer (PC), toward the goal of increasing the benefits of neoadjuvant hormonal therapy (NHT). In 2005–2012, prostatectomy specimens were collected from 134 PC patients who had received NHT and radical prostatectomy. The expression of 13 tissue biomarkers was assessed in the specimens via immunohistochemistry. Time to BCR and factors predictive of BCR were determined by using the Cox proportional hazards model. During the follow-up period (median, 57.5 months), 67 (50.0%) patients experienced BCR. Four (3.0%) patients were tumor-free in the final pathology assessment, and 101 (75.4%) had negative resection margins. Prostate stem cell antigen (PSCA) was the only significant prognostic tissue biomarker of BCR [hazard ratio (HR), 2.58; 95% confidence interval (CI), 1.06–6.27; p = 0.037] in a multivariable analysis adjusted by the clinicopathological variables that also significantly predicted BCR; these were seminal vesicle invasion (HR, 2.39; 95% CI, 1.32–4.34), initial prostate serum antigen level (HR 1.01; 95% CI, 1.001–1.020), prostate size (HR, 0.93; 95% CI, 0.90–0.97), and the Gleason score of preoperative biopsies (HR, 1.34; 95% CI, 1.01–1.79). We suggest that PSCA is a useful tissue marker for predicting BCR in patients with high risk PC receiving NHT and radical prostatectomy.
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Affiliation(s)
- Sung Han Kim
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Weon Seo Park
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- Department of Pathology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sun Ho Kim
- Department of Radiology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Boram Park
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jungnam Joo
- Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Geon Kook Lee
- Department of Pathology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Young Joung
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Ho Kyung Seo
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jinsoo Chung
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Kang Hyun Lee
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
- * E-mail:
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Meng Y, Li H, Xu P, Wang J. Do tumor volume, percent tumor volume predict biochemical recurrence after radical prostatectomy? A meta-analysis. Int J Clin Exp Med 2015; 8:22319-22327. [PMID: 26885209 PMCID: PMC4729995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 12/15/2015] [Indexed: 06/05/2023]
Abstract
The aim of this meta-analysis was to explore the effects of tumor volume (TV) and percent tumor volume (PTV) on biochemical recurrence (BCR) after radical prostatectomy (RP). An electronic search of Medline, Embase and CENTRAL was performed for relevant studies. Studies evaluated the effects of TV and/or PTV on BCR after RP and provided detailed results of multivariate analyses were included. Combined hazard ratios (HRs) and their corresponding 95% confidence intervals (CIs) were calculated using random-effects or fixed-effects models. A total of 15 studies with 16 datasets were included in the meta-analysis. Our study showed that both TV (HR 1.04, 95% CI: 1.00-1.07; P=0.03) and PTV (HR 1.01, 95% CI: 1.00-1.02; P=0.02) were predictors of BCR after RP. The subgroup analyses revealed that TV predicted BCR in studies from Asia, PTV was significantly correlative with BCR in studies in which PTV was measured by computer planimetry, and both TV and PTV predicted BCR in studies with small sample sizes (<1000). In conclusion, our meta-analysis demonstrated that both TV and PTV were significantly associated with BCR after RP. Therefore, TV and PTV should be considered when assessing the risk of BCR in RP specimens.
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Affiliation(s)
- Yang Meng
- Department of Urology, West China Hospital of Sichuan UniversityChengdu, P. R. China
| | - He Li
- Department of Hematology, West China Hospital of Sichuan UniversityChengdu, P. R. China
| | - Peng Xu
- Department of Urology, West China Hospital of Sichuan UniversityChengdu, P. R. China
| | - Jia Wang
- Department of Urology, West China Hospital of Sichuan UniversityChengdu, P. R. China
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Narita S, Mitsuzuka K, Tsuchiya N, Koie T, Kawamura S, Ohyama C, Tochigi T, Yamaguchi T, Arai Y, Habuchi T. Reassessment of the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer treated using radical prostatectomy. Int J Urol 2015; 22:1029-35. [DOI: 10.1111/iju.12898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 07/12/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Shintaro Narita
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Koji Mitsuzuka
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Norihiko Tsuchiya
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
| | - Takuya Koie
- Department of Urology; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | | | - Chikara Ohyama
- Department of Urology; Hirosaki University Graduate School of Medicine; Hirosaki Japan
| | - Tatsuo Tochigi
- Department of Urology; Miyagi Cancer Center; Natori Japan
| | - Takuhiro Yamaguchi
- Department of Medical Sciences and Biostatistics; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Yoichi Arai
- Department of Urology; Tohoku University Graduate School of Medicine; Sendai Japan
| | - Tomonori Habuchi
- Department of Urology; Akita University Graduate School of Medicine; Akita Japan
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De La Roca RLRF, Da Cunha IW, Bezerra SM, Da Fonseca FP. Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome. Int Braz J Urol 2015; 40:306-15. [PMID: 25010296 DOI: 10.1590/s1677-5538.ibju.2014.03.03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/13/2013] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. MATERIALS AND METHODS Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2 ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. RESULTS Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and pathologic factors predicting progression-free survival at 5 years, prostate weight; preoperative PSA; Gleason score; pathologic stage; tumor volume; PSMs; capsular and perineural invasion were correlated with BCR. At multivariate analysis, only Gleason score and percentage of tumor volume correlated as significant independent predictors of BCR. CONCLUSION At univariate analysis, presence, number and location of PSMs have consistent correlation with BCR after RRP, but at follow-up BCR occurred only in 37.8% of patients with PSMs. However at multivariate analysis, the significant risk factors for BCR were percentage of tumor volume (p = 0.022) and Gleason score (p < 0.005) in the surgical specimen. Angiolymphatic invasion and Gleason score were significantly correlated with CR.
