|
1
|
Patel KR, van der Heide UA, Kerkmeijer LGW, Schoots IG, Turkbey B, Citrin DE, Hall WA. Target Volume Optimization for Localized Prostate Cancer. Pract Radiat Oncol 2024; 14:522-540. [PMID: 39019208 PMCID: PMC11531394 DOI: 10.1016/j.prro.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To provide a comprehensive review of the means by which to optimize target volume definition for the purposes of treatment planning for patients with intact prostate cancer with a specific emphasis on focal boost volume definition. METHODS Here we conduct a narrative review of the available literature summarizing the current state of knowledge on optimizing target volume definition for the treatment of localized prostate cancer. RESULTS Historically, the treatment of prostate cancer included a uniform prescription dose administered to the entire prostate with or without coverage of all or part of the seminal vesicles. The development of prostate magnetic resonance imaging (MRI) and positron emission tomography (PET) using prostate-specific radiotracers has ushered in an era in which radiation oncologists are able to localize and focally dose-escalate high-risk volumes in the prostate gland. Recent phase 3 data has demonstrated that incorporating focal dose escalation to high-risk subvolumes of the prostate improves biochemical control without significantly increasing toxicity. Still, several fundamental questions remain regarding the optimal target volume definition and prescription strategy to implement this technique. Given the remaining uncertainty, a knowledge of the pathological correlates of radiographic findings and the anatomic patterns of tumor spread may help inform clinical judgement for the definition of clinical target volumes. CONCLUSION Advanced imaging has the ability to improve outcomes for patients with prostate cancer in multiple ways, including by enabling focal dose escalation to high-risk subvolumes. However, many questions remain regarding the optimal target volume definition and prescription strategy to implement this practice, and key knowledge gaps remain. A detailed understanding of the pathological correlates of radiographic findings and the patterns of local tumor spread may help inform clinical judgement for target volume definition given the current state of uncertainty.
Collapse
Affiliation(s)
- Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - Uulke A van der Heide
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Linda G W Kerkmeijer
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ivo G Schoots
- Department of Radiation Oncology, The Netherlands Cancer Institute (NKI-AVL), Amsterdam, The Netherlands
| | - Baris Turkbey
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Deborah E Citrin
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - William A Hall
- Froedtert and the Medical College of Wisconsin, Milwaukee, Wisconsin
| |
Collapse
|
|
2
|
Dhiman A, Kumar V, Das CJ. Quantitative magnetic resonance imaging in prostate cancer: A review of current technology. World J Radiol 2024; 16:497-511. [PMID: 39494137 PMCID: PMC11525833 DOI: 10.4329/wjr.v16.i10.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 09/26/2024] [Accepted: 10/20/2024] [Indexed: 10/28/2024] Open
Abstract
Prostate cancer (PCa) imaging forms an important part of PCa clinical management. Magnetic resonance imaging is the modality of choice for prostate imaging. Most of the current imaging assessment is qualitative i.e., based on visual inspection and thus subjected to inter-observer disagreement. Quantitative imaging is better than qualitative assessment as it is more objective, and standardized, thus improving interobserver agreement. Apart from detecting PCa, few quantitative parameters may have potential to predict disease aggressiveness, and thus can be used for prognosis and deciding the course of management. There are various magnetic resonance imaging-based quantitative parameters and few of them are already part of PIRADS v.2.1. However, there are many other parameters that are under study and need further validation by rigorous multicenter studies before recommending them for routine clinical practice. This review intends to discuss the existing quantitative methods, recent developments, and novel techniques in detail.
