Biochemical Recurrence In Patients Research Articles

Limited prognostic value of preoperative circulating tumor cells for early biochemical recurrence in patients with localized prostate cancer

IntroductionThe presence of circulating tumor cells (CTCs) is an established marker for prognosis in men with castration-resistant prostate cancer. A cutoff of ≥5 CTCs/7.5ml blood in the CellSearch Epithelial Cell Test has been shown to stratify prognostic groups and predict outcome of abiraterone treatment. In contrast, the value of CTC detection in men with localized prostrate cancer before radical prostatectomy (RP) is unknown. Materials and methodsA total of 152 patients treated with RP between 06/2009 and 09/2009 were included. Peripheral venous blood drawn the day before RP was evaluated for CTCs by the CellSearch system. The detection of CTCs was correlated with prostate-specific antigen (PSA) and the histopathological outcome of the RP specimen. A cutoff of 0 vs. ≥1 CTC/7.5ml blood was defined as the threshold for positive vs. negative CTC status. ResultsMedian age was 62 years and median PSA was 6.7ng/dl. Staging revealed 62.5% pT2, 26.3% pT3a, and 11.2% pT3b tumors, and high-grade disease (≥Gleason 4+3) was determined in 25.6% of patients. CTCs were detected in 17 patients (11%) with a median CTC count/7.5ml of 1 (range: 1–clusters with>100 epithelial cells) without significant correlations to PSA levels, pT stage, or Gleason scores. Postoperative pT stage was a significant predictor of biochemical recurrence (BCR) in univariable logistic regression models and as a composite measure together with positive CTC counts (P<0.0001). CTC positivity alone tended to have a higher hazard ratio for BCR, but this was not statistically significant (P = 0.1). After a median follow-up of 48 months, there was no significant difference in BCR-free survival between patients with or without CTCs (P = 0.7). ConclusionUsing the CellSearch system, we infrequently detected CTCs in patients with localized tumors before RP. The detection of CTCs did not correlate significantly with PSA, disease characteristics, or the development of BCR. However, larger cohorts with extended follow-up are needed to validate our findings.

Does the Number of Lymph Nodes Removed During Radical Prostatectomy Impact Risk of Biochemical Recurrence in Patients With Isolated Seminal Vesicle Invasion?

Does the Number of Lymph Nodes Removed During Radical Prostatectomy Impact Risk of Biochemical Recurrence in Patients With Isolated Seminal Vesicle Invasion?

Loss of TIMP-1 immune expression and tumor recurrence in localized prostate cancer.

ABSTRACTIntroduction and objective:Overexpression of MMPs has been related to biochemical recurrence after radical prostatectomy. TIMP1 and TIMP2 are controllers of MMPs and the aim of this study is to evaluate the expression levels of MMPs and their regulators using immunohistochemistry in tissue microarray of localized prostate cancer (PC).Materials and Methods:Immune-expression of MMP-9, MMP-2, TIMP1, TIMP-2, MMP-14 and IL8, were analyzed by immunohistochemistry in radical prostatectomy specimens of 40 patients with localized PC who underwent surgery between September 1997 and February 2000. Protein expression was considered as categorical variables, negative or positive. The results of the immune-expression were correlated to Gleason score (GS), pathological stage (TNM), pre-operatory PSA serum levels and biochemical recurrence in a mean follow up period of 92.5 months.Results:The loss of TIMP1 immune-expression was related to biochemical recurrence. When TIMP1 was negative, 56.3% patients recurred versus 22.2% of those whose TIMP1 was positive (p=0.042). MMP-9, MMP-2, IL8 and MMP-14 were positive in the majority of PC. TIMP-2 was negative in all cases.Conclusion:Negative immune-expression of TIMP1 is correlated with biochemical recurrence in patients with PC possibly by failing to control MMP-9, an important MMP related to cancer progression.

18F-fluorodeoxyglucose PET/CT for detection of disease in patients with prostate-specific antigen relapse following radical treatment of a local-stage prostate cancer.

