Subcapsular Prostatectomy Research Articles

Transient Occlusion of Bilateral Internal Iliac Arteries Facilitates Bloodless Operative Field in Subcapsular Prostatectomy

Transurethral resection of the prostate is the gold standard of surgical treatment for benign prostatic hyperplasia (BPH). Nevertheless, open subcapsular prostatectomy is still performed for large BPH. While enucleation of prostatic adenoma is being performed, unneglectable bleeding can occur and surgeons need to rush to remove adenomas, often using fingers and in a blinded fashion. The blood supply to the prostatic capsule and adenoma can be reduced to a marked extent in subcapsular prostatectomy if the bilateral internal iliac arteries are transiently occluded. Thus, a bloodless operative field is reasonably acquired during enucleation of adenoma, which would, otherwise, be a cause for concern to surgeons due to bleeding. It is not always applicable, but it could be an option if the estimated volume of BPH is more than 100 mL. In two cases, bilateral internal iliac arteries were occluded with Bulldog clamps, and then adenomas of 159 and 97 g were enucleated.

Contemporary Patients With LUTS/BPH Requiring Prostatectomy Have Long-term History of Treatment With α1-Blockers and Large Prostates Compared With Past Cases

To retrospectively investigate the characteristics of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia for which surgery was needed during the past 20 years. In particular, the chronologic change in prostate volume at surgery and the status of alpha(1)-blocker use before surgery and its duration were studied. The data from 371 consecutive patients with lower urinary tract symptoms/benign prostatic hyperplasia who had undergone surgery in our institute from 1987 through 2006 were retrospectively analyzed. The number of surgeries, type of surgical procedure, content and duration of medical treatment of lower urinary tract symptoms/benign prostatic hyperplasia before surgery, prostate volume on transrectal ultrasonography at baseline and at surgery, and the weight of the removed tissue were determined from the medical charts. The number of surgeries suddenly began to decrease between 1987 and 1990 and again from 1991 to 1994, probably owing to the introduction of 2 nonselective alpha(1)-blockers at those times in Japan. The percentage of use of alpha(1)-blockers before surgery and the duration of use increased in each period. More than 80% of recent patients had received alpha(1)-blockers before surgery, with an average duration of 3 years. Recent patients had a large prostate volume at baseline and at surgery compared with previous patients. Corresponding to the large prostate, open subcapsular prostatectomy was indicated in 18% of the recent patients. Patients with surgical treatment after long-term use of alpha(1)-blockers had large prostates at baseline and at surgery. Although alpha(1)-blockers delayed the need for surgery by a few years, patients with a large prostate volume might finally need to undergo surgery.

Preliminary results of intraoperative photodynamic therapy with 5-aminolevulinic acid in dogs with prostate carcinoma

Six client-owned dogs with prostate carcinoma were treated with a combination of (1) partial subcapsular prostatectomy using an Nd:YAG laser, (2) intraoperative photodynamic therapy using a halogen broad band lamp after local administration of a photosensitiser, and (3) systemic treatment with meloxicam. Median survival time was 41 days (range 10–68 days), which compared negatively with previous reports of subtotal laser prostatectomy combined with topical interleukin-2 administration, and photodynamic therapy alone. Despite treatment, the disease progressed locally, causing signs of stranguria to recur, and in the form of distant metastases. The recurrence of clinical signs due to the primary tumour despite photodynamic therapy is probably largely explained by insufficient penetration of light into the tissue. Better results may be obtained using other light sources (e.g. laser) and alternative techniques of light delivery, such as fibres or catheters allowing interstitial diffusion of light.

1498: Long-Term PSA Trends Following Subcapsular Prostatectomy for Benign Prostatic Hyperplasia

You have accessJournal of UrologyPodium 42, Tuesday, May 22, 2007, 1:00 - 3:00 pm1 Apr 20071498: Long-Term PSA Trends Following Subcapsular Prostatectomy for Benign Prostatic Hyperplasia Paul G. Espy, Ante Wind, Burke Wade, John Rowland, Harry P. Koo, B. Mayer Grob, Adam P. Klausner, and Vidal M. Despradel Paul G. EspyPaul G. Espy More articles by this author , Ante WindAnte Wind More articles by this author , Burke WadeBurke Wade More articles by this author , John RowlandJohn Rowland More articles by this author , Harry P. KooHarry P. Koo More articles by this author , B. Mayer GrobB. Mayer Grob More articles by this author , Adam P. KlausnerAdam P. Klausner More articles by this author , and Vidal M. DespradelVidal M. Despradel More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)31699-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1498: Long-Term PSA Trends Following Subcapsular Prostatectomy for Benign Prostatic Hyperplasia." The Journal of Urology, 177(4S), p. 494 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 494 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Paul G. Espy More articles by this author Ante Wind More articles by this author Burke Wade More articles by this author John Rowland More articles by this author Harry P. Koo More articles by this author B. Mayer Grob More articles by this author Adam P. Klausner More articles by this author Vidal M. Despradel More articles by this author Expand All Advertisement PDF downloadLoading ...