Collapse
Affiliation(s)
- Ankita Dhiman
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Virendra Kumar
- Department of NMR & MRI Facility, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| | - Chandan Jyoti Das
- Department of Radiodiagnosis and Interventional Radiology, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
| |
Collapse
|
|
3
|
Galosi AB, Milanese G, Montesi L, Cimadamore A, Franzese C, Palagonia E, Chiacchio G, Castellani D. The pathway of isolated seminal vesicle invasion has a different impact on biochemical recurrence after radical prostatectomy and pelvic lymphadenectomy. Urol Oncol 2023:S1078-1439(23)00095-9. [PMID: 37142452 DOI: 10.1016/j.urolonc.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/20/2023] [Accepted: 03/20/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Prostate cancer with seminal vesicle invasion (SVI) has been considered an aggressive cancer. To evaluate the prognostic significance of different patterns of isolated SVI in patients undergoing radical prostatectomy (RP) and pelvic lymphadenectomy. METHODS AND MATERIALS We retrospectively analyzed all patients who underwent RP between 2007 and 2019. Inclusion criteria were localized prostate adenocarcinoma, SVI at RP, at least 24-months follow-up, and no adjuvant treatment. Patterns of SVI were following Ohori's classification: type 1: direct spread along the ejaculatory duct from inside; type 2: seminal vesicle invasion outside the prostate, through the capsule; type 3: the presence of cancer island(s) in the seminal vesicle with no continuity from the primary tumor (discontinuous metastases). Patients with type 3 SVI (isolated or in association) were included in the same group. Biochemical recurrence (BCR) was defined as any postoperative PSA ≥0.2 ng/ml. A logistic regression analysis was performed to assess predictors of BCR. Time to BCR was investigated using the Kaplan-Meier analysis with the log-rank test. RESULTS Sixty-one out of 1,356 patients were included. Median age was 67(7.2) years. Median PSA was 9.4(8.92) ng/ml. Mean follow-up was 85.28 ± 45.27 months. BCR occurred in 28(45.9%) patients. Logistic regression showed that a positive surgical margin (OR 19.964, 95%CI:1.172-29.322, P = 0.038) was predictor of BCR. Kaplan-Meier analysis demonstrated that patients with pattern 3 had a significantly shorter time to BCR compared to other groups (log-rank, P = 0.016). The estimated time to BCR was 48.7 months in type 3, 60.9 months in pattern 1 + 2, 74.8, and 100.8 months in isolated patterns 1 and 2, respectively. In patients with negative surgical margins, pattern 3 confirmed a shorter time to BCR compared to other types of invasions, with an estimated time to BCR of 30.8 months. CONCLUSIONS Patients with type 3 SVI demonstrated a shorter time to BCR compared to other patterns.
Collapse
Affiliation(s)
- Andrea B Galosi
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giulio Milanese
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Lorenzo Montesi
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Azienda Ospedaliero-Universitaria delle Marche, Marche Polytechnic University, Ancona, Italy
| | - Carmine Franzese
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Erika Palagonia
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Giuseppe Chiacchio
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy
| | - Daniele Castellani
- Urology Division, Azienda Ospedaliero-Universitaria delle Marche, School of Urology, Polytechnic University of the Marche Region, Ancona, Italy.
| |
Collapse
|
|
4
|
Mayer R, Turkbey B, Choyke P, Simone CB. Assessing and testing anomaly detection for finding prostate cancer in spatially registered multi-parametric MRI. Front Oncol 2023; 12:1033323. [PMID: 36698418 PMCID: PMC9869917 DOI: 10.3389/fonc.2022.1033323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Background Evaluating and displaying prostate cancer through non-invasive imagery such as Multi-Parametric MRI (MP-MRI) bolsters management of patients. Recent research quantitatively applied supervised target algorithms using vectoral tumor signatures to spatially registered T1, T2, Diffusion, and Dynamic Contrast Enhancement images. This is the first study to apply the Reed-Xiaoli (RX) multi-spectral anomaly detector (unsupervised target detector) to prostate cancer, which searches for voxels that depart from the background normal tissue, and detects aberrant voxels, presumably tumors. Methods MP-MRI (T1, T2, diffusion, dynamic contrast-enhanced images, or seven components) were prospectively collected from 26 patients and then resized, translated, and stitched to form spatially registered multi-parametric cubes. The covariance matrix (CM) and mean μ were computed from background normal tissue. For RX, noise was reduced for the CM by filtering out principal components (PC), regularization, and elliptical envelope minimization. The RX images were compared to images derived from the threshold Adaptive Cosine Estimator (ACE) and quantitative color analysis. Receiver Operator Characteristic (ROC) curves were used for RX and reference images. To quantitatively assess algorithm performance, the Area Under the Curve (AUC) and the Youden Index (YI) points for the ROC curves were computed. Results The patient average for the AUC and [YI] from ROC curves for RX from filtering 3 and 4 PC was 0.734[0.706] and 0.727[0.703], respectively, relative to the ACE images. The AUC[YI] for RX from modified Regularization was 0.638[0.639], Regularization 0.716[0.690], elliptical envelope minimization 0.544[0.597], and unprocessed CM 0.581[0.608] using the ACE images as Reference Image. The AUC[YI] for RX from filtering 3 and 4 PC was 0.742[0.711] and 0.740[0.708], respectively, relative to the quantitative color images. The AUC[YI] for RX from modified Regularization was 0.643[0.648], Regularization 0.722[0.695], elliptical envelope minimization 0.508[0.605], and unprocessed CM 0.569[0.615] using the color images as Reference Image. All standard errors were less than 0.020. Conclusions This first study of spatially registered MP-MRI applied anomaly detection using RX, an unsupervised target detection algorithm for prostate cancer. For RX, filtering out PC and applying Regularization achieved higher AUC and YI using ACE and color images as references than unprocessed CM, modified Regularization, and elliptical envelope minimization.