The present study aimed to retrospectively review the contribution of 18F-fluorodeoxygluose-positron emission tomography/computed tomography (18F-FDG PET/CT) in the assessment of biochemical recurrence in patients with a diagnosis of local-stage prostate cancer (PCa) who underwent radical prostatectomy (RP) or received external beam radiation therapy (EBRT). A total of 28 patients who underwent RP or received EBRT for PCa between July 2007 and April 2013, and who underwent 18F-FDG PET/CT scanning for re-staging due to biochemical recurrence were included in the present study. The mean age of the patients was 65.07 years and the standard deviation was 7.51 years (range, 51-82 years). Of the 28 patients, 23 (82.1%) underwent RP and 5 (17.9%) received definitive EBRT. Prior to scanning, all patients were required to fast for 6 h, and ~1 h after the intravenous injection of 555 MBq 18F-FDG, whole-body PET scans were performed from the skull base to the upper thighs. Whole-body CT scans were performed in the craniocaudal direction. 18F-FDG PET images were reconstructed using CT data for attenuation correction. Histopathology examination or clinical follow-up was used to confirm any suspicious recurrent or metastatic lesions. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT were 61.6, 75.0, 61.6, 75.0 and 71.4%, respectively. 18F-FDG PET/CT can detect local and distant metastases with a high accuracy in the assessment of biochemical recurrence, thus detecting occult metastases and allowing the re-staging of PCa in the patients receiving definitive treatment. It is considered that 18F-FDG PET/CT may be useful in re-assessing the patients with PCa receiving definitive treatment.

High preoperative neutrophil-lymphocyte ratio predicts biochemical recurrence in patients with localized prostate cancer after radical prostatectomy.

To investigate the association between preoperative neutrophil-lymphocyte ratio (NLR) and oncological outcomes in patients with localized prostate cancer (PCa) after radical prostatectomy (RP). We retrospectively reviewed the records of 1367 patients who underwent RP between November 2003 and April 2012. Patients who underwent a concurrent biopsy/procedure in other organs, had evidence of acute infection, or had systemic inflammatory disease were excluded. We divided the patients by NLR level and analyzed their perioperative outcomes. To determine NLR significance, we performed a multivariate logistic regression analysis of the pathological adverse outcomes and a Cox proportional hazard analysis of the biochemical recurrence (BCR), which was defined as a prostate-specific antigen level ≥0.2ng/mL on two consecutive tests. Among the 1367 patients, 158 (11.6%) in the high-NLR (≥2.5) group had a higher biopsy Gleason score (p<0.001), pathological Gleason score (p<0.001), and pathological stage (p<0.001) than patients in the low-NLR (<2.5) group (n=1209, 88.4%). Multivariate analysis revealed that high NLR was significantly correlated with adverse pathological outcomes of higher pathological stage (HR 1.688; 95% CI 1.142-2.497; p=0.009) and extracapsular extension (HR 1.698; 95% CI 1.146-2.516; p=0.008). Kaplan-Meier analysis showed significantly worse BCR-free survival (p<0.001) in patients with a high NLR. A high NLR was a significant predictor of BCR after RP (HR 1.358; 95% CI 1.008-1.829; p=0.044). High NLR was significantly related to unfavorable clinicopathological outcomes and worse BCR-free survival. Further studies are needed to clarify the correlation between NLR and PCa.

Prognostic value of Caveolin-1 in patients treated with radical prostatectomy: a multicentric validation study.

To validate Caveolin-1 as an independent prognostic marker of biochemical recurrence (BCR) in a large multi-institutional cohort of patients with prostate cancer treated with radical prostatectomy (RP). Caveolin-1 expression was evaluated by immunochemistry on a tissue microarray in 3117 patients treated with RP for prostate cancer at five institutions. Univariable and multivariable Cox proportional hazards regression models assessed the association of Caveolin-1 status with BCR. Harrell's c-index quantified prognostic accuracy. Caveolin-1 was overexpressed in 644 (20.6%) patients and was associated with higher pathological Gleason sum (P = 0.002) and lymph node metastases (P = 0.05). Within a median (interquartile range) follow-up of 38 (21-66) months, 617 (19.8%) patients experienced BCR. Patients with overexpression of Caveolin-1 had worse BCR-free survival than those with normal expression (log-rank test, P = 0.004). Caveolin-1 was an independent predictor of BCR in multivariable analyses that adjusted for the effects of standard clinicopathological features (hazard ratio 1.21, P = 0.037). Addition of Caveolin-1 in a model for prediction of BCR based on these standard prognosticators did not significantly improve the predictive accuracy of the model. In subgroup analyses, Caveolin-1 was associated with BCR in patients with favourable pathological features (pT2pN0 and Gleason score = 6; P = 0.021). We confirmed that overexpression of Caveolin-1 is associated with adverse pathological features in prostate cancer and independently predicts BCR after RP, especially in patients with favourable pathological features. However, it did not add prognostically relevant information to established predictors of BCR, limiting its use in clinical practice.

