Locally Advanced Prostate Squamous Cell Carcinoma Diagnosed Using PET‐CT and Treated With Robot‐Assisted Radical Prostatectomy

Clinical Behaviors and Outcomes for Adenocarcinoma or Adenosquamous Carcinoma of Cervix Treated by Radical Hysterectomy and Adjuvant Radiotherapy or Chemoradiotherapy

425 Background: Squamous cell carcinoma (SCC) of the posterior urethra is rare and is associated with sexually transmitted infections, urethritis, chronic strictures or urethral surgery. Unlike anterior urethral SCC, the presentation of posterior urethral SCC is often late and there are currently no standardised treatment protocols. We present our series of posterior urethral SCC treated by radical surgery and bladder preservation by performing a pan-urethrectomy, radical prostatectomy with a bladder neck closure and chemoradiotherapy. Methods: We retrospectively collected data from patients diagnosed with posterior urethral SCC from a penile cancer database. Data including patient age, histological subtypes, surgical management, post-operative complications, chemo-radiotherapy and survival rates were recorded. Results: A total of 10 cases with histologically proven posterior urethral SCC were treated in a single centre. Median follow-up was 19 months (SD±10 months). Mean age at presentation was 49 years (SD±6.44) and usual type SCC (80%) was the most prevalent histological subtype followed by NOS and condylomatous SCC. The majority of cases were poorly differentiated SCC (70%), stage ≥ T3 and required radical surgery with total urethrectomy and radical prostatectomy. Complications included post-operative ileus (30%), wound infection (20%), sepsis (10%), perioperative transfusion was required in one patient. Lymphovascular invasion was present in 90% of cases and local recurrence occurred in 60% of patients. Only one patient was suitable for neo-adjuvant chemo-radiotherapy (cisplatin/5-FU) and a further 5 required adjuvant chemoradiotherapy following surgery. 60% of patients developed metastatic disease and 60% died with a median survival of 9.6 months (SD±5.3) from diagnosis to death. Conclusions: Posterior urethral SCC is rare and the late presentation means that neoadjuvant chemoradiotherapy is often not possible. Radical surgery requires a pan-urethrectomy and urinary diversion. Despite adjuvant chemoradiotherapy, posterior urethral SCC is associated with significant mortality with a median survivial of less than one year.

Introduction. To evaluate whether secondary resection of lymph node (LN) metastases (LNMs) can result in PSA remission, we analysed the PSA outcome after resection of LNM detected on PET/CT in patients with biochemical failure. Materials and Methods. 11 patients with PSA relapse (mean 3.02 ng/mL, range 0.5–9.55 ng/mL) after radical prostatectomy without adjuvant therapy were included. Suspicious LN (1–3) detected on choline PET/CT and nearby LN were openly dissected (09/04–02/11). The PSA development was examined. Histological and PET/CT findings were compared. Results. 9 of 10 patients with histologically confirmed LNM showed a PSA response. 4 of 9 patients with single LNM had a complete permanent PSA remission (mean followup 31.8, range 1–48 months). Of metastasis-suspicious LNs (14) 12 could be histologically confirmed. The additionally removed 25 LNs were all correctly negative. Conclusions. The complete PSA remissions after secondary resection of single LNM argue for a feasible therapeutic benefit without adjuvant therapy. For this purpose the choline PET/CT is in spite of its limitations currently the most reliable routinely available diagnostic tool.

Predicting Biochemical Recurrence-Free Survival for Patients With Positive Pelvic Lymph Nodes at Radical Prostatectomy

BackgroundCholine positron emission tomography/computed tomography (PET/CT) represents an option in restaging of prostate cancer patients with disease relapse after local treatment. The present study assess whether salvage resection of lymph node metastases detected on choline PET/CT imaging in prostate cancer patients with biochemical recurrence after radical prostatectomy can result in a long-term complete biochemical remission, without adjuvant therapy.MethodsWe analysed 13 patients with prostate specific antigen (PSA) recurrence (PSA median 1.64 ng/ml, range 0.5-9.55) after radical prostatectomy and suspicious lymph nodes (median 1; range 1–3) detected on [11C]choline and [18F]fluoroethylcholine PET/CT scans. An open salvage lymphadenectomy of positive lymph nodes in a PET/CT scan and nearby lymph nodes was carried out. We examined PSA outcome without adjuvant therapy; defined complete biochemical remission as PSA <0.01 ng/ml. Histological and PET/CT findings were compared.ResultsTen of 11 patients with histologically confirmed lymph node metastases showed a PSA response. Three of ten patients with single lymph node metastases had a complete biochemical remission (median follow-up 72 months, range 31.0-83). In five cases with single lymph node metastasis PSA decreased <0.02 ng/ml. Histologically confirmed 13 of 16 metastasis suspicious lymph nodes. No lymph node metastases were detected in two patients. All of the additionally removed 30 lymph nodes were correctly negative.ConclusionsThis is the first confirmation of a complete biochemical remission after PET/CT guided secondary resection of a single lymph node metastasis in prostate cancer patients with biochemical recurrence after radical prostatectomy, over the long-term (>6.5 years), without adjuvant therapy. In order to improve these promising results, longer-term studies with more patients are required.

