T1c Prostate Cancer Research Articles

Prevalence and Clinical Significance of Prostate Cancer among 12,682 Men with Normal Digital Rectal Examination, Low PSA Levels (≤4 ng/ml) and Percent Free PSA Cutoff Values of 15 and 20%

Aim: To report prevalence and clinical relevance of T1c prostate cancers (PCa) in a selected population of men with serum prostate-specific antigen (PSA) levels ≤4 ng/ml enrolled in a multicenter case-finding protocol. Patients andMethods: A number of 16,298 men, aged 40–75 years, from the urology units they had been referred to, in most cases (81.6%) for lower urinary tract symptoms, were evaluated. Eighty percent of them had PSA ≤4 ng/ml and about 40% PSA ≤2.5 ng/ml. Patients with PSA ≤2.5 ng/ml and PSA between 2.6 and 4 ng/ml and with percent free PSA ≤15 and ≤20%, respectively, were eligible for biopsy; 28 patients refused it, and 11 patients were excluded from the study because of an abnormal digital rectal examination. Among 403 biopsied men, 82 had PSA ≤2.5 ng/ml (group A) and 321 PSA between 2.6 and 4 ng/ml (group B). Results: A PCa was found in 109 cases (27.0%): 21 in group A and 88 in group B. 48 (44%) of the 109 patients with a PCa underwent radical prostatectomy: all cancers had a volume >0.5 cm³, and 41% had a final Gleason sum ≧7; the PCa was organ confined in 34 patients (70.8%) and locally advanced in 14 patients (29.1%), and in 12 patients (25%) positive surgical margins were found. Conclusions: Using percent free PSA thresholds of 15 and 20%, 25.6% of the men with PSA ≤2.5 ng/ml and 27.4% of the men with PSA between 2.6 and 4 ng/ml were found to have a PCa, respectively. Most of these cancers, when submitted to radical prostatectomy, were found to be clinically significant. As these cancers are mostly organ confined, these patients are ideal candidates for curative nerve-sparing surgery.

Do Tumor Volume, Tumor Volume Ratio, Type of Nerve Sparing and Surgical Experience Affect Prostate Specific Antigen Recurrence After Laparoscopic Radical Prostatectomy? A Matched Pair Analysis

We assessed the impact of tumor volume, tumor volume ratio (tumor volume-to-prostate volume), surgical experience and type of nerve sparing procedure on biochemical recurrence after laparoscopic radical prostatectomy. Of 1,600 laparoscopic radical prostatectomies performed between March 1999 and May 2006 we evaluated 555 patients who had at least 24 months of followup and received neither neoadjuvant nor adjuvant therapy. Of 555 patients 81 had biochemical recurrence and were match paired in 3 groups with those without recurrence. Matching decisions were based on factors such as age, preoperative prostate specific antigen, pathological stage, Gleason score, surgical margin status with localization, tumor volume, type of nerve sparing procedure, surgeon and date of operation that are related to surgical experience. We evaluated the impact of tumor volume and tumor volume ratio, type of nerve sparing procedure and surgeon on biochemical recurrence, and excluded the factor being investigated in each matched pair. Tumor volumes were 3.58 vs 3.3 cc and tumor volume ratios were 0.081 vs 0.071 in the biochemical recurrence and no biochemical recurrence groups, respectively (p=0.026 and p=0.040). At the second match pair the numbers of nonnerve sparing, unilateral and bilateral nerve sparing procedures were 65, 12 and 4 vs 62, 13 and 6, respectively, without statistical significance. At the last match pair the volume of cases for the first generation and the other generations were 56 and 25 vs 59 and 22, respectively, also without statistical significance. Although surgical experience based on an adequate training program and type of nerve sparing procedure do not have a significant impact on biochemical recurrence, tumor volume and tumor volume ratio do.