SIGIRR/TIR8, an important regulator of TLR4 and IL-1R–mediated NF-κB activation, predicts biochemical recurrence after prostatectomy in low-grade prostate carcinomas

Single Ig IL-1-related receptor (SIGIRR) is a negative regulator of toll-like receptor 4 and IL-1-mediated activation of nuclear factor κ-light-chain enhancer of activated B cells. The purpose of this study was to qualitatively and quantitatively determine SIGIRR protein expression in human prostate tissues and associate SIGIRR expression with clinical parameters. SIGIRR expression was quantified in glandular prostate tissue using immunohistochemistry and multispectral imaging, and expression was evaluated in relation to clinicopathological features of benign prostatic hyperplasia and prostate cancer (PCa). Subgroupings of low Gleason score (≤ 6 and 3 + 4) and high Gleason score (4 + 3 and ≥ 8) were used for patient outcomes. SIGIRR was predominantly expressed in the cytoplasm and nucleus of the prostatic epithelium with little expression within the stroma. Compared with normal prostate, cytoplasmic SIGIRR expression was similar in benign prostatic hyperplasia, high-grade prostatic intraepithelial neoplasia, PCa, and metastases. A decrease in nuclear expression was found in metastasis samples (P = .04). Changes in SIGIRR expression were not associated with Gleason score, pathological stage, tumor volume, surgical margin status, or serum prostate-specific antigen (P > .05). Nuclear (P = .96) and cytoplasmic (P = .89) SIGIRR expressions were not related to patient outcomes in univariable analysis, but in the analysis of patients with low Gleason scores, high cytoplasmic SIGIRR expression was associated with biochemical recurrence in both univariable (P = .01) and multivariable (hazard ratio, 2.31 [95% confidence interval 1.05-5.06]; P = .04) analyses. Similarly, in multivariable analysis of only low-stage (pT2) tumors, SIGIRR independently predicted biochemical recurrence (P = .009). We conclude that SIGIRR predicts biochemical recurrence in patients with low Gleason score and low pathological stage PCa.

Prostate-specific antigen density predicts favorable pathology and biochemical recurrence in patients with intermediate-risk prostate cancer.

This study was designed to identify clinical predictors of favorable pathology and biochemical recurrence (BCR) in patients with intermediate-risk prostate cancer (IRPCa). Between 2006 and 2012, clinicopathological and oncological data from 203 consecutive men undergoing robot-assisted radical prostatectomy (RARP) for IRPCa were reviewed in a single-institutional retrospective study. Favorable pathology was defined as Gleason score ≤6 and organ-confined cancer as detected by surgical pathology. Logistic regression analysis was used to determine predictive variables of favorable pathology, and the Kaplan–Meier and multivariate Cox regression model were used to estimate BCR-free survival after RARP. Overall, 38 patients (18.7%) had favorable pathology after RARP. Lower quartile prostate-specific antigen density (PSAD) was associated with favorable pathology compared to the highest quartile PSAD after adjusting for preoperative PSA, clinical stage and biopsy Gleason score (odds ratio, 5.42; 95% confidence interval, 1.01–28.97; P = 0.048). During a median 37.8 (interquartile range, 24.6–60.2) months of follow-up, 66 patients experienced BCR. There were significant differences with regard to BCR free survival by PSAD quartiles (log rank, P = 0.003). Using a multivariable Cox proportion hazard model, PSAD was found to be an independent predictor of BCR in patients with IRPCa after RARP (hazard ratio, 4.641; 95% confidence interval, 1.109–19.417; P = 0.036). The incorporation of the PSAD into risk assessments might provide additional prognostic information and identify some patients in whom active surveillance would be appropriate in patients with IRPCa.