KAI1 expression can be a predictor of stage A prostate cancer progression.

The disease progression and rate of cancer death were analyzed in 52 patients with stage A prostate cancer who underwent transurethral resection of the prostate (TURP) or retropubic subcapsular prostatectomy (SCP) between 1987 and 1998. We performed immunohistochemistry on 16 patients to determine the correlation between the expression of the tumor metastasis suppressor gene KAI1 and the subsequent progression of stage A prostate cancer. Nineteen and 33 of the patients had cancer at stage A1 and stage A2, respectively, and their subsequent courses were followed for an average of 53.7 months (24-134 months). Progression to clinical cancer was found in six patients (one with stage A1, and five with stage A2). This progression was evident 40.8 months (5-80 months) after TURP or SCP. Four (66.7%) of the patients died of cancer progression (average 31 months) after prostatectomy. All four patients had stage A2, poorly differentiated adenocarcinoma, and had been followed with administration of diethylstilbestrol diphosphate (DES-P). The disease-free patients (n=10) showed overexpression of KAI1 protein, compared to those with disease progression (n=6). These results indicate that progression arose mainly in the patients with stage A2 cancer, and that poorly differentiated, focal and weak expression of KAI1 protein is highly associated with disease progression. It is suggested that patients in this group should be treated with immediate total androgen blockade, radiation, or radical prostatectomy after diagnosis.Prostate Cancer and Prostatic Diseases (2001) 4, 150-153.

Changes in serum prostate-specific antigen following prostatectomy in patients with benign prostate hyperplasia.

To investigate how prostatectomy for patients with benign prostate hyperplasia (BPH) affected the serum prostate-specific antigen (PSA) levels. In 193 patients who underwent prostatectomy for BPH, serum PSA levels were measured before and three months after the operation. The total prostate weight measured by transrectal ultrasonography (TRUS) and the weight of the surgical specimen were examined in relation to the pretreatment PSA value and the changes in PSA levels after the operation. The transition zone volume measured by TRUS could well estimate the weight of the surgical specimen in patients who underwent subcapsular prostatectomy and transurethral resection of the prostate. The concentration of preoperative serum PSA showed a significant correlation with the prostatic volume and with the transition zone volume. Removal of 1 g of BPH tissue reduced serum PSA levels by an average of 0.18 ng/mL. The change in serum PSA levels after the prostatectomy correlated with the total prostatic gland volume and with the transition zone volume. The elevated PSA levels in patients with BPH were caused by the enlargement of the transition zone. After the resection of the adenoma, PSA levels should be expected to decrease to the normal range.

COMPARATIVE MORPHOMETRIC STUDY OF BLADDER DETRUSOR BETWEEN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA AND CONTROLS

Purpose We determined the change in the amount of connective tissue of the detrusor in patients with benign prostatic hyperplasia (BPH) in relation to the degree of bladder hypertrophy by ultrasound estimated bladder weight. The ratio of connective tissue-to-smooth muscle between controls and BPH cases was compared. Materials and Methods For normal controls we used cadaver bladders excised at autopsy from 13 men with no urinary tract diseases. Bladder wall samples were also obtained at subcapsular prostatectomy for BPH in 26 patients. On thin sections stained with Masson trichrome, the ratio of connective tissue-to-smooth muscle was measured using a computer assisted color image analysis. This ratio was compared in BPH cases with estimated bladder weight, which was measured preoperatively using transabdominal ultrasonography. Results A connective tissue-to-smooth muscle ratio ranged from 19.8 to 28.2% (mean plus or minus standard deviation 24.7 +/− 2.4) and from 12.9 to 53.3% (27.3 +/− 9.9) in control and BPH cases, respectively. In BPH cases a significant correlation was noted between estimated bladder weight and connective tissue-to-smooth muscle ratio (r=0.788, p <0.0001). Interestingly, in BPH cases with an estimated bladder weight of less than 60 gm. the ratio ranged from 12.9 to 30.4% (22.8 +/− 4.9), which was not significantly different compared to control cases. In contrast, in all BPH cases with an estimated bladder weight of 60 gm. or more connective tissue-to-smooth muscle ratio increased significantly to more than 30% (range 33.4 to 53.3%, mean 42.2 +/− 13.6%). Conclusions These results suggest that abnormal increase of connective tissue in addition to smooth muscle hypertrophy and/or hyperplasia could contribute to advanced bladder hypertrophy caused by infravesical obstruction.

