Extraprostatic Extension Of Tumor Research Articles

Full functional-length urethral sphincter- and neurovascular bundle preservation improves long-term continence rates after robotic-assisted radical prostatectomy

The objective of the study was to test the impact of implementing standard full functional-length urethral sphincter (FFLU) and neurovascular bundle preservation (NVBP) with intraoperative frozen section technique (IFT) on long-term urinary continence in patients undergoing robotic-assisted radical prostatectomy (RARP). We relied on an institutional tertiary-care database to identify patients who underwent RARP between 01/2014 and 09/2019. Until 10/2017, FFLU was not performed and decision for NVBP was taken without IFT. From 11/2017, FFLU and IFT-guided NVBP was routinely performed in all patients undergoing RARP. Long-term continence (≥ 12 months) was defined as the usage of no or one safety- pad. Uni- and multivariable logistic regression models tested the correlation between surgical approach (standard vs FFLU + NVBP) and long-term continence. Covariates consisted of age, body mass index, prostate volume and extraprostatic extension of tumor. The study cohort consisted of 142 patients, with equally sized groups for standard vs FFLU + NVBP RARP (68 vs 74 patients). Routine FFLU + NVBP implementation resulted in a long-term continence rate of 91%, compared to 63% in standard RARP (p < 0.001). Following FFLU + NVBP RARP, 5% needed 1–2, 4% 3–5 pads/24 h and no patient (0%) suffered severe long-term incontinence (> 5 pads/24 h). No significant differences in patient or tumor characteristics were recorded between both groups. In multivariable logistic regression models, FFLU + NVBP was a robust predictor for continence (Odds ratio [OR]: 7.62; 95% CI 2.51–27.36; p < 0.001). Implementation of FFLU and NVBP in patients undergoing RARP results in improved long-term continence rates of 91%.

Correlation of Urine Loss after Catheter Removal and Early Continence in Men Undergoing Radical Prostatectomy.

Background: To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. Methods: Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and was grouped as a loss of <1, 1–10, 11–50, and >50 g of urine, respectively. Early UC (median: 3 months) was defined as the usage of no or one safety-pad. Uni- and multivariable logistic regression models tested the correlation between PAD-test results and early UC. Covariates consisted of age, BMI, nerve-sparing approach, prostate volume, and extraprostatic extension of tumor. Results: From 01/2018 to 03/2021, 100 patients undergoing RP with data available for a PAD-test and early UC were retrospectively identified. Ultimately, 24%, 47%, 15%, and 14% of patients had a loss of urine <1 g, 1–10 g, 11–50 g, and >50 g in PAD-test, respectively. Additionally, 59% of patients reported to be continent. In multivariable logistic regression models, urine loss in PAD-test predicted early UC (OR: 0.21 vs. 0.09 vs. 0.03; for urine loss 1–10 g vs. 11–50 g vs. >50 g, Ref: <1 g; all p < 0.05). Conclusions: Urine loss after catheter removal strongly correlated with early continence as well as a severity in urinary incontinence.

Endothelin-1 expression in prostate needle biopsy specimens correlated with aggressiveness of prostatic cancer

As the prostate adenocarcinoma is one of the most common malignant tumors in males, looking for a marker to effectively predict aggressiveness and metastatic potential in an apparently localized cancer in initial needle biopsy specimens can help the clinicians to make more appropriate decision for treatment, planning, and choosing appropriate targeted therapy. The present study assessed the value of Endothelin-1 expression to predict prognosis of prostatic cancer. In a cross sectional study, 83 patients who underwent radical prostatectomy in Hasheminejad Kidney Center in 2008 through 2012 were assigned to two groups including 43 with and 40 without extra-prostatic extension (EPE). Endothelin-1 staining was performed on Paraffin Embedded blocks of preoperative needle biopsies. The expression of Endothelin-1 increased in 72% of patients in the group with EPE (P<0.001). The group with Endothelin-1 positivity showed higher serum level of prostate specific antigen (PSA) (p = 0.039). Endothelin-1 expression was positive in 67% of patients with perineurial invasion (P<0.001). Adjusting the baseline variables of PSA and PN in a multivariable logistic regression model, the Endothelin-1 positivity could effectively predict EPE in patients with prostatic cancer (OR: 5.46, p = 0.010). Correlation of Endothelin-1 expression in needle biopsy specimens in expected with extra-prostatic extension of tumor in radical prostatectomy specimens, perineurial invasion and serum PSA level at the time of diagnosis.