A Family History of Lethal Prostate Cancer and Risk of Aggressive Prostate Cancer in Patients Undergoing Radical Prostatectomy.

We investigated whether a family history of lethal prostate cancer (PCa) was associated with high-risk disease or biochemical recurrence in patients undergoing radical prostatectomy. A cohort of radical prostatectomy patients was stratified into men with no family history of PCa (NFH); a first-degree relative with PCa (FH); and those with a first-degree relative who had died of PCa (FHD). Demographic, operative and pathologic outcomes were analyzed. Freedom from biochemical recurrence was examined using Kaplan-Meier log rank. A multivariate Cox logistic regression analysis was also performed. We analyzed 471 men who underwent radical prostatectomy at our institution with known family history. The three groups had: 355 patients (75%) in NFH; 97 patients (21%) in FH; and 19 patients (4%) in FHD. The prevalence of a Gleason score ≥8, higher pathologic T stage, and biochemical recurrence (BCR) rates did not significantly differ between groups. On Kaplan-Meier analysis there were no differences in short-term BCR rates (p = 0.212). In this cohort of patients undergoing radical prostatectomy, those with first-degree relatives who died of PCa did not have an increased likelihood of high-risk or aggressive PCa or shorter-term risk of BCR than those who did not.

Positive surgical margins after radical prostatectomy: What should we care about?

Positive surgical margins (PSMs) after radical prostatectomy (RP) are a known factor associated with biochemical recurrence (BCR) and raise the issue of adjuvant treatment by radiotherapy versus salvage treatment at recurrence. To help this choice, our study aimed to analyze BCR-free survival and factors associated with BCR in patients with PSM and undetectable postoperative prostate-specific antigen (PSA). Between 2005 and 2008, 630 patients had RP for localized prostate cancer in our center. We included patients with PSM, uninvaded nods, undetectable postoperative PSA and no adjuvant treatment. The 5-year BCR-free survival was calculated using Kaplan-Meier method. Logistic regression models were used to determine the factors associated with BCR in univariate and multivariate analyses (Cox model). The PSM rate was 32.7 % (n = 206 patients), and 110 patients corresponded to the inclusion criteria. The median follow-up was 72 months. The BCR rate was 30 % with a 5-year BCR-free survival of 83.9 %. The factors significantly associated with BCR were preoperative PSA, predominance and percentage of Gleason 4, tumor volume, PSM length and predominance of Gleason 4 at the margin. In the multivariate analysis, the remaining two significant factors were PSM length [OR 4.35, 95 % CI (1.011-1.421), p = 0.037] and tumor volume [OR 4.29, 95 % CI (1.011-1.483), p = 0.038]. Over a 5-year follow-up, only one-third of patients experienced BCR. It might be reasonable to postpone adjuvant radiotherapy for patients with PSM and undetectable PSA after RP. Tumor volume and PSM length were associated with BCR and should be taken into account in the postoperative treatment management.

Adverse Pathologic Features at Radical Prostatectomy: Effect of Preoperative Risk on Oncologic Outcomes

BackgroundUp to 30% of patients with low-risk prostate cancer (PCa) are found to have features of aggressive disease at radical prostatectomy (RP). Several predictive nomograms and novel genomic markers have been developed to estimate the risk of adverse pathology in men eligible for active surveillance (AS). However, oncologic risk associated with these findings remains unknown. ObjectiveTo determine if the presence of adverse pathologic features at RP in patients eligible for AS is prognostic of poor oncologic outcome independent of pretreatment risk status. Design, setting, and participantsA total of 2660 patients underwent immediate RP at our institution between 1998 and 2008. Patients were stratified as low, intermediate, or high risk according to the D’Amico clinical risk criteria. Outcome measurements and statistical analysisThe rates of adverse pathology were reported, and the 5-yr risk of biochemical recurrence (BCR) was calculated in the presence of aggressive disease. Results and limitationsThe 5-yr risk of BCR in patients with extracapsular extension (n=937) was 43% (95% confidence interval [CI], 40–46) overall but only 15% (95% CI, 11–22) for those who met the criteria for low risk (n=181). For the 473 patients with pathologic Gleason score 4+3, the risk of recurrence at 5 yr was 41% (95% CI, 37–46) overall, 13% (95% CI, 5–27) for low-risk men (n=41), 41% (95% CI, 35–47) for intermediate-risk men (n=287), and 51% (95% CI, 43–60) for high-risk men (n=145). Limitations include use of BCR as the study end point and surrogate for oncologic outcome in men who received curative treatment. ConclusionsThe presence of pathologically unfavorable disease in patients eligible for AS is not informative as to the safety of this treatment modality. We question the relevance of adverse pathology as the end point for predictive tools designed to guide treatment decisions in low-risk PCa. Patient summaryThe risk of biochemical recurrence associated with adverse pathologic findings at prostatectomy is reduced by approximately 50% in men with clinically low-risk prostate cancer.

