Cystoprostatectomy Research Articles

Evaluation of cystoprostatectomy on patients with prostate cancer extending to bladder: a retrospective study from single center

BackgroundThis is an exploratory research of cystoprostatectomy (CP) in treating prostate cancer (PCa) extending to the bladder, which aimed to evaluate the effects of CP on survival outcomes and improving quality of life (QoL) in these patients.MethodsA total of 27 PCa patients extending to the bladder were subjected to CP and followed up at regular intervals in our center. Prostate cancer-specific survival (PCSS) and prostate-specific antigen recurrence-free survival (PFS) were assessed by Kaplan–Meier analysis. Multivariate Cox regression was performed to evaluate clinical characteristics predicting survivals. QoL and pelvic symptoms were also evaluated.ResultsMedian PCSS was not reached over the period of follow-up. 5-year PCSS rate was 82.1%. Median PFS was 66.0 months. 5-year PFS rate was 58.5%. Multivariate analysis showed Gleason score (≥ 8) (hazard ratio (HR) 2.55, 95% confidence interval (CI) 1.28–4.04, p = 0.033), positive local lymph node status (HR 3.52, 95% CI 1.57–7.38, p = 0.006) and bladder muscle-invasion (HR 4.75, 95% CI 1.37–7.53, p < 0.001) were independent predictors of worse PCSS. The number of patients suffering pelvic symptoms was significantly decreased, and QoL scores were significantly down-regulated after surgeries.ConclusionCP offered effective and durable palliation in patients of locally advanced prostate cancer with invasion of the bladder, providing better QoL and relieving local symptoms.

Recurrence of Urothelial Carcinoma in the Penis Treated By Emasculation, A Rare Entity: About A Case

Secondary localization of urothelial carcinoma after cystectomy or total cystoprostatectomy (CPT) on the penis (metastasis) is rare, representing 1 to 8%. Occurring within 18 months of the diagnosis of the primary lesion in about 65% according to the literature. The prognosis is often poor with survival rarely exceeding 20 months. The treatment of cavernous metastases of the penis is multidisciplinary, essentially based on surgery (emasculation or penectomy) and chemotherapy, which provide the best results in terms of overall survival. The authors report a case of metastasis, cavernous location of the penis after cystoprostatectomy in 2016 for high-grade urothelial carcinoma of the bladder, whose anatomy-pathology of the surgical specimen is classified pT3a. The patient underwent emasculation (penectomy plus bilateral total orchiepidymectomy involving the entire scrotum). The authors also discuss the diagnostic, therapeutic and prognostic problems that this secondary location poses.

Vascular injuries during urologic surgery

This review article summarizes the epidemiology of vascular injuries during urologic surgery and discusses intraoperative strategies to control bleedings. Techniques of vascular approaches (arteries and veins) are discussed and tricks for vascular repair are explained. Generally, vascular injuries during urologic surgery are rare. However, hemorrhage due to vascular injury is acommon cause of critical morbidity and mortality in the perioperative period. Susceptibility to vascular complications such as oncological debulking and revision surgery increase risk for damage. As vascular injuries range from arrosion to avulsion, treatment is also broad, ranging from vascular suture to open or endovascular repair. Prevention of exsanguination requires visual control to stop the bleeding. The surgeon must act quickly to initiate appropriate repair, aiming for damage control and stabilization of the patient. Planning the surgery and consulting an experienced surgeon are decisive for successful management. Catastrophic bleeding has to be controlled and in the case of arterial injury it is often necessary to reconstitute perfusion. Reconstructions such as vascular anastomoses, patch angioplasty or interposition grafts are the preferred surgical techniques which are influenced by the nature of the injury. Vessels have to be thoroughly prepared before cross clamping to prevent injury by vascular clamps. Veins can often be ligated. Endovascular repair is also apossibility to control the bleeding, but nowadays it is often adefinitive therapy method. For example, resuscitative endovascular balloon occlusion is useful to stabilize the patient and then to initiate vascular repair. Depending on the type of surgery performed, different vessels are concerned. Severe bleeding is usually located retroperitoneal affecting the aorta, renovisceral and iliac vessels. Predisposing urologic operations are lymphadenectomy, nephrectomy and (cysto)prostatectomy and also the laparoscopic approach can cause bleeding complications.