Relationship of ultrasonic and histologic findings in benign prostatic hyperplasia

We compared the ultrasonic and histologic findings in 25 patients with benign prostatic hyperplasia (BPH) who underwent retropubic subcapsular prostatectomy. Preoperative ultrasonograms showed a fine echogenic pattern in one case, a rough echopenic pattern in four cases, and a combination of these patterns in 20 cases. In cases exhibiting a mixed pattern, we analyzed each region individually. Ultrasonic and histologic findings were compared in a total of 45 regions. In the 21 regions with a fine echogenic pattern, 14 regions corresponded to those with complicated hyperplastic glands, one region with small cystic atrophic glands, and six regions with a mixture of the two types on histology in observation. In the 24 regions with a rough echopenic pattern, 20 regions corresponded to those with large cystic atrophic glands and an equal volume of large and small cystic atrophic glands were found in the other four. Thus, the echogenic structures observed in patients with BPH were determined by the presence of complicated hyperplastic glands and small cystic atrophic glands.

DISEASE PROGRESSION IN STAGE A PROSTATE CANCER

To study the disease progression in stage A prostate cancer, 212 patients with stage A from a group of 3370 patients who underwent transurethral resection of the prostate, or subcapsular prostatectomy during the period 1972-1991 were followed. The stage A cases were subdivided into 103 A1 patients and 109 A2 patients and their subsequent course was followed for an average of 41.7 months (6-174 months). Progression to clinical cancer was found in 12 patients, 2 from A1 and 10 from A2 groups. This progression was evident 40.5 months (14-130 months) after prostatectomy. Eight (67%) of these cases responded to endocrine therapy. The rate of expression of ras p21, and the number of argyrophilic nucleolar organizer regions in stage A cancer cells were greater in progressing than in non-progressing cases. These results indicate that stage A cancer with progression arises mainly from the A2 subgroup and exhibits a distinctly proliferative potential even at small foci.

The relationship between serum PSA value and the weight of the inner gland of the prostate in the cases of benign prostatic hyperplasia

To study reasons why serum PSA value (Markit-F) elevates in benign prostatic hyperplasia (BPH). The relationship between total prostatic weight and the outer gland weight in 48 cases of BPH undergoing subcapsular prostatectomy was studied by ultrasound measurement. PSA was compared with prostatic weight, inner gland weight, outer gland weight, growth speed of the inner gland and age in the 48 cases. 1) The weight of the outer gland increased slightly in proportion to the development of BPH. However, the increase was not significant statistically. 2) PSA correlated with the inner gland weight and growing speed of the inner gland well. 3) PSA did not correlate with the outer gland weight and age. It is well known that PSA elevates not only in the cases of prostatic cancer but also in the cases of BPH and that PSA correlates with the whole prostatic weight. This study revealed that the elevation of PSA in the cases of BPH was caused by enlargement of the inner gland.

Prostate cancer after subcapsular prostatectomy diagnosed as benign prostate hypertrophy--clinico-pathological analysis

Of 160 newly diagnosed cases of prostate cancer during last 11 years, six (3.75%) had a prior subcapsular prostatectomy. Digital rectal examination in these six cases revealed a significant prostatic abnormality and multiple bone metastases were showed. Histological examination by step-section technique was done retrospectively using surgical materials from subcapsular prostatectomy. Two cases of incidental carcinoma were detected histologically. One showed stage A1 and another stage A2. Continuous observation should be performed after prostatectomy, even if the surgical specimens revealed no carcinoma.