Correlation of Endothelin-1 expression in prostate cancer with tumor prognostic markers: an Iranian experience

<h3>Background</h3> The importance of Endothelin-1 expression in tumor aggressiveness and metastatic potential has been confirmed in a variety of different organ tumors including prostate gland as well as recent trials of targeted therapy. As the prostate adenocarcinoma is one of the most common malignant tumors in males, looking for a marker with predictive value of aggressiveness and metastatic potential in an apparently localized cancer in initial needle biopsy specimens could help clinicians to make the more appropriate decision for treatment planning and perhaps choosing targeted therapy. <h3>Method</h3> In a cross sectional study, 83 patients who underwent radical prostatectomy were studied in 2 groups: 43 with extraprostatic extension (EPE) and 40 without EPE. Immunohistochemical staining with Endothelin-1 was performed on formalin fixed paraffin embedded (FFPE) blocks of their pre-operative needle biopsies. <h3>Results</h3> Endothelin-1 was positive in 11 (26%) of 43 patients with no extraprostatic extension, but showed increased expression in cases with extraprostatic extension up to 29 (72%) of 40 patients (<i>p</i><0.001). The Endothelin-1 positive group showed higher serum PSA levels than the Endothelin-1 negative group (44.6 ± 10.2ng/mL vs 18.6 ± 6.8ng/mL) with <i>p</i>=0.039. This marker was positive in 29 (67%) of 43 patients with perineurial invasion and so in 11 (27%) of 40 patients who didn't show perineurial invasion (<i>p</i><0.001). The marker was positive in 9 (32.1%) of 28 patients with Gleason's score=6, 18 (54.5%) of 33 patients with Gleason's score=7, 10 (58.8%) of 17 patients with Gleason's score=8,2 (50%) of 4 patients with Gleason's score=9 and in 1 (100%) patient with Gleason's score 10 (<i>p</i>=0.261). <h3>Conclusions</h3> These results supported correlation of Endothelin-1 expression in needle biopsy specimens with extraprostatic extension of tumor in radical prostatectomy specimens, perineurial invasion and serum PSA levels at the time of diagnosis, but didn't show correlation between expression of Endothelin-1 and tumor Gleason's score.

Association of 5α‐reductase inhibitor use and pathological features of prostate cancer in men undergoing radical prostatectomy

We investigated the association of 5α-reductase inhibitor (5-ARI) treatment with pathologic and biochemical outcome among the contemporary prostate cancer (PCa) patients undergoing radical prostatectomy. We reviewed records of 1,204 men who underwent radical prostatectomy from 2003 to 2010. We estimated association of 5-ARI use with high (≥7) pathologic Gleason score and pathologically nonorgan-confined disease (≥pT3) via logistic regression, and biochemical outcome via Cox proportional hazards regression. Of 1,204 patients, 50 (4.2%) reported having history 5-ARI treatment before radical prostatectomy. Median duration of 5-ARI treatment among the 50 patients was 23.0 months. When adjusted for various factors including age, body mass index, prostate-specific antigen, clinical stage, biopsy Gleason, and prostate volume, history of 5-ARI treatment was revealed to be significantly associated with high (≥7) pathologic Gleason score (P = 0.015). Also, 5-ARI use was observed to significantly associated with higher rates of extraprostatic extension of tumor (P = 0.005) and seminal vesicle invasion (P = 0.003), respectively, when adjusted for same variables. However, 5-ARI use was not demonstrated to be a significant preoperative predictor of biochemical recurrence-free survival in multivariate analysis (P = 0.528). Our results showed 5-ARI treatment may be associated with more aggressive PCa demonstrating higher pathologic Gleason score and advanced pathologic tumor stage in men undergoing radical prostatectomy. However, further investigations via larger-scale, prospective studies would be needed on the actual effect of 5-ARI treatment on PCa-specific morbidity and mortality.

