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Unlabelled: The aim of this study was to detect mutations in the human androgen receptor gene in radical prostatectomy specimens., Material and Methods: The genomic sequence was realized in 67 radical prostatectomy specimens. The mean age was 64 years old. The PSA median was 15 ng/ml. TNM 1997: 34.3% were T1 and 65.7% T2. Genomic sequence: 1. Radical prostatectomy specimens desparaffitation. 2. Extraction of the DNA 3. DNA amplification. 4. Automatic genome sequence. 5. Comparison with Gene-Bank., Results: 16.7% of the specimens were mutated. The most frequent mutation was the punctual mutation. The exon most frequent mutated was exon 1.

Prostate carcinoma is diagnosed in earlier phases of its evolution, but this carcinoma may have an unpredictible evolution. Radical treatment (surgery and radiotherapy) is the best treatment in clinically localized tumors. The biochemical failure over 5 years from the surgery is 20-50% of the patients; the biochemical failure over 10 years from the surgery is less frequent because of prognostic factors from the biologic nature of the tumor. We report a case with biochemical and clinical failure over 10 years from the surgery.

Purpose: Prostate biopsy is the diagnostic method to detect prostate carcinoma. We try to identify the optimal PSA cut-off, biopsy indication and the clinico-pathological characteristics in order to differentiate those patients with negative biopsy in which we should repeat the proceeding., Method: We study 344 biopsies in 292 patients for 16 months. An univariate and multivariate study to identify the influent factors in the existence of prostate cancer in the first biopsy and in the patients with a second one was taken place., Results: Patients in the first biopsy Univariate study: Out of these variables (PSA, PSA ratio, digital rectal examination and prostate volume) just the PSA has statistical significance. Multivariate study: Only the the PSA is an indepent influence factor. Receiving Operated Curve: The optimal cut-off is 10.5 ng/ml. Patients with a second biopsy Univariate study: None of the variables is related with the existence of prostate cancer. Groups comparison: A comparison between the patients in the first biopsy and the patients with a second biopsy is performance with no statistical differences in the variables already mentioned., Conclusion: The patient with a PSA greater than 4 ng/ml should be perform a prostate biopsy, mostly if his PSA is over 10 ng/ml. In our experience we do not related the need of a second biopsy with any factor in particular, therefore in our opinion and because of the high rate of negative false, all of the patients should be controlled and undergo a second biopsy if any change in PSA or clinics modification takes place.

Objectives: To study the survival in patients with prostate adenocarcinoma, lymph nodes involvement in the intraoperative pathological examination, evaluating both radical surgery and early ablation as treatment. Identification of clinical factors that can predict node involvement., Method: 20 patients who underwent radical prostatectomy between 1988-1998 were included in the study. All patients clinically diagnosed with T1-2N0Mx prostate adenocarcinoma (T.N.M. 1992), single metastatic node involvement in the pathological study and early sub-albuginea orchidectomy. This group was compared to a 200-patient control group also with T1-2N0Mx prostate adenocarcinoma but with no pathologic nodular involvement. Statistical study: contingency 2Xb tables (Pearson's chi 2 or Fisher's exact test) to compare qualitative variables; Student's t test for means comparison; Kaplan-Meier for actuarial survival calculations and comparison of Log-rank survival curves. For the study of clinical variants with influence in node involvement a logistic regression model was used., Results: Mean age was 63 +/- 0.8 years. Median follow up 56 months. Mean PSA 33 +/- 4.4 ng/mL and 55% had Gleason 5-7. 16 patients were stage pT3. Specific 5-year survival was 90 +/- 8% and biochemical progression free survival 63 +/- 12%. Clinical variables with statistical significance for node involvement are: pre-surgical PSA greater than 20 ng/mL (RR = 4.6), and Gleason higher than 4 (RR = 3). The remaining variables showed no statistical significance., Conclusions: Gleason and PSA are the only clinical values that predict node involvement. The procedure performed obtains good results and a survival comparable to that of the control group.

