Radical Retropubic Prostatectomy Specimens Research Articles

Effect of age on biochemical recurrence after radical prostatectomy

The aim of the study was to evaluate the relationship between patient's age and biochemical recurrence (BCR) after radical retropubic prostatectomy (RRP). Data from RRP applied to 305 patients with clinically localized prostate cancer were included in the study. Patients were divided into the three age groups, < 60 years, 60–70 years, and > 70 years. The groups were compared regarding adverse pathological findings on RRP specimen, BCR, and biochemical recurrence-free survival (bRFS) rates. The rates of positive surgical margin, seminal vesicle invasion, lymph node involvement, RRP specimens' Gleason score, and BCR were not significantly different among the three age groups. bRFS rates were not different either. Nonorgan-confined disease and extracapsular extension (ECE) rates were significantly higher in the group of 60–70 years group than in the other two age groups. Factors associated with BCR in multivariate Cox regression analysis were ECE, seminal vesicle invasion, positive surgical margin, and RRP specimens' Gleason score of ≥ 4+3. Patient age and preoperative prostate specific antigen levels were not identified to be associated with BCR. Post-RRP nonorgan-confined disease and ECE are more frequently seen in patients of 60–70 years of age group than in other age groups. However, patient age is not an independent prognostic factor associated with bRFS.

Impact of positive surgical margin on biochemical recurrence following radical prostatectomy in locally advanced prostate cancer

This study aimed to determine the effect of surgical margin positivity on biochemical recurrence (BCR) in patients with locally advanced prostate cancer (PCa) who underwent radical retropubic prostatectomy (RRP). The medical records of all patients with locally advanced PCa that underwent RRP were retrospectively reviewed. Patient demographics, digital rectal examination findings, prostate biopsy Gleason score, prostate volume, pre- and post-treatment prostate-specific antigen (PSA) levels, definitive pathology Gleason score, surgical margin status, seminal vesicle invasion, perineural invasion, absence or presence of BCR, and the time to BCR were analyzed. The study included 130 patients. The final pathologic examination showed that seven (5.4%) patients had T3a disease and 123 (94.6%) had T3b disease. In all, 93 (71.5%) patients had a positive surgical margin [SM(+)], whereas 37 (28.5%) patients had a negative surgical margin [SM(−)]. Among the seven patients with pT3a disease, four (57.1%) had SM(+), whereas 89 (72.4%) of the 123 patients with pT3b disease had SM(−). BCR occurred in 11.8% (11 of 93) of patients with SM(+) and in 45.9% (17 of 37) of those with SM(−) (p < 0.001). Multivariate logistic regression analysis showed that SM(+) was the only significant predictor of BCR following RRP (relative risk, 0.163; 95% confidence interval (0.062–0.433); p < 0.001). SM(+) in RRP specimens is not always indicative of BCR in patients with locally advanced PCa. RRP should be considered an effective treatment choice for selected patients with locally advanced PCa, despite the associated high SM(+) rate.

Can perineural invasion detected in prostate needle biopsy specimens predict surgical margin positivity in D'Amico low risk patients?

In this study, our aim was to estimate the value of perineural invasion (PNI) in prostate needle biopsy (PNB) specimens in the prediction of surgical margin positivity (SMP) and its prognostic significance (upgrade Gleason Score) in patients who had undergone radical retropubic prostatectomy (RRP) with low risk prostate cancer according to D'Amico risk assessment. We retrospectively analyzed the data of 65 patients who were diagnosed as clinical stage T1c prostate cancer (PC) and underwent RRP between January 2010 and June 2013. Pathological specimens of PNB and RRP were separately examined for the parameters of PNI, vascular invasion (VI), Gleason Score (GS) and SMP. The patients' mean age was 63.65 ± 4.93 (range 47- 75) years. PNI in PNB specimens were identified in 12 of 65 patients and 11 of 12 patients showed SMP on RRP specimens. While 53 of 65 patients had not PNI on PNB, only 11 of them demonstrated SMP on RRP specimens. SMP was 30.64-fold more frequently encountered in PNB specimens obtained from PNI-positive patients relative to PNI-negative patients. In our study, PNI detected in PNB specimens was statistically significantly associated with SMP on RRP specimens (P = 0.0001). It is well known that higher PSA values and GS were independent predictors of SMP in clinically localized prostate cancer (CLPC). We think that PNI in PNB specimens may be a useful prognostic factor for predicting SMP in cases with CLPC.