Minimally Invasive Radical Prostatectomy

LACK OF ASSOCIATION OF PROSTATE CARCINOMA NUCLEAR GRADING WITH PROSTATE SPECIFIC ANTIGEN RECURRENCE AFTER RADICAL PROSTATECTOMY

CancerVolume 78, Issue 12 p. 2455-2460 CommentaryFree Access Prostate carcinoma: Surgical management of regional disease Robert P. Gibbons M.D., Corresponding Author Robert P. Gibbons M.D. Virginia Mason Medical Center, Seattle, WashingtonVirginia Mason Medical Center, 1100 Ninth Avenue C7-URO, P.O. Box 900, Seattle, WA 98111===Search for more papers by this author Robert P. Gibbons M.D., Corresponding Author Robert P. Gibbons M.D. Virginia Mason Medical Center, Seattle, WashingtonVirginia Mason Medical Center, 1100 Ninth Avenue C7-URO, P.O. Box 900, Seattle, WA 98111===Search for more papers by this author First published: 15 December 1996 https://doi.org/10.1002/(SICI)1097-0142(19961215)78:12<2455::AID-CNCR1>3.0.CO;2-JAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL References 1 Murphy GP, Natarajan N, Pontes IE, Schmitz RL, Smart CR, Schmidt JD, Mettlin C. The national survey of prostate cancer in the United States by the American College of Surgeons. J Urol 1982; 127: 928– 34. 2 Stamey TA, McNeal JE. Adenocarcinoma of the prostate. In: PC Walsh, AB Retik, TA Stamey, ED Vaughn, editors. Campbell's Urology. 6th edition. 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RADICAL RETROPUBIC PROSTATECTOMY REDUCES SYMPTOM SCORES AND IMPROVES QUALITY OF LIFE IN MEN WITH MODERATE AND SEVERE LOWER URINARY TRACT SYMPTOMS

Return of serum prostate specific antigen to undetectable level following removal of solitary lymph node metastasis.

Biochemical Recurrence After Radical Prostatectomy: Multiplicative Interaction Between Surgical Margin Status and Pathological Stage

Squamous cell carcinoma is the most common type of sinonasal malignancy. Despite improvements in surgical resection and adjuvant therapy, which are considered the standard of care, the outcome for patients with locoregionally advanced disease remains poor. The objective of this study was to investigate the role of induction chemotherapy in patients with locoregionally advanced sinonasal squamous cell carcinoma and to determine the oncologic outcomes in those patients. The study included 123 consecutive patients with previously untreated, locoregionally advanced (stage III and IV) sinonasal squamous cell carcinoma who were treated with curative intent at The University of Texas MD Anderson Cancer Center between 1988 and 2017 with induction chemotherapy followed by definitive local therapy. Patient demographics, tumor staging, treatment details, and oncologic outcomes were reviewed. The outcomes of this study included response to induction chemotherapy, recurrence, organ preservation, and survival. The median follow-up was 32.6 months (range, 12.4-240 months). Of the 123 patients, 110 (89%) had T4 disease, and 13 (11%) had T3 disease. Lymph node metastasis at the time of presentation was observed in 36 patients (29.3%). The overall stage was stage IV in 111 patients (90.2%) and stage III in 12 patients (9.8%). The chemotherapy regimen consisted of the combination of a platinum and taxanes in most cases (109 patients; 88.6%), either as a doublet (41 patients) or in combination with a third agent, such as 5-fluorouracil (34 patients), ifosfamide (26 patients), or cetuximab (8 patients). After induction chemotherapy, 71 patients (57.8%) achieved at least a partial response, and 6 patients had a complete response. Subsequent treatment after induction chemotherapy was either: 1) definitive chemoradiation or radiation followed by surgical salvage for any residual disease, or 2) surgery followed by adjuvant radiation or chemoradiation. Overall, 54 patients (49.5%) underwent surgical resection. The 2-year overall and disease-free survival rates for the whole cohort were 61.4% and 67.9%, respectively. The rate of orbital preservation was 81.5%. The recurrence rate was 26.8% (33 patients), and distant metastases occurred in 8 patients (6.5%). Patients who had at least a partial response or stable disease had significantly better overall and disease-free survival than those who had progressive disease (P = .028 and P = .021, respectively). The current results indicate that a high proportion of patients with sinonasal squamous cell carcinoma achieved a favorable response to induction chemotherapy. The data suggest that response to induction chemotherapy is associated with an improved outcome and a good chance of organ preservation. The oncologic outcomes in this cohort with locally advanced (mostly T4) disease are better than those historically reported in the literature. Further study of induction chemotherapy in patients with advanced sinonasal squamous carcinoma is warranted.

