Preoperative Serum Prostate-specific Antigen Level Research Articles

Significance of the cribriform morphology area ratio for biochemical recurrence in Gleason score 4 + 4 prostate cancer patients following robot-assisted radical prostatectomy.

In prostate cancer, histological cribriform patterns are categorized as Gleason pattern 4, and recent studies have indicated that their size and percentage are associated with the risk of biochemical recurrence (BCR). However, these studies included a mixture of cases with various Gleason scores (GSs). We therefore examined the prognostic value of the area and percentage of cribriform patterns in patients with GS 4 + 4 prostate cancer. We investigated 108 patients with GS 4 + 4 prostate cancer who underwent robot-assisted radical prostatectomy (RARP). After digitally scanning the hematoxylin and eosin-stained slides, we measured the area of the entire cancer and cribriform patterns. Predictive factors for BCR were explored using log-rank test and Cox proportional hazard model analyses. Sixty-seven (62.0%) patients had a cribriform pattern in RARP specimens, and 32 (29.6%) experienced BCR. The median total cancer area, cribriform pattern area, and percentage of cribriform pattern area (% cribriform) were 427.70 mm2 (interquartile range [IQR], 171.65-688.53 mm2 ), 8.85 mm2 (IQR, 0-98.83 mm2 ), and 2.44% (IQR, 0%-33.70%), respectively. Univariate analyses showed that higher preoperative serum prostate-specific antigen (PSA) levels, positive resection margins, advanced pathological T stage, extraprostatic extension, larger total cancer area, larger cribriform morphology area, and higher % cribriform values were significantly associated with BCR. A multivariate analysis demonstrated that the PSA level (hazard ratio [HR], 1.061; 95% confidence interval [CI], 1.011-1.113; p = 0.017) and % cribriform (HR, 1.018; 95% CI, 1.005-1.031; p = 0.005) were independent predictors of BCR. An increased % cribriform value was associated with BCR in patients with GS 4 + 4 prostate cancer following RARP.

LONG-TERM RADICAL PROSTATECTOMY ONCOLOGIC OUTCOMES IN PATIENTS WITH CLINICALLY LOCALLY ADVANCED PROSTATE CANCER: A SINGLE-CENTER STUDY.

Prostate cancer (PCa) is the second most frequently diagnosed cancer in males worldwide and placed fifth in cancer mortality among males. Between 14-24% of PCa patients have newly diagnosed advanced stages, which paradoxically has remained stable over time. To estimate and compare long-term radical prostatectomy (RP) oncologic outcomes in patients with clinically locally advanced prostate cancer (LAPCa), to determine the prognostic significance of common clinical-pathological parameters. The study included 105patients with LAPCa who underwent RP with extended pelvic lymphadenectomy between September 2003- April 2015. Kaplan - Meier method was used for calculating biochemical recurrence- (BRFS), progression-free- (PFS), overall (OS), and prostate cancer-specific survival (PCSS) rates. Analyses of features associated with outcomes were conducted using Cox proportional hazards regression model. Patients from cT3b group had worse PFS, OS and PCSS rates in comparison with cT3a, while there was no significant difference in BRFS rates. Preoperative serum prostate-specific antigen level (hazard ratio (HR) 1.023, 95% confidence interval (CI): 1.014-1.033, p < 0.001), pT3a (HR 3,027, 95% CI: 1.449-7.096, p < 0.01), pT3b (HR 2.792, 95% CI: 1.133-6.881, p < 0.05) pT4stage (HR 31.12, 95% CI: 7.646-126.6p< 0.001) and positive lymph nodes status (HR 6.503, 95% CI: 3.190-13.25, p < 0.001) were significant factors in BRFS. Preoperative serum prostate-specific antigen level (HR 1.018, 95% CI: 1.007-1.030, p = 0.001) and positive lymph nodes status (HR 3.191, 95% CI: 1.672-6.088, p < 0.001) were significant factors in PFS and PCSS. RP as the initial treatment option of multimodal therapy in the management of LAPCa patients demonstrates encouraging oncologic outcomes. Patients from the cT3b group had the worse rates of PFS, OS, and PCSS in comparison with the cT3a group. Heterogeneity of LAPCa patients' outcomes reflects the insufficiency of the existing clinical risk classification for the prediction of systemic progression and cancer-specific survival.