468: Prognostic Significance of Number of Tumors in T2C Prostate Cancer

You have accessJournal of UrologyPodium 17, Sunday, May 20, 2007, 1:00 - 3:00 pm1 Apr 2007468: Prognostic Significance of Number of Tumors in T2C Prostate Cancer Dieuwertje E. Kok, Inge M. van Oort, Peter F. Mulders, Lambertus A. Kiemeney, J. Alfred Witjes, and Christina A. Hulsbergen-vandeKaa Dieuwertje E. KokDieuwertje E. Kok More articles by this author , Inge M. van OortInge M. van Oort More articles by this author , Peter F. MuldersPeter F. Mulders More articles by this author , Lambertus A. KiemeneyLambertus A. Kiemeney More articles by this author , J. Alfred WitjesJ. Alfred Witjes More articles by this author , and Christina A. Hulsbergen-vandeKaaChristina A. Hulsbergen-vandeKaa More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)30721-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "468: Prognostic Significance of Number of Tumors in T2C Prostate Cancer." The Journal of Urology, 177(4S), p. 157 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 177Issue 4SApril 2007Page: 157 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Dieuwertje E. Kok More articles by this author Inge M. van Oort More articles by this author Peter F. Mulders More articles by this author Lambertus A. Kiemeney More articles by this author J. Alfred Witjes More articles by this author Christina A. Hulsbergen-vandeKaa More articles by this author Expand All Advertisement PDF downloadLoading ...

Prediction models in urology

Predicting risk is an inherent feature of clinical practice. How likely is a man with a given PSA level to have prostate cancer? Can lymph node dissection be safely avoided in a patient with testicular cancer? Should chemotherapy be given after cystectomy for bladder cancer? Traditionally, physicians use clinical judgment to estimate risks, relying on rules of thumb (heuristics) or assigning patients to simple risk groups. In the March issue of Nature Clinical Practice Urology, Novara et al. described a series of nomograms (or models) that can be used to predict whether a man with penile cancer has lymph node metastases and the likelihood that he will survive his cancer for 5 years (Novara et al. [2007] Nat Clin Pract Urol 4: 140–146). Risk stratification schemes have already been published that classify such patients into risk groups, and guidelines are available for the management of men with penile cancer. So why do we need nomograms? Nomograms are graphical representations of mathematical algorithms that incorporate multiple prognostic factors into optimized statistical models to predict a particular outcome. Since the first report of a nomogram for a urological disease (Kattan MW et al. [1998] J Natl Cancer Inst 90: 766–771), these models have come into widespread use, made easier to use in digital formats (www.nomograms.org). Despite their complexity, nomograms routinely provide more accurate predictions than risk group assignment or expert judgment (Kattan MW [2005] Nat Clin Pract Urol 2: 183–190). Risk groups are popular but their accuracy is limited, in that they combine individuals with similar but not identical risk factors into a single group and categorize variables, such as PSA (0–4 ng/ml, 4.1–10 ng/ml, etc.), which give more information when analyzed as continuous variables. D’Amico’s ‘low-risk’ prognostic group of prostate cancer patients (Stage T1c or T2a, Gleason score <7, PSA level <10 ng/ml) includes patients with a uniformly favorable prognosis, but many patients in his intermediate-risk and high-risk groups actually have an excellent prognosis as well (Kattan MW [2003] Curr Opin Urol 12: 111–116). Erroneous assignment to a high-risk group might lead to an inappropriate treatment decision, such as the pessimistic recommendation to avoid radical prostatectomy in a patient with a Gleason score 8, clinical stage T1c prostate cancer, whose PSA level is 4.5 ng/ml. This ‘high-risk’ patient actually has a 65% probability of freedom from biochemical recurrence 10 years after surgery alone (Stephenson et al. [2005] J Clin Oncol 23: 7005–7012). Nomograms sometimes seem counterintuitive, especially when they include prognostic factors that have not been found to be statistically significant as independent predictors of outcome in multivariable analyses or if they weigh the values of a risk factor nonlinearly. Nevertheless, the prediction is usually more accurate than if fewer factors are included or the results are weighted linearly. Novara et al. have made a valuable contribution by refining the accuracy of predicting nodal stage and survival in men with penile cancer. These nomograms, which incorporate standard, readily available, clinical and pathological variables are remarkably accurate (Ficarra V et al. [2006] J Urol 175: 1700–1705; Kattan MW et al. [2006] J Urol 175: 2103–2108). Before nomograms can be accepted in practice, or used to stratify patients in clinical trials, they should be validated in large, independent cohorts. Such nomograms provide patients with what they surely wish for: to know their own prognosis, not that of a risk group to which they might be assigned.