Collapse
Affiliation(s)
- Rulon Mayer
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States,OncoScore, Garrett Park, MD, United States,*Correspondence: Rulon Mayer,
| | - Baris Turkbey
- Molecular Imaging Branch, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Peter Choyke
- Molecular Imaging Branch, National Institutes of Health (NIH), Bethesda, MD, United States
| | - Charles B. Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY, United States,Memorial Sloan Kettering Cancer Center, New York, NY, United States
| |
Collapse
|
|
5
|
Mayer R, Simone CB, Turkbey B, Choyke P. Development and testing quantitative metrics from multi-parametric magnetic resonance imaging that predict Gleason score for prostate tumors. Quant Imaging Med Surg 2022; 12:1859-1870. [PMID: 35284265 PMCID: PMC8899928 DOI: 10.21037/qims-21-761] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/18/2021] [Indexed: 08/17/2023]
Abstract
BACKGROUND Radiologists currently subjectively examine multi-parametric magnetic resonance imaging (MRI) to detect possible clinically significant lesions using the Prostate Imaging Reporting and Data System (PI-RADS) protocol. The assessment of imaging, however, relies on the experience and judgement of radiologists creating opportunity for inter-reader variability. Quantitative metrics, such as z-score and signal to clutter ratio (SCR), are therefore needed. METHODS Multi-parametric MRI (T1, T2, diffusion, dynamic contrast-enhanced images) were resampled, rescaled, translated, and stitched to form spatially registered multi-parametric cubes for patients undergoing radical prostatectomy. Multi-parametric signatures that characterize prostate tumors were inserted into z-score and SCR. The multispectral covariance matrix was computed for the outlined normal prostate. The z-score from each MRI image was computed and summed. To reduce noise in the covariance matrix, following matrix decomposition, the noisy eigenvectors were removed. Also, regularization and modified regularization was applied to the covariance matrix by minimizing the discrimination score. The filtered and regularized covariance matrices were inserted into the SCR calculation. The z-score and SCR were quantitatively compared to Gleason scores from clinical pathology assessment of the histology of sectioned wholemount prostates. RESULTS Twenty-six consecutive patients were enrolled in this retrospective study. Median patient age was 60 years (range, 49 to 75 years), median prostate-specific antigen (PSA) was 5.8 ng/mL (range, 2.3 to 23.7 ng/mL), and median Gleason score was 7 (range, 6 to 9). A linear fit of the summed z-score against Gleason score found a correlation of R=0.48 and a P value of 0.015. A linear fit of the SCR from regularizing covariance matrix against Gleason score found a correlation of R=0.39 and a P value of 0.058. The SCR employing the modified regularizing covariance matrix against Gleason score found a correlation of R=0.52 and a P value of 0.007. A linear fit of the SCR from filtering out 3 and 4 eigenvectors from the covariance matrix against Gleason score found correlations of R=0.50 and 0.44, respectively, and P values of 0.011 and 0.027, respectively. CONCLUSIONS Z-score and SCR using filtered and regularized covariance matrices derived from spatially registered multi-parametric MRI correlates with Gleason score with highly significant P values.
Collapse
Affiliation(s)
- Rulon Mayer
- University of Pennsylvania, Philadelphia, PA, USA
- OncoScore, Garrett Park, MD, USA
| | | | | | - Peter Choyke
- National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
|
6
|
Mayer R, Simone CB, Turkbey B, Choyke P. Prostate tumor eccentricity predicts Gleason score better than prostate tumor volume. Quant Imaging Med Surg 2022; 12:1096-1108. [PMID: 35111607 DOI: 10.21037/qims-21-466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022]
Abstract
Background Prostate tumor volume predicts biochemical recurrence, metastases, and tumor proliferation. A recent study showed that prostate tumor eccentricity (elongation or roundness) correlated with Gleason score. No studies examined the relationship among the prostate tumor's shape, volume, and potential aggressiveness. Methods Of the 26 patients that were analyzed, 18 had volumes >1 cc for the histology-based study, and 25 took up contrast material for the MRI portion of this study. This retrospective study quantitatively compared tumor eccentricity and volume measurements from pathology assessment sectioned wholemount prostates and multi-parametric MRI to Gleason scores. Multi-parametric MRI (T1, T2, diffusion, dynamic contrast-enhanced images) were resized, translated, and stitched to form spatially registered multi-parametric cubes. Multi-parametric signatures that characterize prostate tumors were inserted into a target detection algorithm (Adaptive Cosine Estimator, ACE). Various detection thresholds were applied to discriminate tumor from normal tissue. Pixel-based blobbing, and labeling were applied to digitized pathology slides and threshold ACE images. Tumor volumes were measured by counting voxels within the blob. Eccentricity calculation used moments of inertia from the blobs. Results From wholemount prostatectomy slides, fitting two sets of independent variables, prostate tumor eccentricity (largest blob eccentricity, weighted eccentricity, filtered weighted eccentricity) and tumor volume (largest blob volume, average blob volume, filtered average blob volume) to Gleason score in a multivariate analysis, yields correlation coefficient R=0.798 to 0.879 with P<0.01. The eccentricity t-statistic exceeded the volume t-statistic. Fitting histology-based total prostate tumor volume against Gleason score yields R=0.498, P=0.0098. From multi-parametric MRI, the correlation coefficient R between the Gleason score and the largest blob eccentricity for varying thresholds (0.30 to 0.55) ranged from -0.51 to -0.672 (P<0.01). For varying thresholds (0.60 to 0.80) for MRI detection, the R between the largest blob volume eccentricity against the Gleason score ranged from 0.46 to 0.50 (P<0.03). Combining tumor eccentricity and tumor volume in multivariate analysis failed to increase Gleason score prediction. Conclusions Prostate tumor eccentricity, determined by histology or MRI, more accurately predicted Gleason score than prostate tumor volume. Combining tumor eccentricity with volume from histology-based analysis enhanced Gleason score prediction, unlike MRI.