142 USAGE OF EPSTEIN CRITERIA FOR PREDICTION OF CLINICALLY INSIGNIFICANT PROSTATE CANCER IN KOREAN MEN

You have accessJournal of UrologyProstate Cancer: Staging I1 Apr 2010142 USAGE OF EPSTEIN CRITERIA FOR PREDICTION OF CLINICALLY INSIGNIFICANT PROSTATE CANCER IN KOREAN MEN Sung Kyu Hong, Dae Sung Kim, Hongzoo Park, Won Ki Lee, Seung Hwan Doo, Seong Jin Jeong, Cheol Yong Yoon, Seok-Soo Byun, and Sang Eun Lee Sung Kyu HongSung Kyu Hong More articles by this author , Dae Sung KimDae Sung Kim More articles by this author , Hongzoo ParkHongzoo Park More articles by this author , Won Ki LeeWon Ki Lee More articles by this author , Seung Hwan DooSeung Hwan Doo More articles by this author , Seong Jin JeongSeong Jin Jeong More articles by this author , Cheol Yong YoonCheol Yong Yoon More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , and Sang Eun LeeSang Eun Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.194AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The Epstein criteria represent currently one of the most widely used definitions for clinically insignificant prostate cancer. Meanwhile, although the Epstein criteria have been validated in several western institutions, no formal validation of Epstein criteria was performed among Asian men. Also, considering the potential differences between prostate cancers diagnosed in Western and Asian men, diagnostic criteria developed from analysis of western cohort may not be appropriate for application in patients of other race or region. Thus, we investigated the rate of pathologically-proven unfavorable prostate cancers among Korean men who fulfilled the contemporary Epstein criteria for clinically insignificant prostate cancer. METHODS A retrospective study of 131 Korean men who received radical prostatectomy (RP) for clinically insignificant prostate cancer as defined by contemporary Epstein criteria was performed. We assessed the percentage of unfavorable prostate cancer (pathological Gleason sum ≥ 7 and/or extraprostatic extension of tumor) among such men and tried to identify useful predictors for such unfavorable tumor profile among our subjects via uni- and multivariate analyses. RESULTS Among 131 men with clinically insignificant prostate cancer, 40 (30.5%) were found to have pathological Gleason ≥ 7 tumor after RP. Of these 40 men, 4 (3.1%) also had extraprostatic extension of tumor on examination of RP specimen. All those who did not demonstrate Gleason score upgrading postoperatively were observed to have organ-confined disease from examination of RP specimen. Overall, 40 (30.5%) of 131 men who fulfilled contemporary Epstein criteria for clinically insignificant prostate cancer preoperatively were turned out to have pathologically unfavorable disease. Among our subjects, no significant preoperative predictor of pathologically unfavorable disease was observed via uni- and multivariate analyses. CONCLUSIONS Our results showed that a significant proportion of contemporary Korean patients who meet all the conditions of contemporary Epstein criteria for prediction of clinically insignificant prostate cancer may actually harbor prostate cancer with unfavorable pathological features. Such findings should be considered when treatment options are contemplated based upon Epstein criteria among Asian patients. Seongnam-si, Republic of Korea© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e58 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sung Kyu Hong More articles by this author Dae Sung Kim More articles by this author Hongzoo Park More articles by this author Won Ki Lee More articles by this author Seung Hwan Doo More articles by this author Seong Jin Jeong More articles by this author Cheol Yong Yoon More articles by this author Seok-Soo Byun More articles by this author Sang Eun Lee More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Prostate Volume and the Incidence of Extraprostatic Extension: Is There a Relation?

Extraprostatic extension (EPE) of tumor is an important prognostic indicator that has an impact on long-term survival after radical prostatectomy. We investigated whether the prostate size has any association with the tumor volume and the incidence of EPE. Seven hundred consecutive robot-assisted radical prostatectomy procedures performed by a single surgeon at a single center were studied. Preoperative parameters (demographic details, prostate-specific antigen (PSA) level, biopsy characteristics, and tumor volume) and the postoperative histopathologic details of the specimen (prostate volume, Gleason sum, EPE, and surgical margin status) were compared among the small prostate (< 40 cc), intermediate size (40-70 cc), and large prostate (> 70 cc) groups. Chi-square analysis was performed for comparison of groups with nominal variables while continuous variables were compared using analysis of variance. A double-sided P value of less than 0.05 was considered statistically significant. A greater proportion of patients in the large prostate group had T(1c) tumor compared with those in the small prostate group (90.2% v 78.3%). Younger men and smaller prostates had lower preoperative PSA levels (P < 0.001). A significantly higher PSA density (0.16 v 0.07) and cancer density (0.0102 v 0.0025), however, was observed in patients with small prostates compared with those with large prostates. A total of 102 (14.6%) patients had EPE on the final pathologic analysis while 8.6% of the patients had positive surgical margins. Greater incidence of EPE was observed in the group with smaller prostates compared to those in the large prostate group (16.7% v 7.3%). Small prostates have a higher cancer density and a greater incidence of EPE of tumor.