Evaluation of the residual prostate cancer rate on cystoprostatectomy specimen in patients treated with radiotherapy for prostate cancer.

To evaluate the residual cancer rate after cystoprostatectomy (CPT) in patients with a history of radiation therapy for prostate cancer and the postoperative complication rates. We conducted a retrospective study involving 21 patients who had a CPT over 7years and who had a history of radiotherapy for prostate cancer. To compare results, two additional groups were created: a group of patients without a history of radiotherapy in whom a CPT was performed, and a group without a history of radiotherapy and in whom was accidentally discovered a prostate cancer after CPT on histology specimens. The median age at the time of radiotherapy was 69years. The median age at the time of cystoprostatectomy was 78years. The median PSA at the time of the intervention was 0.6ng/ml in the group with a history of radiotherapy. The residual cancer rate was 24%. No patients had criteria for biological recurrence. There were no additional surgical complications in the radiotherapy group (p = 0.2). The rate of cutaneous ureterostomy was higher (p = 0.0006) due to increased surgical difficulties (p = 0.0009). The residual cancer rate was 24% after radiotherapy for prostate cancer. PSA alone does not appear to be sufficient to detect the persistence of residual prostate cancer after radiotherapy. There were no more surgical complications after prostate radiotherapy.

Incidental prostate cancer detected in cystoprostatectomy specimens in patients treated with radical cystectomy for bladder cancer

Introduction: Prostate cancer (PCa) is a major global health concern as it is the most frequently diagnosed malignancy in both Europe and USA with greater proportion in elder men. Bladder cancer is the second most common malignancy of the urinary system after PCa. The purpose of this article is to report the prevalence, the characteristics and the clinical significance of incidental PCa in bladder cancer patients treated with radical cystectomy in our department. Methods : We reviewed data from 64 patients who underwent radical cystectomy as during the years 2012 and 2013 in our department. Prostate cancer was described as clinical significant when there were positive surgical margins, extraprostatic extension, Gleason score > 6 or tumor volume ≥ 0.5 cm 3 . Results : Incidental PCa was diagnosed in 22 patients (34.3%), 16 were diagnosed with Gleason score 6 disease (72.7%), 5 with Gleason score 7 (22.7%) and 1 with Gleason score 8 (4.6%). The mean age of PCa patients was 70.1 years. Extraprostatic extension was present in 2 patients (9.2%) and positive surgical margins in one patient (4.6%). Moreover in 2 patients the PCa tumor volume was above 0.5 cm 3 . As a result, 8 patients were diagnosed with clinical significant incidental PCa. Σκοπός: Ο καρκίνος του προστάτη αποτeλeί την συχνότeρα διαγνωσμένη κακοήθeια σe άνδρeς στην Eυρώπη και τις ΗΠΑ μe μeγαλύτeρη eπίπτωση σe μeγάλeς ηλικίeς. Ο καρκίνος της ουροδόχου κύστης αποτeλeί την δeύτeρη σe συχνότητα κακοήθeια του ουροποιητικού. Σκοπός της μeλέτης η καταγραφή της συχνότητας και της κλινικής σημασίας καρκίνου προστάτη ως τυχαίο eύρημα σe ασθeνeίς που υποβάλλονται σe ριζική κυστeκτομή ως θeραπeία καρκίνου κύστης. Μέθοδος: Αναλύθηκαν τα δeδομένα 64 ασθeνών που υποβλήθηκαν σe ριζική κυστeκτομή κατά τα έτη 2012 και 2013 στο τμήμα μας. Κλινικά σημαντικός καρκίνος προστάτη ορίσθηκe όταν υπήρχαν θeτικά χeιρουργικά όρια, eξωπροστατική eπέκταση, Gleason score > 6 ή όγκος νeοπλάσματος ≥ 0,5 cm 3 . Αποτeλέσματα: Καρκίνος προστάτη ως τυχαίο eύρημα διαγνώσθηκe σe 22 ασθeνeίς (34,3%), 16 παρουσίασαν Gleason score 6 (72,7%), 5 Gleason score 7 (22,7%) και 1 Gleason score 8 (4,6%). Η μέση ηλικία ήταν 70,1 έτη. Eξωπροστατική eπέκταση ανιχνeύτηκe σe 2 ασθeνeίς (9,2%) και θeτικά χeιρουργικά όρια σe έναν (4,6%) eνώ 2 eίχαν νeοπλασματικό όγκο ≥ 0,5 cm 3 . Συνολικά, 8 ασθeνeίς διαγνώσθηκαν μe κλινικά σημαντικό καρκίνο προστάτη.

