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Background: Intraoperative Frozen Section (IFS) with further tissue resection in case of positive margins has been proposed to decrease positive surgical margins rate during radical prostatectomy. There are a few reports on the benefits of this potential reduction of positive margins (PSM)., Objective: The aim of this study is to assess the oncological advantages of PSM rate reduction with the use of IFS and additional tissue excision in case of PSM. DESIGN, SETTING AND PARTECIPANTS: 270 patients undergoing laparoscopic radical prostatectomy were included in a prospective study, to evaluate the results of further tissue excision in case of PSM at IFS. Median age was 65 yrs. Median PSA was 7.0 ng/ml., Intervention: The prostate was extracted during the operation. IFS was performed in all patients on the prostate surface, at the base, the apex and along the postero-lateral aspect of the gland. In case of PSM additional tissue was excised from the site of the prostatic bed corresponding to the surgical margin., Measurements: Endpoint was biochemical recurrence-free survival., Results and Limitations: PSM were found in 67 patients (24.8%). With additional tissue resection, PSM rate dropped from 24.8% to 12.6%. Decreased PSM after further resection didn't improve biochemical-free survival. Patients with initial PSM at IFS rendered negative with further resection, had similar results if compared to patients with margins still positive, and worse results if compared to patients with negative margins (NSM). Biochemical recurrence rate was 2.95% at 58 months in 203 patients with NSM, 15.1% at 54 months in 33 patients with PSM at IFS that were rendered negative after further resection, and 11.7% at 67 months in 34 patients with still PSM after additional resection. These results were confirmed also according to: stage, nerve-sparing procedure, Gleason score., Conclusions: Our data don't support IFS during radical prostatectomy to improve biochemical-free survival.

Objectives: Immunotherapy with Bacillus Calmette Guerin (BCG) has been widely used recently as primary option for treatment of high grade superficial (G3T1) carcinoma of the bladder. We describe our long term experience of therapy of G3T1 bladder cancer., Methods: From January 1982 to December 2000, 785 patients were diagnosed with superficial bladder cancer. All patients underwent preoperative CT scan and transurethral resection of the bladder. Eighty-six patients (11%) had histological high grade superficial bladder cancer infiltrating the lamina propria. This group was treated with the following schedule of BCG Pasteur strain plus maintenance. Four cycles BCG, 6 instillations per cycle, first cycle weekly x 6, second cycle every 2 weeks x 6, third cycle monthly x 6, fourth cycle (maintenance) every 3 months x 6 instillations., Results: The median follow-up is 91 months (30-197 months). The overall recurrence rate was 35% (30/86). The median time to recurrence was 29 months (5-128 months). Of these patients, 12 (14%) had progression at a median follow-up of 16 months (range 8-58 months). Cystectomy was needed in 8 (9%) patients. Death due to disease occurred in 5/86 (6%) patients. One patient died due to adenocarcinoma at the ureterosigmoidostomy site. Sixty-four (74%) patients are alive at a median follow-up of 71 months (range 28-197 months). Sixty patients (70%) are alive with an intact bladder., Conclusions: Treatment with BCG is a feasible conservative therapy for patients with primary G3T1 transitional bladder cancer. Long term results of BCG treatment are excellent. Cystectomy shouldn't be considered first line treatment for high grade superficial carcinoma of the bladder.

Objectives: Immunotherapy with bacille Calmette-Guérin (BCG) has been proposed in the past decade as first-line treatment for high-grade superficial bladder cancer (G3T1). We report our 18-year experience in the treatment of patients with G3T1 bladder cancer., Methods: From January 1989 to July 1997, 670 patients underwent transurethral resection for superficial bladder cancer. Eighty-one patients (12%) had G3T1 tumors. All of these patients were treated with an innovative schedule of Pasteur strain BCG followed by maintenance BCG therapy. Treatment consisted of four cycles of 6 instillations per cycle of BCG. The first cycle was administered weekly x 6, the second was given every 2 weeks x 6, the third cycle was given monthly x 6, and the fourth was given every 3 months x 6 instillations., Results: Sixty-nine patients (84%) completed at least the first two cycles. At a median follow-up of 76 months (range 30 to 197), the overall recurrence rate was 33% (27 of 81). The median time to recurrence was 20 months (range 5 to 128). Of these patients, 12 (15%) had progression at a median follow-up of 16 months (range 8 to 58). Cystectomy was required in 7 patients (8%). Death from disease occurred in 5 (6%) of 81 patients. One patient died of adenocarcinoma at the ureterosigmoidostomy site. Sixty patients (74%) were alive at a median follow-up of 79+ months (range 15 to 182). Of these, 56 (69%) were alive with a functioning bladder., Conclusions: Conservative treatment with BCG is a reasonable approach for patients with primary G3T1 transitional cell carcinoma of the bladder. The long-term results of BCG therapy are good. Cystectomy may not be justified as the therapy of choice in first-line treatment of high-grade superficial carcinoma of the bladder.