Incidence, predictive factors and oncological outcomes of incidental prostate cancer after endoscopic enucleation of the prostate: a systematic review and meta-analysis.

This systematic review aims at reporting the incidence, predictive factors, and the oncological outcomes of incidental prostate cancer (IPCa) in men who underwent endoscopic enucleation of prostate (EEP). A literature search was performed using the following Medical Subject Heading (MeSH) terms and keywords: "Prostatic Neoplasms", "Prostate Cancer", "Transurethral Resection of Prostate", "Prostate resection", "Prostate enucleation". Meta-analysis was performed if there were two or more studies reporting the same outcome under the same definition. In case of insufficient data, results were presented in a narrative manner. Sixty-one studies were included in qualitative synthesis and 55 were included in meta-analysis. The pooled IPCa rate was 0.08 (95% CI 0.073-0.088). Increasing age, higher preoperative serum prostate-specific antigen (PSA) level, higher preoperative PSA density (PSAD), smaller prostate volume, higher postoperative PSA velocity and lower enucleated prostate weight, were reported to have significant correlation with IPCa. In BPH patients, the mean pre-operative and post-operative PSA levels were 5.58 ± 1.48ng/dL and 1.06 ± 0.27ng/dL, respectively. In patients with IPCa, the mean pre-operative and post-operative PSA levels were 7.72 ± 2.90ng/dL and 2.77 ± 1.66ng/dL, respectively. The mean percentage PSA reduction was 82.0% ± 1.8% for BPH patients and 68.2% ± 12.1% for IPCa patients. IPCa was most commonly managed byactive surveillance (68.7%). The pooled incidence of IPCa after EEP was 8%. An absolute post-operative PSA level of < 2.0 and a percentage PSA reduction of > 70% should be expected in BPH patients after EEP.

NANOG as prognostic factor of prostate cancer course.

To investigate the level of NANOG mRNA in tumor tissue of patients with PC and to analyze the possibility of its use as a marker of the disease course. The study involved 85patients with PC of stages II-IV. Morphological and immunohistochemical studies were performed on serial paraffin sections of resected PC using monoclonal antibodies to Ki-67and androgen receptor. NANOG and miR-214mRNA expression in tumor cells was analyzed by real-time reverse transcription polymerase chain reaction. The identification of CSCs was performed by double-labeled immunohistochemical method using primary antibodies to CD24and CD44. We have revealed notable variability of NANOG mRNA levels in tumor tissue of patients with PC (mean 4.18 ± 0.65a.u. with individual deviations from 0.11 ± 0.03a.u. to 15.24 ± 0.36a.u.). According to NANOG mRNA levels, two groups of the PC patients were delineated: group 1and group 2, with the average NANOG mRNA levels of 2.12 ± 0.16a.u., and 8.68 ± 1.24a.u., respectively. The NANOG mRNA levels in tumor tissue of PC patients of groups 1and 2correlated with preoperative serum prostate-specific antigen level (r = 0.58; p < 0.05and r = 0.64;p < 0.05, respectively), tumor volume (r=0.42; p <0.05and r = 0.72; p < 0.05, respectively), regional lymph node metastases (r = 0.70; p < 0.05and r = 0.75; p < 0.05, respectively). High NANOG mRNA levels in tumor cells were associated with such molecular and biological features of PC as androgen receptor expression (r = 0.52; p < 0.05), high proliferative activity (r = 0.60; p < 0.05) and the presence of CSC markers (r = 0.75; p < 0.05). The findings indicate that NANOG is involved in the formation of the PC malignancy and should be further studied as a potential marker for the prediction of the disease course.

KPNA2/ERG Coexpression is Associated With Early Recurrence in Advanced Prostate Cancers.