High dose Bacillus Calmette-Guerin (BCG) for urothelial carcinoma is trickier than expected

Intravesical instillation of Bacillus Clamette-Guerin (BCG) is the first line adjuvant therpay to transuretheral resection of bladder tumor (TURBT) for patients with intermediateand high-risk non-muslce invasive bladder cancer (NMIBC) lesions (1). Its effectiveness, however, comes at a cost of complications, with up to 91% of patients developing some type of irritative local symptoms (1). Additionally, about 10– 20% of responders and 66% of non-responders eventually progress to muscle-invasive disease, leaving them with an invasive option of cystoprostatectomy (2).

Not all gleason pattern 4 prostate cancers are created equal: A study of latent prostatic carcinomas in a cystoprostatectomy and autopsy series.

The Gleason grading system represents the cornerstone of the management of prostate cancer. Gleason grade 4 (G4) is a heterogeneous set of architectural patterns, each of which may reflect a distinct prognostic value. We determined the prevalence of the various G4 architectural patterns and intraductal carcinoma (IDC) in latent prostate cancer in contemporary Russian (n = 220) and Japanese (n = 100) autopsy prostates and in cystoprostatectomy (CP) specimens (n = 248) collected in Italy. We studied the association of each G4 pattern with extraprostatic extension (EPE) and tumor volume to gain insight into their natural history. Presence of IDC and nine architectural features of Gleason grade 4 and 5 cancer were recorded. The prevalence of Gleason score ≥ 7 PC was higher in the autopsy series (11%) compared to the CP series (6.5%, P = 0.04). The prevalence of IDC and carcinoma with a cribriform architecture was 2.2% and 3.4% in the autopsy series and 0.8% and 3.6% in the cystoprostatectomy series, respectively. In multivariable analysis, cribriform architecture was significantly associated with increased tumor volume (P < 0.001) and EPE (OR:11.48, 95%CI:2.30-57.16, P = 0.003). IDC was also significantly associated with EPE (OR:10.08, 95%CI:1.58-64.28, P = 0.014). Small fused glands had a strong negative association with EPE in the autopsy series (OR:0.06, 95%CI:0.01-0.58, P = 0.015). Our study revealed that in latent prostate cancer both cribriform architecture and IDC are uniquely associated with poor pathological outcome features. In contrast, Gleason score 7 (3 + 4) cancers with small-fused gland pattern might possibly include some prostate cancers with a more indolent biology.

Oncologic aspects of long-term followed incidental prostate cancer detected by cystoprostatectomy in Korean patients.

