Preoperative Prostate-specific Antigen Research Articles

Predicting survival in node-positive prostate cancer after open, laparoscopic or robotic radical prostatectomy: A competing risk analysis of a multi-institutional database.

To investigate cancer-specific mortality and other-cause mortality in prostate cancer patients with nodal metastases. The study included 411 patients treated with radical prostatectomy and pelvic lymph node dissection for prostate cancer with lymph node metastases at 10 tertiary care centers between 1995 and 2014. Kaplan-Meier analyses were used to assess cancer-specific mortality-free survival rates at 8 years' follow up in the overall population, and after stratifying patients according to clinical and pathological parameters. Uni- and multivariable competing risk Cox regression analyses were used to assess cancer-specific mortality and other-cause mortality. Finally, cumulative-incidence plots were generated for cancer-specific mortality and other-cause mortality after stratifying patients according to the number of positive lymph nodes and the median age at surgery, according to the competing risks method. Men with prostate-specific antigen ≤40 ng/mL and those with one to three positive lymph nodes showed higher cancer-specific mortality-free survival estimates as compared with their counterparts with prostate-specific antigen >40 ng/mL and >3 metastatic lymph nodes, respectively (all P < 0.001). At multivariable Cox regression analyses, preoperative prostate-specific antigen >40 ng/mL, >3 lymph node metastases and pathological Gleason score 8-10 were all independent predictors of cancer-specific mortality (all P-values ≤0.001). On competing risk analysis, when patients were stratified according to the number of positive lymph nodes (namely, ≤3 vs >3), the 8-year cancer-specific mortality rates were 27.4% versus 44.8% for patients aged <65 years, and 15.2% versus 52.6% for patients aged ≥65 years, respectively. Three positive lymph nodes represent the best prognostic cut-off in node-positive prostate cancer patients. In those individuals with >3 positive lymph nodes, the overall mortality rate is completely related to prostate cancer in young patients.

Prognostic Significance of TMPRSS2-ERG Fusion Gene in Prostate Cancer.

Current research of prostate cancer (PCa) offers a promising way of identifying patients with adverse prognosis who do benefit from radical treatment that can affect quality of life as resections are associated with numerous side-effects. The aim of our study was to evaluate the relationship of TMPRSS2-ERG fusion gene status, tumor tissue prostate-specific antigen (PSA), prostate cancer antigen 3 (PCA3), miR-23b, miR-26a and miR-221 expression levels in combination with preoperative serum PSA level to the risk of PCa recurrence after radical prostatectomy. The study group consisted of 108 patients who underwent radical prostatectomy. PSA was measured in peripheral blood collected preoperativelly. The expression of TMPRSS2-ERG transcript and the expression of miR-23b, miR-26a and miR-221 in formalin-fixed, paraffin-embedded (FFPE) tumor tissues was analyzed by reverse transcription (RT) real-time polymerase chain reaction (PCR). Significantly shorter time to recurrence was observed in patients with high expression of TMPRSS2-ERG (p=0.0020). High levels of preoperative PSA (>10.0 ng/ml) proved to be marker of shorter time to recurrence (p=0.0153). The most promising marker of the risk of recurrence after radical prostatectomy was a combination of high level of preoperative serum PSA and high expression of TMPRSS2-ERG fusion transcript in tumor tissue (p=0.0001). A combination of high preoperative serum PSA and high expression of TMPRSS2-ERG could be promising in distinguishing those tumors that are aggressive and life-threatening.

Prophylactic Robotic-assisted Laparoscopic Radical Prostatectomy for Preoperative Suspicion of Prostate Cancer: Experience with 55 Cases.

Expanded indications are not yet reported for robotic-assisted laparoscopic radical prostatectomy (RARP) performed by experienced surgeons for patients with preoperative suspicion of prostate cancer. We report our experience with 55 cases of prophylactic RARP for preoperative suspicion of prostate cancer, including postoperative pathological characteristics and outcomes. This retrospective study reviewed data of a subset of 55 consecutive patients among 1,060 patients who underwent RARP for preoperative suspicion of prostate cancer. Pathological characteristics and outcomes of patients with suspected prostate cancer were analyzed and preoperative, intraoperative and postoperative parameters were compared between three groups. Patients were stratified by final pathology reports of RARP specimens: Group I: Prostate cancer, N=22 (40%); group II: abnormal (prostate intraepithelial neoplasia; atypical small acinar proliferation), N=18 (32.7%); and group III: benign (nodular hyperplasia or inflammation), N=15 (27.3%). Mean preoperative prostate-specific antigen (PSA) was 16.04±2.21 ng/ml. Twenty-two patients with adenocarcinoma had pathology stage pT2a/T2b/ T2c/T3a/T3b (6/7/2/6/1 patients, respectively), with positive surgical margins in 18.2% (4/22). Preoperative incidence of PSA velocity >0.75 ng/ml/yr was significantly higher in group I than in groups II and III (81.8% vs. 38.9% vs. 33.3%, p=0.004). Predictive parameters of prostate cancer showed that PSA velocity (>0.75 vs. ≤0.75 ng/ml/yr) had crude odds ratio of 9.0 for group I vs. group III, p=0.005. Posteperatively, statistically significant improvements were found in uroflow rate, post-voiding residual urine and symptom scores (all p<0.0001). Prophylactic RARP with bilateral neurovascular bundle preservation performed by experienced surgeons is a safe and viable option for preoperative suspicion of prostate cancer.