Most prostate cancers (PC) overexpress the ERG oncogene and karyopherin α 2 (KPNA2). These genes play a role in prostatic carcinogenesis, but their prognostic significance is still debated. The aim of this study was to determine the prognostic significance of ERG and KPNA2 expression, and their association to early prostate-specific antigen (PSA) biochemical recurrence in advanced PC with lymph node metastases. A series of 65 consecutive pN1 M0 R0 PC samples obtained by radical prostatectomy with lymphadenectomy has been analyzed for ERG and KPNA2 expression by immunohistochemistry. For each case, the following clinical data were collected: age, preoperative serum PSA levels, Gleason grade group, TNM stage, and follow-up. PC recurrence was investigated by serum PSA assay and defined by a PSA concentration >0.2 ng/mL after a nadir of <0.1 ng/mL following radical prostatectomy. ERG-positive staining was found in 25/65 cases (38%), and KPNA2 in 56/65 cases (86%); neither was detected in normal prostatic tissue. Immunohistochemical concordance was found between primary tumor and lymph node metastases in 24/25 (96%) of ERG and 53/56 (95%) of KPNA2-positive cases. The follow-up was known in all cases, and early PSA recurrence occurred in 25/65 cases (38%). ERG positivity, both alone and in conjunction with KPNA2 positivity, was strongly associated with early PSA recurrence [both ERG+ and KPNA+, odds ratio: 22.2 (95% confidence interval, 6.0-82.3); ERG+ alone odds ratio: 17.9 (95% confidence interval, 5.1-63.5); P<0.0001 for both]. KPNA2 expression was significantly associated with the tumor stage (P<0.00001). The results suggest that the ERG+ phenotype might be selected in metastasis-initiating clones. ERG and KPNA2 may have a prognostic value, and their positivity in PC might warrant more aggressive treatments.

Analysis of quality of life and late biochemical predictors for localized cancer recurrence following radical prostatectomy.

Patients with localized prostate cancer (PCa) experience biochemical recurrence (BCR) despite a curatively intended radical prostatectomy (RP). The aim of this study was to describe the quality of life (QoL) of patients with a BCR while identifying predictors of early (ER) and late recurrence (LR). For this purpose, a total of 330 PCa patients with a BCR following RP at Charité University Hospital in Berlin were analyzed. BCR was defined as two consecutive PSA values ≥0.2 after a previous non-detectable level. LR was defined as a BCR after 3years post-RP. Differences in overall survival (OS) were calculated using the log-rank testing. A logistic regression model was applied to identify predictors of ER and LR. We further evaluated difference between ER and LR with respect to functional outcomes in urinary and sexual domains as well as the patients QoL. Out of 330 patients, 180 patients showed late BCR. Patients rated their global QoL with 64.5% in ER and 68.8% LR as good (EORTC quality of life Questionnaire, question 29 and 30). The questionnaire did not reveal QoL differences in terms of sexual and urinary function within ER and LR. The main predictor for LR was preoperative serum prostate-specific antigen (PSA) levels with a relative risk (RR) of 0.96 (p = 0.011). OS for patients with LR was significant longer than for patients with ER (154.3 vs. 143.2months, p = 0.018). Patients with a BCR show a good quality of life possibly irrespective of the time point of BCR. We further identified preoperative PSA levels as a predictor of LR and noted that patients with LR patients lived longer. Further studies are needed.

Olfactomedin 4 downregulation is associated with tumor initiation, growth and progression in human prostate cancer.

The olfactomedin 4 (OLFM4) gene has been analyzed as a tumor‐suppressor gene and a putative biomarker in many cancers. In our study, we analyzed the relationship of OLFM4 expression with clinicopathological features and with CpG site methylation in the OLFM4 gene promoter region in human primary prostate adenocarcinoma. OLFM4 protein expression was significantly reduced in prostate cancer tissue compared to adjacent normal tissue and was further significantly reduced in more advanced cancers. Bioinformatic studies with clinical datasets revealed that primary prostate adenocarcinoma patients with reduced OLFM4 mRNA expression exhibited higher Gleason scores and higher preoperative serum prostate‐specific antigen levels, as well as lower recurrence‐free survival. Three of the eight CpG sites in the OLFM4 gene promoter region were hypermethylated in cancerous prostate cells compared to adjacent normal cells, and reduced methylation of eight CpG sites was associated with increased OLFM4 mRNA expression in RWPE1 and PC‐3 cells. Furthermore, knockdown of OLFM4 gene expression was associated with enhanced epithelial–mesenchymal transition (EMT)‐marker expression in RWPE immortalized normal prostate cells. In contrast, restoration of OLFM4 expression in PC‐3 and DU145 prostate cancer cells lacking OLFM4 significantly inhibited both EMT‐marker expression and tumor cell growth in in vitro and in vivo models, indicating that OLFM4 may play a tumor‐suppressor role in inhibiting the EMT program, as well as tumor initiation and growth, in prostate cells. Taken together, these findings suggest that OLFM4 plays an important tumor‐suppressor role in prostate cancer progression and might be useful as a novel candidate biomarker for prostate cancer.