PurposeTo determine the incidence and clinical features of incidentally discovered prostate adenocarcinoma in patients undergoing radical cystoprostatectomy (CPT) for bladder cancer.MethodsNinety-six consecutive patients scheduled to undergo CPT were prospectively enrolled. The prostates were excised completely during CPT. The CPT specimens were examined, and the clinicopathologic characteristics of incidental prostate cancer studied. Complete transverse sections of the prostate were taken from the apex to the base at 4-mm intervals and all prostates were examined by a single pathologist.ResultsThe mean patient age and prostate-specific antigen level were 66.1 ± 10.0 years and 2.8 ± 5.0 ng/mL, respectively. Of the 96 patients, 35 (36.5%) had prostate cancer (PCa). Of these incidental PCas, 57.1% (20.8% of all patients undergoing CPT) were clinically significant. None of the patients who were age ≤50 years had incidental PCa. However, the incidences of PCa in the 51–60 years, 61–70 years, and ≥71 years age groups were 27.8% (5/18), 48.7% (19/39), and 35.5% (15/31), respectively, and the difference according to the age subgroup was significant (P = 0.048). During the median follow-up of 49 months, 29.2% (28/96) of patients died. There were no PCa-specific deaths, and two patients (2.1%) showed biochemical recurrences.ConclusionIncidental PCas were diagnosed in ∼40% of CPT specimens, and ∼50% of incidental PCas were clinically significant. During radical CPT in patients aged ≥60 years, the possibility of the presence of PCa and the potential oncologic risk of partial prostatectomy during CPT should be remembered.

Incidental prostate cancer prevalence at radical cystoprostatectomy--importance of the histopathological work-up.

The reported incidental prostate cancer prevalence rates at radical cystoprostatectomy cover a range from 4 to 60 %. We investigated the influence of the histopathological work-up on prostate cancer prevalence rates. We identified 114 patients who had undergone cystoprostatectomy for bladder cancer between 2000 and 2012. Complete histopathological assessment was defined as follows: (i) complete embedding of the prostate gland, (ii) sectioning of 15 or more prostate sections, and (iii) processing as whole mount slides. Prostate cancer prevalence rates derived from complete and incomplete histopathological assessments were compared. The overall prostate cancer prevalence rate was 59.6 %. A mean of 14.4 macroscopic tissue sections (thickness 3-5 mm) were sectioned. Sectioning ≥15 sections resulted in a prostate cancer detection rate of 75 %, compared to 42.6 % when sectioning <15 sections (p < 0.001). Complete embedding yielded a prostate cancer detection rate of 72.3 and of 23.1 % for partly embedded prostates (p < 0.0001). Prostate cancer was detected in 68.8 % of the whole mounted samples and in 38.2 % of the samples sectioned as standard slides (p < 0.01); according to the criteria described by Epstein and Ohori, 44.1 % of the detected prostate cancers were clinically significant. The quality of the histopathological work-up significantly influences prostate cancer detection rates and might at least partially explain the highly variable reported incidental prostate cancer prevalence rates at cystoprostatectomy (CP). The high proportion of significant prostate cancer found in our series calls for a careful surgical approach to the prostate during CP.

The Frequency of Incidentally Detected Prostate Cancer in Patients Undergoing Radical Cystoprostatectomy for Urotelial Bladder Carcinoma

Gerec ve Yontem: Ocak 2005 ile Haziran 2011 yillari arasinda mesane urotelyal kanseri nedeniyle radikal sistoprostatektomi yapilan ve ameliyat oncesi prostat kanseri tanisi olmayan 157 erkek hasta calismaya alindi. Hastalarin patolojileri geriye donuk olarak degerlendirildi. Uriner diversiyon olarak 125 hastaya ileal konduit, 28 hastaya ortotopik ileal mesane ve dort hastaya ureterokutanostomi teknigi uygulandi.