Promoter methylation of the immune checkpoint receptor PD-1 (PDCD1) is an independent prognostic biomarker for biochemical recurrence-free survival in prostate cancer patients following radical prostatectomy

ABSTRACTBiomarkers that facilitate the prediction of disease recurrence in prostate cancer (PCa) may enable physicians to personalize treatment for individual patients. In the current study, PD-1 (PDCD1) promoter methylation was assessed in a cohort of 498 PCa patients included in The Cancer Genome Atlas (TCGA) and a second cohort of 300 PCa cases treated at the University Hospital of Bonn.In the TCGA cohort, the PD-1 promoter was significantly hypermethylated in carcinomas versus normal prostatic epithelium (55.5% vs. 38.2%, p < 0.001) and PD-1 methylation (mPD-1) inversely correlated with PD-1 mRNA expression in PCa (Spearman's ρ = −0.415, p < 0.001). In both cohorts, mPD-1 significantly correlated with preoperative prostate specific antigen (PSA). In univariate Cox Proportional Hazard analysis, mPD-1 served as a significant prognostic factor for biochemical recurrence (BCR)-free survival (Hazard ratio: HR = 2.35 [1.35–4.10], p = 0.003, n = 410) in the TCGA cohort. In multivariate analysis, mPD-1 was shown to add significant independent prognostic information adjunct to pathologic tumor category (pT) and Gleason grading group (HR = 2.08 [1.16–3.74], p = 0.014, n = 350).PD-1 promoter methylation analyses could thus potentially aid the identification of patients which might benefit from adjuvant treatment after radical prostatectomy. Moreover, our data suggest an intrinsic role of PD-1 in PCa carcinogenesis and disease progression, which needs to be addressed in future studies.

Adverse Features and Competing Risk Mortality in Patients With High-Risk Prostate Cancer

PurposeTo assess survival and competing causes of mortality in prostate cancer (PCa) patients referred to radical prostatectomy through a combination of unfavorable characteristics. Patients and MethodsWe evaluated 615 PCa patients referred to radical prostatectomy and pelvic lymph node dissection at single tertiary-care center with at least one adverse feature (AF): preoperative prostate-specific antigen ≥ 20 ng/mL, pathologic Gleason score 8 to 10, and no organ-confined disease at final pathology (seminal vesicle involvement, positive surgical margins, and/or lymph node invasion). Kaplan-Meier analyses were used to assess cancer-specific mortality (CSM)-free survival rates by stratifying patients into 3 risk categories according to the number of AFs (namely, 1, 2, and 3 AFs). Multivariable competing risk Cox regression analyses were used to assess CSM and other cause of mortality. ResultsSignificant differences were found in terms of preoperative and pathologic tumor characteristics, adjuvant therapies, and biochemical recurrence (BCR). Men with 1 AF had higher CSM-free survival estimates compared to those with 2 and 3 AFs (92.8% vs. 84.2% vs. 27.7% at 10 years' follow-up, P < .001). Moreover, the presence of 3 AFs (hazard ratio [HR], 2.96), postoperative adjuvant treatment status (HR, 2.44), and time to BCR (HR, 0.96) were all independent predictors of CSM (P ≤ .04). Age at surgery and time to BCR were the only independent predictors of other causes of mortality (P ≤ .0009). ConclusionThe risk group stratification according to the number of AFs could help physicians to accurately predict oncologic outcomes and to select PCa patients for the most appropriate postoperative strategies.

Infragradación de la biopsia de próstata respecto a la pieza de prostatectomía la población china: nomogramas actualizados

