Disease In Prostatectomy Specimen Research Articles

Can contralateral lymph-node metastases be ruled out in prostate cancer patients with only unilaterally positive prostate biopsy?

PurposeOur study evaluated the diagnostic benefits of bilateral pelvic lymphadenectomy in prostate cancer patients with unilaterally positive prostate biopsy.MethodsOur retrospective analysis included clinical, surgical, and histopathological data of 440 prostate cancer patients treated with radical prostatectomy and bilateral sentinel-guided and risk-adapted complementary extended pelvic lymphadenectomy at our hospital between 2015 and 2022. We performed multiparametric logistic regression analysis to identify the most relevant predictive factors for detecting lymph-node metastasis in this group of patients.ResultsOverall, 373 patients (85%) had histopathologically bilateral tumours and 45 (10%) pN1 status, of which 22 (49%) also had lymph-node metastasis contralateral to the side of the positive prostate biopsy. In two patients with confirmed unilateral disease in prostatectomy specimens, bilateral lymph-node metastases were observed. Eight pN1 patients would have been missed by unilateral pelvic lymphadenectomy, resulting in a false-negative rate of 18%, 82% sensitivity, and 98% accuracy. Clinical tumour category, International Society of Urological Pathology grade, and percentage of prostate biopsy cores that are positive, as well as number of dissected lymph nodes contralateral to positive prostate biopsy, were determined as the most relevant predictive factors for detecting lymph-node metastasis. Our analysis was limited by its retrospective nature as well as by the fact that 80% of the patients did not receive MRI-targeted biopsy.ConclusionOur study highlights the diagnostic value of bilateral pelvic lymphadenectomy and the need for careful planning in surgery for prostate cancer patients with unilaterally positive prostate biopsy.

MP39-10 SERUM INSULIN-LIKE GROWTH FACTOR-1 (IGF-1) WAS A VALUABLE BIOMARKER TO PREDICT THE HIGH GRADE PROSTATE CANCER IN FINAL PATHOLOGY IN PATIENTS WHO HAD LOW TO INTERMEDIATE DISEASE ON BIOPSY.

You have accessJournal of UrologyProstate Cancer: Detection & Screening V1 Apr 2016MP39-10 SERUM INSULIN-LIKE GROWTH FACTOR-1 (IGF-1) WAS A VALUABLE BIOMARKER TO PREDICT THE HIGH GRADE PROSTATE CANCER IN FINAL PATHOLOGY IN PATIENTS WHO HAD LOW TO INTERMEDIATE DISEASE ON BIOPSY. Myong Kim, Myungchan Park, Jong Won Kim, Donghyun Lee, Won Hee Park, In Gab Jeong, Cheryn Song, Jun Hyuk Hong, Choung-Soo Kim, Tai Young Ahn, and Hanjong Ahn Myong KimMyong Kim More articles by this author , Myungchan ParkMyungchan Park More articles by this author , Jong Won KimJong Won Kim More articles by this author , Donghyun LeeDonghyun Lee More articles by this author , Won Hee ParkWon Hee Park More articles by this author , In Gab JeongIn Gab Jeong More articles by this author , Cheryn SongCheryn Song More articles by this author , Jun Hyuk HongJun Hyuk Hong More articles by this author , Choung-Soo KimChoung-Soo Kim More articles by this author , Tai Young AhnTai Young Ahn More articles by this author , and Hanjong AhnHanjong Ahn More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.135AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES High level of Insulin-like growth factor-1 (IGF-1) was reported to be positively associated with low grade prostate cancer but not to high grade disease. We evaluated the role of preoperative serum IGF-1 level in predicting high grade disease (Gleason score [GS] ≥ 8) in the prostatectomy specimen in patients with low (GS ≤ 6) or intermediate grade (GS = 7) disease on biopsy. METHODS We analyzed the data from 793 patients who received radical prostatectomy. The serum testosterone, IGF-1, and IGF binding protein-3 (IGFBP-3) level were measured immediately before operation. Multivariate analyses were performed to find out predictive parameters for high grade disease in prostatectomy specimen in patients with low or intermediate disease on prostate biopsy. RESULTS Low, intermediate, and high grade disease on final pathology were observed in 159 (20.1%), 502 (63.3%), and 132 (16.6%) patients. Mean IGF-1 levels of patients with low, intermediate, and high grade disease were 151.7 (± 49.8), 144.1 (± 50.0), and 132.9 (± 46.4) ng/mL (p = 0.006). Patients with low preoperative IGF-1 level tended to have high grade disease on final pathology (OR = 0.680; p = 0.013). Serum IGF-1 level was significantly correlated with age (r = -0.313), diabetes mellitus (r = -0.165), serum testosterone level (r = -0.130), and serum IGFBP-3 level (r = 0.583; all p < 0.05). On multivariate analyses, low serum IGF-l level was an independent predictor for high grade disease on final pathology in patients with biopsy GS ≤ 6 (OR = 5.439; p = 0.016), and GS ≤ 7 (OR = 2.489; p = 0.030) after controlling preoperative variables such as age, PSA, prostate volume, percentage of positive core, clinical T stage, serum testosterone, and serum IGFBP-3 level. CONCLUSIONS Serum IGF-1 was a valuable biomarker to predict the high grade disease in final pathology in patients with low to intermediate disease on biopsy. Especially, low serum IGF-1 level in patient with low grade disease on biopsy portends the high grade disease on final pathology. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e545 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Myong Kim More articles by this author Myungchan Park More articles by this author Jong Won Kim More articles by this author Donghyun Lee More articles by this author Won Hee Park More articles by this author In Gab Jeong More articles by this author Cheryn Song More articles by this author Jun Hyuk Hong More articles by this author Choung-Soo Kim More articles by this author Tai Young Ahn More articles by this author Hanjong Ahn More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Low pretreatment serum total testosterone is associated with a high incidence of Gleason score 8–10 disease in prostatectomy specimens: data from ethnic Chinese patients with localized prostate cancer