Significance of preoperative HbA1c level in patients with diabetes mellitus and clinically localized prostate cancer

We investigated potential relationships of history of diabetes mellitus (DM) and glycemic control, represented by hemoglobin A1c (HbA1c) level, with characteristics of tumor among patients who received radical prostatectomy (RP) for clinically localized prostate cancer. We reviewed data of 740 patients who underwent RP for clinically localized prostate cancer between 2004 and 2008 without receiving preoperative radiation or hormonal treatment. Univariate and multivariate logistic regression analyses addressed the associations of history of DM and HbA1c level with known prognostic variables of prostate cancer. No significant differences were observed in various preoperative and pathological parameters between those with (n = 89) and without DM (n = 651). When only the subjects with DM were divided into two groups (group 1 and 2) according to HbA1c level (<6.5% vs. >/=6.5%), group 2 demonstrated significantly higher rate of extraprostatic extension of tumor (P = 0.043) and high (>/=7) pathological Gleason score (P = 0.005) than group 1. Also among those with DM, HbA1c level was observed to be an independent predictor for high pathologic Gleason score (P = 0.010) and extraprostatic extension of tumor (P = 0.035), respectively in multivariate analyses. Although simple history of having DM may not be a significant factor regarding aggressiveness of clinically localized prostate cancer, the glycemic control, as represented by HbA1c level, may be a useful preoperative predictor of aggressive tumor profile among patients with DM who are also diagnosed with clinically localized prostate cancer.

Prediction of Gleason score upgrading in low-risk prostate cancers diagnosed via multi (≥12)-core prostate biopsy

A paucity of data exists on actual pathology of the contemporary patients strictly categorized as having low-risk prostate cancer. We tried to identify useful preoperative predictors of Gleason score upgrading in patients who underwent radical retropubic prostatectomy (RRP) for low-risk prostate cancer diagnosed via multi-core prostate biopsy. A total of 203 patients who underwent radical RRP for low-risk prostate cancer, as defined by D'Amico et al.'s classification (clinical stage < or = T2a, biopsy Gleason sum < or = 6, and PSA < or = 10 ng/ml), detected via multi (> or = 12)-core prostate biopsy were enrolled. We reviewed patients preoperative and pathological data. Among all subjects, 81 (39.9%) were upgraded to Gleason score > or = 7 after RRP, whereas no downgrading was observed. In multivariate analysis, only preoperative PSA level (P = 0.024) and number of positive cores (P = 0.027) were observed to be independent predictors of Gleason score upgrading following RRP. Also, Gleason core upgrading was observed to be significantly associated with extraprostatic extension of tumor (P < 0.001) and positive surgical margin (P = 0.002). A significant proportion of patients with low-risk prostate cancer as defined by D'Amico et al.'s classification diagnosed via multi-core prostate biopsy in contemporary period may have Gleason score upgrading following RRP. For patients with low-risk prostate cancer, preoperative PSA level and number of positive cores may be useful predictors of Gleason score upgrading, which was observed to significantly associated with other adverse pathologic features.

Preoperative Serum Sex Hormone-Binding Globulin as a Predictive Marker for Extraprostatic Extension of Tumor in Patients with Clinically Localized Prostate Cancer