A pathological study of incidental carcinoma of the prostate. Pathological study of age-groups

We reviewed 66 patients with stage A adenocarcinoma of the prostate who were treated at our 7 affiliated hospitals in Yokohama between 1984 and 1988. Of 1377 patients who underwent subcapsular prostatectomy (SCP) or transurethral resection of the prostate (TUR-P) for benign prostatic hyperplasia, 66 patients (4.8%) were diagnosed as an incidental carcinoma of the prostate. Of these patients, 36 and 30 were in stage A1 and A2, respectively. In the 66 patients, 59 (4.5%) were detected in 1315 TUR-P and 7 (11.3%) in 62 SCP. Elderly patients over 80 years of age had a higher risk of stage A2 disease. In histological grade, well, moderately and poorly differentiated adenocarcinoma were found in 48 patients (72.7%), 13 (19.7%) and 5 (7.6%), respectively. Among the patients with stage A prostate carcinoma the majority of the age-group less than 79 years old had well differentiated adenocarcinoma. In the age-group more than 80 years old, there were 6 (37.5%) moderately and 2 (12.5%) poorly differentiated tumors. In other words, the age-group more than 80 years old tended to have the moderately or poorly differentiated adenocarcinoma more frequently than those other decades. We expect an increase in the number of patients with stage A2 disease in the future with the expansion of the operative indication, especially in elderly patients.

恥骨上式前立腺摘除術後 Step section 法により発見された前立腺偶発癌の検討

In 244 cases treated by subcapsular prostatectomy during the period from April 1975 to December 1985, whole tissue specimens were prepared by a step section technique to examine them histopathologically in accordance with the handling agreement for prostatic cancer presented by the Urologic Society of Japan. The degree of differentiation, clinical stage of the disease, the size of the lesion and the distance to the margin were determined. Incidental carcinoma was found in 35 cases (14.3%), which increased with age. There were 21 cases of stage A1 and 14 cases of A2. Diffuse proliferation was found in 4 cases. Isolated carcinomatous focus was observed in 40 sites, and well, moderately, and poorly differentiated adenocarcinoma in 33, 3 and 4 sites respectively. The maximum diameter of cancer was below 5 mm in 80%, while the distance from the center of the carcinomatous focus to the surgical margin was within 3.5 mm in 905. Seven cases had plural lesions. These lines of evidence mentioned above may support carcinogenesis from the subcapsular region as well as multicentric origin of cancer.

前立腺偶発癌の検討

We reviewed 157 patients retrospectively with incidental carcinoma of the prostate who had been treated at our collaborating hospitals during the past ten years. Of 5212 patients with benign prostatic hyperplasia who received subcapsular prostatectomy or transurethral resection of the prostate (TUR-P), 157 (3.0%) were diagnosed as having an incidental carcinoma of the prostate, which was somewhat lower than that in previously published reports. Of these, 30 and 127 patients were in stage A1 and A2, respectively. Well, moderately and poorly differentiated carcinomas were found in 44.6%, 36.7% and 18.5% of the patients, respectively. The incidence of poorly differentiated carcinoma in the study seemed to be higher than that in the previous reports. A positive correlation was identified in TUR-P specimens between the carcinoma differentiation and its extension which was evaluated by cancer-positive chip ratio. Atypical adenomatous hyperplasia and intraductal dysplasia were identified in 36.9% and 85.3% of the patients with incidental carcinoma, respectively. These incidences tended to become lower as the carcinoma became less differentiated or more extended. Further studies will be necessary to define the significance of these pathological findings as a direct biological precursor of prostatic carcinoma. Six out of the 157 patients with incidental carcinoma showed a progression during the follow-up period. All of these patients were in stage A2 and all but one showed a histology of moderately or poorly differentiated carcinoma at the time of diagnosis. Radical prostatectomy or radiation therapy as well as endocrine therapy should be considered as treatment modalities for stage A2 patients, when staging lymphadenectomy shows no pelvic lymph node metastasis.

Stage A prostatic cancer: a comparative study in Japan and the Netherlands

To obtain more accurate information on the prevalence of stage A prostatic cancer (incidental or latent carcinoma), a prospective collaborative study was set up in Japan and the Netherlands. A total of 859 specimens were submitted for routine histological examination (Japan: 343 specimens; the Netherlands: 516 specimens). All specimens were obtained from patients more than 50 years of age showing clinical signs of obstructive benign prostatic disease. The overall prevalence of stage A cancer in both countries was almost equal (Japan 13% vs the Netherlands 14%). A relatively large number of incidental tumors were found in subcapsular prostatectomy specimens in the Netherlands. Increasing prevalence of stage A disease in subsequent age decades was not found in the Netherlands, where the highest prevalence was observed in the 70–79 age-group. Subdivision of stage A disease into A1 and A2 tumors did not reveal any significant difference in prevalence between the two countries. Of particular interest is that the number of A2 lesions found in the Netherlands was not higher than that found in Japan. In both countries almost all A1 lesions were identified as G1 tumors in stage A1 disease. Both G2 and G3 lesions were present in Japan and the Netherlands in 79% and 72% of the A2 cases respectively. Results are discussed and especially related to their possible impact upon the differences in mortality rate between the two countries.