Risk factors for biochemical recurrence after robotic assisted radical prostatectomy: a single surgeon experience

BackgroundRadical prostatectomy is a standard surgical treatment of clinically localized prostate cancer. Margin status has been found to be an independent predictor of biochemical recurrence (BCR) after open radical prostatectomy in several large series but this is still controversy in Robotic Assisted Radical Prostatectomy (RARP) series. We therefore wanted to investigate the prognostic significance of positive surgical margin (PSM) and other pathological factors on BCR in patients treated with RARP by a single surgeon.MethodsProspectively collected data of 439 patients treated with RARP between October 2005 and June 2013 by a single surgeon at a single institution were analyzed. BCR was defined as follow-up PSA level > 0.2 ng/ml on two separate occasions or patients who had to undergo salvage therapy. Kaplan Meier curves and Log Rank test were used to compare the risk of BCR. Univariate and Multivariate Cox Regression analyses were performed to determine the prognostic impact of age, BMI, prostate weight, PSA prior to surgery, pathological T-stage, pathological Gleason sum, PSM and operative period.ResultsIn this study period, 34 out of 439 had BCR, giving an overall BCR rate of 7.7% for this cohort. Overall 2- and 3-year BCR-free survival rates were 93% and 88%, respectively. Patients with a PSM had a 2-year BCR free survival of 88% compared to 94% in those with negative margins (p < .0001). On the multivariate analysis, PSM as well as pathological Gleason sum > = 8, PSA, pathological stage and operative period were significantly associated with BCR.ConclusionsIn our case series of RARP performed by a single surgeon, PSM as well as pathological Gleason sum, PSA, pathological stage and early operative period for this surgeon were the independent predictors of BCR.Electronic supplementary materialThe online version of this article (doi:10.1186/s12894-015-0024-7) contains supplementary material, which is available to authorized users.

MP6-07 SENSITIVITY OF [-2]PROPSA AS AN ULTRASENSITIVE PSA SURROGATE FOR THE PREDICTION OF EARLY BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY: AN OBSERVATIONAL COHORT STUDY