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Affiliation(s)
| | - Isabela Werneck Da Cunha
- Department of Pelvic Surgery and Department of Pathology, Fundação Antonio Prudente A. C. Camargo Cancer Center, São Paulo - SP, Brazil
| | - Stephania Martins Bezerra
- Department of Pelvic Surgery and Department of Pathology, Fundação Antonio Prudente A. C. Camargo Cancer Center, São Paulo - SP, Brazil
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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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Prognostic Importance of Small Prostate Size in Men Receiving Definitive Prostate Brachytherapy. Int J Radiat Oncol Biol Phys 2012; 84:396-401. [DOI: 10.1016/j.ijrobp.2011.11.068] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 11/16/2011] [Accepted: 11/21/2011] [Indexed: 11/24/2022]
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Jorns JJ, Thiel DD, Lohse C, Williams A, Arnold M, Cheville J, Leibovich B, Parker AS. Kidney size and cancer-specific survival for patients undergoing nephrectomy for pT1 clear cell renal cell carcinoma. Urology 2012; 80:147-50. [PMID: 22748870 DOI: 10.1016/j.urology.2012.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 03/15/2012] [Accepted: 04/06/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To examine the association between kidney size and renal cell carcinoma (RCC) death among patients with Stage pT1 clear cell RCC undergoing surgery. METHODS We used a case-cohort design and evaluated 191 patients from our Nephrectomy Registry who had undergone open radical nephrectomy for unilateral, sporadic, Stage pT1N0/NxM0, noncystic clear cell RCC from 1989 to 2004. Of these, 47 patients died of RCC ("cases") and 144 patients were alive at the last follow-up visit or had died of other causes ("cohort"). Univariate and multivariate associations with RCC death were evaluated using weighted Cox regression analysis and summarized with hazard ratios and 95% confidence intervals. RESULTS The median kidney size was 12 cm. We observed a positive association between increasing kidney size and the risk of RCC death. A 1-cm increase in kidney size was associated with an 18% increased risk of RCC death, even after adjusting for tumor size, nuclear grade, and the presence of necrosis. After multivariate adjustment, those patients with a kidney size greater than the median were 95% more likely to die of RCC than those with a kidney size less than the median (hazard ratio 1.95, 95% confidence interval 1.00-3.81; P = .05). The limitations of our study included a lack of data on the 3-dimensional kidney volume and an inability to generalize to patients with larger tumors (ie, Stage pT2) or other RCC subtypes. CONCLUSION Our data suggest that kidney size is an independent predictor of survival for patients with Stage pT1 clear cell RCC. Future investigations are needed to confirm this finding and investigate this issue in larger, organ-confined tumors and other RCC subtypes.
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Affiliation(s)
- Jacob J Jorns
- Department of Urology, Mayo Clinic, Jacksonville, Florida 32224-1865, USA
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Yun SJ, Min BD, Kang HW, Shin KS, Kim TH, Kim WT, Lee SC, Kim WJ. Elevated insulin and insulin resistance are associated with the advanced pathological stage of prostate cancer in Korean population. J Korean Med Sci 2012; 27:1079-84. [PMID: 22969256 PMCID: PMC3429827 DOI: 10.3346/jkms.2012.27.9.1079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2011] [Accepted: 06/07/2012] [Indexed: 11/20/2022] Open
Abstract
The study was designed to investigate the effect of serum glucose, insulin and insulin resistance on the risk of prostate cancer (CaP) and on the clinicopathological characteristics in Korean men. Subjects were retrospectively recruited from 166 CaP patients underwent radical prostatectomy and 166 age-matched benign prostatic hyperplasia (BPH) patients. The serum was taken on the morning of the day of operation and insulin resistance was assessed by homeostasis model assessment insulin resistance index (HOMA-IR). Men in highest tertile of insulin was associated with 55% reduced odds of CaP than those with the lowest tertile (OR = 0.45, 95% CI = 0.23-0.89, P = 0.022). The patients in highest tertile of insulin had a more than 5.6 fold risk of locally advanced stage than those in the lowest tertile (OR = 5.62, 95% CI = 1.88-16.83, P = 0.002). Moreover, the patients in the highest tertile HOMA-IR group was associated with an increased risk of locally advanced stage than the lowest tertile group (OR = 3.10, 95% CI = 1.07-8.99, P = 0.037). These results suggest that elevated insulin and insulin resistance are associated with the advanced pathological stage of prostate cancer in Korean patients.
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Affiliation(s)
- Seok Joong Yun
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Byung-Dal Min
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Ho-Won Kang
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Kyung-Sub Shin
- Department of Laboratory Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Won-Tae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Sang Cheol Lee
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Wun-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| |
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