IntroductionTo assess the risk factors of Gleason sum upgrading between biopsy and radical prostatectomy (RP) and update the nomogram for the prediction of Gleason sum upgrading. MethodsThe study cohort consisted of 237 Chinese prostate adenocarcinoma patients who underwent 10-core prostate biopsy and subsequently received RP in Huashan Hospital from February 2011 to May 2015. The main outcome of our study was Gleason sum upgrading between biopsy and RP pathology. Univariate and multivariate logistic regression models were conducted to explore the potential predictors, and ultimately to build the nomograms. The prediction model was further evaluated for its ability to predict significant upgrading in patients with biopsy Gleason sum<8. ResultsIn the main cohort of all the patients, Gleason sum upgrading was observed in 62 (26.16%) patients. The pre-operative prostate-specific antigen (PSA) level, biopsy Gleason sum, and digital rectal examination were used in building the nomogram, which was validated internally with a bootstrap-corrected concordance index of 0.787. In the sub-cohort of 115 patients with standardized biopsy details, Gleason sum upgrading was observed in 31 (26.96%) patients. The pre-operative PSA level, biopsy Gleason sum, and number of positive cores were used in the nomogram, which was also validated internally with a bootstrap-corrected concordance index of 0.833. These two nomograms both demonstrated satisfactory statistical performance for predicting significant upgrading. ConclusionsUpdated nomograms to predict Gleason sum upgrading in Chinese population between biopsy and RP were developed, demonstrating good statistical performance upon internal validation.

Comparison of antegrade and retrograde laparoscopic radical prostatectomy techniques

We evaluated the effect of antegrade and retrograde approaches on functional recovery and surgical outcomes of extraperitoneal laparoscopic radical prostatectomy (LRP). We analyzed 135 patients who underwent extraperitoneal LRP, with the retrograde technique performed on 42 (31%; Group 1) and the antegrade technique on 93 (69%; Group 2). Both groups were statistically similar with respect to age, clinical stage, preoperative prostate-specific antigen (PSA) and American Society of Anesthesiologists (ASA) scores, prostate volume, and previous surgical history. Mean operative time was significantly longer in Group 1 (244±18.3 vs. 203.3±18.4 min, p<0.001), whereas mean anastomosis times for both groups were similar (35.8±7.2 vs. 34.7±5.8 min, p=0.155). Estimated blood loss and transfusion rates were significantly lower in Group 2. A significant difference was observed for both hospitalization (6.79±3.3 vs. 5.46±3.08 days, respectively; p=0.026) and catheterization times (12.24±2.1 vs. 11±1.08 days, respectively; p=0.001) for Group 2. The total complication rate was 47.6% in Group 1, and 11.8% in Group 2 (p<0.01). Rates of positive surgical margins were 14.2% and 15% for Groups 1 and 2, respectively. At the 12-month interval from operation, similar recoveries in urinary continence were obtained for both groups (81% in Group 1; 91% in Group 2). Upon comparison of the two LRP techniques, we found that both were effective; however, the latter resulted in lower minor complication rate, lower blood loss, shorter operation time, and shorter length of hospital stay.

Primary care follow-up of radical prostatectomy patients: A regional New Zealand experience.

BackgroundContemporary recommendations regarding the duration of follow-up after radical prostatectomy (RP) are highly heterogeneous. Protocol-based follow-up schemes have been implemented to facilitate the expeditious identification of patients with recurrence. The aim of this study is to assess the reliability and comfort of general practitioners (GPs) in follow-up of RP.MethodsFollowing institutional ethical approval, we performed a retrospective review in patients undergoing follow-up after RP between January 2004 and December 2010. Patient factors, disease variables, and follow-up prostate specific antigen (PSA) compliance was collected. “Noncompliant” follow-up care was defined as: patients that had not received a PSA for a 14 month period within 5 years of prostatectomy. Patient and disease-based risk factors for noncompliant follow-up were assessed. GPs were also surveyed in their follow-up practice of RP patients, to assess their familiarity in caring for these patients.ResultsIn total, 65 cases were identified that met the inclusion criteria. At 60 months of follow-up, 66% (43/65) of patients had a compliant follow-up regime. For patients with noncompliant follow-up at 60 months, median time of compliance did not differ significantly when assessing preoperative PSA, Gleason sum, extraprostatic extension, or surgical margin status. Of the GPs surveyed, 68% of GPs felt comfortable in follow-up of RP patients. Some 62% of GPs would expect the PSA to be < 0.1 and 25% of GPs would measure the PSA annually.ConclusionOur study identified that follow-up by GPs after RP is insufficient. Accordingly, there is a requirement for formal educational programs if primary care is to take a greater role in follow-up of these patients.

Akt Activation Correlates with Snail Expression and Potentially Determines the Recurrence of Prostate Cancer in Patients at Stage T2 after a Radical Prostatectomy