Collapse
Affiliation(s)
- Rulon Mayer
- University of Pennsylvania, Philadelphia, PA, USA.,Oncoscore, Garrett Park, MD, USA
| | | | | | - Peter Choyke
- National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
|
7
|
Mayer R, Simone CB, Turkbey B, Choyke P. Correlation of prostate tumor eccentricity and Gleason scoring from prostatectomy and multi-parametric-magnetic resonance imaging. Quant Imaging Med Surg 2021; 11:4235-4244. [PMID: 34603979 DOI: 10.21037/qims-21-24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/22/2021] [Indexed: 01/25/2023]
Abstract
Background Proliferating cancer cells interacting with their microenvironment affects a tumor's spatial shape. Elongation or roundness (eccentricity) of lung, skin, and breast cancers indicates the cancer's relative aggressiveness. Non-invasive determination of the prostate tumor's shape should provide meaningful input for prognostication and clinical management. There are currently few studies of prostate tumor shape, therefore this study examines the relationship between a prostate tumor's eccentricity, derived from spatially registered multi-parametric MRI and histology slides, and Gleason scores. Methods A total of 26 consecutive patients were enrolled in the study. Median patient age was 60 years (range, 49 to 75 years), median PSA was 5.8 ng/mL (range, 2.3 to 23.7 ng/mL, and median Gleason score was 7 (range, 6 to 9). Multi-parametric MRI (T1, T2, Diffusion, Dynamic Contrast Enhanced) were resampled, rescaled, translated, and stitched to form spatially registered multi-parametric cubes. Multi-parametric signatures that characterize prostate tumors were inserted into a target detection algorithm (Adaptive Cosine Estimator, ACE). Various detection thresholds were applied to discriminate tumor from normal tissue. Also, tumor shape was computed from the histology slides. Blobbing, labeling, and calculation of eccentricity using moments of inertia were applied to the multi-parametric MRI and histology slides. The eccentricity measurements were compared to the Gleason scores from 25 patients. Results From histology slides analysis: the correlation coefficient between the eccentricity for the largest blob and a weighted average eccentricity against the Gleason score ranged from -0.67 to -0.78 for all 18 patients whose tumor volume exceeded 1.0 cc. From multi-parametric MRI analysis: the correlation coefficient between the eccentricity for the largest blob for varying thresholds against the Gleason score ranged from -0.60 to -0.66 for all 25 patients showing contrast uptake in the Dynamic Contrast Enhancement (DCE) MRI. Conclusions Spherical shape prostate adenocarcinoma shows a propensity for higher Gleason score. This novel finding follows lung and breast adenocarcinomas but depart from other primary tumor types. Analysis of multi-parametric MRI can non-invasively determine the prostate tumor's morphology and add critical information for prognostication and disease management. Eccentricity of smaller tumors (<1.0 cc) from MP-MRI correlates well with Gleason score, unlike eccentricity measured using histology of wholemount prostatectomy.