Objective: To assess the influence of neo-adjuvant hormone therapy on the pathologic stage, margins and disease-free survival in patients with T1-T2 prostate cancer after radical prostatectomy., Material and Methods: Forty-two non-randomised, T1-T2 patients who underwent complete neo-adjuvant blockade and radical prostatectomy between 1988-1998 were included in the study. This group is part of a larger cohort of 220 T1-T2 patients treated with radical surgery. The group is compared to: a) the remaining patients (178) (Group I) and b) a selected group (54 patients) of consistent characteristics relative to clinical variables (Group II). Mean follow-up: 35 months; median: 32 months., Results: Compared to Group I patients with neo-adjuvant therapy show worse Gleason (p: 0.01), worse clinical stage (p: 0.02), higher rate of patients with high clinical risk (p: 0.03), and higher PSA (though not statistically different). No differences were seen relative to pathological status or margins. Compared to Group II (54 patients) no differences are found in clinical or pathological variables. Groups are comparable in terms of progression-free survival., Conclusions: Neo-adjuvant hormone therapy in high clinical risk, T1-T2 patients does not involve improvement in pathological stage, margins or progression-free survival.

Objectives: To assess the efficacy of surgery in pT3c patients; to discern whether this is an independent influential factor for survival and clinical factor for diagnostic prediction., Material and Methods: Forty-five pT3c (TNM 1982) patients from a cohort of 220 subjects with T1-T2 prostate cancer who underwent radical prostatectomy. Mean and median follow-up: 42 and 36 months, respectively., Results: pT3 stage accounts for 20% (45/220) patients. They display a significantly higher mean PSA (25 +/- 2 ng/ml) (0.001), worse Gleason (0.0002) and clinical stage (0.0003), greater margins involvement (0.0007), and biochemical (0.02), local (0.05) and metastatic (0.001) progression. Independent influential factors are: PSA > 20 ng/ml; T2bc and Gleason 7-10. From these values patients can be divided into 3 risk groups: a) Group I (0-1 unfavourable variables): risk of seminal vesicle involvement 7%; Group II (2 unfavourable variables): risk 47%; Group III (3 unfavourable variables): risk 61%. Progression-free survival: significantly lower than patients with pT2 (58 +/- 8% vs 66 +/- 6% at 5 years) (0.002), but similar to those with pT3ab (0.91). Seminal vesicle involvement is not an independent influential factor (Cox's multivariate study). Influential factors are PSA, Gleason and clinical stage., Conclusions: pT3c tumours are not an independently influential group in progression-free survival. Progression-free survival is lower than pT2 but similar to pT3ab. Their poor prognosis is dependent on association to negatively influential clinico-pathological factors.

Objectives: Analysis in T1-T2 prostate cancer of the following: a) Whether there is a relationship between Ki67 and p53 over-expression, and clinico-pathological variables. b) Whether that expression influences on progression free survival., Material and Methods: The study included 68 patients diagnosed with T1-T2 prostate cancer undergoing radical prostatectomy and immunohistochemical testing of Ki67 and p53 in the prostatectomy specimen, indicating in each case the percentage of stained cells. The study was carried out by: a) Comparison of means between percentage groups of stained cells. b) Grouping patients according to expression percentage. In Ki67, a comparison is made between those expressing 0-5% vs > 5%. In p53, those expressing (0%) vs > 1%. Mean follow-up: 20 months; median: 16 months., Results: Mean expression of Ki67 is 7.2% (57% cases > 5%). 60% do not over-express p53; mean 3.65; only 15% is higher than 5%. There is a correlation between Ki67 and p53 (p: 0.002), but not to PSA. Ki67 expression is related with a poorer pathological stage (p: 0.07) and greater biochemical progression (p: 0.07), and it has a significant influence on progression free survival in both the univariate (at three years 76% vs 48%; p: 0.04) and the multivariate studies (RR: 5.7; p: 0.005). Over-expression of p53 is not related to any clinico-pathological variable, and does not influence progression free survival.

Objectives: Margins involvement in T1-T2 patients undergoing radical prostatectomy is a negative prognostic factor. We aimed to: a) Study the clinical and pathological features of patients with surgical margins involvement; b) Elucidate the influence of margins involvement on the progression-free survival., Material and Method: The study included the group with "positive margins" out of a series of 160 patients with localised prostate adenocarcinoma who underwent radical prostatectomy at the Clínica Universitaria de Navarra between 1988-1997. statistics used: Fisher's or Pearson's test for qualitative variables. Kaplan-Meyer, Log-rank and Cox's multivariate tests for the survival study., Results: The group accounts for 28% (45/158) of all patients undergoing radical prostatectomy. Mean PSA (22 +/- 14 ng/ml) is similar to the remaining group although there is greater significant rates of PSA > 15 ng/ml (p: 0.006), worse Gleason (p: 0.01), higher proportion of T2bc (p: 0.003) and node involvement (0.001). Progression-free survival (BPFS) is significantly lower in this group (32 +/- 12% vs 61 +/- 6% at 5 years). Margins are the single factor with higher influence (RR:5) in the multivariate study. Influence is clear in patients with Gleason < 5 (0% vs 87%) and PSA < 30 ng/ml (33 +/- 14 vs 70 +/- 7%), but has no influence on BPFS of patients with PSA > 30 ng/ml or Gleason 5-10., Conclusions: Positive margins in patients undergoing radical prostatectomy is associated to higher PSA, worse Gleason and higher stage. They are the most significant independent risk factor (except for PSA > 30 ng/ml) for biochemical progression-free survival as evidenced in the multivariate study, although it is likely this influence is diluted in patients with PSA > 30 ng/ml and/or Gleason 5-10.