You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 2015MP6-07 SENSITIVITY OF [-2]PROPSA AS AN ULTRASENSITIVE PSA SURROGATE FOR THE PREDICTION OF EARLY BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY: AN OBSERVATIONAL COHORT STUDY Massimo Lazzeri, Giovanni Lughezzani, Alberto Abrate, Andrea Losa, Alessandro Mistretta, Nicolò Maria Buffi, Giuliana Lista, Giulio Maria Gadda, Alessandro Larcher, Nicola Fossati, Paolo Dell'Oglio, Vittorio Bini, Ferruccio Ceriotti, and Giorgio Guazzoni Massimo LazzeriMassimo Lazzeri More articles by this author , Giovanni LughezzaniGiovanni Lughezzani More articles by this author , Alberto AbrateAlberto Abrate More articles by this author , Andrea LosaAndrea Losa More articles by this author , Alessandro MistrettaAlessandro Mistretta More articles by this author , Nicolò Maria BuffiNicolò Maria Buffi More articles by this author , Giuliana ListaGiuliana Lista More articles by this author , Giulio Maria GaddaGiulio Maria Gadda More articles by this author , Alessandro LarcherAlessandro Larcher More articles by this author , Nicola FossatiNicola Fossati More articles by this author , Paolo Dell'OglioPaolo Dell'Oglio More articles by this author , Vittorio BiniVittorio Bini More articles by this author , Ferruccio CeriottiFerruccio Ceriotti More articles by this author , and Giorgio GuazzoniGiorgio Guazzoni More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.254AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The clinical sensitivity for detecting biochemical recurrence (BCR) after radical prostatectomy (RP) is directly related to the analytical sensitivity of the PSA assays, which is expressed in ng/ml. [-2]proPSA (p2PSA) assay is normally expressed in pg/mL and demonstrated superior analytical sensitivity than generally use PSA assays. It might be more sensitive than PSA for detecting early BCR in patients after RP. The objective of the study is to test the hypothesis that p2PSA is more sensitive of total PSA for early detection of BCR after RP for localized prostate cancer (PCa). METHODS The current study is an observational, on-going, prospective, cohort study in a contemporary cohort of consecutive patients with localized PCa (pT2-3/N0, who underwent RP. Biochemical follow-up consisted of a blood sample drawn after 3–6-12 months and then every 6 months in the following years. The primary outcome is to determine whether or not elevation of p2PSA or kinetics in rising of p2PSA significantly outperform the sensitivity of tPSA driven BCR defined as two consecutive values of tPSA 0.2 ng/mL. The statistical analysis includes both Kaplan-Meier survival analysis and the McNemar test for comparison of paired frequencies, considering 0.8 pg/ml the optimal threshold for p2PSA BCR. RESULTS From April 2012 to September 2014, a total of 134 patients were enrolled in the study. The median follow-up was 18 months (range 3–29). Over 134 patients, 10 (7.5%) developed a BCR according to PSA definition (4 after 3 mo; 1 after 6 mo; 3 after 12 mo and 2 after 24 mo). All the patients with a BCR had a p2PSA > 0.8 pg/ml at timing of the diagnosis; this correlation was statistically significant (p < 0.001). Two patients with a BCR after 12 months had a p2PSA > 0.8 pg/ml 9 months early and the other one 6 months early. One patient with a BCR detected after 24 months had a p2PSA > 0.8 pg/ml 21 months early and the other one 12 months early. At established cut-offs, the frequencies of p2PSA positive subjects were significantly higher than frequencies of positive subjects identified with tPSA after 3, 6, 12 and 24 months (p<0.0001). The mean survival BCR-free time was 14.1 months (95%CI: 11.4-16.89.0) for p2PSA, and 25 months (95%CI: 22.4-27.5) for PSA (p<0.05). CONCLUSIONS The current findings suggest that p2PSA could be more sensitive than tPSA in detecting early BCR. Further studies are mandatory for clinical practice purposes. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e56-e57 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Massimo Lazzeri More articles by this author Giovanni Lughezzani More articles by this author Alberto Abrate More articles by this author Andrea Losa More articles by this author Alessandro Mistretta More articles by this author Nicolò Maria Buffi More articles by this author Giuliana Lista More articles by this author Giulio Maria Gadda More articles by this author Alessandro Larcher More articles by this author Nicola Fossati More articles by this author Paolo Dell'Oglio More articles by this author Vittorio Bini More articles by this author Ferruccio Ceriotti More articles by this author Giorgio Guazzoni More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

508 Association of cigarette smoking and smoking cessation with biochemical recurrence in patients treated with radical prostatectomy for prostate cancer

508 Association of cigarette smoking and smoking cessation with biochemical recurrence in patients treated with radical prostatectomy for prostate cancer

511 Impact of borderline negative margins at the neurovascular bundle on biochemical recurrence in patients undergoing bilateral nerve-sparing radical prostatectomy: Results of a comparative analysis

511 Impact of borderline negative margins at the neurovascular bundle on biochemical recurrence in patients undergoing bilateral nerve-sparing radical prostatectomy: Results of a comparative analysis

Importance of prostate volume in the stratification of patients with intermediate-risk prostate cancer.