Collapse
Affiliation(s)
- Rulon Mayer
- University of Pennsylvania, Philadelphia, PA, USA.,OncoScore, Garrett Park, MD, USA
| | | | | | - Peter Choyke
- National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
|
8
|
Mayer R, Simone CB, Turkbey B, Choyke P. Algorithms applied to spatially registered multi-parametric MRI for prostate tumor volume measurement. Quant Imaging Med Surg 2021; 11:119-132. [PMID: 33392016 DOI: 10.21037/qims-20-137a] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Prostate tumor volume correlates with critical components of cancer staging such as Gleason score (GS) grade, predicted disease progression, and metastasis. Therefore, non-invasive tumor volume measurement may elevate clinical management. Radiology assessments of multi-parametric MRI (MP-MRI) commonly visually examine individual images to determine possible tumor presence. This study combines registered MP-MRI into a single image that display normal tissue and possible lesions. This study tests and exploits the vector nature of spatially registered MP-MRI by using supervised target detection algorithms (STDA) and color display and psychovisual analysis (CIELAB) to non-invasively estimate prostate tumor volume. Methods MRI, including T1, T2, diffusion [apparent diffusion coefficient (ADC)], dynamic contrast enhanced (DCE) images, were resampled, rescaled, translated, and stitched to form spatially registered Multi-parametric cubes. The multi-parametric or multi-spectral signatures (7-component or T1, T2, ADC, etc.) that characterize the prostate tumors were inserted into target detection algorithms with conical decision surfaces (adaptive cosine estimator, ACE). Various detection thresholds were applied to discriminate tumor from normal tissue. In addition, tumor appeared as yellow in color images that were created by assigning red to washout from DCE, green to high B from diffusion, and blue to autonomous diffusion image. The yellow voxels in the three-channel hypercube were visually identified by a reader and recording voxels that exceed a threshold in the b* component of the CIELAB algorithm. The number of reported tumor voxels were converted to volume based on spatial resolution and slice separation. The tumor volume measurements were quantitatively validated by comparing the tumor volume computations to the pathologist's assessment of the histology of sectioned whole mount prostates from 26 consecutive patients with prostate adenocarcinoma who underwent radical prostatectomy. This study analyzed tumors exceeding 1 cc and that also took up contrast material (18 patients). Results High correlation coefficients for tumor volume measurements using supervised target detection and color analysis vs. histology from wholemount prostatectomy were computed (R=0.83 and 0.91, respectively). A linear fit for tumor volume measurements using for supervised target detection and color analysis vs. tumor measurements from radical prostatectomy (after correcting for shrinkage from the radical prostatectomy) results in a slope of 1.02 and 3.02, respectively. A polynomial fit for the color analysis to the histology found (R=0.95). Voxels exceeding a threshold in the b* part of the CIELAB algorithm yielded correlation coefficients (0.71, 0.80) offsets (0.01 cc, -0.63 cc) and slopes (1.99, 0.89) against the wholemount prostatectomy and color analysis, respectively. Conclusions Supervised target detection and color display and analysis applied to registered MP-MRI non-invasively estimates prostate tumor volumes >1 cc and displaying angiogenesis.
Collapse
Affiliation(s)
- Rulon Mayer
- Oncoscore, Garrett Park, MD, USA.,University of Pennsylvania, Philadelphia, PA, USA
| | | | | | - Peter Choyke
- National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
|
9
|
Tafuri A, Sebben M, Pirozzi M, Processali T, Shakir A, Rizzetto R, Amigoni N, Tiso L, De Michele M, Panunzio A, Cerrato C, Migliorini F, Novella G, De Marco V, Siracusano S, Artibani W, Porcaro AB. Predictive Factors of the Risk of Long-Term Hospital Readmission after Primary Prostate Surgery at a Single Tertiary Referral Center: Preliminary Report. Urol Int 2020; 104:465-475. [PMID: 31991418 DOI: 10.1159/000505409] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the predictors of the risk of long-term hospital readmission after radical prostatectomy (RP) in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. MATERIALS AND METHODS The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the 2 surgical approaches. Patients were followed for complications and hospital readmission for a period of 6 months. The association of factors with the risk of readmission was assessed by Cox's multivariate proportional hazards. RESULTS From December 2013 to 2017, 885 patients underwent RP. RARP was performed in 733 cases and ORP in 152 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 479 patients. Hospital readmission was detected in 46 cases (5.2%). Using a multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (hazard ratio [HR] 2.065; 95% CI 1.116-3.283; p = 0.021), ORP (HR 3.506; 95% CI 1.919-6.405; p < 0.0001), and ePLND (HR 5.172; 95% CI 1.778-15.053; p < 0.0001). CONCLUSIONS In a large single tertiary referral center, independent predictors of the risk of long-term hospital readmission after RP included ORP, ePLND, and seminal vesicle invasion. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of long-term hospital readmission and its related risk factors.
