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Background : The objective of the present study was to investigate the significance of pelvic lymphadenectomy during radical prostatectomy in Japanese men with prostate cancer. Methods : A total of 178 consecutive patients who underwent radical prostatectomy and standard pelvic lymphadenectomy targeting the external iliac nodes and obturator fossa for clinically localized prostate cancer were studied. The median observation period of this series was 18 months (range: 3–36 months). Results : Lymph node metastases were detected in 13 patients; that is, positive nodes were located in the external iliac nodes alone in seven patients, the obturator fossa alone in four patients, and both external iliac nodes and obturator fossa in two patients. Of these 13 patients, all of the seven with more than one positive node demonstrated biochemical recurrence, whereas five of the six with single node involvement remained without signs of biochemical recurrence. Furthermore, a single positive node was located in the external iliac region in five of the six patients. When a group at high-risk for lymph node metastasis was defined as those meeting more than two of the following three criteria: (i) pretreatment serum prostate specific antigen value ≥ 20 ng/mL; (ii) biopsy Gleason sum ≥ 8; or (iii) percentage of positive biopsy core ≥ 50%, the incidence of lymph node metastasis was 24.5% in the high-risk group and 0.8% in the low-risk group. Conclusions : These findings suggest that limited dissection of the obturator node alone may not be sufficient for Japanese men undergoing radical prostatectomy; therefore, we recommend performing standard pelvic lymphadenectomy targeting both the external iliac nodes and the obturator fossa for patients at high-risk of lymph node involvement. [ABSTRACT FROM AUTHOR]

The objectives of the present study were to investigate whether buttressing sutures, which prevent the bladder neck from pulling open as the bladder fills, can promote earlier recovery from urinary incontinence after radical retropubic prostatectomy (RRP) and to identify possible risk factors associated with urinary incontinence after RRP.The present study included 72 patients who underwent non-nerve-sparing RRP without neoadjuvant therapy between January and December 2003. Among these 72 patients, intussusception of the bladder neck was performed in 24 who consented to this procedure. In the present series, continence was defined as the absence of any need to use sanitary pads or diapers. Continence was evaluated by a patient interview 1, 3 and 6 months after RRP.There were no significant differences in clinicopathological characteristics between patients with and without intussusception of the bladder neck. The percentage of continent patients 1, 3 and 6 months after RRP was 34.7%, 63.9% and 95.8%, respectively, and there were no significant differences in continence between the two groups at any time point. Among several factors examined, only bladder neck preservation was an independent predictor of recovery from urinary incontinence 1 and 3 months after RRP.These findings suggest that it would be important to preserve the bladder neck for early return to continence after non-nerve-sparing RRP; however, intussusception of the bladder neck may not offer significant improvement in earlier return of urinary control. [ABSTRACT FROM AUTHOR]

Background : The objective of this study was to evaluate the prognostic significance of the local extent of prostate cancer in relation to the prostate capsule. Patients and methods : The series included 110 patients with prostate cancer who underwent radical retropubic prostatectomy in a single institution in Japan between September 1997 and February 2003. The resected prostatectomy specimens were investigated by whole-mount step section at 5 mm intervals. According to the pathological findings, patients were divided into three groups as follows: 44 with localized cancer tissues apart from the capsule (group A), 33 with capsular invasion without penetration (group B) and 33 with capsular penetration (group C). Several clinicopathological factors of these patients were analyzed in relation to the capsular status. Results : The capsular status was significantly related to lymph node metastasis, seminal vesicle invasion and tumor volume. During the observation period (median: 22 months), biochemical recurrence occurred in 13 patients (three in group A, two in group B and eight in group C), and the biochemical-recurrence free survival rate in group C was significantly lower than those in groups A and B. Patients with capsular penetration at more than one site were at significantly increased risk for biochemical recurrence compared with those with a single capsular penetration; however, there was no significant relationship between the location of capsular penetration and biochemical recurrence. Furthermore, the biochemical recurrence-free survival rate was significantly associated with capsular penetration, seminal vesicle invasion and tumor volume among various factors examined, nevertheless these three factors were not independent predictors for biochemical recurrence on multivariate analysis. Conclusion : Subclassification of patients undergoing radical prostatectomy according to the capsular status provides valuable prognostic information; that is, patients with capsular penetration, particularly at more than one site, have a significantly higher risk of biochemical recurrence than those without capsular involvement or with capsular invasion alone. Thus, careful follow-up and if necessary, additional treatment should be considered in cases demonstrating capsular penetration. [ABSTRACT FROM AUTHOR]