Prostate Volume in Patients Undergoing Primary Surgical or Radiotherapeutic Management of Localized Adenocarcinoma: Implications for Design of Minimally Invasive Imaging and Treatment Devices for the Prostate

Introduction: The objective of this study was to collect and analyze prostate volumetric data from different patient cohorts treated for localized prostate cancer. These data were examined with respect to the design of minimally invasive treatment devices for localized prostate cancer. Methods: Among 700 patients with prostate cancer (stages T1a-T3c), 342 had radical retropubic prostatectomy (RRP) specimens submitted for whole mounting; 308 received permanent prostate brachytherapy and underwent transrectal ultrasonography (TRUS); and 50 received external beam radiotherapy with computed tomographic (CT)- based 3-dimensional treatment planning. Analysis included cumulative histograms, descriptive statistics, and statistical comparisons of median height, width, length, and volume. Results: Median prostate dimensions (in millimeters) and volumes (in cubic centimeters) were as follows: Height by RRP was 30; TRUS prolate, 33; TRUS planimetry, 35; and CT, 42. Width by RRP was 47; TRUS prolate, 50; TRUS planimetry, 51; and CT, 51. Length by RRP was 42; TRUS prolate, 49; TRUS planimetry, 45; and CT, 41. Volume by RRP was 32; TRUS prolate, 41; TRUS planimetry, 43; and CT, 45. Conclusions: Although median TRUS and CT volumes were similar (41-45 cm3), median RRP volume was 9 to 13 cm3 less. Of the cases examined, 75% would be encompassed by an imaging device with an azimuthal field of view of 48 to 55 mm and 95% by a device with a length of 54 to 63 mm.

Biobanking of derivatives from radical retropubic and robot‐assisted laparoscopic prostatectomy tissues as part of the prostate cancer biorepository network

The goal of the Prostate Cancer Biorepository Network (PCBN) is to develop a biorepository with high-quality, well-annotated specimens obtained in a systematic, reproducible fashion using optimized and standardized protocols, and an infrastructure to facilitate the growth of the resource and its wide usage by the prostate cancer research community. An emerging area of concern in the field of prostate cancer biobanking is an apparent shift in the proportion of surgical procedures performed for prostate cancer treatment from radical retropubic prostatectomy (RRP) to robot-assisted laparoscopic prostatectomy (RALP). Our study aimed to determine the potential impact of the RALP procedure on the detection of known prostate cancer biomarkers, and the subsequent suitability of RALP-derived specimens for prostate cancer biomarker studies. DNA and RNA were extracted from RRP and RALP specimens. Quality assessment was conducted using spectrophotometric analysis and RNA was analyzed for RNA integrity number (RIN) and by real-time reverse-transcription PCR (qRT-PCR) for racemase, hepsin, ERG, TMPRSS2-ERG gene fusions, and the microRNAs miR-26a, miR-26b, miR-141, and miR-221. We demonstrate that extraction of derivatives from frozen tissues from RRP and RALP specimens yields samples of equally high quality as assessed by spectrophotometric and RIN analysis. Likewise, expression levels of genes analyzed by qRT-PCR did not differ between RRP and RALP-derived tissues. Our studies indicate that samples obtained from RALP specimens may be suitable for prostate cancer biomarker studies-an important finding given the current shift in surgical procedures for prostate cancer treatment.