Collapse
Affiliation(s)
- Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.,USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Marco Sebben
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Marco Pirozzi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Tania Processali
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Aliasger Shakir
- USC Institute of Urology and Catherine and Joseph Aresty Department of Urology, University of Southern California, Los Angeles, California, USA
| | - Riccardo Rizzetto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Leone Tiso
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Mario De Michele
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanni Novella
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Salvatore Siracusano
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Walter Artibani
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy,
| |
Collapse
|
|
10
|
The impact of extended pelvic lymph node dissection on the risk of hospital readmission within 180 days after robot assisted radical prostatectomy. World J Urol 2020; 38:2799-2809. [PMID: 31980875 DOI: 10.1007/s00345-020-03094-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE To evaluate the factors associated with the risk of hospital readmission after robot assisted radical prostatectomy (RARP) with or without extended pelvic lymph node dissection (ePLND) for prostate cancer (PCA) over a long term. MATERIALS AND METHODS The risk of readmission was evaluated by clinical, pathological, and perioperative factors. Skilled and experienced surgeons performed the procedures. Patients were followed for complications and hospital readmission for a period of six months. The logistic regression model and Cox's proportional hazards assessed the association of factors with the risk of readmission. RESULTS From January 2013 to December 2018, 890 patients underwent RARP; ePLND was performed in 495 of these patients. Hospital readmission was detected in 25 cases (2.8%); moreover, it was more frequent when RARP was performed with ePLND (4.4% of cases) than without (0.8% of patients). On the final multivariate model, ePLND was the only independent factor that was positively associated with the risk of hospital readmission (hazard ratio, HR = 5935; 95%CI 1777-19,831; p = 0.004). CONCLUSIONS Over the long term after RARP for PCA, the risk of hospital readmission is associated with ePLND. In patients who underwent RARP and ePLND, 4.4% of them had a readmission, compared to RARP alone, in which only 0.8% of cases had a readmission. When ePLND is planned for staging pelvic lymph nodes, patients should be informed of the increased risk of hospital readmission.
Collapse
|
|
11
|
Sebben M, Tafuri A, Pirozzi M, Processali T, Rizzetto R, Amigoni N, Shakir A, De Michele M, Panunzio A, Cerrato C, Tiso L, Novella G, Brunelli M, Migliorini F, De Marco V, Siracusano S, Artibani W, Porcaro AB. Open approach, extended pelvic lymph node dissection, and seminal vesicle invasion are independent predictors of hospital readmission after prostate cancer surgery: a large retrospective study. MINERVA UROL NEFROL 2019; 72:72-81. [PMID: 31833722 DOI: 10.23736/s0393-2249.19.03586-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The aim of this study is to evaluate factors (clinical, pathological and perioperative) associated with the risk of hospital readmission after radical prostatectomy (RP) over the long term in a single tertiary referral center where both open RP (ORP) and robot assisted RP (RARP) are performed. METHODS From January 2013 to December 2018 patients older than 18 years, who provided signed consent and underwent open or robot assisted radical prostatectomy were enrolled and retrospectively evaluated. Patients who underwent any previous prostate cancer (PCA) treatments were excluded. Specifically, skilled and experienced surgeons performed the two surgical approaches. Patients were followed for complications and hospital readmission (RAD) for a period of six months. The association of factors with the risk of readmission was assessed by Cox's multivariate proportional hazards. RESULTS A total of 1062 patients underwent RP. RARP was performed in 891 cases and ORP in 171 subjects. Extended pelvic lymph node dissection (ePLND) was performed in 651 patients. Hospital readmission occurred in 53 cases (5%). Based on the final multivariate model, independent factors associated with the risk of hospital readmission were seminal vesicle invasion (HR=2.093; 95% CI: 1.177-3.722), ORP (HR=4.393; 95% CI: 2.516-7.672) and ePLND (HR=4.418; 95% CI: 1.544-12.639). CONCLUSIONS ORP, ePLND and seminal vesicle invasion are independent predictors of the risk of hospital readmission over the long term at a large single tertiary referral center. When surgery is chosen as a primary treatment of PCA, patients should be informed of the risk of hospital readmission and related risk factors. Assessing seminal vesicle invasion by preoperative clinical staging identifies locally advanced disease, which is associated with an increased risk of hospital readmission.