Robotic radical prostatectomy in 93 cases: Outcomes of the first ERUS robotic urology curriculum trained surgeon in Turkey.

This study presents the surgical, oncological, and functional outcomes of the first 93 robotic radical prostatectomy (RARP) procedures performed in Erzurum, Turkey. These procedures were performed by a single surgeon who had completed the European Association of Urology Robotic Urology Section (ERUS) RARP curriculum in an ERUS-certified training center in Ankara. The study present the results of 93 RARP procedures performed by a single surgeon. The surgeon performing the operations completed an ERUS training program structured for RARP by two robotic surgeons holding ERUS training certificates in an ERUS-approved academic robotic surgery training center in Ankara. The RARP cases performed by the surgeon after completion of the training between April 2016 and August 2018 were retrospectively evaluated. The mean patient age was 63.62±7.04 years, and the mean preoperative serum prostate-specific antigen level was 8.34±4.96 ng/mL. Preoperatively, 82 and 4 patients had prostate biopsy Gleason scores of 3+3 and 4+3, respectively. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 21, 13, and 59 cases, respectively. The mean prostate weight was 85.34±47.57 g. Posterior rhabdosphincter reconstruction was performed in 60 (64.5%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 170.49±36.50 min, 100.70±34.08 cc, 6.84±2.28 days, and 7.40±3.11 days, respectively. During the perioperative period (0-30 days), five minor (prolonged drain output, n=3; rectocele, n=1; gout arthritis, n=1) and six major (inguinal hernia, n=1; incisional hernia, n=2; anastomotic urinary leakage, n=2; myocardial infarction, n=1) complications were identified. No complication was detected during postoperative days 31-90. Postoperative pathological stages included pT2a, pT2b, and pT2c disease in 77 (82.8%), 9 (9.7%), and 7 (7.5%) patients, respectively. The positive surgical margin (SM) rate was 10.7% (n=10), including patients with pT2a (n=6) and pT2c (n=2) diseases. Eleven (11.8%) patients underwent pelvic lymph node (LN) dissection. The mean LN yield was 16.45±4.29. The mean length of follow-up was 11.17±8.01 months. Biochemical recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up (n=48, 51.6%) were fully continent (0 pads/day). Of the 40 (43%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 18 (45%) had no ED, with or without any additional medication including phosphodiesterase-5 (PDE5) inhibitors. RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results. The ERUS RARP curriculum provides effective and sufficient training.

Robot-assisted laparoscopic radical prostatectomy: A single center initial experience

Aim: The aim of this study is to present the surgical, oncologic and functional results of the first 34 robotic radical prostatectomy (RARP) procedures performed in our clinic.Material and Methods: Data of 34 patients who underwent RARP between July 2017 and October 2019 were evaluated.Results: The mean patient age was 58.73±4.94 years, and the mean preoperative serum prostate-specific antigen level was 8.9±2.07 ng/mL. Bilateral neurovascular bundle (NVB) sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 7.5, and 22 cases, respectively. The mean prostate weight was 58.73±26.03g. Anterior reconstruction suture was performed in 22 (64.7%) cases. Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 195.2±14.03min, 120.3±21.2cc, 7.34±1.62 days, and 7.26±1.26 days, respectively. Biochemi¬cal recurrence was observed in two patients, one of whom received maximal androgen blockage (MAB), and the other one received pelvic radiotherapy+MAB. All the patients with at least one-year follow-up were fully continent (0 pads/day). Of the 16 (47%) patients with no preoperative erectile dysfunction (ED) and with at least three-month follow-up, 9 (62.5%) had no ED, with or without any additional medica¬tion including phosphodiesterase-5 (PDE5) inhibitors. Conclusion: RARP is a safe minimally invasive procedure with acceptable morbidity, excellent operative, pathological and oncological outcomes, and satisfactory functional results.

Preoperative Serum Prostate-Specific Antigen Level is a Predictive Factor for Biochemical Recurrence in High Risk Prostate Cancer after Radical Prostatectomy

Preoperative Serum Prostate-Specific Antigen Level is a Predictive Factor for Biochemical Recurrence in High Risk Prostate Cancer after Radical Prostatectomy

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.

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.