ObjectivesWe investigated the relationships of serum sex hormone-binding globulin (SHBG) level with known prognostic factors for prostate cancer in men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. MethodsPreoperative serum levels of SHBG were analyzed in 288 consecutive patients who were scheduled to undergo RRP for clinically localized prostate cancer. We investigated the potential associations of preoperative serum SHBG level with various clinical and pathological factors. Accuracy of variables in predicting adverse pathological features was assessed via receiver operator characteristics (ROC) curves. ResultsIn univariate analysis, preoperative serum SHBG level was observed to be significantly associated with extraprostatic extension of a tumor (p=0.019) and with pathological Gleason score (p=0.001). In multivariate analysis, serum SHBG level (p=0.039) along with serum PSA (p<0.001) level, biopsy Gleason score (p<0.001), and clinical stage (p=0.004) was observed to be an independent predictor of the extraprostatic extension of prostate cancer. The area under ROC curve that demonstrated the performance of a multivariate logistic regression model (MLRM), which included serum SHBG level and other preoperative variables, in predicting extraprostatic extension of tumor was larger than that of MLRM without SHBG (0.797 vs. 0.758, p=0.121). Meanwhile, serum SHBG level was not observed to be significantly associated with pathological Gleason score in multivariate analysis (p=0.303). ConclusionsOur data showed that serum SHBG level is an independent predictive factor for extraprostatic extension of tumor in patients with clinically localized prostate cancer.

Editorial Comment on: Preoperative Serum Sex Hormone-Binding Globulin as a Predictive Marker for Extraprostatic Extension of Tumor in Patients with Clinically Localized Prostate Cancer

Editorial Comment on: Preoperative Serum Sex Hormone-Binding Globulin as a Predictive Marker for Extraprostatic Extension of Tumor in Patients with Clinically Localized Prostate Cancer

Percentage of Gleason pattern 4 and 5 predicts survival after radical prostatectomy

Morphologic and clinical heterogeneity within tumor grades is well recognized in prostate cancer. The objective of the current study was to determine whether the combined percentage of Gleason patterns 4 and 5 in radical prostatectomy specimens is an independent predictor of cancer-specific survival in prostate cancer patients. The radical prostatectomy specimens were analyzed from 504 consecutive prostate cancer patients who were treated at Indiana University Medical Center between 1990 and 1998. Various clinical and pathologic characteristics were analyzed. A higher combined percentage of Gleason patterns 4 and 5 was associated with older age, higher preoperative serum prostate-specific antigen level, higher pathologic stage, positive surgical margins, extraprostatic extension of tumor, higher Gleason score, perineural invasion, and lymph node metastasis. In the multivariate Cox regression model, the combined percentage of Gleason patterns 4 and 5 was found to be an independent predictor of cancer-specific survival (P = .04). The combined percentage of Gleason patterns 4 and 5 is a powerful predictor of prostate cancer-specific survival. Assessment of high-grade cancer amounts may allow for better stratification of patients into appropriate prognostic groups and treatment protocols.

Prediction of Radial Distance of Extraprostatic Extension From Pretherapy Factors

Extraprostatic extension (EPE) of tumor conveys an adverse prognosis in early-stage prostate cancer. Previous studies reported on the linear and radial distance of EPE (EPEr) as measured from the prostate edge. In this study, the correlation of the EPEr from a large whole mount prostatectomy series was determined with respect to the needle biopsy and prostatectomy specimen findings. In a 24-month period, 404 patients underwent radical prostatectomy and the specimens were whole mounted. The preoperative records, biopsy findings, and EPEr from these specimens were evaluated. The range of the EPEr distance was 0.0-5.7 mm. A three-category model was used that included 283 patients (70%) with no EPE, 59 (15%) with "near EPE" (range, 0.01-0.59 mm), and 62 (15%) with "far EPE" (>or=0.6 mm). Univariate analysis revealed that patient age and prostate volume did not correlate with EPEr, in contrast to all other factors evaluated. Multivariate analysis identified the preoperative serum prostate-specific antigen, the percentage of cancer in the biopsy cores, and clinical tumor stage as significant. However, the Gleason score was not associated with the EPEr. Greater discrimination was possible in estimating the probability of extension in the "near" category than in the "far" category. EPEr is associated with the preoperative prostate-specific antigen level, percentage of cancer in the biopsy cores, and clinical tumor stage. These data might be useful in planning local therapies for prostate cancer, but additional studies identifying factors associated with EPEr beyond 3-5 mm could have relevance regarding the appropriate radiotherapeutic management strategies.