Collapse
Affiliation(s)
- Marco Sebben
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy.,Catherine and Joseph Aresty Department of Urology, Institute of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Marco Pirozzi
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Tania Processali
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Nelia Amigoni
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Aliasger Shakir
- Catherine and Joseph Aresty Department of Urology, Institute of Urology, University of Southern California (USC), Los Angeles, CA, USA
| | - Mario De Michele
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Andrea Panunzio
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Clara Cerrato
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Leone Tiso
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Giovanni Novella
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, Verona University Hospital, University of Verona, Verona, Italy
| | - Filippo Migliorini
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Vincenzo De Marco
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Salvatore Siracusano
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Walter Artibani
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy
| | - Antonio B Porcaro
- Department of Urology, Verona University Hospital, University of Verona, Verona, Italy -
| |
Collapse
|
|
12
|
Martini A, Gupta A, Cumarasamy S, Lewis SC, Haines KG, Briganti A, Montorsi F, Tewari AK. Novel nomogram for the prediction of seminal vesicle invasion including multiparametric magnetic resonance imaging. Int J Urol 2019; 26:458-464. [PMID: 30659663 DOI: 10.1111/iju.13905] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/17/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To create a model that predicts side-specific seminal vesicle invasion using clinical, biopsy and multiparametric magnetic resonance imaging data. METHODS We analyzed data from 544 patients who underwent robot-assisted radical prostatectomy at a single institution. To develop a side-specific predictive model, we ultimately considered four variables: prostate-specific antigen, highest ipsilateral biopsy Gleason grade, highest ipsilateral percentage core involvement and seminal vesicle invasion on multiparametric magnetic resonance imaging. A binary multivariable logistic regression model was fitted to predict seminal vesicle invasion. A nomogram was then built based on the coefficients of the resulting logit function. The leave-one-out cross validation method was used for internal validation, and the decision curve analysis for the evaluation of the net clinical benefit. RESULTS We relied on 804 side-specific cases after excluding negative biopsy observations (n = 284). Seminal vesicle invasion was reported on multiparametric magnetic resonance imaging in 41 (5%) cases, and on final pathology in 64 (8%) cases. All variables in the model emerged as predictors of seminal vesicle invasion (all P ≤ 0.001) and were subsequently considered to build a nomogram. The area under the curve of multiparametric magnetic resonance imaging alone in predicting seminal vesicle invasion was 59.1%; whereas one of the clinical variables only was 85.1%. The area under the curve of the nomogram resulting from their combination was 86.5%. After internal validation, this resulted in 84.7%. The model achieved good calibration and the decision curve analysis showed its clinical benefit, especially when compared with relying only on multiparametric magnetic resonance imaging prediction of seminal vesicle invasion. CONCLUSIONS A nomogram based on clinical and multiparametric magnetic resonance imaging data can predict seminal vesicle invasion and serve as a tool to urologists for surgical planning.
Collapse
Affiliation(s)
- Alberto Martini
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA.,Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Akriti Gupta
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Shivaram Cumarasamy
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Sara C Lewis
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Kenneth G Haines
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| |
Collapse
|
|
13
|
Greco C, Castiglioni S, Fodor A, De Cobelli O, Longaretti N, Rocco B, Vavassori A, Orecchia R. Benefit on Biochemical Control of Adjuvant Radiation Therapy in Patients with Pathologically Involved Seminal Vesicles after Radical Prostatectomy. TUMORI JOURNAL 2018; 93:445-51. [DOI: 10.1177/030089160709300507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and Background To determine whether there is a benefit for biochemical control with adjuvant radiation therapy to the surgical bed following radical prostatectomy in patients with seminal vesicle invasion and pathologically negative pelvic lymph nodes (pT3b-pT4 pN0). Methods We retrospectively reviewed the clinical records of radical prostatectomy patients treated between 1995 and 2002. A total of 66 patients with seminal vesicle invasion were identified: 45 of these patients received adjuvant radiation therapy and 21 were observed. Radiation therapy was initiated within 4 months of prostatectomy. Median dose was 66 Gy (range, 60–70 Gy). Median follow-up from the day of surgery was 40.6 months (mean, 41.5; range, 12–99). Biochemical recurrence was defined as the first value ≥0.2 ng/ml. Results At two years, the proportion of patients free from biochemical recurrence was 80% in patients who received adjuvant radiation therapy versus 54% for those not given radiation therapy (P = 0.036). Actuarial biochemical recurrence at 5 years was 59% vs 41% for the radiation therapy and no radiation therapy groups, respectively. On univariate Cox regression model, the hazard of biochemical failure was also associated with a detectable (≥0.2 ng/ml) postsurgical prostate-specific antigen (P = 0.02) prior to radiation therapy. Pathological T stage (pT3b vs pT4), Gleason score, primary Gleason pattern and positive surgical margins were not significantly associated with biochemical recurrence. The hazard of biochemical failure was around 85% lower in the radiation therapy group than in the observation group (P = 0.002). Conclusions Data from the present series suggest that adjuvant radiation therapy for patients with seminal vesicle invasion and undetectable (≤0.2 ng/ml) postoperative prostate-specific antigen significantly reduces the likelihood of biochemical failure.