The efficacy of adjuvant radiochemotherapy (RCT) in patients with advanced stage head and neck carcinoma has been proven in prospective randomized trials. However, these trials focused on different head and neck sites. Specific analyses for treatment effects in squamous cell carcinoma of the oral cavity (OSCC) are missing. We evaluated our experiences with adjuvant concomitant RCT in advanced OSCC to compare the results with other treatment schemes using adjuvant RCT. A total of 183 patients with OSCC of UICC stages II-IVb were reviewed retrospectively. All patients were treated with radical surgery followed by adjuvant, conventional fractionated concomitant RCT using carboplatin. Overall survival was plotted by Kaplan-Meier analysis. Prognostic factors were identified through univariate and multivariate analysis. Univariate analysis showed a significant impact of T, N, and UICC stage, histopathologic grading, surgical margins, extracaspular spread (ECS), and lymphangiosis carcinomatosa on overall survival (Table 3). Patients with stage IVa had a higher 5-year overall survival rate (42.8%) than patients with stage IVb (25.0%) (Figure 1). The differences were significant in multivariate analysis (p = 0.033) (Table 4). Adjuvant concomitant RCT is an effective treatment in patients with advanced stage OSCC. However, it remains unclear, which patients should be treated with adjuvant RCT. For patients with stage IVb, adjuvant RCT yields poor results. Prospective randomized trials are needed to confirm which patients should be treated with adjuvant RCT.

Objective To describe a standardized surgical technique and clinical efficacy of extended pelvic lymph node dissection (e-PLND) in prostate cancer patients. Methods The data of 127 prostate cancer patients with radical prostatectomy and extended pelvic lymph node dissection (e-PLND) from January 2004 to December 2014 were analyzed retrospectively. The mean age was 66.2 (47-78) years, preoperative PSA 13.1 μg /L, Gleason score 6.8. Risk group assessment showed low risk of 49 patients, medium risk of 46 patients, high risk of 32 patients. The pelvic lymph nodes were divided into 9 regions in 5 groups according to the common guideline, namely the external iliac, internal iliac, obturator and common iliac lymph nodes bilaterally, and the presacral lymph nodes. All surgical procedures were understood radical prostatectomy + e-PLND through abdominal incision under general anesthesia. The rates of lymph node metastasis at low risk, medium risk, and high risk group were compared. Relatively metastatic frequency of lymph nodes groups at the different anatomical area with node-positive lymph node patients. Intraoperative and postoperative complications were observed. And serum PSA was checked once every 3 months at postoperative 3 months, the biochemical recurrence was observed. Overall survival was calculated by Kaplan-Meier at 3, 5, and 10-year. Results Among 127 patients, 104 patients were lymph node dissection 5 groups, 23 patients of cleaning the obturator, internal iliac, external iliac, common iliac lymph nodes 4 groups. Totally, 2 727 lymph nodes were dissected. The average number of removed lymph nodes was 21.5(range 13-41). Lymph nodes metastases were detected in 26 of 127 patients (20.5%), including 2.0%(1/49) with low risk group, 23.9%(11/46) with intermediate risk group and 43.8%(14/32) in high risk group (P<0.01). The metastatic frequency of lymph node groups in these patients from higher to lower were as follows: 57.7%(15/26) in internal lilac region, 50%(13/26) in obturator region, 30.8%(8/26) in external iliac region, 11.5%(3/26) in presacral region and 3.8%(1/26) in common iliac region. The intraoperative and postoperative overall complication was diagnosed in 19 of 127 patients (15.0%). Intraoperative venous injury was 2 patients, postoperative lymphatic leakage 5 patients, the lymphocele 10 patients, the lower extremities embolism 2 patients. They were appropriately cured after symptomatic treatment. We had no patients with lymphedema of the lower extremities. Pathological stage were pT1 13, pT2 50, pT3a 49, pT3b 15. One hundred and seventeen patients were followed up postoperatively, the time was 12-123 months, an average of 42.7 months. Biochemical recurrence was 27 patients(23.1%), of which 3 patients died because of tumor recurrence and distant metastasis. Other cause of death was 5 patients. The 3-, 5-, and 10-year accumulate survival rates for all patients were 88.9%(56/63), 78.0%(32/41), and 11/18, respectively. Conclusions The standardization of e-PLND can remove lymph nodes metastasis in radical prostatectomy more thoroughly. It is conducive to determine the anatomical localization of lymph node metastasis, the pathological staging is accurate, which can improve the quality of surgery and improve survival. Key words: Prostatic neoplasms; Prostatectomy; Lymph node excision; Surgical technique

Recurrent bilateral cutaneous squamous cell carcinoma arising within hypertrophic lichen planus with metastasis while on cemiplimab