Our previous work demonstrated the epithelial-mesenchymal transition factor, Snail, is a potential marker for predicting the recurrence of localized prostate cancer (PCa). Akt activation is important for Snail stabilization and transcription in PCa. The purpose of this study was to retrospectively investigate the relationship between the phosphorylated level of Akt (p-Akt) in radical prostatectomy (RP) specimens and cancer biochemical recurrence (BCR). Using a tissue microarray and immunohistochemistry, the expression of p-Akt was measured in benign and neoplastic tissues from RP specimens in 53 patients whose cancer was pathologically defined as T2 without positive margins. Herein, we observed that the p-Akt level was higher in PCa than in benign tissues and was significantly associated with the Snail level. A high p-Akt image score (≥8) was significantly correlated with a higher histological Gleason sum, Snail image score, and preoperative prostate-specific antigen (PSA) value. Moreover, the high p-Akt image score and Gleason score sum (≥7) showed similar discriminatory abilities for BCR according to a receiver-operator characteristic curve analysis and were correlated with worse recurrence-free survival according to a log-rank test (p < 0.05). To further determine whether a high p-Akt image score could predict the risk of BCR, a Cox proportional hazard model showed that only a high p-Akt image score (hazard ratio (HR): 3.12, p = 0.05) and a high Gleason score sum (≥7) (HR: 1.18, p = 0.05) but not a high preoperative PSA value (HR: 0.62, p = 0.57) were significantly associated with a higher risk of developing BCR. Our data indicate that, for localized PCa patients after an RP, p-Akt can serve as a potential prognostic marker that improves predictions of BCR-free survival.

Upregulation of Talin-1 expression associates with advanced pathological features and predicts lymph node metastases and biochemical recurrence of prostate cancer

Talin-1 functions to regulate cell–cell adhesion, and its altered expression was reported to be associated with human carcinogenesis.A total of 280 tissue specimens from prostate cancer (PCa) patients who underwent radical prostatectomy, 75 cases of benign prostatic hyperplasia (BPH) tissue, and 6 cases of normal prostate tissue specimens were collected for construction of tissue microarray and subsequently subjected to immunohistochemical staining of Talin-1 expression.Talin-1 expression was significantly higher in PCa than both normal and BPH tissues (P <0.001). Talin-1 expression in PCa tissues was associated with preoperative prostate-specific antigen (PSA) level, Gleason score, tumor stage, lymph node metastasis, positive surgical margin, extracapsular extension and seminal vesicle invasion (all P <0.05). Logistic regression analysis showed that Talin-1 and Gleason score were independent risk factors for lymph node metastasis of PCa (P <0.001). Receiver operating characteristic (ROC) curve indicated that Talin-1 expression (AUC = 0.766) had a better accuracy to predict PCa lymph node metastasis than Gleason score (AUC = 0.697), whereas their combination could further enhance the prediction accuracy (AUC = 0.803). Kaplan–Meier curve analysis showed that increased Talin-1 expression was associated with shortened biochemical-free survival of PCa patients after radical prostatectomy (P <0.001).These findings suggested that Talin-1 protein was significantly upregulated in PCa tissues compared with that of BPH tissue and Talin-1 expression was an independent predictor for lymph node metastasis and biochemical recurrence of PCa. Further study will investigate the underlying molecular mechanism and the role of Talin-1 in PCa.

Preoperative Multiparametric Magnetic Resonance Imaging Predicts Biochemical Recurrence in Prostate Cancer after Radical Prostatectomy.

ObjectivesTo evaluate the utility of preoperative multiparametric magnetic resonance imaging (MP-MRI) in predicting biochemical recurrence (BCR) following radical prostatectomy (RP).Materials/MethodsFrom March 2007 to January 2015, 421 consecutive patients with prostate cancer (PCa) underwent preoperative MP-MRI and RP. BCR-free survival rates were estimated using the Kaplan-Meier method. Cox proportional hazards models were used to identify clinical and imaging variables predictive of BCR. Logistic regression was performed to generate a nomogram to predict three-year BCR probability.ResultsOf the total cohort, 370 patients met inclusion criteria with 39 (10.5%) patients experiencing BCR. On multivariate analysis, preoperative prostate-specific antigen (PSA) (p = 0.01), biopsy Gleason score (p = 0.0008), MP-MRI suspicion score (p = 0.03), and extracapsular extension on MP-MRI (p = 0.03) were significantly associated with time to BCR. A nomogram integrating these factors to predict BCR at three years after RP demonstrated a c-index of 0.84, outperforming the predictive value of Gleason score and PSA alone (c-index 0.74, p = 0.02).ConclusionThe addition of MP-MRI to standard clinical factors significantly improves prediction of BCR in a post-prostatectomy PCa cohort. This could serve as a valuable tool to support clinical decision-making in patients with moderate and high-risk cancers.

Does bilateral seminal vesicle invasion at radical prostatectomy predict worse prognosis than unilateral invasion among patients with pT3b prostate cancers?