What's known on the subject? and What does the study add? Previous data from clinically localized prostate cancer (PCa) series treated with radical prostatectomy (RP) have suggested that low preoperative serum total testosterone level is associated with more aggressive PCa; however, the definition of low preoperative total testosterone level varied among these studies (from 220 ng/dL to 387 ng/dL). Moreover, no relevant data exist in the literature regarding ethnic Chinese patients. The study shows that the most widely used threshold for low pretreatment total testosterone level (total testosterone < 300 ng/dL) is not appropriate for ethnic Chinese patients, because it could not distinguish patients with more aggressive PCa from those with less aggressive disease. Setting the threshold at the level of total testosterone < 250 ng/dL works better, because pretreatment total testosterone < 250 ng/dL is associated with a significantly higher incidence of Gleason score 8-10 disease in RP specimens. • To investigate the relationship between preoperative serum total testosterone level and prognostic factors of Chinese patients with clinically localized prostate cancer (PCa). • A total of 110 patients with localized PCa, treated by radical prostatectomy (RP), were included in this prospective study. • Clinical and pathological data from each patient were collected. Total testosterone was measured on the morning of surgery. • Total testosterone levels for each patient were compared using two thresholds: threshold 1 (total testosterone <300 ng/dL vs total testosterone ≥ 300 ng/dL) and threshold 2 (total testosterone <250 ng/dL vs total testosterone ≥ 250 ng/dL). • The median preoperative total testosterone level was 346 ng/dL. Gleason scores of ≤ 6, 7 and ≥ 8 were found in the RP specimens from 21 (19.1%), 67 (60.9%) and 22 (20.0%) patients, respectively. • Compared with those with low grade disease, patients with high grade disease (Gleason score ≥ 8) in RP specimens had a significantly lower preoperative total testosterone. • When comparing 35 patients with hypogonadism with 75 patients with eugonadism, classified by threshold 1, no significant relationships were found. • When comparing 18 patients with hypogonadism with 92 patients with eugonadism, classified by threshold 2, pathological Gleason score ≥ 8 tumours were more common in patients with hypogonadism. • Setting the threshold for hypogonadism at the level of pretreatment serum total testosterone <250 ng/dL is appropriate for ethnic Chinese patients with localized PCa, because patients with pretreatment total testosterone <250 ng/dL are associated with a higher incidence of Gleason score 8-10 disease in RP specimens.

Low pretreatment total testosterone (&lt;3 ng/mL) predicts extraprostatic disease in prostatectomy specimens from patients with preoperative localized prostate cancer

• To investigate the relationship between pretreatment testosterone levels and pathological specimen characteristics, by prospectively examining serum androgen concentrations in a well-studied cohort of patients who underwent radical prostatectomy (RP) for localized prostate cancer. • A total of 107 patients with clinically localized prostate cancer had an assay of total testosterone before laparoscopic RP at our institution. • The results were classified into two groups based on the total serum testosterone: group1, < 3 ng/mL; group 2, ≥ 3 ng/mL. • Student's t-test was used to compare continuous variables, and Fisher's exact test or the chi-squared test was used to compare categorical variables. • Survival curves were established using the Kaplan-Meier method and compared using the log-rank test. In all tests, P < 0.05 was considered to indicate statistical significance. • All patients had localized prostate cancer based on digital rectal examination (DRE) and preoperative magnetic resonance imaging (MRI). Groups 1 and 2 were similar in terms of age, body mass index, preoperative co-morbidities (cardiovascular and diabetes mellitus), clinical stage of prostate cancer and preoperative PSA levels. • In pathological specimens, low total testosterone (< 3 ng/mL) was an independent risk factor for high Gleason score (> 7) and for locally advanced pathological stage (pT3 and pT4). • Higher preoperative testosterone correlated with disease confined to the gland. • There was no association between serum testosterone levels and surgical margin status, on the one hand, and biochemical recurrence on the other. • Low serum testosterone appears to be predictive of aggressive disease (Gleason score >7 and extraprostatic disease, pathological stage > pT2) in patients who underwent RP for localized prostate cancer.