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Incidental Prostate Cancer at the Time of Cystectomy: The Incidence and Clinicopathological Features in Chinese Patients  [PDF]
Jiahua Pan, Wei Xue, Jianjun Sha, Hu Yang, Fan Xu, Hanqing Xuan, Dong Li, Yiran Huang
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0094490
Abstract: Objectives To evaluate the incidence and the clinicopathological features of incidental prostate cancer detected in radical cystoprostatectomy (RCP) specimens in Chinese men and to estimate the oncological risk of prostate apex-sparing surgery for such patients. Methods The clinical data and pathological feature of 504 patients who underwent RCP for bladder cancer from January 1999 to March 2013 were retrospectively reviewed. Whole mount serial section of the RCP specimens were cut transversely at 3–4 mm intervals and examined in same pathological institution. Results Thirty-four out of 504 patients (6.8%) had incidental prostate cancer with a mean age of 70.3 years. 12 cases (35.2%) were diagnosed as significant disease. 4 cases were found to have apex involvement of adenocarcinoma of the prostate while in 5 cases the prostate stroma invasion by urothelial carcinoma were identified (one involved prostate apex). The mean follow-up time was 46.4±33.8 months. Biochemical recurrence occurred in 3 patients but no prostate cancer-related death during the follow-up. There was no statistical significance in cancer specific survival between the clinically significant and insignificant cancer group. Conclusions The prevalence of incidental prostate cancer in RCP specimens in Chinese patients was remarkably lower than in western people. Most of the incidental prostate cancer was clinically insignificant and patient's prognosis was mainly related to the bladder cancer. Sparing the prostate apex was potentially associated with a 1.0% risk of leaving significant cancer of the prostate or urothelial carcinoma.
Gynecologic-tract sparing extra peritoneal retrograde radical cystectomy with neobladder
Kulkarni, Jagdeesh N.;Rizvi, S. Jamal;Acharya, U. Purushotthama;Kumar, K. S. Shiva;Tiwari, P.;
International braz j urol , 2008, DOI: 10.1590/S1677-55382008000200008
Abstract: objective: we report on a series of female patients with transitional cell carcinoma of the bladder who underwent extraperitoneal retrograde radical cystectomy sparing the female reproductive organs with neobladder creation. materials and methods: 14 female patients between the ages of 45 and 72 years who underwent gynecologic-tract sparing cystectomy (gtsc) with neobladder between 1997 and 2002 were retrospectively reviewed. our surgical technique is also described. radical cystectomy is accomplished by a retrograde method sparing the uterus, adnexa, vagina and distal urethra. an orthotopic neobladder was constructed using small bowel or sigmoid colon, brought extraperitoneally, and anastomosed to the distal urethra. results: operating time ranged from 4.5 to six hours with a mean of 5.3 hours. ten patients were able to void satisfactorily while four required self-catheterization for complete emptying of the bladder. seven patients were continent day and night and another 7 reported varying degrees of daytime and nighttime incontinence. one patient died of metastases and another of pelvic recurrence. there were no urethral recurrences. patient satisfaction with the procedure was high. conclusions: gynecologic-tract sparing cystectomy with orthotopic neobladder is a viable alternative in female patients with muscle invasive traditional cell carcinoma of the bladder, providing oncological safety with improved quality of life. our extraperitoneal technique, which is an extension of our successful experience with retrograde extraperitoneal radical cystectomy in men, minimizes intraoperative complications and simplifies the management of post-operative morbidity with the neobladder.