To determine whether bilateral seminal vesicle invasion is associated with worse biochemical recurrence-free survival than unilateral seminal vesicle invasion after radical prostatectomy. We reviewed the clinicopathological data of 598 men who underwent radical prostatectomy between 2008 and 2015. Among them, 107 (17.9%) had seminal vesicle invasion. After excluding cases with neo-/adjuvant hormone treatment or radiotherapy, 93 were included in the analysis. We compared biochemical recurrence-free survival rates in subgroups with or without bilateral seminal vesicle invasion using Kaplan-Meier estimates. Cox proportional hazard regression models were used to determine the predictors of biochemical recurrence-free survival. Bilateral prostatic lobes and bilateral seminal vesicles were involved by prostate cancers in 85 (91.4%) and 35 patients (37.6%), respectively. Actuarial 3-year and 5-year biochemical recurrence-free survival rates in patients with pT3b tumors with/without bilateral seminal vesicle invasion were 13.0%/34.3%, and 4.3%/19.8%, respectively. On multivariable analysis, preoperative prostate-specific antigen (hazard ratio 1.01, 95% confidence interval 1.00-1.02, P = 0.034), lymph node metastasis (hazard ratio 2.88, 95% confidence interval 1.43-5.81, P = 0.003) and bilateral seminal vesicle invasion (hazard ratio 1.75, 95% confidence interval 1.01-3.05, P = 0.047) were independent predictors of biochemical recurrence-free survival. After excluding cases with lymph node metastasis, preoperative prostate-specific antigen, surgical margin status and bilateral seminal vesicle invasion were independent predictors of biochemical recurrence-free survival. Although most men with seminal vesicle invasion experience biochemical recurrences after radical prostatectomy, their survival outcome is not uniform. Bilateral seminal vesicle invasion seems to represent an independent prognostic factor for pT3b patients, together with the preoperative prostate-specific antigen and lymph node status.

Significance and outcome of nuclear anaplasia and mitotic index in prostatic adenocarcinomas

ObjectivesThe Gleason grading system measures architectural differentiation and disregards nuclear atypia and the cell proliferation index. Several studies have reported that nuclear grade and mitotic index (MI) are prognostically useful. Patients and methodsThis study included 232 radical prostatectomy specimens. Nuclear anaplasia (NA) was determined on the basis of nucleomegali (at least 20µm); vesicular chromatin; eosinophilic macronucleoli, nuclear lobulation, and irregular thickened nuclear membranei. The proportion of area of NA was recorded in each tumor in 10% increments. The MI was defined as the number of mitotic figures in 10 consecutive high-power fields (HPF). ResultsIn univariate analysis, significant differences included associations between biochemical prostate-specific antigen recurrence (BCR) and Gleason score, extraprostatic extension, positive surgical margin, the presence of high-pathologic stage, NA≥10% of tumor area, MI≥3/10 HPF, and preoperative prostate-specific antigen. In a stepwise Cox regression model, a positive surgical margin, the presence of a NA≥10% of tumor area, and a MI of≥3/10 HPF were independent predictors of BCR after radical prostatectomy. NA≥10% of tumor area appeared to have a stronger association with outcome than MI≥3/10 HPF, as still associated with BCR when Gleason score was in the model. ConclusionsThe results of our study showed that, in addition to the conventional Gleason grading system, NA, and MI are useful prognostic parameters while evaluating long-term prognosis in prostatic adenocarcinoma.

Predictive factors and oncological outcomes of persistently elevated prostate-specific antigen in patients following robot-assisted radical prostatectomy.

Our aim was to evaluate factors associated with persistently elevated prostate-specific antigen (PSA) and biochemical recurrence following robotic-assisted radical prostatectomy (RARP). The study population (N=5300) consisted of consecutive patients who underwent RARP for localized prostate cancer by a single surgeon (VP) from January 2008 through July 2013. A query of our Institutional Review Board-approved registry identified 162 men with persistently elevated PSA (group A), defined as PSA level ≥0.1ng/ml at 6weeks after surgery, who were compared with rest of the cohort group having undetectable PSA, group B (<0.1ng/ml). A univariate and multivariate logistic regression analysis was used to evaluate the significant association between various variables and the following: (1) persistently elevated PSA, (2) BCR (PSA value ≥0.2ng/ml) on follow-up in the persistent PSA group. On multivariate analysis, only the following parameters were significantly associated with persistent PSA after RARP-preoperative [PSA >10ng/ml (p=0.01), Gleason Score ≥8 (p=0.001) and clinical stage(p=0.001)]; postoperative [pathologic stage (p=0.001), extraprostatic extension (EPE, p=0.01), lymph node positivity (p=0.001), positive surgical margin (PSM, p=0.02), Gleason score (p=0.01) and tumor volume percent (p<0.001)]. The mean follow-up was 38.1months. The BCR was significantly higher in group A as compared to group B(52.47 vs 7.9%) respectively; p=0.01). The mean time to BCR was significantly lesser in group A as compared to group B(8.9 vs 21.1months respectively; p=0.01). The BCR-free survival rates at 1year and 3years were significantly lower statistically in the persistent PSA group in comparison to other groups (69.7 vs 97.3% and 48.5 vs 92.1%, respectively; p=0.01). On multivariate logistic regression analysis in patients with persistent PSA on follow-up, preoperative PSA >10ng/ml, postoperative Gleason score ≥8, postoperative stage≥pT3, positive pelvic lymph nodes, PSM >3mm and post-RARP PSA doubling time (DT)<10months (p<0.001) were significantly associated with BCR. In patients after RARP, factors associated with aggressive disease (high preoperative PSA, Gleason score≥8, stage≥T3, PSM, high tumor volume percent and EPE) predict PSA persistence. Although these patients with persistent PSA after RARP are more likely to have BCR and that too earlier than those patients with undetectable PSA after RARP, a significant proportion of these patients (47.53%) remain free of BCR. This subset of patients is associated with these favorable parameters (preoperative PSA<10ng/ml, post-RARP PSA DT≥10months, postoperative Gleason score<8, pathologic stage<pT3, PSM<3mm and no lymph node involvement), thus potentially not requiring any adjuvant treatment.