A Study on the Incidence and Preoperative Predicting Factors of Extraprostatic Extension in T1c Prostate Cancers

Purpose: To evaluate the incidence and identify the predicting factors of extraprostatic extension (EPE) in T1c prostate cancers. Materials and Methods: Of 267 consecutive men who underwent radical retropubic prostatectomy (RRP) as initial treatment for prostate cancers, 131 (49.1%) presented with a clinical stage T1c disease. Clinicopathological data were collected, and factors related to biopsy collected; i.e. the number of positive cores (No. (+) core); the percentage of positive cores (% (+) core); the maximal tumor length (Max. mm cancer); the sum of tumor length (Total mm cancer); the maximal ratio of tumor/core length (Max. % mm cancer) and the mean ratio of tumor/core length (Mean % mm cancer). A logistical regression analysis was performed after dividing the cases into organ-confined (OC) and EPE. Results: Of the T1c tumors, 107 (81.7%) and 24 (18.3%) were found to be OC and to have EPE after RRP, respectively. The preoperative factors that showed a significant difference between the two groups (OC vs. EPE) were %free prostate-specific antigen (17.7 vs. 11.1%), prostate volume (43.5 vs. 34.6ml), Gleason score (6.4 vs. 6.8), % (+) core (17.9 vs. 27%), Max. mm cancer (3.5 vs. 6.7mm) and Max. % mm cancer (24.0 vs. 41.6%). Of these factors, those significantly predicting EPE in the receiver operator characteristics curve were: the Gleason score, % (+) core, Max. mm cancer and Max. % mm cancer. Of these, only the % (+) core and Max. mm cancer were significant in predicting EPE in the multivariate logistical regression. When the cutoff of % (+) core was 19%, the risk of EPE increased 2.3 times, and when the cutoff of Max. mm cancer was 5mm the risk increased 3.6 times. Conclusions: Max. mm cancer and % (+) core during a biopsy are preoperative factors that predict the EPE of a clinical stage T1c disease, and should be considered for modifying the surgical technique and in establishing treatment plans. (Korean J Urol 2007;48:797-803) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Continuing Trends of the Clinical Parameter Migration in Patients with Prostate Cancer in Korea

Purpose: With the widespread use of screening for prostate-specific antigen (PSA), T1c prostate cancer has shown a marked increase in Western countries. We reviewed the trends in clinical stage migration and the changes in the clinical characteristics for patients with prostate cancer in Korea, and we compared these values with those of Western men. Materials and Methods: Between 1997 and 2006, 758 men (mean age: 68.6 years) were diagnosed with prostate cancer at our institution. According to the diagnostic period, the patients were divided into 3 groups (the 1997-2000, 2001-2003 and 2004-2006 groups) for comparative analysis of the clinical stage, the serum PSA level and the biopsy Gleason score. Results: The proportion of clinically localized prostate cancer significantly increased by the period (56.8%, 62.5% and 75.4%, respectively; p＜0.001) with that of metastatic disease showing a decreasing according to groups (40.0%, 27.5% and 17.6%, respectively; p＜0.001). For localized disease, T1c cancers also increased from 26.4% to 19.2% to 31.6% (p=0.002), respectively. The median serum PSA level at diagnosis decreased from 34.5 ng/ml to 16.6ng/ml to 10.8ng/ml (p＜0.001), respectively, with the proportion of patients with a PSA level≤10ng/ml increasing significantly (19.2%, 33.3% and 47.7%, respectively; p＜0.001). Although the proportion of biopsy Gleason scores that were 8-10 decreased from 71.2% to 50.2% to 38.3%, respectively, it still comprised 20.8% of the T1c cancers and 22.8% of the cancers with a PSA≤10ng/ml in the last period, and these values were significantly higher than those in the Western reports. Conclusions: Downward migration of the clinical stage along with decreases for the serum PSA level and biopsy Gleason score were evident in Korean men. However, the proportion of T1c cancer was still lower than that in the Western series and the fraction of Gleason score 8-10 cancer was distinctively high. We believe this mandates establishing PSA screening programs and administering vigorous management. (Korean J