Radical Cystectomy after BCG Immunotherapy for High-Risk Nonmuscle-Invasive Bladder Cancer in Patients with Previous Prostate Radiotherapy  [PDF]
Manoj V. Rao,Marcus L. Quek,Gautam Jayram,Chandy Ellimoottil,Timothy Sondej,Cory M. Hugen,Robert C. Flanigan,Gary D. Steinberg
ISRN Urology , 2013, DOI: 10.1155/2013/405064
Abstract: Purpose. Intravesical Bacillus Calmette-Guerin (BCG) immunotherapy is indicated for high-grade nonmuscle-invasive bladder cancer (NMIBC). The efficacy of BCG in patients with a history of previous pelvic radiotherapy (RT) may be diminished. We evaluated the outcomes of radical cystectomy for BCG-treated recurrent bladder cancer in patients with a history of RT for prostate cancer (PC). Methods. A retrospective chart review was performed to identify patients with primary NMIBC. We compared the outcomes of three groups of patients who underwent radical cystectomy for BCG-refractory NMIBC: those with a history of RT for PC, those who previously underwent radical prostatectomy (RP), and a cohort without PC or RT exposure. Results. From 1996 to 2008, 53 patients underwent radical cystectomy for recurrent NMIBC despite BCG. Those with previous pelvic RT were more likely to have a higher pathologic stage and decreased recurrence-free survival compared to the groups without prior RT exposure. Conclusion. Response rates for intravesical BCG therapy may be impaired in those with prior prostate radiotherapy. Patients with a history of RT who undergo radical cystectomy after failed BCG are more likely to be pathologically upstaged and have decreased recurrence-free survival. Earlier consideration of radical cystectomy may be warranted for those with NMIBC who previously received RT for PC. 1. Introduction In 2012, over 240,000 American men will be diagnosed with prostate cancer [1]. Approximately 28% will receive some form of radiation therapy (RT) [2]. Pelvic radiation may be associated with an elevated risk of secondary bladder malignancies that may be seen as early as five years after exposure [3]. Intravesical BCG therapy is a standard treatment for high-risk nonmuscle-invasive bladder cancer (NMIBC) (clinical stages Ta, Tis, and T1) [4]. We have previously shown that 50% of patients with NMIBC who were previously exposed to prostate RT will have a durable response to intravesical BCG. We now report our experience with radical cystectomy after failed BCG immunotherapy for high-risk NMIBC in men with and without a prior history of RT for PC. 2. Methods With institutional review board approval, we retrospectively identified all patients who underwent radical cystectomy for recurrent/persistent high-risk NMIBC urothelial carcinoma and received intravesical BCG therapy from a dataset of nearly 1500 cystectomy patients at two academic medical centers from 1995 to 2008. We divided this cohort into three groups based on the history of PC and its associated treatment
Incidentally Found Prostate Cancer and Influence on Overall Survival after Radical Cystoprostatectomy  [PDF]
Algimantas Sruogis,Albertas Ulys,Giedre Smailyte,Zygimantas Kardelis,Arunas Kulboka,Giedre Anglickien?,Nerimantas Samalavicius,Marius Anglickis
Prostate Cancer , 2012, DOI: 10.1155/2012/690210
Abstract: Objectives. To determine incidentally found prostate cancer frequency and impact on overall survival after RCP. Patients and Methods. The records of 81 men who underwent cystoprostatectomy from January 2000 to December 2009 were reviewed. The vital status of the study group was assessed as on September 1, 2009, by passive followup, using data from the population registry. Results. The 81 men underwent RCP. The incidental prostate cancer was found in the specimens of 27 (33.3%) patients. 13 (48.1%) of 27 prostate cancer cases were clinically significant. For 3 patients (11.1%) an extraprostatic extension was found. For 2 patients (7.4%)—positive margins, for 1 patient (3.7%)—Gleason sum 8, and for the rest 7 patients bigger than 0.5?cm3 volume tumor, and Gleason sum 7 was found. The mean follow-up time was months (varies from 0.8 to 131.2 months). The patients with bladder cancer and incidentally found prostate cancer lived shorter ( and months). Higher overall survival ( ) was found in the patient group with bladder cancer without incidentally diagnosed prostate cancer. Conclusion. There are indications that in this small study prostate cancer has influenced on patients' survival with bladder cancer after radical cystoprostatectomy. 1. Introduction Bladder cancer is the second most common cancer of urinary tract after prostate cancer and the fourth most common malignancy in men [1]. Although the disease may occur in young persons, about 78% of all cancers are diagnosed in persons of age 55 years and older [2]. 70% of all patients with bladder cancer have superficial cancer that does not reach the muscular layer, and most of these patients have a fairly good prognosis. Most of the patients with superficial bladder cancer have pTa bladder cancer stage. 20% of all patients with bladder cancer have pT1 bladder cancer stage and just 10% is carcinoma in situ [3]. Patients with carcinoma in situ have the biggest risk of cancer progression into the muscular layer and also are in the biggest risk group of death. Radical cystoprostatectomy (RCP) is the standard and effective treatment method for the patients with invasive or superficial recurrent bladder cancer who are in a high progression risk group. Patients’ survival after RCP depends on the primary tumor grade and stage. 5-year survival after RCP varies from 33 to 73%, and no other medical attempts during the last 10 years had no influence for patients’ survival [4]. The standart technique of RCP in men consists of removing a bladder together with the removal of a prostate, seminal vesicles, a part of the