Increased rate of positive biopsies using a combination of MR-Tomography, spectroscopy and diffusion-weighted magnetic resonance imaging prior to prostate biopsies in patients with persistent elevated prostate-specific antigen values: A retrospective analysis

Purpose:Persistently elevated prostate-specific antigen (PSA) values following negative biopsies result in a diagnostic dilemma. In order to improve detection rates in patients with former negative biopsies and persistently elevated PSA values, magnetic resonance tomography (MRT), magnetic resonance spectroscopy (MRS), and diffusion-weighted magnetic resonance imaging (DW-MRI) were performed prior to prostate rebiopsies.Materials and Methods:Over a 14-month period, 67 patients (mean age of 66 years) with a history of 1-5 negative biopsies underwent endorectal magnetic resonance imaging (MRI) using T2-weighted MRT MRS and DW-MRI before an additional prostate biopsy was performed. Subsequently, 5 contrast-enhanced transrectal ultrasound-guided biopsies were performed according to a 10-core systematic scheme. Out of the 67 men, 25 patients had positive biopsies and opted for radical prostatectomy. Histological evaluation of cancer localization, PSA, diameters of primary tumors, numbers and diameters of satellite tumors, prostate volume, and staging pathology was performed. These findings were compared with MRI and MRS results.Results:Serum PSA levels ranged from 3.1 to 19.5 g/ml (median level of 7.96 ng/ml). After the 25 patients underwent radical prostatectomy, analysis of 20 whole-mount sections of 25 radical retropubic prostatectomy (RPE) specimens presented results agreeing with the tumor location from MRI and MRS data.Conclusions:The aim of image-guided diagnostics should be to provide more critical information prior to biopsy. Furthermore, the acquisition of such data is important for better risk stratification in therapeutic decisions.

Blood and tissue nitric oxide and malondialdehyde are prognostic indicators of localized prostate cancer

Our objective was to examine blood and tissue levels of nitric oxide (NO) and malondialdehyde (MDA), and their correlations with well-known prognostic indicators [total prostate-specific antigen (tPSA), %free/total PSA (%f/t PSA), pathological stage (pT), and Gleason sum] in patients who had radical retropubic prostatectomy (RRP) for localized prostate cancer (PCa) without metastasis. Preoperatively 31 patients' bloods were obtained for determination of NO, MDA, fPSA, tPSA, and %f/tPSA ratios. Tissues were obtained from RRP specimens for determination of NO and MDA. Gleason sum was assigned for each patient, and pT was determined according to 2002 TNM staging system. pTs were as follows: 10 pT2a, 7 pT2b, 8 pT2c, 4 pT3a, and 2 pT3b. Gleason sum of the PCa in the RRP specimens was as follows: 5 in 1, 6 in 14, 7 in 14, and 9 in 2 patients. There were strong correlations between blood and tissue levels of NO (r=0.83, p<0.001) and MDA (r=0.63, p<0.001), between serum NO and plasma MDA (r=0.88, p<0.001), and finally between tissue NO and tissue MDA (r=0.83, p<0.001). There was also a significant (p<0.05) relationship between all well-known prognostic indicators of PCa (tPSA, %f/tPSA, Gleason sum, and pT) and blood and tissue NO and MDA levels, with single exception of correlation between tissue MDA and Gleason sum (p=0.073). Clinically appropriate correlations shown in this study indicates that NO and MDA may be used for prognostic assessment of localized PCa, especially if supported with other well-designed studies including higher number of patients through multi-institutional collaboration.

Cadaveric Analysis of Periprostatic Nerve Distribution: An Anatomical Basis for High Anterior Release During Radical Prostatectomy?

An accurate, complete understanding of the prostate neuroanatomy is required to optimize nerve sparing techniques during radical prostatectomy. However, the precise topography and function of the periprostatic nerves remain contentious and there is uncertainty about which nerve sparing technique is most optimal. We accurately quantified the distribution, precise localization and cross-sectional area of periprostatic neural tissue using cadaveric specimens. We analyzed 13 cadaveric hemipelves using hematoxylin and eosin stained sections from the base, mid zone and apex of each prostate. Each section was digitized and divided into 6 sectors numbered clockwise. Analysis was performed using National Institutes of Health ImageJ software to calculate the total periprostatic neural cross-sectional area per sector. Calculating the total neural cross-sectional area highlighted a decrease from prostate base to mid zone to apex of 24.7, 19.7 and 13.7 mm(2), respectively. Most neural tissue was located in the posterolateral region. However, the proportion surrounding the anterior part of the prostate increased toward the apex with a median of 6.0% and 7.6% at the base and mid zone regions, respectively, increasing to 11.2% at the apex. Simple numerical nerve quantification may be insufficient to accurately describe the periprostatic neural distribution. Calculating nerve bundle cross-sectional area confirmed that most neural tissue is in the posterolateral region, although the proportion located anterior increases from base to apex. Thus, higher release of the periprostatic fascia may be indicated toward the apex.