To evaluate the role of prostate volume assessed at final pathology in the risk of biochemical recurrence in patients with clinically localized prostate cancer treated with radical prostatectomy. Overall, 5637 patients treated with radical prostatectomy between January 1993 and August 2013 were identified. Multivariable Cox regression analyses tested the association between prostate volume and biochemical recurrence in the overall population and after stratifying patients according to the D'Amico risk groups. Mean (median) prostate volume was 50.61 mL (46 mL). When patients were stratified according to D'Amico risk groups, mean (median) prostate volume was 51.7 mL (48 mL), 49.8 mL (45 mL) and 50.6 mL (46 mL) in low-, intermediate-, and high-risk prostate cancer, respectively (P = 0.04). Overall, the 5-year biochemical recurrence-free survival rate was 87.9%. In multivariable Cox regression analyses, prostate volume was associated with a lower risk of biochemical recurrence (hazard ratio 0.99, 95% confidence interval 0.99-1.00), after accounting for disease characteristics. However, when patients were stratified according to D'Amico risk groups, prostate volume represented an independent predictor of biochemical recurrence only in individuals with intermediate-risk disease (hazard ratio 0.99, 95% confidence interval 0.99-1.00). Conversely, prostate volume was not associated with the risk of experiencing biochemical recurrence in patients with low- and high-risk disease. Smaller prostates are associated with increased risk of biochemical recurrence after surgery only in men with intermediate-risk disease. In this category, the preoperative assessment of prostate volume might be helpful in order to identify patients at higher risk of biochemical recurrence after surgery. Additionally, prostate volume might be used to individualize follow-up schedules after radical prostatectomy.

The association between metabolic syndrome and prostate cancer: Effect on cancer aggressiveness and progression

ObjectivesTo evaluate the impact of metabolic syndrome and its individual components on prostate biopsy findings, the radical prostatectomy specimen and on biochemical recurrence. Materials and methodsAn observational study was conducted of 1319 men who underwent prostate biopsy between January 2007 and December 2011. The impact on the biopsy findings, the radical prostatectomy specimen and biochemical recurrence was evaluated using logistic regression and Cox regression. ResultsOf the 1319 patients, 275 (21%) had metabolic syndrome, and 517 prostate cancers were diagnosed. A greater percentage of metabolic syndrome was found among patients with prostate cancer than among patients without prostate cancer (25% versus 18%; p=.002). Poorer results were found in the radical prostatectomy specimens (Gleason score≥7, p<.001; stage≥T2c, p<.001; positive surgical margins, p<.001), and there was a greater percentage of biochemical recurrence in patients with metabolic syndrome than in those without metabolic syndrome (24% versus 13%; p=.003). Metabolic syndrome behaved as an independent predictive factor of finding a Gleason score≥7 for the specimen, as well as for finding a specimen stage≥T2c. Metabolic syndrome was also able to independently predict a greater rate of biochemical recurrence (OR: 3.6, p<.001; OR: 3.2, p=.03; HR: 1.7; respectively). ConclusionsMetabolic syndrome is associated with poorer findings in the radical prostatectomy specimens and is an independent prognostic factor of biochemical recurrence.

Can mpMRI predict biochemical recurrence after radical prostatectomy? Implications for preoperative staging and surgical planning.

161 Background: Multiparametric magnetic resonance imaging (mpMRI) used in conjunction with MR/TRUS fusion-guided biopsy has improved detection and localization of clinically significant prostate cancer. We aim to evaluate the utility of preoperative MRI characteristics to predict biochemical recurrence (BCR) following radical prostatectomy. Methods: Patients who underwent robotic assisted radical prostatectomy (RARP) between 2007-2014 at the National Institutes of Health were reviewed. We identified patients with BCR defined following the guidelines of the AUA Localized Prostate Cancer Update Panel report (serum PSA ≥0.2 ng/ml with a subsequent confirmatory value). Bivariate analysis and logistic regression were used to determine the association of mpMRI and preoperative patient characteristics with BCR. Results: Of 365 patients who had RARP, 21 met criteria for BCR with a median follow up of 19 months (IQR: 10-34). Mean preoperative PSA (ng/mL) [p&lt;0.001], high MRI suspicion level [p=0.016], presence of extracapsular extension (ECE) on MRI [p=0.003], and total prostate volume by MRI (cc) [p&lt;0.001] were associated with BCR. Increasing MRI suspicion corresponded to increases in rates of BCR within suspicion levels (2.22% of low, 3.88% of moderate, and 10.64% of high). The rates of BCR were significantly greater in men with ECE on final pathology [p&lt;0.001]. Gleason grade trended toward significance [p=0.058]. Controlling for potentially confounding preoperative variables on multivariate analysis, MRI suspicion score, ECE on MRI, and total prostate volume by MRI remained significantly associated with predicting BCR. Conclusions: MRI suspicion score, ECE on mpMRI, and total prostate volume were associated with BCR in patients undergoing RARP. Preoperative mpMRI characteristics aid in risk stratification, patient counseling, and modification of surgical technique in those with high risk imaging features for BCR. The integration of mpMRI characteristics into a comprehensive model of BCR may provide robust tools for preoperative staging and surgical planning.