Overall and worst gleason scores are equally good predictors of prostate cancer progression
Teemu T Tolonen, Paula M Kujala, Teuvo LJ Tammela, Vilppu J Tuominen, Jorma J Isola, Tapio Visakorpi
BMC Urology , 2011, DOI: 10.1186/1471-2490-11-21
Abstract: The study material consisted of needle biopsies from 236 prostate cancer patients that were endocrine-treated in 1999-2003. Biopsies from left side and right side were embedded separately. Haematoxylin-eosin-stained slides were scanned and analyzed on web-based virtual microscopy. Worst and overall Gleason scores were assessed according to the modified Gleason score schema after analyzing each biopsy separately. The compound Gleason scores (CGS) were obtained from the original pathology reports. Two different grade groupings were used: GS 6 or less vs. 7 vs. 8 or above; and GS 7(3 + 4) or less vs. 7(4 + 3) and 8 vs. 9-10. The prognostic ability of the three scoring methods to predict biochemical progression was compared with Kaplan-Meier survival analysis and univariate and multivariate Cox regression analyses.The median follow-up time of the patients was 64.5 months (range 0-118). The modified GS criteria led to upgrading of the Gleason sums compared to the original CGS from the pathology reports 1999-2003 (mean 7.0 for CGS, 7.5 for OGS, 7.6 for WGS). In 43 cases WGS was > OGS. In a univariate analysis the relative risks were 2.1 (95%-confidence interval 1.8-2.4) for CGS, 2.5 (2.1-2.8) for OGS, and 2.6 (2.2-2.9) for WGS. In a multivariate analysis, OGS was the only independent prognostic factor.All of the three Gleason scoring methods are strong predictors of biochemical recurrence. The use of modified Gleason scoring leads to upgrading of GS, but also improves the prognostic value of the scoring. No significant prognostic differences between OGS and WGS could be shown, which may relate to the apparent narrowing of the GS scale from 2-10 to 5-10 due to the recent modifications.Grading of prostatic needle biopsies has undergone several refinements in the last decade. First, Epstein suggested that a diagnosis of Gleason score (GS) 2 + 2 = 4 cancer should not be made on the needle biopsies, because subsequent radical specimens showed upgrading in virtually all cases [
The Role of Adjuvant Hormonal Treatment after Surgery for Localized High-Risk Prostate Cancer: Results of a Matched Multiinstitutional Analysis  [PDF]
Maria Schubert,Steven Joniau,Paolo Gontero,Susanne Kneitz,Claus-Jürgen Scholz,Burkhard Kneitz,Alberto Briganti,R. Jeffrey Karnes,Bertrand Tombal,Jochen Walz,Chao-Yu Hsu,Giansilvio Marchioro,Pia Bader,Chris Bangma,Detlef Frohneberg,Markus Graefen,Fritz Schr?der,Paul van Cangh,Hein van Poppel,Martin Spahn
Advances in Urology , 2012, DOI: 10.1155/2012/612707
Abstract: Introduction. To assess the role of adjuvant androgen deprivation therapy (ADT) in high-risk prostate cancer patients (PCa) after surgery. Materials and Methods. The analysis case matched 172 high-risk PCa patients with positive section margins or non-organ confined disease and negative lymph nodes to receive adjuvant ADT (group 1, ) or no adjuvant ADT (group 2, ). Results. Only 11.6% of the patients died, 2.3% PCa related. Estimated 5–10-year clinical progression-free survival was 96.9% (94.3%) for group 1 and 73.7% (67.0%) for group 2, respectively. Subgroup analysis identified men with T2/T3a tumors at low-risk and T3b margins positive disease at higher risk for progression. Conclusion. Patients with T2/T3a tumors are at low-risk for metastatic disease and cancer-related death and do not need adjuvant ADT. We identified men with T3b margin positive disease at highest risk for clinical progression. These patients benefit from immediate adjuvant ADT. 1. Introduction Patients with high-risk localized prostate cancer (PCa) based on either PSA >20?ng/mL, Gleason score (GS) ≥8, or an advanced clinical stage have a risk of biochemical failure of up to 70% with surgery alone [1–5]. This has raised the question on the need of adjuvant treatments including androgen deprivation, radiation, and chemotherapy. Adjuvant androgen deprivation therapy (ADT) has shown significant improvement in disease-free survival for men with high-risk PCa treated with definitive radiation therapy and a survival benefit for men with GS 8–10 [6, 7]. For patients treated with radical prostatectomy (RP) the role of adjuvant ADT is still controversial. In a small prospective, randomized trial a survival benefit with adjuvant ADT in patients with lymph node positive disease was shown [8]. Two retrospective studies have reported a survival advantage for immediate ADT in patients with locally advanced disease [9, 10]. For patients with pT3N0M0 PCa Thompson et al. recently reported improved metastasis-free and overall survival (OS) with adjuvant radiation therapy when compared to observation [11]. Current guidelines therefore recommend adjuvant radiation for these patients [12, 13]. However, the results of the ADT-alone control arm of the SWOG study S9921 reported on excellent 5-year progression-free (92.5%) and OS rates (95.9%) for men with high-risk PCa treated with RP and adjuvant ADT over a two-year period [14]. These excellent results were seen despite a minority of patients receiving adjuvant radiation and therefore suggest there might be a role for adjuvant ADT in men with pT3
