The Wednesday news reports: January 7, 2009


Wednesday’s news reports include  items on:

  • The occurrence of “clinically insignificant” prostate cancer in an autopsy series
  • The value of a patient decision aid in management of localized prostate cancer
  • The clinical value of the 2005 International Society of Urologic Pathology Gleason Grading Consensus score (ISUP GS)
  •  Outcomes of radical prostatectomy for prostate cancer discovered incidental to a transurethral resection of the prostate (TURP)
  • Outcomes of 11 cases of salvage robot-assisted laparoscopic radical prostatectomy

Stamatiou et al. examined 40 cases of non-palpable prostate cancer found in 212 prostate autopsy specimens of men between 30 and 98 years of age who died of diseases other than carcinoma of the prostate and related conditions. Most clinical stage T1 prostate cancers (57.5 percent) had a Gleason score between 2 and 4, while 30 percent had Gleason scores of 5 and 6. Only 5/40 (12.5 percent) had a Gleason score > 7. Of all clinical stage T1 cancers, 29/40 (67.5 percent) had a volume of < 1 cm3. The highest volume tumors were those of intermediate and high grade (Gleason sums 5-8). Among tumors with volumes of < 1 cm3, 96.55 percent were confined within the prostatic capsule. As have others in the past, the authors concluded that, “The majority of impalpable [prostate cancers] were low-volume, well-differentiated tumors corresponding to clinically insignificant neoplasms.”

Isebaert et al., working with patients in Belgium, have developed yet another patient decision aid that assisted patients to become more active partners in the decision-making process regarding first-line therapy.

Uemura et al. have investigated the relative merits of the 2005 International Society of Urologic Pathology Gleason Grading Consensus score (ISUP GS) and the older, conventional Gleason score (CGS) as indicators to determine the most appropriate treatments for patients with early-stage prostate cancer. Of 250 patients undergoing radical prostatectomy, 103 with clinical stage T1-2N0M0 were enrolled. Pathological tumor grades of needle biopsy and radical prostatectomy specimens were classified prospectively according to CGS by experienced pathologists in the central pathology department of the authors’ hospital, and retrospectively according to ISUP GS by a single  uropathologist at the central pathology department of another hospital. All patients were treated by radical prostatectomy, with no neoadjuvant or adjuvant therapy. The concordance rates between needle biopsy and radical prostatectomy specimens by CGS and ISUP GS were 64.1  and 69.9 percent, respectively. Under-grading and over-grading rates by CGS and ISUP GS were 28.2 and 7.8 percent for needle biopsy, and 27.2 and 2.9 percent for radical prostatectomy specimens, respectively. There was a significant difference in the over-grading rate between CGS and ISUP GS (P = 0.026). When the CGS and ISUP GS of needle biopsy and radical prostatectomy specimens were compared, the concordance rates were similar, at 67 and 69.9 percent. The ISUP GS values of needle biopsy specimens were significantly associated with biochemical progression-free survival after radical prostatectomy. The authors conclude that the ISUP system is clinically more useful for determining the most appropriate treatments for patients with early-stage prostate cancer.

Melchior et al. have evaluated data from a contemporary series of patients with incidental prostate cancer detected by transurethral resection of the prostate (TURP) and undergoing radical prostatectomy (RP) between 1998 and 2004. A total of 1,931 patients had a TURP for obstructive voiding symptoms and suspected BPH. Incidental prostate cancer was found in 104 patients (5.4 percent); 26 of these patients had an RP. Of the 26 patients who had an RP, 17 had T1a and 9 had T1b disease. After RP, 6/17 in the T1a group (37 percent) had no residual tumour (pT0) and 11/17 (65 percent) had pT2 cancer; the respective incidence in those with T1b was 2 and 7, with no pT3 disease in either group. The preoperative Gleason grading did not correspond well with that after RP; 30 percent of the patients had upgraded Gleason scores, and 42 percent showed either downgrading or no residual tumor, with 81 percent having Gleason scores of < 7. After a median follow-up of 47 months, one patient is receiving hormonal therapy because of biochemical relapse.

Boris et al. have evaluated the initial results of salvage robotic-assisted laparoscopic prostatectomy (sRALP) after recurrence following primary radiotherapy (RT) for localized prostate cancer. Between December 2002 and January 2008, 11 patients had an sRALP with  a pelvic lymph node dissection (PNLD) by one surgeon from one institution. Six patients had had prior brachytherapy, three had had external beam RT (EBRT), one had had intensity-modulated RT, and one had received brachytherapy with an EBRT boost. The mean follow-up was 20.5 months  (ramge: 1-77 months). The mean interval from RT to sRALP was 53.2 months; the mean preoperative PSA level was 5.2 ng/ml; the median operative duration was 183 min; and the estimated blood loss was 113 ml. Three patients had biochemical recurrences, at 1, 2 and 43 months. The authors conclude that sRALP after RT-resistant disease recurrence is feasible, with minimal perioperative morbidity, and that functional outcomes appear to be at least equivalent to historical salvage RP series.

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