Pathological Outcomes and Biochemical Progression in Men With T1c Prostate Cancer Undergoing Radical Prostatectomy With Prostate Specific Antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml

Pathological Outcomes and Biochemical Progression in Men With T1c Prostate Cancer Undergoing Radical Prostatectomy With Prostate Specific Antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml

UP-02.48: The sensitivity of prostate octant biopsy in detection of clinical T1c prostate cancer

UP-02.48: The sensitivity of prostate octant biopsy in detection of clinical T1c prostate cancer

Efficacy of primary hormone therapy for localized or locally advanced prostate cancer: results of a 10‐year follow‐up

To evaluate the efficacy of primary hormone therapy for localized or locally advanced prostate cancer, by analysing the 10-year survival rates for men with localized or locally advanced prostate cancer treated with primary hormone therapy or prostatectomy. Between February 1993 and March 1995, men with T1b, T1c or T2-3 N0M0 prostate cancer were enrolled. In all, 176 men who had a prostatectomy were assigned to Study 1 and were given adjuvant luteinizing hormone-releasing hormone (LHRH) agonist; 151 men who did not have a prostatectomy were assigned to Study 2 and had LHRH agonist monotherapy or combined androgen blockade. They were followed until death, loss to follow-up, or until the end of the observation period (31 March 2004). We analysed all cases in each study as a single population, and compared Study 1 with Study 2. The mean patient ages were 67.2 years in Study 1 and 75.7 years in Study 2. During a median of 10.4 years of follow-up, 20 men in Study 1 and 17 in Study 2 died from prostate cancer, and 21 men in Study 1 and 50 in Study 2 died from other causes. In Study 1, the 10-year overall survival rate was 73% and the 10-year cause-specific survival rate was 86%, vs 41% and 78% in Study 2. Overall survival curves were similar to expected survival curves in both studies. There was no significant difference between studies in cause-specific survival. The progression of prostate cancer was retarded by primary hormone therapy in men with localized or locally advanced prostate cancer. With primary hormone therapy or prostatectomy, the men had a life-expectancy similar to that of the normal population.

Pathological Outcomes and Biochemical Progression in Men With T1c Prostate Cancer Undergoing Radical Prostatectomy With Prostate Specific Antigen 2.6 to 4.0 vs 4.1 to 6.0 ng/ml

Recent studies have suggested that the cut point for recommending prostate biopsy among men with a normal digital rectal examination should be greater than 2.5 ng/ml as opposed to the more traditional greater than 4.0 ng/ml. We compared outcomes between men with clinical stage T1c disease undergoing radical prostatectomy who had a low vs slightly increased prostate specific antigen. The study population consisted of 2,896 men treated with radical prostatectomy between 1985 and 2004 at a tertiary care referral center with clinical stage T1c disease and a pre-biopsy prostate specific antigen between 2.6 and 6.0 ng/ml. Using multivariate analysis we evaluated the association between pre-biopsy prostate specific antigen 2.6 to 4.0 ng/ml (784) vs 4.1 to 6.0 ng/ml (2,112), and pathological outcomes and biochemical progression. After adjusting for multiple clinical and pathological characteristics, lower preoperative serum prostate specific antigen values were associated with decreased odds of Gleason score 7 or greater in the surgical specimen (p = 0.004), positive surgical margins (p = 0.02) and extraprostatic extension (p = 0.001). There was no significant association between these preoperative prostate specific antigen groups and odds of seminal vesicle invasion (p = 0.47) or lymph node metastasis (p = 0.90). Among the 1,534 men with followup information available there was a trend for increased risk of biochemical progression associated with a higher preoperative prostate specific antigen, although this trend did not reach statistical significance (relative risk 1.48, 95% CI 0.69-3.19, p = 0.31). In the current study of men with clinical stage T1c treated with radical prostatectomy a lower preoperative prostate specific antigen was associated with significantly more favorable pathological findings. Whether this degree of improved outcomes justifies the limitations associated with decreasing the prostate specific antigen cut point (eg increased biopsies performed and diagnosis of insignificant cancers) remains to be determined.