The Impact of Co-Existing Prostate Adenocarcinoma with Bladder Carcinoma on Disease Specific Survival of The Patients in Our Radical Cystoprostatectomy Series  [PDF]
?zgür Ugurlu,Volkan ?ztekin,Murat Kosan,?mer Doluoglu
Journal of Clinical and Analytical Medicine , 2010, DOI: 10.4328
Abstract: The aim of this study was to compare the patients with and without histologically proven prostate carcinoma who underwent radical cystectomy for muscle invasive bladder cancer in terms of bladder tumor properties and survival rates. Material and Methods: A total of 149 male patients who had undergone radical cystectomy and urinary diversion between 1994-2007 in our institution were included in our study. Medical records of the patients were analyzed retrospectively. Fourteen (9.3%) patients had co-existing prostate carcinoma, while remaining 135 (90.7%) did not. The two groups were compared to each other with respect to the oncological properties of the bladder tumors (stage and grade) and disease specific mortality rates. Results: The mean ages for the patients with and without co-existing prostate carcinoma were 64.2±8.4 and 57.7±10.8, respectively. There was a significant difference between the ages of the two groups (p=0.029). There were not any significant differences among the two groups regarding bladder cancer pathological stage (p=0.199) and grade (p=0.544). The disease specific survival rates of the two groups for three years were: 61.76% and 81.82% for the patients with and without coexisting prostate carcinoma respectively. No significant difference was observed between the disease specific survival rates of the two groups (p=0.325). Conclusion: The co-existing prostate carcinoma had no significant effect on tumor stage, grade and disease specific survival rates of patients who underwent radical cystectomy for muscle invasive bladder cancer.
Vitamin D Levels in Subjects with Prostate Cancer Compared to Age-Matched Controls  [PDF]
Subhashini Yaturu,Sonya Zdunek,Barbara Youngberg
Prostate Cancer , 2012, DOI: 10.1155/2012/524206
Abstract: Prostate cancer (PCa) is the second most common cancer in men worldwide and the second leading cause of cancer deaths in men in the United States. Vitamin D is considered to have anticancer properties, currently thought to work mainly through its nuclear receptor or vitamin D receptor. In this retrospective study, we compared vitamin D levels in subjects with PCa with those of age-matched men without PCa. Study subjects included 479 in each group with a mean age of 73 and a mean creatinine of 1.05 and 1.15. Levels of 25 (OH) vitamin D were and in subjects with and without PCa. Levels of 1,25 (OH) vitamin D were and in subjects with and without PCa. In contrast to other studies, we did not find a significant difference in vitamin D levels. Among prostate cancer patients, vitamin D levels correlated positively with age ( , ), and were negatively associated with BMI ( , ), glucose ( , ), HbA1C ( , ), and PTH ( ; ). The data do not show the causal effect of vitamin D levels on PCa. 1. Introduction Prostate cancer is the most commonly diagnosed cancer in men in the United States [1]. It is estimated that 241,740 men will be diagnosed with and 28,170 men will die of cancer of the prostate in 2012 [1]. Vitamin D from the skin and diet is metabolized in the liver to 25-hydroxyvitamin D (25(OH)D), which is used to determine a patient’s vitamin D status [2]. Vitamin D insufficiency affects almost 50% of the population worldwide [2, 3]. In the Third National Health and Nutrition Examination Survey (NHANES III), a cross-sectional multivariate analysis, the lowest quartile of 25(OH)D level (<17.8?ng/mL) was independently associated with all-cause mortality in the general population [4]. Prostate cells contain vitamin D receptors as well as enzymes necessary for vitamin D metabolism. Vitamin D metabolites are considered to have an antiproliferative and a prodifferentiating effect on prostate cancer cell lines in vitro and in vivo. Low levels of plasma vitamin D have been implicated as a possible risk factor for both prostate cancer incidence and advanced disease. In a study to examine the association between vitamin D receptor (VDR) polymorphisms and prostate cancer stage, the authors concluded that low levels of vitamin D may increase the risk of prostate cancer progression [2]. However, meta-analysis of published literature of studies on vitamin D levels and association with prostate cancer reported no association [5, 6] or little evidence to support a major role of vitamin D in preventing prostate cancer or its progression [7]. There are on-going clinical trials