PT3 Predictive Factors in Patients with a Gleason Score of 6 in Prostate Biopsies

PurposeOften, a diagnosis of pT3 is made on the basis of radical retropubic prostatectomy specimens, despite a Gleason score of 6 on the preoperative prostate biopsy. Thus, we investigated the preoperative variables in patients displaying these characteristics.Materials and MethodsStudy subjects comprised patients at our institute from 1996 to July 2010 who had exhibited a Gleason score of 6 on their prostate biopsies and had undergone a radical retropubic prostatectomy. Through univariate and multivariate analysis, we investigated pT3 predictive factors including age, preoperative prostate-specific antigen (PSA) levels, transrectal ultrasonography (TRUS)-weighted prostate volume, digital rectal examination findings, bilaterality via prostate biopsy, prostatic cancer in prostate base cores via prostate biopsy, maximum length and percent of prostatic cancer, and number of cores detected in prostatic cancer via prostate biopsy.ResultsIn the univariate logistic regression mode, a PSA value of 7.4 ng/ml or higher, TRUS-weighted PSA density of 0.2 ng/ml/cc or higher, prostate cancer detected in the basal core, and prostate cancer detected in 2 or more cores out of 12 were predictive factors for extraprostatic extension. Independent predictive factors for stage pT3 were a PSA of 7.4 ng/ml or higher and prostate cancer detected in 2 or more cores out of 12.ConclusionsIn the case of patients with the foregoing risk factors, it is advisable not to perform nerve-sparing surgery but to prepare for the possibility of a pT3 stage.

Comparative Analysis of Whole Mount Processing and Systematic Sampling of Radical Prostatectomy Specimens: Pathological Outcomes and Risk of Biochemical Recurrence

Whole mount processing is more resource intensive than routine systematic sampling of radical retropubic prostatectomy specimens. We compared whole mount and systematic sampling for detecting pathological outcomes, and compared the prognostic value of pathological findings across pathological methods. We included men (608 whole mount and 525 systematic sampling samples) with no prior treatment who underwent radical retropubic prostatectomy at Vanderbilt University Medical Center between January 2000 and June 2008. We used univariate and multivariate analysis to compare the pathological outcome detection rate between pathological methods. Kaplan-Meier curves and the log rank test were used to compare the prognostic value of pathological findings across pathological methods. There were no significant differences between the whole mount and the systematic sampling groups in detecting extraprostatic extension (25% vs 30%), positive surgical margins (31% vs 31%), pathological Gleason score less than 7 (49% vs 43%), 7 (39% vs 43%) or greater than 7 (12% vs 13%), seminal vesicle invasion (8% vs 10%) or lymph node involvement (3% vs 5%). Tumor volume was higher in the systematic sampling group and whole mount detected more multiple surgical margins (each p <0.01). There were no significant differences in the likelihood of biochemical recurrence between the pathological methods when patients were stratified by pathological outcome. Except for estimated tumor volume and multiple margins whole mount and systematic sampling yield similar pathological information. Each method stratifies patients into comparable risk groups for biochemical recurrence. Thus, while whole mount is more resource intensive, it does not appear to result in improved detection of clinically important pathological outcomes or prognostication.