T1c prostate cancer detection rate and pathologic characteristics: Comparison between patients with serum prostate-specific antigen range of 3.0 to 4.0 ng/mL and 4.1 to 10.0 ng/mL in Korean population

Objectives To prospectively evaluate the Stage T1c prostate cancer detection rate and pathologic characteristics of patients with a serum prostate-specific antigen (PSA) level of 3.0 to 4.0 ng/mL and compare this with the rate of patients who had a PSA level of 4.1 to 10.0 ng/mL. Methods We analyzed the data of patients who had PSA levels of 3.0 to 10.0 ng/mL, benign findings on digital rectal examination, and no specific lesion identified on transrectal ultrasonography. The clinical characteristics, cancer detection rate, and pathologic findings of the biopsy and prostatectomy specimen were compared between the low (3.0 to 4.0 ng/mL) and intermediate (4.1 to 10.0 ng/mL) PSA groups. Results A total of 450 patients met our criteria. Of these 450 patients, 85 and 365 had a low or an intermediate PSA level, respectively. Prostate cancer was diagnosed in 26% of the low and 19% of the intermediate PSA group. No significant difference was found between the two groups in the pathologic biopsy findings, including the mean Gleason score and percentage of patients with a Gleason score of 7 or more. The pathologic findings of the prostatectomy specimens also showed no significant differences between the two groups, including the mean Gleason score, pathologic stage, and percentage of insignificant prostate cancer. Conclusions No statistically significant difference was found in the incidence of Stage T1c prostate cancer or pathologic characteristics in comparison between the low and intermediate PSA groups. These results suggest that a lower PSA cutoff should be considered as an indication for prostate biopsy in the Korean population.

Prospective evaluation of a “Watchful Waiting” program using initial pathology criteria and PSA-doubling time monitoring for patients with stage T1c prostate cancer

14651 Background: “Watchful waiting (WW)” is becoming a common treatment option for patients (pts) with screening detected prostate cancer. There is, however, no consensus about which pts are suitable for WW and how pts are monitored. Methods: Eligibility criteria: 1) stage T1c prostate cancer pts, 2) age 50–80, 3) serum PSA: 20 ng/ml or less, 4) 1 or 2 positive cores per 6 to 12 systematic core biopsies, 5) Gleason score of 6 or less, 6) 50% or less maximum % cancer occupation in a positive core. The criteria of 4), 5), 6) were confirmed by a central pathologist before pts registration. Registered patients chose either WW or immediate aggressive treatment. In patients who chose WW, serum PSA was monitored every 2 months for 6 months and PSA-doubling time (PSADT) was calculated centrally. Those who showed PSADT 2y and re-biopsy at 13 months fit the initial pathology criteria again. Primary endpoint was “% PSADT &gt; 2 y”, which was defined as proportion of patients who showed PSADT at 6 months &gt; 2 y out of all patients who chose WW. Point estimate of “% PSADT &gt; 2 y” was expected to be higher than 80%. The planned sample size was 100 pts who chose WW, which gives the width of 95% confidence intervals for % PSADT &gt; 2 y within 10%. Results: 134 pts were enrolled from 01/2002 to 12/2003 and 118 pts chose WW while 13 pts chose aggressive treatment (surgery, radiotherapy, hormonal therapy). The initial 6 months’ PSADT could be assessed in 106 patients (measurement point error in 6, early dropout in 6). Of 106 patients, 22 showed PSADT &lt; 2 y (“rapid riser”) while 84 showed PSADT &gt; 2 y. “% PSADT &gt; 2 y” was 71.2% (84/118, 95% CI: 62.1–79.2%). 84 pts have continued WW with median follow-up of 27 months. Neither metastasis nor cancer-death was observed until 06/2005. As to health-related QOL, any domain of SF-36 was not impaired in patients who continued WW at least for 1 year. Conclusion: Our initial selection criteria for WW may include at least 20% of “rapid riser”, hence need further modification. Additionally, it should be confirmed by further follow-up of 84 pts whether eliminating “rapid riser” from WW by initial 6 months’ PSADT is appropriate. No significant financial relationships to disclose.