1630 PROSTATE PATHOLOGY IN PARTIAL VERSUS COMPLETE SUBMISSIONS OF CYSTOPROSTATECTOMY SPECIMENS

You have accessJournal of UrologyBladder Cancer: Invasive (II)1 Apr 20131630 PROSTATE PATHOLOGY IN PARTIAL VERSUS COMPLETE SUBMISSIONS OF CYSTOPROSTATECTOMY SPECIMENS Zhan Tao (Peter) Wang, Emily Filter, Manal Gabril, Jose Gomez, Johnathan Izawa, Joseph Chin, and Madeleine Moussa Zhan Tao (Peter) WangZhan Tao (Peter) Wang London, Canada More articles by this author , Emily FilterEmily Filter London, Canada More articles by this author , Manal GabrilManal Gabril London, Canada More articles by this author , Jose GomezJose Gomez London, Canada More articles by this author , Johnathan IzawaJohnathan Izawa London, Canada More articles by this author , Joseph ChinJoseph Chin London, Canada More articles by this author , and Madeleine MoussaMadeleine Moussa London, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.3180AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The incidence of clinically significant prostate cancer (PCa) in cystoprostatectomy (CP) specimens is 25%. There are no guidelines for the pathological examination of prostates in CP specimens. In our institution, prior to 2000, the prostates were partially submitted whereas currently all prostates are completely submitted. The aim of this study is to evaluate the incidence, pathological features and clinical outcomes of patients with PCa found on CP specimens with partial versus complete submission. METHODS CP specimens with incidental PCa were identified from our archives between 1990 to 2006. Patients with known metastatic PCa, previous radiotherapy or partial prostatectomy were excluded. A total of 72 patients were found, 51 (complete group) had CP specimens that underwent complete submission versus 21 (partial group) that were partially submitted. Clinical outcomes were retrospectively collected via paper and electronic charts. Each CP specimen was retrieved and reviewed by the pathology department. Clinically significant PCa was defined as: Gleason score > 7, seminal vesical invasion, extraprostatic extension (EPE) and positive surgical margins. Statistical analysis was performed with the Student t-test, Fisher's exact test and the Kaplan-Meier method. Significance was set at <0.05. RESULTS Patient demographics between the two groups were similar. Median follow-up for the partial and complete group were 65.7 and 72.9 months respectively. There was a total of 40 (55.5%) clinically significant PCa, of these 13 were in the partial group versus 27 in the complete group. Positive surgical margins at the apex was found in 7% of specimens and EPE was found in 2 versus 11 specimens in the partial and complete group respectively. Invasive urothelial carcinoma was found in 7 specimens in the partial group versus 11 in the complete group. There was one death from metastatic PCa in the complete group and none in the partial group. There was no significant difference in overall mortality between the two groups (Figure 1). CONCLUSIONS This study comparing partial versus complete submission of the prostates in CP specimens showed no significant differences in the detection of clinically significant PCa or survival. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e670 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Zhan Tao (Peter) Wang London, Canada More articles by this author Emily Filter London, Canada More articles by this author Manal Gabril London, Canada More articles by this author Jose Gomez London, Canada More articles by this author Johnathan Izawa London, Canada More articles by this author Joseph Chin London, Canada More articles by this author Madeleine Moussa London, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

801 Palliative radical (cysto)prostatectomy in locally advanced castration-resistant prostate cancer

801 Palliative radical (cysto)prostatectomy in locally advanced castration-resistant prostate cancer

Influence pronostique de l’envahissement tumoral de la glande prostatique par la tumeur de vessie et/ou du cancer de la prostate découvert après cystoprostatectomie : analyse de la littérature