Preoperative Serum Prostate-Specific Antigen Levels Vary According to the Topographical Distribution of Prostate Cancer in Prostatectomy Specimens

To evaluate whether the spatial distribution of prostate cancer (PCa) influences the concentration of prostate-specific antigen (PSA). An observational prospective study was performed in 775 consecutive men with preoperative PSA levels ≤20 ng/mL who underwent radical prostatectomy for organ-confined PCa. We evaluated prostate specimens using a cMDX-based map model of the prostate and determined the prostate volume, number of cancer foci, relative tumor volume, Gleason score, zone of origin, localization, and pathologic stage after stratification according to PSA levels categorized into 3 groups: <4 ng/mL, 4-10 ng/mL, and 10.1-20 ng/mL. The distribution of 5254 PCa foci was analyzed after stratification according to PSA levels and visualized on heat maps. A logistic regression analysis was performed to assess the odds ratios of PSA levels for the presence of PCa in 16 regions. PCa with PSA <4 ng/mL was predominantly localized to the apical part and the peripheral zone of the prostate. PCa with a PSA level 10.1-20 ng/mL (16.4% of cases) was observed more frequently in the anterior part and the base of the prostate than PCa with a PSA level <4 or 4-10 ng/mL (6% and 10%, respectively). Preoperative PSA levels vary according to the spatial distribution of PCa in radical prostatectomy specimens. The probability of anterior PCa is increased with higher PSA serum levels. Regions of interest harboring the PCa can be defined according to preoperative PSA and prostate volume. These findings are useful to optimize the focal therapy or to adjust the radiation fields.

A Comparison of Prostatic Acinar Adenocarcinoma Gleason 3+4 versus 4+3 in Different Laboratory Practice Settings

Objective: To evaluate Gleason 7 tumors from radical prostatectomy specimens that were stratified by 3+4 and 4+3 status, focusing on the clinical and morphologic features. Methods and results: In the first series of 20 Gleason 7 tumors processed by total embedding, cases with 4+3 status were associated with a higher proliferation index. In a second series of 106 Gleason 7 tumors processed by partial embedding, 4+3 status was associated with higher preoperative serum prostate-specific antigen levels and a higher frequency of extraprostatic extension and seminal vesicle invasion. Conclusion: For those laboratories that employ partial samplings as the adopted method for processing radical prostatectomy specimens, inclusion of the entire prostatic periphery and extraprostatic tissue is advised to avoid understaging caused by missing extraprostatic extension.

Outcomes of Robotic Radical Prostatectomy in High-risk Prostate Cancer Patients: Experience in 60 Patients with Oncological and Functional Outcomes

Introduction: In this retrospective study, we report outcomes of robot-assisted laparoscopic radical prostatectomy (RARP) in high-risk prostate cancer (HRPC), classified according to the D’Amico risk criteria and with a minimum follow-up of 1 year. Methods: A total of 60 patients who had at least one preoperative HRPC feature and underwent RARP were included. Mean patient age and preoperative serum prostate-specific antigen level were 66.4±7.5 years and 13.4±11.0 ng/ml, respectively. Preoperatively, 3 (5.0%), 4 (6.7%), 17 (28.3%), 3 (5.0%), and 33 (55.0%) patients had prostate biopsy-proven Gleason scores of 5+4, 4+5, 4+4, 3+5, and &lt;8, respectively. Bilateral neurovascular bundle (NVB)-sparing, unilateral NVB-sparing, and non-NVB-sparing surgery were performed in 44 (73.3%), 3 (5.0%), and 13 (21.7%) patients, respectively. Results: Mean console time, intraoperative blood loss, duration of hospital stay, and urethral catheter removal time were 159.7±62.4 minutes, 210±201.9 ml, 3.9±1.9 days, and 10.9±5.3 days, respectively. During the perioperative period (Days 0-30), 7 minor and 5 major complications occurred as categorised using the modified Clavien classification. No complications were detected during postoperative Days 31-90. Postoperative pathological stages included pT0, pT2a, pT2b, pT2c, pT3a, and pT3b disease in 2 (3.3%), 8 (13.3%), 4 (6.7%), 14 (23.3%), 18 (30.0%), and 14 (23.3%) patients, respectively. The positive surgical margin rate was 26.7% and mean lymph node yield was 11.8±8.3 (range: 3-37). Mean follow-up was 27.8±11.1 months. Biochemical recurrence was detected in 13 (21.7%) patients. Of the total 60 patients, 26 (43.3%) were fully continent (0 pad/day), 15 (25.0%) wore a safety pad/day, 10 (16.7%) wore 1 pad/day, 5 (8.3%) wore 2 pads/day, and 4 (6.7%) wore &gt;2 pads/day. Of the 27 patients with no preoperative erectile dysfunction (ED), 17 (63.0%) had no ED at a mean follow-up of 1 year. Trifecta and pentafecta rates were 43.2% and 28.7%, respectively. Conclusion: Based on our experience, RARP in HRPC is a relatively safe procedure with satisfactory oncological and functional outcomes.