African‐American men with nonpalpable prostate cancer exhibit greater tumor volume than matched white men

Although prostate cancer (PC) mortality disproportionately affects African-American (AA) men, limited data exist comparing the pathologic characteristics of white and AA patients with nonpalpable PC (clinical stage T1c). The authors reviewed the radical prostatectomy (RP) specimens from 37 consecutive AA men with clinical stage T1c PC and 35 white men who were matched for age, clinical stage, serum prostate-specific antigen (PSA) level, year of surgery, prostate weight, and prostate biopsy strategy. Pathologic characteristics were compared after mapping tumor foci and calculating tumor volumes by using computer software. For AA men, the median age (57.7 years), mean serum PSA level (9.3 ng/mL), mean prostate weight (43 g), and biopsy strategy (73% sextant) were matched with the cohort of 35 white men (median age, 57.1 years; mean PSA, 9.3 ng/mL;, mean prostate weight, 43 g; biopsy strategy, 66% sextant). Despite similar biopsy characteristics between the 2 groups (Gleason score > or =7 in 43% of AA men vs. 37% of white men), AA men exhibited significantly higher prostatectomy Gleason scores (> or =7 in 76% of AA men vs. 34% of white men; P = .01). AA men also had a higher mean tumor volume (1.82 cm3 vs. 0.72 cm3; P = .001) and had 2.8 times more tumor per ng/mL of serum PSA (0.22 cm3 per ng/mL vs. 0.079 cm3 per ng/mL; P = .001). Compared with a cohort of white men with similar clinical features at the time of biopsy, AA men with nonpalpable PC had higher prostatectomy Gleason scores, greater cancer volume, and greater tumor volume per ng/mL of serum PSA. These data provide additional support for the concept of early PC detection using a serum PSA threshold of 2.5 ng/mL for biopsy among AA men.

Three-dimensional combination of transrectal and transperineal biopsies for efficient detection of stage T1c prostate cancer

Although an increasing number of men present with stage T1c prostate cancer, the optimal biopsy strategy for detecting stage T1c disease still remains to be defined. The aim of this study was to explore an efficient first-time biopsy scheme for detecting stage T1c and T2 prostate cancer. A transrectal ultrasound-guided systematic three-dimensional 26-core (3D26) biopsy comprising 12 transrectal and 14 transperineal sampling sites was performed in 321 men with median prostate-specific antigen (PSA) level of 6.0 ng/ml in the first-time biopsy setting. By analyzing site-specific cancer detection rates, we determined the best combination of transperineal and transrectal sampling sites. Prostate cancer was detected in 109 of the 321 men (34%) with a major complication rate of 0.6%. 3D26 biopsy significantly improved cancer detectability by 60% relative to the conventional transrectal sextant (TR6) biopsy. Improvement was significant in 263 men with normal digital rectal examination (DRE) (85%, P = 0.0004) but not in 58 men with abnormal DRE (22%, P = 0.18). The mean Gleason score of the 41 cancers without a positive core within the TR6 sites was marginally lower than that of 68 cancers with a positive core within the TR6 sites (P = 0.04). Recursive partitioning revealed that a three-dimensional 14-core (transrectal 8-core plus transperineal 6-core) and a three-dimensional 8-core (transrectal 4-core plus transperineal 4-core) biopsies could detect more than 95% of stage T1c and T2 cancers with a minimum number of cores, respectively. We propose a three-dimensional 14-core and a three-dimensional 8-core biopsy as efficient first-time biopsy schemes to detect stage T1c and T2 prostate cancer, respectively.