Factors influencing biochemical recurrence in patients who have received salvage radiotherapy after radical prostatectomy: a systematic review and meta-analysis

Several studies have evaluated the risk factors influencing biochemical recurrence (BCR) of prostate cancer in patients receiving salvage radiotherapy (SRT) for BCR after radical prostatectomy (RP), but the results remain conflicting. In this study, we performed a meta-analysis to resolve this conflict. We searched the following databases: PubMed, Embase, and Web of Science using the following terms in “All fields”: “salvage radiation therapy,” “salvage IMRT,” “S-IMRT,” “salvage radiotherapy,” “SRT,” “radical prostatectomy,” “RP,” “biochemical recurrence,” “BCR,” “biochemical relapse.” Eleven studies, with a total of 1383 patients, were included in our meta-analysis. Of all the variables, only Gleason score (GS) ≥7 (odds ratio [OR]: 3.82; 95% confidence interval [CI]: 2.60–5.64) and pathological tumor (pT) stage ≥3a (OR: 1.82; 95% CI: 1.36–2.42) were positively correlated with BCR. However, SRT combined with androgen deprivation therapy (ADT) (OR: 0.63; 95% CI: 0.44–0.90) and radiation therapy (RT) dose ≥64 Gy (OR: 0.35; 95% CI: 0.19–0.64) were negatively correlated with BCR. Perineural invasion (OR: 2.64; 95% CI: 1.11–6.26), preoperative prostate-specific antigen (PSA) ≥10 ng ml−1 (OR: 1.36; 95% CI: 0.94–1.96), positive surgical margin (OR: 0.92; 95% CI: 0.7–1.19), and seminal vesicle involvement (SVI) (OR: 1.09; 95% CI: 0.83–1.43) had no effect on BCR. Our meta-analysis indicated that pT stage, GS, RT dose, and SRT combined with ADT may influence BCR, while preoperative PSA, surgical margin, perineural invasion, and SVI have only a weak effect on BCR.

Long-Term Outcomes of Using Hyaluronic Acid-Carboxymethylcellulose Adhesion Barrier Film on the Neurovascular Bundle.

We hypothesize that the use of hyaluronic acid-carboxymethylcellulose (HACM) adhesion barrier at the neurovascular bundle may hasten the return of erectile function after robot-assisted laparoscopic prostatectomy. A retrospective review identified 462 consecutive patients who underwent a nerve-sparing prostatectomy between 2009 and 2012. The first 246 patients were administered the barrier film, while the next 216 patients, the control group, did not receive HACM. Postoperative erectile function and oncologic outcomes were compared. Independent t-test and Kaplan-Meier analysis were conducted, p < 0.05 was considered significant. The two groups were well matched, without significant differences in age, weight, operative time, prostate size, preoperative prostate-specific antigen, sexual health inventory for men (SHIM), or AUA symptom scores. The mean SHIM was significantly higher for the experimental group at 6 months (6.39 vs 4.75, p = 0.008), 9 months (7.32 vs 5.44, p = 0.006), 1 year (8.52 vs 6.90, p = 0.049), and 18 months (10.01 vs 7.60, p = 0.018). This effect was not noted beyond 18 months. A subgroup analysis of patients with initial SHIM scores 22 or greater demonstrated a higher rate of return to the preoperative SHIM score for the barrier film group, 23% vs 12% (p = 0.046). There was no significant difference in biochemical recurrence between groups, with a median follow-up duration of 18 months. HACM application at the neurovascular bundle during prostatectomy may decrease the time to return of erectile function, with improved SHIM at 6 to 18 months after surgery. This effect is more pronounced in patients with better baseline erectile function. There is no significant effect on biochemical recurrence.