Cystoprostatectomy (CPT) is the gold standard surgical treatment for muscle invasive bladder cancer (MIBC). In certain cases, MIBC can invade the prostate gland and/or a prostate cancer (PCa) can be discovered fortuitously on the pathologic specimen. The aim of the current study was to report the prognostic influence of PCa in patients who underwent a CPT for MIBC. A systematic review of the scientific literature was achieved in the Pubmed database, using the following keywords: prostatic neoplasm; urinary bladder neoplasm; cystectomy; surgery; recurrence; prognosis; survival. Clinical cases and series of less than five cases were deliberately excluded herein. Overall, ten studies published between 2004 and 2011 and involving 2196 patients were selected. Only retrospective studies of low level of evidence (NP 4) were available. The incidence of neoplastic invasion of the prostate gland by MIBC ranged from 25 to 48%. Preoperative predictors were multiple BC, recurrent, location in the trigone and existence of CIS. Overall survival at 3 years was significantly affected by the invasion of the prostate gland (pT4a) in these patients. The incidence of PCa discovered incidentally pathologic specimen CPT ranged from 14 to 49%. Only age was found as a positive predictor. The diagnosis of PCa did not influence survival of patients with MIBC and no specific PCa adjuvant treatment was systematically advocated. Fortuitous diagnosis of PCa and/or neoplastic invasion of the prostatic gland by BC on CPT specimen is not uncommon but this is variable across studies, depending on the quality of the pathological analysis. The invasion of the prostate gland by MIBC is a serious situation (pT4a) and linked with a poor prognosis. In case of concomitant PCa and MIBC, the prognosis is much more related to the natural history of the bladder tumour.

Cistite glandular evoluindo com uropatia obstrutiva

INTRODUCAO: Cistite glandular e um processo proliferativo benigno e infrequente da mucosa vesical, caracterizado por proliferacao do epitelio e, em alguns casos, formacao de glândulas intestinais. Alteracoes metaplasicas na cistite glandular sao bem documentadas na literatura, embora sua etiologia nao seja totalmente esclarecida. RELATO DO CASO: Relatamos um caso de cistite glandular em um paciente de 55 anos, apresentando sintomas miccionais irritativos e obstrutivos persistentes sem resposta a terapia com alfabloqueadores. Ultrassonografia evidenciou lesao vegetante no trigono vesical e o paciente foi submetido a resseccao endoscopica por duas vezes e evoluiu com ureterohidronefrose bilateral. Dado o extenso acometimento vesical e a persistencia dos sintomas, o paciente foi submetido a cistoprostatectomia e neobexiga ileal com boa evolucao pos-operatoria. DISCUSSAO: Ha duas formas de cistite glandular: tipica e intestinal. A forma tipica e a mais comum e a intestinal e marcada pela producao de mucina, mais frequentemente associada ao adenocarcinoma de bexiga. A maioria dos casos de cistite glandular e assintomatica, sendo que os pacientes sintomaticos normalmente apresentam hematuria, sintomas urinarios irritativos e tipicos de cistite cronica. Ha controversias sobre o tratamento precoce agressivo, sendo que varios estudos propoem a resseccao transuretral e o acompanhamento com biopsias.

Bilateral Adrenal Haemorrhage following Cystoprostatectomy: A Case Report

Bilateral Adrenal Haemorrhage following Cystoprostatectomy: A Case Report

Incidental Prostate Cancer Detected by Cystoprostatectomy in Korean Men

To determine the incidence and characteristics of incidental prostate cancer diagnosed by cystoprostatectomy (CPT) in Korean men. Thirty-six consecutive male patients scheduled to undergo CPT were prospectively enrolled. The CPT specimens were examined and the clinicopathologic characteristics of incidental cancers compared with those of T1c prostate cancers that had undergone radical prostatectomy. Complete transverse sections of the prostate were taken from the apex to the base at 4-mm intervals. Of the 36 CPT patients, 18 (50%) had incidental prostate cancer. Most of the incidental tumors were confined to the prostate gland, except in 1 patient. Tumor involvement at the prostate apex was found in 3 patients (16.7%), and Gleason scores in 3 cases were 7 to 10. Median tumor volume was 0.08 cm(3) (range, 0.01 to 20.51 cm(3)), and a tumor volume of more than 0.5 cm(3) was identified in 5 patients. Of these incidental prostate cancers, 38.9% (19.4% of all CPT patients) were clinically significant. As compared with the 38 T1c prostate cancer patients, incidental prostate cancer patients were older, had a lower prostate-specific antigen level, a lower grade, smaller tumor volume, and were less likely to have multiple tumors. However, no significant differences were observed between these two groups with respect to apical tumor involvement or tumor confinement to the prostate (P >0.05 for each). Incidental prostate cancers were diagnosed in 50% of CPT specimens, and 19.4% of these were clinically significant.