474: Pathologic Outcomes and Biochemical Progression in Men with T1C Prostate Cancer Undergoing Radical Prostatectomy with PSA 2.6-4.0 ng/ml Versus PSA 4.1-6.0 ng/ml

You have accessJournal of UrologyPodium, Sunday, May 21, 2006, 1:00 - 3:00 pm1 Apr 2006474: Pathologic Outcomes and Biochemical Progression in Men with T1C Prostate Cancer Undergoing Radical Prostatectomy with PSA 2.6-4.0 ng/ml Versus PSA 4.1-6.0 ng/ml Danil V. Makarov, Elizabeth B. Humphreys, Leslie A. Mangold, Patrick C. Walsh, Alan W. Partin, Jonathan I. Epstein, and Stephen J. Freedland Danil V. MakarovDanil V. Makarov More articles by this author , Elizabeth B. HumphreysElizabeth B. Humphreys More articles by this author , Leslie A. MangoldLeslie A. Mangold More articles by this author , Patrick C. WalshPatrick C. Walsh More articles by this author , Alan W. PartinAlan W. Partin More articles by this author , Jonathan I. EpsteinJonathan I. Epstein More articles by this author , and Stephen J. FreedlandStephen J. Freedland More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)32730-7AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "474: Pathologic Outcomes and Biochemical Progression in Men with T1C Prostate Cancer Undergoing Radical Prostatectomy with PSA 2.6-4.0 ng/ml Versus PSA 4.1-6.0 ng/ml." The Journal of Urology, 175(4S), p. 154 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 154 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Danil V. Makarov More articles by this author Elizabeth B. Humphreys More articles by this author Leslie A. Mangold More articles by this author Patrick C. Walsh More articles by this author Alan W. Partin More articles by this author Jonathan I. Epstein More articles by this author Stephen J. Freedland More articles by this author Expand All Advertisement PDF DownloadLoading ...

1583: PSA-Doubling Time Assessment Based Upon 4 Consecutive Measurements for 6 Months: Is it a Realistic Strategy to Spare Over-Treatment for Patients with Stage T1C Prostate Cancer Presenting Favorable Biopsy Features?

1583: PSA-Doubling Time Assessment Based Upon 4 Consecutive Measurements for 6 Months: Is it a Realistic Strategy to Spare Over-Treatment for Patients with Stage T1C Prostate Cancer Presenting Favorable Biopsy Features?

1478: T1C Prostate Cancer Detection Rate and Pathologic Charaterisitics: Comparison Between Patients with a Serum Prostate-Specific Antigen (PSA) Range of 3.0 to 4.0NG/ML and 4.1 to 10.0NG/ML in Korean Population

You have accessJournal of UrologyDiscussed Poster, Wednesday, May 24, 2006, 9:00 am - 12:00 pm1 Apr 20061478: T1C Prostate Cancer Detection Rate and Pathologic Charaterisitics: Comparison Between Patients with a Serum Prostate-Specific Antigen (PSA) Range of 3.0 to 4.0NG/ML and 4.1 to 10.0NG/ML in Korean Population Hyoung Keun Park, Goyang Si, Sung Kyu Hong, Seok-Soo Byun, and Sang Eun Lee Hyoung Keun ParkHyoung Keun Park More articles by this author , Goyang SiGoyang Si More articles by this author , Sung Kyu HongSung Kyu Hong More articles by this author , Seok-Soo ByunSeok-Soo Byun More articles by this author , and Sang Eun LeeSang Eun Lee More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(18)33682-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "1478: T1C Prostate Cancer Detection Rate and Pathologic Charaterisitics: Comparison Between Patients with a Serum Prostate-Specific Antigen (PSA) Range of 3.0 to 4.0NG/ML and 4.1 to 10.0NG/ML in Korean Population." The Journal of Urology, 175(4S), p. 477 © 2016 by American Urological AssociationFiguresReferencesRelatedDetails Volume 175Issue 4SApril 2006Page: 477 Advertisement Copyright & Permissions© 2016 by American Urological AssociationMetricsAuthor Information Hyoung Keun Park More articles by this author Goyang Si More articles by this author Sung Kyu Hong More articles by this author Seok-Soo Byun More articles by this author Sang Eun Lee More articles by this author Expand All Advertisement Loading ...