Abstract Background: The objective of the present study was to analyze the pathological findings of radical prostatectomy specimens diagnosed on single core positive prostate biopsy in eight systematic transrectal ultrasonography (TRUS)-guided biopsies with a Gleason score ≤ 4. Methods: Between January 1993 and March 2001, 975 patients underwent TRUS-guided prostate biopsy, and 32 patients were diagnosed as having prostate cancer based only on one positive core with a Gleason score ≤ 4. In this study, 14 of the 32 patients who underwent radical prostatectomy without any neoadjuvant therapies were enrolled, and the pathological findings of their radical prostatectomy specimens were evaluated. Results: The clinical stage of the 14 patients was T1c in 10 and T2 in four. Cancer was detected in the prostate apex in seven patients, the middle in two, the base of the peripheral zone (PZ) in three, the lateral horn of the PZ in one and the transitional zone (TZ) one. Pathological stage of the 14 patients was pT2a in four, pT2b in six, pT3a in three and pT3b one. Gleason score of the radical prostatectomy specimens in 11 patients was also ≤ 4. Of the 10 patients diagnosed with cT1c, extraprostatic disease was found in only one radical prostatectomy specimen. All three patients whose cancer was detected from the base of the PZ showed pT3 disease. During the median follow-up period of 47.5 months, all patients were alive with no evidence of disease. Conclusion: The prognosis of patients who were diagnosed with one core positive prostate biopsy with a Gleason score ≤ 4 is generally favorable; however, advanced disease tended to be observed in patients who were diagnosed with cT2a and/or whose cancer was detected from the base of PZ. [ABSTRACT FROM AUTHOR]

Abstract Background: The objective of this study was to assess the usefulness of combined systematic prostate biopsy with the serum level of cathepsin D, which has recently been shown to be a useful marker for prostate cancer, to predict the disease extension. Methods: Seventy-two patients with clinically organ-confined disease who underwent radical prostatectomy were evaluated for serum prostate-specific antigen (PSA) and cathepsin D levels, systematic biopsy, and pathological stage. Results: The incidence of extraprostatic disease in patients with more than half the biopsy cores positive or ≥ 15 ng/mL cathepsin D was significantly higher than that in patients with less than half the biopsy cores positive or < 15 ng/mL cathepsin D, respectively; whereas cancer in bilateral lobes or ≥ 10 ng/mL PSA could not be used as a predictor of extraprostatic disease. Furthermore, in patients with more than half the biopsy cores positive and ≥ 15 ng/mL cathepsin D or those with more than half the biopsy cores positive and ≥ 10 ng/mL PSA, extraprostatic disease was significantly more common than in those with less than half the biopsy cores positive and < 15 ng/mL cathepsin D or those with less than half the biopsy cores positive and < 10 ng/mL PSA, respectively. Furthermore, the prediction of the incidence of extraprostatic disease using these three variables was significantly more accurate than using two of the variables (percentage positive biopsy cores plus serum cathepsin D or PSA). Conclusion: Systematic biopsy together with serum cathepsin D and/or PSA was a useful predictor of the extent of prostate cancer. Patients with more than half the biopsy cores positive, ≥ 15 ng/mL cathepsin D and/or ≥ 10 ng/mL PSA could avoid prostatectomy because there is a significantly high probability that they already have extraprostatic disease. [ABSTRACT FROM AUTHOR]