Patients with Localised Prostate Cancer (T1 - T2) Show Improved Overall Long-Term Survival Compared to the Normal Population  [cached]
Michael J. Mathers, Stephan Roth, Monika Klinkhammer-Schalke, Michael Gerken, Ferdinand Hofstaedter, Stefan Wilm, Theodor Klotz
Journal of Cancer , 2011,
Abstract: Background: Little information is available on the long-term outcomes of patients with localised prostate cancer. Objective: To examine the long-term survival of patients with localised prostate gland carcinoma T1 - T2, N0, M0 (UICC stage I and II) compared to the normal population. Design: Retrospective cohort. Setting: Regensburg, Germany. Participants: Data on 2121 patients with histologically-confirmed, localised prostate cancer diagnosed between 1998 and 2007 were extracted from the cancer registry of the tumour centre in Regensburg, Germany. Measurements: Overall survival rate in the patient cohort was estimated and compared to the expected survival rate of a comparable group in the general population derived from the official life-tables of Germany stratified by age, sex and calendar year. Results: Ten years after diagnosis, patients with stage I and II localised prostate gland carcinoma had an approximately 10% increase in survival compared to the normal male population (Relative Survival = 110.7%, 95%-CI 106.6 - 114.8%). Limitations: We did not examine the effect of cancer treatment or cancer aggressiveness on the overall survival of patients. We did not assess the incidence of subsequent non-primary cancers in our patient population or how this incidence affects the patients' follow-up care and survival. Conclusions: Patients with stage I+II localised prostate gland carcinoma have improved survival compared with the normal male population. This finding cannot be explained solely by the administration of prostate carcinoma treatments, suggesting that men who participate in PSA screening may have better overall health behaviors and care than men who do not participate in screening. Future research should examine how treatment choice, especially an “active surveillance” approach to care, affects survival in these patients more than ten years after diagnosis.
Comorbidities and Concomitant Medication Use in Men with Prostate Cancer or High Levels of PSA Compared to Matched Controls: A GPRD Analysis  [PDF]
Haojie Li,Elizabeth Hodgson,Louise Watson,Amit Shukla,Jeanenne J. Nelson
Journal of Cancer Epidemiology , 2012, DOI: 10.1155/2012/291704
Abstract: Comorbidity influences screening practice, treatment choice, quality of life, and survival. The presence of comorbidities and medication use could place patients at greater risks of adverse effects from certain interventions. We conducted a longitudinal cohort study in the General Practice Research Database to better understand comorbidities and medication use in men with or at risk of prostate cancer (CaP). Compared with men with similar age but no CaP, CaP patients had higher incidence of urinary tract infection, impotence and breast disorder, and 2.6-fold higher all-cause mortality. Among men with elevated prostate-specific antigen (PSA) but no CaP, the mortality rates were slightly lower, and fewer differences in comorbidities and medication use were noted compared to men without elevated PSA. Many prevalent comorbidities and medications were consistent across groups and are typical of an older male population. These real-world data are broadly applicable throughout the drug development cycle and subsequent patient management. 1. Introduction Prostate cancer (CaP) is the most common nonskin cancer and the second or third leading cause of death from cancer among men in the developed world [1]. In the UK, more than 36,000 men are diagnosed with CaP each year, comprising a quarter of all cancers diagnosed in men. Although approximately 10,000 men died from CaP in the UK in 2008, survival rates for CaP patients have changed markedly over the past 40 years. More than 75% of CaP patients currently survive beyond five years, compared with less than a third of the patients with five-year survival in the 1970s; the differential is even greater in the ten-year survival experiences now compared to 40 years ago [2]. Thus, the CaP patient population is large. Moreover, in this large group, the burden of disease from CaP is preponderantl in elderly men, with men who are 70 years or older comprising more than half the patient population in the UK. Consequently, CaP patients often present for medical care with advanced age-related comorbidities [3]. The number and types of patient comorbidities have informed treatment choice for CaP in clinical practice, with less aggressive treatment used as comorbidity increases [4–9]. Comorbidity scores have been shown to predict outcomes ranging from late urinary complications [10] to overall survival [11] among men who have undergone radical prostatectomy. Moreover, specific comorbidities, or a high number of comorbidities, have been used in some instances to exclude patients from clinical trials due to concerns of increased
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