α-Methylacyl Coenzyme A Racemase, Ki-67, and Topoisomerase IIα in Cystoprostatectomies With Incidental Prostate Cancer

alpha-Methylacyl coenzyme A racemase (AMACR), Ki-67, and topoisomerase IIalpha were immunohisto-chemically evaluated in prostate carcinoma (PCa), high-grade prostatic intraepithelial neoplasia (HPIN), normal-looking epithelium (NEp), and atrophy in 20 cystoprostatectomy (CyP) and 20 radical prostatectomy (RP) specimens with pT2a Gleason score 6 PCa. The aim was to see whether there were differences in marker expression between CyP and RP specimens. The results showed that the proportions of AMACR-, Ki-67-, and topoisomerase IIalpha-positive cells in the CyP and RP specimens increased from NEp and atrophy through HPIN, away from and adjacent to PCa, to PCa. AMACR expression in PCa in CyP specimens was slightly lower than in RP specimens, but the differences were not significant; there were significant differences in Ki-67 and topoisomerase IIalpha indices. Our findings in marker expression in NEp, atrophy, and HPIN suggest that there are some differences in the field effects in terms of prostatic carcinogenesis between CyP and RP specimens.

Characteristics of incidental prostatic adenocarcinoma in contemporary radical cystoprostatectomy specimens

To investigate the relationship between prostate-specific antigen (PSA) level and tumour volume for incidental adenocarcinoma of the prostate found in cystoprostatectomy (CP) specimens, and to analyse the incidence of clinically significant prostate cancers in CP specimens and the biochemical recurrence of incidental prostate cancers on short-term follow up. Complete data from 97 of 105 prostates from CP specimens were available. Prostates were thoroughly analysed and sectioned at 2 mm intervals. PSA levels and the findings at digital rectal examination before surgery were obtained prospectively. None of the patients had any evidence of prostate cancer before CP. Incidental prostate cancer was detected in 58 of 97 (60%) of the CP specimens; of these, 31 (53%) were significant according to the definition of Stamey et al. There was a weak correlation between tumour volume and PSA level, weighted solely by the four larger-volume cancers. The median PSA level for patients with and without prostate cancer was not significantly different (3.1 vs 1.1 ng/mL, P = 0.06). The follow-up of the 35 patients alive with prostate cancer showed four PSA recurrences (PSA >0.02 ng/mL) with one distant metastasis after a median follow-up of 3 years. None of the patients with insignificant tumours developed biochemical recurrence. The weak correlation between PSA level and tumour volume in these patients supports the argument that PSA is largely produced by benign prostatic hyperplasia and is therefore a poor screening tool for asymptomatic healthy men. Most incidental prostate cancers in CP specimens are significant, contrary to previous analyses, but have little practical importance in terms of oncological outcome.

HER2 expression and gene amplification in pT2a Gleason score 6 prostate cancer incidentally detected in cystoprostatectomies: comparison with clinically detected androgen-dependent and androgen-independent cancer