Gleason score and laterality concordance between prostate biopsy and prostatectomy specimens

Prostate biopsy involvement and Gleason score guide treatment decisions in prostate cancer. We evaluated concordance in Gleason score and laterality between biopsy and radical retropubic prostatectomy (RRP) specimens and factors that influenced this relationship. We reviewed 538 prostate cancer diagnoses at a Veterans Affairs medical center (2000-2005) to identify men with prostate biopsy and RRP specimens. During this time there was a move from limited (6 core) to extended (12 core) biopsy schemes. Discordance in Gleason score was defined as any change in Gleason score. 152 men underwent RRP with biopsy showing Gleason < 7 in 56%, 7 in 36%, and > 7 in 8%. Biopsy involvement was unilateral in 59% and bilateral in 41%. Compared to the biopsy, RRP Gleason score was concordant in 76 (50%), higher in 51 (34%), and lower in 25 (16%). Bilateral involvement was concordant in 97%, while unilateral involvement was concordant in only 20%. Both Gleason score and laterality were concordant in only 26%. Gleason concordance was higher in those with 8 or more cores compared to < 8 cores taken (54% vs. 34%, p = 0.046), but concordance was not affected by age, PSA, prostate volume, or length of time from biopsy to RRP. During later years, concordance did not improve despite taking more cores. Prostate biopsy underestimated prostatectomy Gleason score in 34% of men and bilateral involvement in 80% of those with unilateral disease on biopsy. Taking at least eight cores improves the accuracy of the prostate biopsy.

Correlation of ADC and T2 Measurements With Cell Density in Prostate Cancer at 3.0 Tesla

To assess the relationship between MRI derived parameters (apparent diffusion coefficient (ADC) and T2 relaxation time) and tumor cellularity as determined from whole mounted radical prostatectomy specimens, for both prostatic carcinoma and normal peripheral zone tissue. Over a 16-month period, 20 patients (mean age: 61 years, range: 42-70 years) were prospectively recruited. Diffusion and T2 imaging were performed on a 3.0 Tesla scanner to enable subsequent ADC and T2 calculation. After radical retropubic prostatectomy specimens were whole-mounted and regions of interest (ROIs) drawn in areas of prostatic carcinoma and normal peripheral zone. Cell density was then determined using an adaptive histogram thresholding technique. Differences in tissue type were explored using the unpaired t test while the relationship between parameters was assessed using scatter-plots and the Pearson correlation coefficient. Significant differences (P < 0.0001 in all cases) were noted between peripheral zone tissue and prostatic carcinoma in terms of ADC (1.88 +/- 0.22 vs. 1.43 +/- 0.19 x 10(-3) mm2/s), T2 (142 +/- 24 vs. 109 +/- 20 milliseconds), and cell density (9.4% +/- 3.0% vs. 19.8% +/- 5.3%). A significant negative correlation with cell density was noted for both ADC (R = -0.695, P < 0.0001) and T2 (R = -0.505, P = 0.001). Trends for increased cell density, decreased ADC, and decreased T2 with increasing Gleason score were also noted. ADC and to a lesser extent T2 are good indicators of cell density. Because of the potential link with Gleason score, MRI derived parameters may have a prognostic role with regard to potential metastatic activity and tumor aggressiveness.

Histological Upgrading and Upstaging in the UK Population following Radical Prostatectomy and Their Implications for Active Surveillance

Background: Upgrading of Gleason score at radical retropubic prostatectomy (RRP) is a recognised event; however there are few large, national, multicentre studies of upgrading. With the increasing utilisation of active surveillance as an option in the treatment of prostate cancer upgrading is an increasing concern to urologists. Objective: To analyse the discordance between the biopsy Gleason score and the RRP Gleason score using the BAUS database from a non-screened UK population. Methods and subjects: Data were obtained from the BAUS cancer registry which holds data on national complex operations. All patients who underwent RRP with pre and post-operative Gleason score were included in the study. Results: 1420 men were included in the study, mean age 62. Comparing Gleason score between the biopsy and the RRP specimen, 30% men were found to upgraded and 9% downgraded. Clinically significant upgrading was seen in 28%. Age and PSA were found to be higher in the upgraded cohort ( p&lt; 0.02). Positive margins and seminal vesicle invasion were significantly higher in the upgraded group ( p &lt; 0.02). Univariate analysis revealed PSA and age as significant predictors of upgrading at RRP ( p&lt;0.05). Conclusions: This large study provides novel data from a non-screened UK population, nearly one-third of whom had clinically significant upgrading. We have also shown that adverse pathological events, positive margin and seminal vesicle invasion, are more common in the upgraded cohort. This evidence needs to be considered when managing men with localised prostate cancer especially when considering active surveillance.