Iatrogenic and non-iatrogenic positive margins: incidence, site, factors involved, and time to PSA progression following radical prostatectomy

There are conflicting data regarding the incidence, site and prognostic significance of positive margins resulting from iatrogenic incision into the prostate (pT2+) or non-iatrogenic inability to excise extraprostatic extension (EPE) of tumor. The surgical specimens were whole-mount processed. Nerve-sparing, tumor extension and Gleason score were considered possible factors involved in positive margins. Time to PSA progression was studied using a Kaplan-Meier product-limit analysis. Positive margins resulted from iatrogenic incision in 61/230 (26.52%) prostates and from EPE in 34/230 (14.78%) prostates. The site most frequently involved in pT2+ prostates was the posterolateral quadrants (40.98%); in cases with EPE both anterolateral and posterolateral quadrants (67.65%) were most frequently involved. Positive margins occurred equally in patients with and without nerve-sparing in both groups. Tumors were significantly more extensive and with higher Gleason score in patients with EPE. Time to PSA progression was similar in patients with pT2+ versus EPE and no invasion of the seminal vesicle, but was significantly shorter in patients with EPE and invasion of the seminal vesicle. The frequency of positive margins in our institution was similar to others with large experience in performing radical prostatectomies. The higher frequency of posterolateral quadrants in iatrogenic positive margins is probably related to the preservation of adjacent vital structures and not to nerve-sparing surgery. A trend for a decreasing frequency of non-iatrogenic surgical margins may be explained by the marked increase of clinical stage T1c in recent years. More-extensive tumors and higher Gleason scores seem to influence only non-iatrogenic positive margins. Biochemical (PSA) progression in EPE must be studied by stratifying the patients into two groups: with and without seminal vesicle invasion.

Histopathologic characterization of seminal vesicle invasion in prostate cancer: implications for radiotherapeutic management

Purpose: Occult extraprostatic extension (EPE) of tumor in clinically organ-confined prostate cancer frequently occurs, but prior studies have shown that it usually is within 2 mm of the prostate margin and within radiotherapy (RT) treatment margins. Occult seminal vesicle invasion (SVI) may occur less frequently, but its extent beyond the prostate is less well characterized. Prior studies described the risk of SVI and its association with pretherapy predictive factors. However, few studies quantified the extent of SVI in detail. In this study, new measurement parameters are defined for SVI which have relevance for patient management.

Seminal vesicle volume as a sonographicpredictor of prostate cancer stage

Objectives Accurate clinical staging of prostate cancer continues to challengethe urologist, with understaging a common problem. Preoperative identification of men with capsular penetration or seminal vesicle invasion would allow deferment of radical surgery unlikely to cure the patient. We investigated the ability of seminal vesicle volume as determined by transrectal ultrasound (TRUS) to predict the stage of prostate carcinoma. Methods Forty-seven consecutive men undergoing radical prostatectomy had preoperative determination of the seminal vesicle volume by TRUE. The volume was determined for each individual seminal vesicle as well as the total seminal vesicle volume. Asymmetry was defined as one seminal vesicle having twice the volume of the other. Results Average total seminal vesicle volume was statistically greater for patients withStage C disease as opposed to those with organ-confined tumors. Seminal vesicle asymmetry was also present statistically more often in Stage C patients than Stage B men. The combination of total seminal vesicle volume less than 15 cc and symmetrical seminal vesicles yielded a possibility of only 18% of extraprostatic extension of tumor. Conclusions We believe that seminal vesicle volume as determined by TRUS can aid in the staging of adenocarcinoma of the prostate and should be considered along with other parameters, such as prostate-specific antigen, acid phosphatase, and Gleason score, when planning therapy for this disease.

Radical Perineal Prostatectomy for Clinical Stage B2 Carcinoma of the Prostate

To refine the criteria for radical surgery in clinical stage B2 prostatic cancer a retrospective study was made of 53 patients who underwent radical perineal prostatectomy between 1951 and 1963. The 15-year survival free of tumor was 25 per cent, significantly less than the 51 per cent survival rate in a series of patients with clinical B1 disease undergoing radical perineal prostatectomy during the same period. Sixty-six per cent of the patients had extraprostatic extension of tumor on histological examination. The 15-year survival free of tumor in these patients was only 13 per cent, whereas those patients with tumor histologically confined to the prostate had a 15-year survival rate of 50 per cent, equal to an age-matched control population. Thus, although prolonged survival was demonstrated in patients without extraprostatic extension only a third of all clinical B2 cases were in this favorable category. Consequently, until improved reliable techniques for detection of extraprostatic extension become available it seems unwise to recommend radical prostatectomy as the treatment of choice for all men with clinical stage B2 disease.