Oncologic Outcome of Radical Prostatectomy as Monotherapy for Men with High-risk Prostate Cancer

Background: The objective of this study was to review our experience with radical prostatectomy (RP) as monotherapy for men with high-risk prostate cancer (PCa). Patients and Methods: This study included 382 consecutive patients who were diagnosed with high-risk PCa according to the D'Amico definition and subsequently underwent RP without neoadjuvant therapy. Biochemical recurrence (BR) was defined as a serum prostate-specific antigen (PSA) level ≥ 0.2 ng/ml on two consecutive measurements, and none of the patients received any adjuvant therapies until their serum PSA levels reached ≥ 0.4 ng/ml. Results: The median preoperative serum PSA level in these 382 patients was 15.9 ng/ml. Pathological stages ≥ pT2c and Gleason scores ≥ 8 were observed in 288 and 194 patients, respectively. During the observation period (median, 48.0 months), BR occurred in 134 patients, and the 5-year BR-free survival rate was 60.1%; however, no patient died of cancer progression. Multivariate analysis identified capsular invasion, seminal vesicle invasion, and surgical margin status as independent predictors of BR. Conclusions: Comparatively favorable cancer control could be achieved using RP as monotherapy for men with high-risk PCa; however, RP alone may be insufficient for patients with capsular invasion, seminal vesicle invasion, and/or surgical margin positivity.

MP40-20 RELATIONSHIP BETWEEN NON-TUMOR PROSTATE VOLUME AND RISK OF POSITIVE SURGICAL MARGIN IN ORGAN CONFINED PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy I1 Apr 2016MP40-20 RELATIONSHIP BETWEEN NON-TUMOR PROSTATE VOLUME AND RISK OF POSITIVE SURGICAL MARGIN IN ORGAN CONFINED PROSTATE CANCER Yong Jin Kang, Won Sik Jang, Jong Kyou Kwon, Cheol Yong Yoon, Joo Yong Lee, Kang Su Cho, Won Sik Ham, In Rae Cho, Young Deuk Choi, Myung Soo Kim, and Won Tae Kim Yong Jin KangYong Jin Kang More articles by this author , Won Sik JangWon Sik Jang More articles by this author , Jong Kyou KwonJong Kyou Kwon More articles by this author , Cheol Yong YoonCheol Yong Yoon More articles by this author , Joo Yong LeeJoo Yong Lee More articles by this author , Kang Su ChoKang Su Cho More articles by this author , Won Sik HamWon Sik Ham More articles by this author , In Rae ChoIn Rae Cho More articles by this author , Young Deuk ChoiYoung Deuk Choi More articles by this author , Myung Soo KimMyung Soo Kim More articles by this author , and Won Tae KimWon Tae Kim More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.166AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES It is not uncommon for the prostate cancer to form multiple satellite foci with main index tumor which has kept uniform method for approximation of tumor volume a difficult task. This has been suggested as one reason behind the controversy over association of tumor volume with biochemical recurrence and treatment failure. We have quantified non-tumor prostate volume to analyze its correlation with occurrence of positive surgical margin which is renown as strong predictor of biochemical recurrence. METHODS Among the 1653 patients at the single center who received robot-assisted radical prostatectomy from 2005 to 2014, 629 who were AJCC clinical stage T2 or below with no evidence of distant or lymph node metastasis and have not received neoadjuvant androgen deprivation therapy has been analyzed retrospectively. Non-tumor prostate volume has been calculated by subtracting the aggregated tumor volume of all foci from the measured prostate volume. RESULTS Median patient age was 65 (IQR 60-70) years with preoperative prostate-specific antigen(PSA) of median 6.5 (IQR 4.7-9.9) ng/mL. 214 (34%) patients were at clinical stage T1 and 415 (66%) were at stage T2. Patients with pathologic Gleason score 7 were 320 (50.9%), while 8 or greater were 74 (11.8%). 207 (43%) patients were found to contain positive surgical margins in their postoperative pathologic report. Total prostate volume was median 30.8 (IQR 24.1-38.35) mL and non-tumor prostate volume was median 28.9 (IQR 22.8-36.9) mL. From the logistic regression for the odds of having positive surgical margin, patients with greater non-tumor prostate volume were at decreased odds (p=0.002 OR 0.977) while patients with higher PSA (p=0.002 OR 1.041), higher Gleason score (p=0.002 OR 1.738) were at increased odds. CONCLUSIONS Results from the current study suggests that non-tumor prostate volume tends to be lower in the prostates when there are no extraprostatic organ involvement. This parameter may serve as an indirect indicator for the distance from the tumor margin and prostate capsule, which may show close association with the occurrence of positive surgical margins. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e559 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Yong Jin Kang More articles by this author Won Sik Jang More articles by this author Jong Kyou Kwon More articles by this author Cheol Yong Yoon More articles by this author Joo Yong Lee More articles by this author Kang Su Cho More articles by this author Won Sik Ham More articles by this author In Rae Cho More articles by this author Young Deuk Choi More articles by this author Myung Soo Kim More articles by this author Won Tae Kim More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

PD30-05 THE IMPACT OF DOWNGRADING FROM BIOPSY GLEASON SCORE 7 TO RADICAL PROSTATECTOMY GLEASON SCORE 6 ON BIOCHEMICAL RECURRENCE