Treatment patterns in patients with metastatic prostate cancer at King Abdulaziz Medical City in Jeddah – a retrospective study

Introduction: Prostate cancer is the fifth most common cancer in men in Saudi Arabia. It accounts for 6% of all newly diagnosed cases among Saudi males. Approximately one-third of cases present at an advanced stage or develop metastatic disease after the initial definitive treatment. To our knowledge, there are no data available in Saudi Arabia on the treatment modalities or on the outcome of patients with metastatic prostate cancer. Objectives: To evaluate treatment modalities and the outcome of patients with metastatic prostate cancer in patients attending King Abdulaziz Medical City (KAMC), Jeddah, Saudi Arabia. Materials and methods: The medical records at KAMC in Jeddah were searched to identify patients with metastatic prostate cancer. Patients aged ≥ 18 years with adenocarcinoma subtype who were treated at KAMC were included in this study. Results: After exclusion of early and locally advanced cases, 80 cases with metastatic prostate cancer were identified. The median age was 71 years (range 44– 90 years), the majority had a Gleason score ≥ 7; 83% (48/58 patients), median preoperative serum prostate-specific antigen level 177μ g/ml (range 5– 2000). Bone metastasis were seen in 90% (n =73) and visceral metastasis in 27% (n =22). The median follow-up was 49 months (37– 61 months). All patients received hormonal deprivation therapy (either luteinizing hormone-releasing hormone agonist or antiandrogen or both), around 27% (n =22) underwent bilateral orchiectomy. Out of 81 patients, 22 received second-line therapy, either chemotherapy (docetaxel or mitoxantrone) or abiraterone acetate (Zytiga®, Janssen, Titusville, NJ, USA) or both. The median survival was significantly longer in patients who received second-line therapy than in patients who received best supportive treatment [29 months (95% confidence interval 15.4 to 42.5) vs. 15 months (95% confidence interval 12.3 to 17.6); P =0.049]. Conclusions: The clinicopathological characteristics and outcome of patients with metastatic prostate cancer were comparable to previous findings. Second-line therapies improved the median survival time for those patients significantly. Acknowledgements: Dr Mubarak Almansour for his great supervision in this project.

Upgrading and upstaging of low-risk prostate cancer among Korean patients: a multicenter study.

Only 54% of prostate cancer cases in Korea are localized compared with 82% of cases in the US. Furthermore, half of Korean patients are upgraded after radical prostatectomy (41.6%–50.6%). We investigated the risk factors for upgrading and/or upstaging of low-risk prostate cancer after radical prostatectomy. We retrospectively reviewed the medical records of 1159 patients who underwent radical prostatectomy at five hospitals in Honam Province. Preoperative data on standard clinicopathological parameters were collected. The radical prostatectomy specimens were graded and staged and we defined a “worsening prognosis” as a Gleason score ≥ 7 or upstaging to ≥ pT3. Multivariate logistic regression models were used to assess factors associated with postoperative pathological upstaging. Among the 1159 patients, 324 were classified into the clinically low-risk group, and 154 (47.5%) patients were either upgraded or upstaged. The multivariable analysis revealed that the preoperative serum prostate-specific antigen level (odds ratio [OR], 1.131; 95% confidence interval [CI], 1.007–1.271; P= 0.037), percent positive biopsy core (OR: 1.018; 95% CI: 1.002–1.035; P= 0.032), and small prostate volume (≤30 ml) (OR: 2.280; 95% CI: 1.351–3.848; P= 0.002) were predictive of a worsening prognosis. Overall, 47.5% of patients with low-risk disease were upstaged postoperatively. The current risk stratification criteria may be too relaxed for our study cohort.