Increased Urokinase-Type Plasminogen Activator Receptor and Epidermal Growth Factor Receptor in Serum of Patients With Prostate Cancer

Prostate cancer cell motility and invasion have been linked to the up-regulated signaling of epidermal growth factor receptor and urokinase-type plasminogen activator receptor. We analyzed the expression of serum urokinase-type plasminogen activator receptor and epidermal growth factor receptor in the serum of patients with clinical suspicion of prostate cancer to evaluate the possible role as prostate cancer markers. Serum was collected from 79 consecutive patients referred to our institution for transrectal ultrasound guided prostate biopsy. All blood samples were obtained before prostate biopsy. Total urokinase-type plasminogen activator receptor and epidermal growth factor receptor antigen in serum were measured by specific enzyme-linked immunosorbent assays. Gleason score, the number of positive cores, maximum percent of cancer and inflammation were considered on biopsy. Patients determined to have prostate adenocarcinoma underwent radical retropubic prostatectomy. Gleason score, pathological stage (extraprostatic extension), surgical margins, seminal vesicle involvement, perineural infiltration, lymphovascular invasion and cancer volume were evaluated in radical retropubic prostatectomy specimens. The 30 patients with prostate cancer had significantly higher levels of serum urokinase-type plasminogen activator receptor and epidermal growth factor receptor in comparison to those without prostate cancer but not significantly higher levels of prostate specific antigen. Urokinase-type plasminogen activator receptor and epidermal growth factor receptor levels closely correlated in the serum of patients with prostate cancer. In a multivariate model high serum epidermal growth factor receptor increased the probability of positive biopsies by 1.9 times. ROC analysis revealed that serum epidermal growth factor receptor had 93.3% sensitivity and 98% specificity for detecting prostate cancer at a cutoff of 67.9 ng/ml. Urokinase-type plasminogen activator receptor and epidermal growth factor receptor were significantly higher in patients with extraprostatic extension, seminal vesicle involvement and perineural infiltration in the radical retropubic prostatectomy specimens. Serum urokinase-type plasminogen activator receptor was the only independent predictive serum marker of extraprostatic extension, seminal vesicle involvement and perineural infiltration. The measurement of urokinase-type plasminogen activator receptor and epidermal growth factor receptor in the serum of patients with clinical suspicion of prostate cancer might provide clinically relevant information on the state of the prostate gland. Measuring serum epidermal growth factor receptor could help predict which patients have prostate cancer, while serum urokinase-type plasminogen activator receptor over expression seems to be related to tumor extraprostatic spread.

Pathologic Outcome of Unilateral Low Risk Prostate Cancers on Multicore Prostate Biopsy after Radical Prostatectomy

Purpose: To investigate clinicopathologic characteristics of unilateral, low risk prostate cancers detected via multi (≥12)-core prostate biopsy. Materials and Methods: One hundred four patients who underwent radical retropubic prostatectomy (RRP) for unilateral, low risk prostate cancer (clinical stage ≤T2a, biopsy Gleason sum ≤6, PSA ≤10ng/ml, and ipsilateral positive cores ≤2) detected via multi (≥12)-core prostate biopsy were enrolled. In this retrospective study, we reviewed the patients’ preoperative and pathologic data to assess potential predictors of pT2c or greater disease at the time of RRP, as well as characteristics of such disease. Results: Of the 104 subjects, only 34 (32.7%) were pathologically-proven to have unilateral disease, while the others showed pathologically-bilateral or worse disease from analysis of the RRP specimens. Subjects pathologically found to have uniand bi-lateral disease showed no significant differences regarding age, prostate-specific antigen (PSA), free-to-total PSA ratio, prostate volume, clinical stage, number of positive cores, biopsy Gleason score, number of total biopsy sites, and highest percentage of tumor at any biopsy site. Multivariate logistic regression analysis revealed no significant preoperative predictors of pT2c or greater disease at RRP. Conclusions: Most patients with unilateral, low risk prostate cancer detected on multi (≥12)-core prostate biopsy actually had pathologicallyworse disease. For clinically-localized prostate cancer, a more accurate method to identify appropriate candidates for unilateral or focal ablative therapy should be developed. (Korean J Urol 2008;49:874-878) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Integrity of Prostatic Tissue for Molecular Analysis After Robotic-Assisted Laparoscopic and Open Prostatectomy