Previous studies have demonstrated HER2 protein overexpression and/or gene amplification in a subset of patients with clinically significant prostate cancer (PCa), especially in the androgen-independent phase of the disease. There are no studies on incidentally detected PCa. The aim of the study was to analyze HER2 expression and gene amplification in PCa incidentally detected in cystoprostatectomies. High-grade prostatic intraepithelial neoplasia (HGPIN) was also investigated. Comparison was made with clinically detected PCa, both untreated and hormonally treated, and with androgen-independent PCa. Nineteen cystoprostatectomy (CyP) and 44 radical prostatectomy specimens (25 untreated and 19 hormonally treated) with pT2a Gleason score 6 cancer and HGPIN were used in this study. It also included 9 specimens of transurethral resection of the prostate with hormone-independent cancer and 8 cases of normal prostate tissue from CyP specimens without PCa and prostatic intraepithelial neoplasia. HER2 protein and Ki-67 were investigated immunohistochemically. Patients with immunohistochemical scores of 2+ and 3+ were considered to have HER2 overexpression (HercepTest method). Dual-color fluorescence in situ hybridization analysis was performed using the CEP-17/HER dual probe combination. High-grade prostatic intraepithelial neoplasia showed HER2 overexpression in 26% of the CyP cases and in 40% and 83% of the untreated and treated cases, respectively. Prostate cancer showed HER2 overexpression in 16% of cases in the CyP group and in 36% and 47.5% in the untreated and treated groups, respectively. HER2 overexpression was present in 78% of androgen-independent cancers. HER2 gene amplification was seen in a small proportion of nuclei and some of the cases. In HGPIN, it ranged from 1.1% (in 5 cases) in the CyP group to 2.1% (in 10 cases) and 1.9% (in 6 cases) in the untreated and treated groups, respectively. In PCa, the proportion of nuclei with gene amplification was 0.7% (in 3 cases) in the CyP group, 2.6% (in 10 cases) and 2.5% (in 12 cases) in the untreated and treated groups, respectively, and 9% (in 6 cases) in the androgen-independent PCa. Ki-67 expression in HGPIN and PCa in CyP specimens was lower than in the radical prostatectomies and cases of transurethral resection of the prostate. Our findings in the current HER2-related study indicate that incidentally detected cancer has features of less aggressiveness than clinically detected cancer. This may contribute to a better understanding of the results obtained in screening programs where insignificant cancers are detected along with clinically significant cancers.

Alteration of proliferation and apoptotic markers in normal and premalignant tissue associated with prostate cancer

BackgroundMolecular markers identifying alterations in proliferation and apoptotic pathways could be particularly important in characterizing high-risk normal or pre-neoplastic tissue. We evaluated the following markers: Ki67, Minichromosome Maintenance Protein-2 (Mcm-2), activated caspase-3 (a-casp3) and Bcl-2 to determine if they showed differential expression across progressive degrees of intraepithelial neoplasia and cancer in the prostate. To identify field effects, we also evaluated whether high-risk expression patterns in normal tissue were more common in prostates containing cancer compared to those without cancer (supernormal), and in histologically normal glands adjacent to a cancer focus as opposed to equivalent glands that were more distant.MethodsThe aforementioned markers were studied in 13 radical prostatectomy (RP) and 6 cystoprostatectomy (CP) specimens. Tissue compartments representing normal, low grade prostatic intraepithelial neoplasia (LGPIN), high grade prostatic intraepithelial neoplasia (HGPIN), as well as different grades of cancer were mapped on H&E slides and adjacent sections were analyzed using immunohistochemistry. Normal glands within 1 mm distance of a tumor focus and glands beyond 5 mm were considered "near" and "far", respectively. Randomly selected nuclei and 40 × fields were scored by a single observer; basal and luminal epithelial layers were scored separately.ResultsBoth Ki-67 and Mcm-2 showed an upward trend from normal tissue through HGPIN and cancer with a shift in proliferation from basal to luminal compartment. Activated caspase-3 showed a significant decrease in HGPIN and cancer compartments. Supernormal glands had significantly lower proliferation indices and higher a-casp3 expression compared to normal glands. "Near" normal glands had higher Mcm-2 indices compared to "far" glands; however, they also had higher a-casp3 expression. Bcl-2, which varied minimally in normal tissue, did not show any trend across compartments or evidence for field effects.ConclusionThese results demonstrate that proliferation and apoptosis are altered not only in preneoplastic lesions but also in apparently normal looking epithelium associated with cancer. Luminal cell expression of Mcm-2 appears to be particularly promising as a marker of high-risk normal epithelium. The role of apoptotic markers such as activated caspase-3 is more complex, and might depend on the proliferation status of the tissue in question.