Search

Introduction and Objectives. The reported rate of seminal vesicles invasion in RP series varies between 6-26%. Invasion of seminal vesicles by adenocarcinoma of the prostate is considered an adverse prognostic factor and consequently patients are at high risk of cancer recurrence after radical prostatectomy. The reported biochemical recurrence free rates at 5 years after RP are between 5-60% (median 30%). The aim of this paper is to assess the role of postoperative radiation in patients with seminal vesicle (SV) invasion after radical prostatectomy (RP). Materials and Methods. From a database of 500 consecutive patients who underwent RP at the University of Florida, sixty two (12%) were diagnosed with seminal vesicle invasion. All patients underwent adjuvant radiation (RT). Median age was 65 (range 48-77), median pre RP PSA was 15 ng/ml (range 4.3-91). Median pre RT PSA was 0.2 ng/ml (range 0.1 - 19 ng/ml). The PSA cut off value signifying serological failure after RP was ≥ 0.4 ng/ml. Median follow up was 56 months (range 12-104). Results. Thirty three patients (53%) relapsed serologically. Median time to PSA failure was 34 months (range 1-75). One patient (1.6%) died of metastatic prostate cancer. Pre RT PSA was the most significant prognostic factor with respect to serological failure (p=0.003). Perineural invasion (PNI) was also found as statistically significant prognostic factor (p=0.05). Pre operative PSA, pathological Gleason score, extra capsular cancer extension in addition to SV invasion (eCe) and positive surgical margins were not found to be significant prognostic factors with respect to PSA failure. Conclusions. When analyzed in the light of other reports in the literature, the present study suggests that adjuvant radiation given in pT3c patients that have undetectable PSA after RP, the PSA recurrence rate at 5 years is lower than that of patients treated with RP alone. [ABSTRACT FROM AUTHOR]

Introduction and Objectives. According to the NCCN, patients with carcinoma of prostate can be categorized based on their initial PSA, clinical stage and Gleason score in three groups according to their risk of definitive treatment failure. The aim of this paper is to report on the outcome of patients with intermediate and high risk of recurrence who underwent radical prostatectomy (RP). Materials and Methods. Eighty-five consecutive patients categorized as intermediate (17.5%) and high risk (82.5%) of failure after definitive therapy for carcinoma of prostate according to the National Comprehensive Cancer Network (NCCN) underwent RP between 1989 and 1997. Median preoperative PSA was 26 ng/ml (range 15 ng/ml - 91 ng/ml). Fifty-nine patients (70%) received 3 months neoadjuvant hormone therapy. Thirty-six patients (42%) underwent early (3-4 months after RP) adjuvant radiation for pT3 disease and/or positive surgical margins. Results. The median follow-up was 58 months (range 12 - 104 mos.). There was no difference in the biochemical recurrence rate between the intermediate and high risk group of patients. The overall relapse rate was 33%. Cancer specific mortality was 3.5%. Patients with T1c tumors had a significantly lower biochemical recurrence rate (bRR) (7%) compared to palpable tumors (p=0.03). Age above 65 was a significant negative prognostic factor with respect to biochemical recurrence (p=0.01). Adjuvant radiation was associated with biochemical recurrence rates of 25% vs. 40% in patients who were not radiated. (p=0.05). Conclusions. In the intermediate and high risk group of patients with nonpalpable prostate cancer, RP and adjuvant RT may provide a biochemical recurrence free rate (bRFR) comparable to that reported in other series with RP alone on patients in the low risk groups. We encourage the multimodality treatment approach incorporating adjuvant postoperative radiation in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Secondary retroperitoneal fibrosis (RPF) due to pelvic radiation alone or together with pelvic surgery is one of the causes of obstructive renal failure. Ureteral obstruction is caused by ischemic stricture and encasement by fibrotic tissue. Endo-ureterotomy alone, without vascular supply, is not successful in these cases., Material and Methods: We present eleven cases of ureteral obstruction due to radiation and surgery induced RPF. Seven patients had radiation therapy with or without radical hysterectomy and three patients had anterior resection of the rectum with pre-emptive radiation and one patient had anal cancer treated with local excision and radiation therapy. Nine of the eleven patients had bilateral ureteral obstruction. Open ('intubated') stented ureterotomy and omental sleeve wrap was performed. In one patient, Boari flap ureteroneocystostomy was necessary., Results: Of the eleven patients (twenty renal units) we succeeded in nine patients (eighteen renal units). In two patients with bilateral ureteral obstruction, we were able to reestablish ureteral patency in only one renal unit each., Conclusions: Ureterolysis with ureterotomy and omental sleeve wrap is a valid surgical approach for alleviation of ureteral ischemic obstruction due to secondary retroperitoneal fibrosis caused by radiation alone or together with pelvic surgery., Competing Interests: The authors declare no conflicts of interest., (Copyright by Polish Urological Association.)