INTRODUCTION AND OBJECTIVES: Downgrading from biopsy Gleason score (Bx GS) 7 to radical prostatectomy (RP) GS 6 could occur if tangentially-sectioned small glands of Gleason 3 on Bx are overgraded as pattern 4, or alternatively if small foci of pattern 4 in the RP specimen are not recorded or unsampled deeper within the paraffin block. In the later scenario, downgraded men might have a worse prognosis than those with Bx and RP GS 6. We investigated whether there was a difference in biochemical recurrence-free survival (BCRFS) rates based on downgrading status. METHODS: Among 24,536 men with RP between 1984 and 2015, we reviewed 15,586 men (group I [Bx GS 6 to RP GS 6]1⁄4 10,538 [67.6%], group II [Bx GS 7 to RP GS 6]1⁄4 941 [6.0%], and group III [Bx GS 7 to RP GS 7]1⁄4 4,107 [26.4%]). For men with complete follow-up, the log-rank test was used to compare BCRFS between the groups. Cox regression analyses were used to determine the impact of downgrading on BCR. RESULTS: At a median follow-up of 5 years (IQR 2-12), 1,025 men experienced BCR. There were significant differences in age, preoperative prostate-specific antigen (PSA), year of surgery, clinicopathological stage, and positive surgical margin (PSM) between groups (all p<0.001). In group II, there was no difference in BCRFS between men with Bx GS 3+4 and men with 4+3, so they were combined into Bx GS 7. The BCRFS rate for group II was better than that of group III, but worse than that of group I (p<0.001, Fig 1). Downgrading from Bx GS 7 to RP GS 6 was an independent predictor for BCR after adjusting for clinico-pathological variables (HR 2.01, p<0.001 for group I versus group II, Table 1). CONCLUSIONS: Downgrading of a GS 7 tumor at Bx could be attributed in most cases to the presence of a small foci of tertiary Gleason grade 4 pattern in the RP specimen. Downgrading from Bx GS 7 to RP GS 6 was an independent predictor of BCR following RP. Source of Funding: none

MP80-14 MRI PRIOR TO PROSTATECTOMY DOES NOT IMPROVE SURGICAL OUTCOMES

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy VII1 Apr 2016MP80-14 MRI PRIOR TO PROSTATECTOMY DOES NOT IMPROVE SURGICAL OUTCOMES Eric Kim, Niraj Badhiwala, Joel Vetter, Robert Grubb, and Gerald Andriole Eric KimEric Kim More articles by this author , Niraj BadhiwalaNiraj Badhiwala More articles by this author , Joel VetterJoel Vetter More articles by this author , Robert GrubbRobert Grubb More articles by this author , and Gerald AndrioleGerald Andriole More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2046AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Magnetic resonance imaging (MRI) of the prostate has been increasingly utilized in the diagnosis of prostate cancer (PCa). Multiple studies have demonstrated benefits in risk stratification of patients as well as biopsy outcomes with MRI. However, the added value of prostate MRI prior to surgical intervention is not well defined. We examined our institutional experience in order to evaluate for improvements in prostatectomy outcomes associated with preoperative MRI. METHODS We identified patients at our institution who underwent prostatectomy for PCa between January 2012 and June 2015 (n=465). Of these patients, 199 had received MRI prior to prostatectomy. Using propensity scoring analysis, patients who had received MRI prior to prostatectomy were matched 1:1 to patients who did not receive MRI, based on age, comorbidity, body-mass index (BMI), prostate-specific antigen (PSA), and biopsy Gleason score. The final matched cohort included 128 patients with preoperative MRI and 128 patients without. Multivariate logistic and linear regression analysis was performed on this cohort examining operative time, estimated blood loss (EBL), perioperative complication, lymph node yield, and positive surgical margin. RESULTS When controlling for all measured variables between the propensity matched cohorts, preoperative MRI was not predictive of operative time, EBL, complications, lymph node yield, or positive surgical margins. No measured variable was predictive of a perioperative complication in this cohort. Preoperative biopsy Gleason score 8 and 9 were predictive of lymph node yield (Estimate 3.2, p=0.02 and 4.8, p<0.01) on multivariate linear regression. Preoperative PSA was predictive of positive surgical margin (OR=1.06, p=0.03). The only predictive variable for EBL and operative time was surgeon. CONCLUSIONS Although prostate MRI has become increasingly utilized in the diagnosis of PCa, preoperative MRI does not improve technical prostatectomy outcomes in our institutional experience. At this time, for patients who are already diagnosed with PCa and planned to undergo prostatectomy, preoperative MRI should not be recommended. Future studies should examine the impact of preoperative MRI on patient self-reported outcomes of urinary continence and sexual function after prostatectomy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1048 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Eric Kim More articles by this author Niraj Badhiwala More articles by this author Joel Vetter More articles by this author Robert Grubb More articles by this author Gerald Andriole More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...