AZGP-1 Immunohistochemical Marker in Prostate Cancer

One of the major challenges in prostate cancer research is to identify prognostic/predictive factors to distinguish aggressive disease from indolent one. To select prognostic/predictive markers of postoperative biochemical recurrence (BCR) that could be easily performed in daily pathology practice, the expression of 6 immunohistochemical markers including zinc-α-2-glycoprotein (AZGP-1), hCAP-D3, mucin 1, vimentin, E-cadherin, and ERG was assessed in a tissue microarray of 400 radical prostatectomy specimens. The expression levels were correlated with clinicopathologic factors and BCR. During the median follow-up period of 55 months, BCR occurred in 70 cases (17.5%). Low expression of AZGP-1 was noted in 76 cases (19.0%), whereas high expression of hCAP-D3, mucin 1, vimentin, and ERG was observed in 205 (51.3%), 81 (20.3%), 33 (8.3%), and 58 (14.5%) cases, respectively. Aberrant E-cadherin expression was noted in 29 cases (7.3%). By univariate analysis, BCR was associated with low expression of AZGP-1, high expression of hCAP-D3, and aberrant expression of E-cadherin. By multivariate analysis, only AZGP-1 remained an independent immunohistochemical factor, in addition to age, preoperative serum prostate-specific antigen level, Gleason score, tumor stage, and resection margin status. These results show that AZGP-1, hCAP-D3, and E-cadherin are potentially useful immunohistochemical markers to predict BCR, and that AZGP-1 can be used as an independent prognostic marker of aggressive prostate cancer.

Nuclear KLLN expression associates with improved relapse-free survival for prostate carcinoma.

Men with organ-confined prostate cancer (CaP) are often treated with radical prostatectomy. Despite similar postoperative characteristics, a significant proportion of men with an intermediate risk of progression experience prostate-specific antigen (PSA)-defined failure, while others have relapse-free survival (RFS). Additional prognostic markers are needed to predict the outcome of these patients. KLLN is a transcription factor that regulates the cell cycle and induces apoptosis in cancer cells. We have shown that KLLN is an androgen-regulated gene and that loss of KLLN expression in primary CaP is associated with high Gleason score. In this retrospective study, we evaluated KLLN expression in the high-grade malignancy components from 109 men with intermediate risk CaP. Patients with nuclear KLLN-negative tumors had significantly higher preoperative serum PSA levels (12.24±2.37 ng/ml) and larger tumor volumes (4.61±0.71 cm(3)) compared with nuclear KLLN-positive patients (8.35±2.45 ng/ml, P=0.03, and 2.66±0.51 cm(3), P<0.0001, respectively). None of the nuclear KLLN-positive tumors had capsular penetration, whereas 34% of nuclear KLLN-negative tumors (P=0.004) had capsular penetration. Maintaining KLLN expression in tumor nuclei, but not in cytoplasm or stroma, associated with improved RFS after surgery (P=0.002). Only 7% of patients with nuclear KLLN-positive tumors had tumor recurrence, while 60% of patients in the KLLN-negative group developed PSA-defined failure with median relapse time of 6.6 months (P=0.0003). Our data suggest that KLLN expression may be used as a prognostic marker to predict outcome for intermediate risk patients, which could provide useful information for postoperative management.

Histologic Inflammatory Changes on the Prostatic Gland Due to Immunosuppression for Kidney Transplantation

To determine the incidence of type IV prostatitis in patients with kidney transplantation receiving an immunosuppression regimen and to compare it with that of a nonimmunosuppressed control group. We retrospectively reviewed 216 electronic charts of patients who had undergone surgical treatment for benign prostatic hyperplasia from August 2000 to January 2006. Of the 216 patients, 183 did not receive immunosuppressive therapy and were included in the control group (group 1). The other 33 patients had undergone kidney transplantation and were included in the study group (group 2). The patient data were accessed for age at surgery, International Prostate Symptom Score, prostate volume, preoperative serum prostate-specific antigen level, history of acute urinary retention, and surgical approach (open vs transurethral resection of prostate). Histologic findings from the surgical specimens were also recorded. The mean age at surgery, mean serum prostate-specific antigen level, mean prostate volume, and mean International Prostate Symptom Score were not significantly different between both groups. However, histologic evidence of chronic prostatitis was obtained in 145 surgical specimens (78%) from group 1 and in just 3 specimens from group 2 (9%; P < .001). Moreover, nonimmunosuppressed patients had a 38.2 times greater risk of presenting with prostatitis than did the immunosuppressed patients. Immunosuppression therapy in kidney transplantation has a protective factor in the prostatitis incidence.