Asociación entre síndrome metabólico y cáncer de próstata: efecto sobre su agresividad y progresión

ObjectivesTo evaluate the impact of metabolic syndrome and its individual components on prostate biopsy findings, the radical prostatectomy specimen and on biochemical recurrence. Material and methodsAn observational study was conducted of 1319 men who underwent prostate biopsy between January 2007 and December 2011. The impact on the biopsy findings, the radical prostatectomy specimen and biochemical recurrence was evaluated using logistic regression and Cox regression. ResultsOf the 1319 patients, 275 (21%) had metabolic syndrome, and 517 prostate cancers were diagnosed. A greater percentage of metabolic syndrome was found among patients with prostate cancer than among patients without prostate cancer (25% vs. 18%; P=.002). Poorer results were found in the radical prostatectomy specimens (Gleason score ≥7, P<.001; stage≥T2c, P<.001; positive surgical margins, P<.001), and there was a greater percentage of biochemical recurrence in patients with metabolic syndrome than in those without metabolic syndrome (24% vs. 13%; P=.003). Metabolic syndrome behaved as an independent predictive factor of finding a Gleason score ≥7 for the specimen, as well as for finding a specimen stage ≥T2c. Metabolic syndrome was also able to independently predict a greater rate of biochemical recurrence (OR: 3.6, P<.001; OR: 3.2, P=.03; HR: 1.7; respectively). ConclusionsMetabolic syndrome is associated with poorer findings in the radical prostatectomy specimens and is an independent prognostic factor of biochemical recurrence.

Pathological significance and prognostic role of microvessel density, evaluated using CD31, CD34, and CD105 in prostate cancer patients after radical prostatectomy with neoadjuvant therapy.

BACKGROUNDNeoadjuvant hormonal therapy (NHT) is performed to improve the outcome in organ-confined prostate cancer. However, there is little information regarding the relationship between angiogenesis and NHT. The aim of this study was to identify a suitable method to evaluate the angiogenic status of tissue, and to determine the prognostic value of this method for biochemical recurrence in patients who had undergone radical prostatectomy after NHT.METHODSWe analyzed 108 formalin-fixed specimens from patients treated by radical prostatectomy. NHT was administered in 48 patients (52.9%) and 60 patients who had a similar Gleason score and pT stage were selected as a non-NHT treated control group. Microvessel density (MVD) was measured using anti-CD31, anti-CD34, and anti-CD105 antibodies. The expressions of vascular endothelial growth factor (VEGF)-A and thrombospondin (TSP)-1 were also evaluated by immunohistochemistry. The prognostic value of CD31-, CD34-, and CD105-MVD for biochemical recurrence was investigated.RESULTSThe mean/SD of CD105-MVD in the NHT group (13.3/4.7) was significantly (P < 0.001) lower than that in the non-NHT group (125.8/7.3). In the NHT group, CD105-MVD was associated with pT stage and it was positively correlated with VEGF-A expression (r = 0.56, P < 0.001) and negatively correlated with TSP-1 expression (r = 0.42, P = 0.003). CD105-MVD was identified as a significant predictor of biochemical recurrence (BCR) in patients treated with NHT (log rank test, P < 0.001). Although CD31- and CD34-MVD were significantly associated with pT stage or Gleason score in non-NHT group, they were not associated with pathological features and BCR in NHT group.CONCLUSIONSOur results indicate that CD105-MVD reflects the angiogenic conditions in prostate cancer tissues treated with NHT. CD105-MVD was also identified as a significant and independent predictor of biochemical recurrence in prostate cancer patients who underwent radical prostatectomy with NHT. Prostate 75:84–91, 2015. © 2014 The Authors. The Prostate published by Wiley Periodicals, Inc.