The warm ischemia time of tissue before fixation for pathologic analysis has been linked to changes in cell morphology and nucleic acid and protein integrity. Robotic-assisted laparoscopic prostatectomy (RALP) results in longer warm ischemia times than open radical retropubic prostatectomy. To assess the effect of longer ischemia times on biomolecular integrity, we analyzed DNA, RNA and protein collected from robotic and open prostatectomy specimens. We examined 22 consecutive RALP (n = 11) and open radical retropubic prostatectomy (n = 11) specimens after hematoxylin-eosin staining by light microscopy. To assess protein integrity, immunohistochemical staining for p63, E-cadherin, and AE1/AE3 was performed. DNA was assessed by gel analysis. An RNA integrity score was determined by microfluidic capillary electrophoresis and calculated according to the electropherogram findings and simulated gel view. Finally, epithelial cells were cultured on collagen-coated plates. No differences in clinicopathologic characteristics were found between the two groups, with the exception of a significantly longer warm ischemia time during RALP (82 +/- 23 minutes) compared with open radical retropubic prostatectomy (23 +/- 2 minutes; P <0.001). Tissue integrity was suitable for the assessment of pathologic grade and stage for all samples. Protein and DNA analyses demonstrated no evidence of degradation in any samples. No significant differences in the RNA integrity scores were demonstrated between the surgical approaches. Prostate epithelial cells were cultured successfully in 66% of the RALP specimens. RALP, although it involves additional exposure to warm ischemia, does not significantly affect the histopathologic characteristics or biomolecular integrity of the specimen. Provided a rapid response occurs for tissue banking after specimen removal, molecular research studies using prostatic tissue harvested by way of RALP appear feasible.

Association of Prostate Size and Tumor Grade in Korean Men with Clinically Localized Prostate Cancer

To investigate the association of prostate size with aggressiveness of prostate cancer in Korean men who received radical retropubic prostatectomy (RRP) for clinically localized prostate cancer. We evaluated the association of RRP specimen weight and prostate volume measured by transrectal ultrasound (TRUS) with pathologic tumor grade, extraprostatic extension of disease, surgical margin status, and seminal vesicle invasion by reviewing data of 346 consecutive patients who underwent RRP for clinically localized prostate cancer at our institution without receiving preoperative radiation or hormonal treatment. A strong correlation was observed between RRP specimen weight and TRUS-measured prostate volume (Spearman r = 0.76; P <0.001). After adjustment for multiple variables including age, body mass index, and preoperative prostate-specific antigen level, RRP specimen weight was observed to be significantly associated with presence of Gleason pattern 4 or greater at RRP in an inverse fashion (P = 0.03). Regarding other adverse pathologic features, prostate weight was also significantly inversely associated with extraprostatic extension of prostate cancer (P = 0.04) and surgical margin positivity (P = 0.002). When TRUS-measured prostate volume was applied in place of RRP specimen weight, results were the same. Our data indicate that prostate size may be a useful predictor of tumor aggressiveness in Korean men with clinically localized prostate cancer. Further efforts should be made to elucidate actual mechanisms behind the association of prostate size and/or in vivo androgenicity with aggressiveness of prostate cancer.

Trends in distribution and prognostic significance of Gleason grades on radical retropubic prostatectomy specimens between 1989 and 2001

