Search

OBJECTIVES To evaluate the prognostic potential of prostate-specific antigen (PSA) expression in tumor specimens in a large cohort of prostate cancers treated by prostatectomy. Although serum PSA measurement has been established as a diagnostic and prognostic tool in prostate cancer, no larger studies have been done of the prognostic potential of this parameter. METHODS We used a tissue microarray containing samples of 3261 prostatectomy specimens. PSA expression was scored after immunohistochemical staining on a scale from 0 (absent) to 3 (strong) by an investigator unaware of all other variables. The results were correlated with the pre- and postoperative clinical and pathologic parameters and follow-up data. RESULTS Of 2556 eligible tumors, PSA expression was strong in 48.0%, moderate in 36.7%, weak in 12.2%, and absent in 3.1%. The loss of PSA expression correlated significantly with a greater Gleason score, the presence of extraprostatic extension, and a peripheral zone prostate cancer location. It was also significantly associated with PSA recurrence after prostatectomy on univariate analysis but not on multivariate analysis containing the pathologic parameters of the prostatectomy specimens. In the subsets of patients with a preoperative PSA value

OBJECTIVES: To examine the rate of biochemical recurrence (BCR) in patients with pathologically confirmed insignificant prostate cancer (PIPCa). METHODS: A total of 1358 patients underwent open retropubic radical prostatectomy at the University Medical Center Eppendorf in Hamburg, Germany, and their specimens were whole-mounted, step-sectioned, and subjected to computer-based three-dimensional reconstruction. We identified patients who fulfilled the Epstein criteria for definition of PIPCa (tumor volume

Objectives Up to 20% of men may harbor a transition zone (TZ) prostate cancer (PCa) at radical prostatectomy (RP). TZ PCa may be associated with more favorable RP pathologic findings than peripheral zone (PZ) PCa. To identify these men, we developed a model capable of predicting the probability of TZ PCa at RP. Methods The study cohort consisted of 945 consecutive men treated with RP, with clinical stage, prostate-specific antigen (PSA) level, and detailed biopsy and RP pathology data available. The preoperative variables were used as predictors in the multivariate logistic regression models to predict the rate of TZ PCa at RP. PCa was defined as a TZ tumor when more than 50% of the planimetrically measured tumor volume was situated within the TZ. Regression coefficients were used to develop nomograms, which were subjected to 200 bootstrap resamples to reduce overfit bias. Results TZ PCa at the final pathologic examination was recorded in 110 patients (11.6%). After 200 bootstraps, the most parsimonious and most accurate nomogram was 77.3% accurate in predicting the probability of TZ PCa. Conclusions This nomogram is ideally suited to identify patients with markedly elevated, nearly metastatic serum PSA levels who harbor a TZ tumor that is highly treatable by RP.

Objectives To analyze the zonal location of prostate cancer as a possible predictive feature of progression-free survival after radical prostatectomy. Methods Prostate cancers were divided into three groups according to the percentage of cancer volume (70% or more, 31% to 69%, and 30% or less) located in the transition zone (TZ). In a total of 307 patients, 5-year progression-free probabilities were estimated for different clinical and pathologic tumor characteristics using the Kaplan-Meier method. With emphasis on the percentage of cancer volume located in the TZ, univariate and multivariate analyses were performed to calculate their prognostic significance in predicting progression-free probability. Results Prostate cancer with 70% or more, 31% to 69%, and 30% or less of the cancer volume in the TZ was found in 17.3%, 6.8%, and 75.9% of the patients, respectively. Patients with tumors with 70% or more of the cancer volume in the TZ had a significantly (log-rank P = 0.0402) greater rate of biochemical cure than those with 30% or less (82.1% versus 66.2%). The increasing percentage of cancer volume located in the TZ was significantly (P = 0.0258) associated with a greater progression-free probability in univariate analysis, but did not retain independent significance (P = 0.5748) in multivariate analysis. Instead, pathologic stage (P

Objectives. To examine the significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in biopsy specimens. Methods. We performed sextant biopsies on a series of 83 cystoprostatectomy specimens removed for bladder cancer. For each case the number of foci and volume of both HGPIN and prostate cancer were assessed in the prostatectomy specimens and compared with the number of biopsy specimens involved by HGPIN. Results. We identified HGPIN in 82 (99%) of 83 prostatic glands, whereas prostate cancer was found in 41 cases (49%). Corresponding sextant biopsies harbored both HGPIN and prostate cancer in 6 cases (7%), whereas only HGPIN was diagnosed in 29 sextant biopsies (35%). There was a positive correlation between the number of biopsy specimens containing HGPIN and the volume and multifocality of HGPIN in the corresponding prostatic glands. Prostates with HGPIN on sextant biopsy contained prostate cancer significantly more often when compared to cases with no HGPIN on sextant biopsy. Frequency of concurrent prostate cancer was higher in cases with two or more biopsy specimens containing HGPIN than in cases with only one such biopsy specimen, but case numbers of these categories were too small to render this difference statistically significant. Conclusions. The presence of HGPIN in sextant biopsies is a significant predictor of concurrent prostate cancer. Multifocality of HGPIN is a useful parameter in assessing the extent of HGPIN in the corresponding prostates. Its value in predicting a significantly increased risk of concurrent prostate cancer needs to be further investigated in larger case studies.