Intra‐operative prostate examination: predictive value and effect on margin status

To evaluate the ability of intra-operative prostate examination (IOPE) to predict extraprostatic extension (EPE) and its effect on margin status in the region of the neurovascular bundle (NVB) when combined with wide excision. We retrospectively reviewed 403 patients with clinical stage T1c prostate adenocarcinoma undergoing radical retropubic prostatectomy (RRP). All patients had IOPE during RRP, and those with palpable abnormalities in the region of the NVB underwent wide excision. Pathological outcomes were analysed. Of 403 patients, 49 (12%) had a palpable abnormality in the region of the NVB. After wide excision, 18 (37%) of these 49 patients were found to have EPE at the site of the palpable abnormality; with wide excision of the NVB, only one of these 18 patients (6%) had a corresponding positive surgical margin (PSM). In 354 patients with a normal IOPE and who underwent bilateral NVB preservation, 30 were found to have EPE in the region of the NVB. The PSM rate in this subset was 23% (seven of 30). The positive predictive value of IOPE for detecting EPE was 37%. IOPE detects abnormalities in 12% of patients with preoperative stage T1c prostate cancer. Although the predictive value of this test is limited, IOPE may decrease PSMs in a subset of patients with EPE in the region of the NVB. The present study reaffirms the value of IOPE for assessing the risk of extraprostatic disease, and for guiding surgical management.

Preoperative PSA and progression-free survival after radical prostatectomy for Stage T1c disease

Objectives To examine biochemical progression-free survival (PFS) rates as a function of preoperative prostate-specific antigen (PSA) in patients with clinical Stage T1c prostate cancer treated with radical prostatectomy. Controversy exists about whether performing prostate biopsies for PSA levels in the 2.6 to 4.0 ng/mL range provides a PFS advantage compared with detection at higher PSA ranges. Methods A total of 2804 men with clinical Stage T1c prostate cancer were treated with radical retropubic prostatectomy and monitored prospectively. The study parameters included preoperative PSA level, pathologic tumor stage, and Gleason grade. Patients were grouped into four clinically relevant strata according to their preoperative PSA level: 2.6 to 4.0, 4.1 to 7.0, 7.1 to 10.0, and greater than 10 ng/mL. The primary outcome was the 10-year actuarial biochemical PFS estimate generated using the Kaplan-Meier method. We compared the strata using the log-rank test. Cancer progression rates were compared using the Cochran Armitage test for trend. The chi-square test was used to compare the pathologic parameters among the PSA strata. Results Of the men with a preoperative PSA level of 2.6 to 4.0, 4.1 to 7.0, 7.1 to 10.0, and greater than 10.0 ng/mL, 81%, 74%, 72%, and 60%, respectively, had organ-confined disease ( P = 0.001) and 23%, 28%, 35%, and 47%, respectively, had a pathologic Gleason grade of 7 or greater ( P = 0.001). The corresponding 10-year PFS estimates were 88%, 80%, 76%, and 61% ( P = 0.0001, for trend). Conclusions Among men with clinical Stage T1c prostate cancer, those with a PSA level of 2.6 to 4.0 ng/mL had the greatest rate of organ-confined disease, lowest pathologic Gleason grade, and greatest 10-year PFS rate.

Age as a prognostic factor for prostate cancer patients treated with brachytherapy

4731 Background: PSA level and Gleason score are well-established prognostic factors for patients with prostate cancer. The purpose of this retrospective study was to investigate the prognostic importance of age in prostate cancer patients treated with I-125 seed implantation. Methods: 162 consecutive patients with stage T1a, T1b, T1c, T2a, T2b, and T2c prostate cancers underwent Iodine-125 seed implantation at our institution between 1996 and 2001. 7 patients received neo-adjuvant hormone ablation therapy, and 5 patients received adjuvant external beam radiation therapy. All underwent an initial workup consisting of pretreatment PSA level and multiple biopsies with determination of Gleason score. Patients were stratified into a group of patients consisting of individuals aged 60 years or less at the time of brachytherapy (Group A, n=35), and another group of patients aged 61 and over at the time of brachytherapy (Group B, n=127). The mean follow up for patients in both groups was 4.0 years, and all patie...