Material and Methods: Study on the efficacy of stage diagnosis, how to support it based on clinical objective data and description of a prognostic model. Analysis of 160 patients diagnosed with localized prostate adenocarcinoma undergoing radical prostatectomy in the Clínica Universitaria de Navarra between 1988-1997. The statistical study used Fisher's or Pearson's tests for the comparison of qualitative variables. A logistic regression multivariate analysis was run to avoid confounding factors in the pathological stage., Results: 85/160 (53%) were correctly staged. Incorrect staging occurred in patients with higher clinical stage (T1-T2a: 25%; T2bc: 65%). The univariate study shows that the pathological stage is significantly correlated to: a) serum PSA levels (15 ng/mL in P2 vr. 25 ng/mL in P3-4), the most suitable cutoff value being 15 ng/mL. b) digital rectal examination and Gleason. Negatively influencing factors in the multivariate study were: PSA greater than 15 ng/mL, Gleason greater than 5 and a T2bc clinical stage. Risk groups: 4 risk groups are established based on the above factors (inclusion in group 1 involves an 8% risk of having P3, 30% in group 2, 56% in group 3 and 84% in group 4)., Conclusions: The clinical factors with influence in the pathological stage are PSA, Gleason and clinical stage. The reliability of the risk groups established based on these factors is remarkable.

Material and Method: Study of biochemical progression (PSA > 0.5 ng/ml) and biochemical progression-free survival in 160 patients diagnosed with clinically localized prostate adenocarcinoma who underwent radical prostatectomy at the University Clinic in Navarra between 1988-1997., Results: At the end of the study, 120 patients (75%) are alive and free of progression, 33 (20%) are alive and in progression, 3 (1.9%) died of cancer, and 4 (2.5%) died for other causes. Biochemical progression occurred in 43/160 (27%) patients. Progression is related to previous PSA, both in absolute terms and divided into greater or smaller than 15 ng/ml; to Gleason grade greater or smaller than 7 or divided into 2-4, 5-7, 8-10; to pathological stage and to urethro-vesical junction stenosis. Biochemical progression-free survival (BPFS) in the univariate study is related to PSA (the ideal prognostic cut-off value being 15 ng/ml); to Gleason, specially when divided into 2-4, 5-7, 8-10; to the pathological stage and to margins. The multivariate study evidences that the single most influential factors are PSA (divided as greater or smaller than 15 ng/ml), Gleason grade (divided into: 2-4, 5-7, 8-10) and margins involvement. There are 3 highly reliable risk groups based on PSA, Gleason and clinical stage. When these are introduced as variables in the multivariate study, they appear as the strongest predictive variables., Conclusions: The influential factors on progression-free survival are PSA (15 ng/ml being the best prognostic cut-off value), Gleason grade (divided into 2-4, 5-7, 8-10) and margins' positivity, which are the single most significant pathological factor ahead of clinical stage. Serum PSA, clinical stage and Gleason grade allow to define three reliable risk groups.

Presentation of our experience on the clinico-pathological staging of clinically localized prostate cancer (PCa) in 38 patients undergoing staging lymphadenectomy, 34 of which were treated with radical prostatectomy. From total number of patients, 37% were correctly staged, 60% were under-staged and only 3% were over-staged. A total of 11 patients (29%) presented nodular metastasis at the time of lymphadenectomy. Out of the 34 patients undergoing radical prostatectomy, 10 (29%) had microscopical invasion of prostatic capsule and seminal vesicles infiltration. The likelihood of nodes affectation in patients with prostatic capsule invasion and seminal vesicles infiltration was 60% and 70%, respectively. Mean PSA was significantly higher in patients with advanced disease as compared to those with disease localized in the prostatic gland. Also, mean PSA was significantly higher in patients with prostatic capsule invasion and seminal vesicles infiltration. The analysis by logistic regression identified pre-operative PSA as the only variable significantly correlated to the patient's final pathological stage.