The objectives of the current study were to examine time trends in the prevalence of Gleason grades of prostate cancer on radical retropubic prostatectomy (RRP) specimens and to assess the resultant impact on prognosis. The authors examined the prevalence over time of each grade and Gleason score (GS) on RRP specimens from 8750 patients who were treated between 1989 and 2001. Biochemical recurrence-free survival (BRFS), which was estimated by using Kaplan-Meier methodology, was examined in subgroups of patients defined by tumor grade and era of surgery. The prevalence of Grade 3 prostate cancers increased (86% vs. 49% for primary Gleason grade and 71% vs. 47% for secondary Gleason grade; 1999-2001 vs. 1989-1990, respectively), whereas the prevalence of Grade 2 tumors decreased (0.4% vs. 38% for primary Gleason grade and 1.3% vs. 28% for secondary Gleason grade, respectively) over the study period, leading to fewer GS 4 and 5 tumors and more GS 6 and 7 tumors. BRFS improved over time for patients who had GS 5 tumors (hazards ratio [HR], 0.92 per year; P = .003) and GS 6 tumors (HR, 0.93; P < .001) but remained unchanged for GS 7 tumors (HR 0.99; P = .462) and GS 8-10 tumors (HR 1.02; P = .360). Patients who were treated in the recent era (1997-2001) had greater differentiation of BRFS based on GS or Gleason grade compared with patients who were treated earlier (1989-1991). The current results confirmed that there were changes in the prevalence of Gleason grades on RRP specimens between 1989 and 2001. A chronological change in pathologic grading classification is suggested by evolving prognostic implications, which must be accounted for when comparing outcomes from different eras.

Editorial comment

Purpose: We have previously have reported a tree structured regression model for predicting SS-ECE. Others recently reported a logistic regression based SS-ECE nomogram. We developed a nomogram and compared the performance and discriminant properties of the tree regression and the nomogram in a contemporary cohort of European patients treated with radical retropubic prostatectomy. Materials and Methods: The cohort consisted of 1,118 patients with pretreatment prostate specific antigen 0.1 to 73.2 ng/ml (median 6.6). Each of the 2,236 prostate lobes was considered separately. Clinical stage, pretreatment PSA, biopsy Gleason sum, percent positive cores and percent cancer in the biopsy specimen were used as predictors in a logistic regression model predicting SS-ECE. Regression coefficients were then used to generate an SS-ECE nomogram. Performance characteristics and discriminant properties of the previously published tree regression were also tested in the same cohort. For internal validation and to decrease overfit bias 200 bootstrap re-samples were applied to accuracy estimates for each method. Results: ECE was present in 303 of 1,118 radical retropubic prostatectomy specimens (27%) and in 385 lobes (17%). In logistic regression models all variables were statistically significant multivariate predictors of SS-ECE except the percent of positive biopsy cores (p = 0.7). Bootstrap corrected predictive accuracy of the SS-ECE nomogram was 0.840 vs 0.700 for the tree regression model. Conclusions: Logistic regression based nomogram predictions of SS-ECE are highly accurate and represent a valuable aid for assessing the risk of ECE prior to surgery.

Validation of a Nomogram for Prediction of Side Specific Extracapsular Extension at Radical Prostatectomy

We have previously have reported a tree structured regression model for predicting SS-ECE. Others recently reported a logistic regression based SS-ECE nomogram. We developed a nomogram and compared the performance and discriminant properties of the tree regression and the nomogram in a contemporary cohort of European patients treated with radical retropubic prostatectomy. The cohort consisted of 1,118 patients with pretreatment prostate specific antigen 0.1 to 73.2 ng/ml (median 6.6). Each of the 2,236 prostate lobes was considered separately. Clinical stage, pretreatment PSA, biopsy Gleason sum, percent positive cores and percent cancer in the biopsy specimen were used as predictors in a logistic regression model predicting SS-ECE. Regression coefficients were then used to generate an SS-ECE nomogram. Performance characteristics and discriminant properties of the previously published tree regression were also tested in the same cohort. For internal validation and to decrease overfit bias 200 bootstrap re-samples were applied to accuracy estimates for each method. ECE was present in 303 of 1,118 radical retropubic prostatectomy specimens (27%) and in 385 lobes (17%). In logistic regression models all variables were statistically significant multivariate predictors of SS-ECE except the percent of positive biopsy cores (p = 0.7). Bootstrap corrected predictive accuracy of the SS-ECE nomogram was 0.840 vs 0.700 for the tree regression model. Logistic regression based nomogram predictions of SS-ECE are highly accurate and represent a valuable aid for assessing the risk of ECE prior to surgery.