Collapse
Affiliation(s)
- Carlo Greco
- Division of Radiation Oncology, University of Magna Graecia, Catanzaro
- Division of Radiation Oncology, European Institute of Oncology, Milan
| | | | - Andrei Fodor
- Division of Radiation Oncology, European Institute of Oncology, Milan
| | | | | | - Bernardo Rocco
- Division of Urology, European Institute of Oncology, Milan
| | - Andrea Vavassori
- Division of Radiation Oncology, European Institute of Oncology, Milan
| | - Roberto Orecchia
- Division of Radiation Oncology, European Institute of Oncology, Milan
- Chair of Radiation Oncology, University of Milan, Italy
| |
Collapse
|
|
14
|
Billis A, Freitas LLL, Costa LBE, Angelis CM, Carvalho KR, Magna LA, Ferreira U. Does index tumor predominant location influence prognostic factors in radical prostatectomies? Int Braz J Urol 2017; 43:686-697. [PMID: 28379672 PMCID: PMC5557445 DOI: 10.1590/s1677-5538.ibju.2016.0335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 01/01/2017] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To find any influence on prognostic factors of index tumor according to predominant location. MATERIALS AND METHODS Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (anterolateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model. RESULTS Index tumors with predominant posterior location were significantly associated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic extension, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analysis but not on multivariate analysis. CONCLUSIONS The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not offer advantage over other well-established prognostic factors.
Collapse
Affiliation(s)
- Athanase Billis
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Leandro L L Freitas
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Larissa B E Costa
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Camila M Angelis
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Kelson R Carvalho
- Departamento de Patologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Luis A Magna
- Departamento de Genética Médica/Bioestatística, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| | - Ubirajara Ferreira
- Departamento Urologia, Faculdade de Ciências Médicas da Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brasil
| |
Collapse
|
|
15
|
Dell'Atti L, Galosi AB. Ultrasound analysis of seminal vesicles in prostate cancer invasion: monocentric experience of an extended prostate biopsy scheme. Abdom Radiol (NY) 2017; 42:1250-1254. [PMID: 27838771 DOI: 10.1007/s00261-016-0968-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE At present, uniformity does not exist with regard to the indication criteria of seminal vesicle (SV) biopsies. The aim of this study was to define the ultrasonographic (US) patterns observed in SV invaded by prostate cancer (PCa), and propose an extended prostate biopsy protocol when SV invasion (SVI) is suspected. METHODS We reviewed 1.252 patients who underwent an initial transrectal ultrasound-guided prostate biopsy for suspicious PCa. We performed a 14-core biopsy scheme, as first intention, including 1 SV sample on each side when SVI is suspected: a nodule at the base of prostate (determined by digital rectal examination or US) and/or an US pattern that suggests a SVI. US patterns of SVs were classified as abnormal by a variation of the body anterior-posterior diameter, asymmetry of the volume, parietal thickness, distance between the SVs and the rectal surface, and altered echogenicity of SVs and the base of the prostate. RESULTS Of the 137 biopsies performed in SVs, the SVI by PCa was diagnosed in 66.5% of candidate patients. The overall prevalence of SVI was 28.5%. No significant difference was noted between the patients with SVI and without SVI, when comparing age, prostate volume, and total core length, except for preoperative PSA serum levels. The sensitivity of any abnormal finding on transrectal ultrasound for the presence of SVI by PCa is 90.8%, whereas the specificity is 96%. CONCLUSIONS We believe that an extended prostate biopsy protocol to provide the possibility of taking one biopsy core of each SV when SVI is suspected should be considered a complementary procedure for PCa staging.
Collapse
Affiliation(s)
- Lucio Dell'Atti
- Department of Urology, University Hospital "St.Anna", 8 A. Moro Street, 44124, Ferrara, Cona, Italy.
| | - Andrea B Galosi
- Department of Urology, Marche Polytechnic University, Ancona, Italy
| |
Collapse
|
|
16
|
Jang WS, Yoon CY, Kim KH, Kang YJ, Shin SJ, Cho NH, Lee JY, Cho KS, Ham WS, Rha KH, Hong SJ, Choi YD. Prognostic Significance of Vas Deferens Invasion After Radical Prostatectomy in Patients with Pathological Stage T3b Prostate Cancer. Ann Surg Oncol 2016; 24:1143-1149. [PMID: 27796593 DOI: 10.1245/s10434-016-5653-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Seminal vesicle invasion (SVI) is associated with adverse clinical outcomes in prostate cancer (PCa) patients. Despite its anatomical similarity and close proximity to the seminal vesicle, the prognostic significance of vas deferens invasion (VDI) by PCa has not been elucidated. For these reasons, we investigated the impact of VDI on the oncological outcome of pT3b PCa in association with SVI. METHODS We retrospectively reviewed the medical records of 3359 patients who had undergone a radical prostatectomy at our institution between January 2000 and December 2014 for PCa. Patients who received neoadjuvant or adjuvant treatment (radiation, androgen deprivation therapy, or both) and those without adequate medical records were excluded. A Kaplan-Meier analysis was performed to analyze biochemical recurrence-free survival (BCRFS), and a Cox regression model was used to test the influence of VDI on biochemical recurrence (BCR). RESULTS Of 350 patients with pathologically confirmed SVI (pT3b), 87 (24.9%) had VDI, while the remaining 263 patients (75.1%) had isolated SVI. Compared with SVI patients without VDI, SVI patients with VDI were noted to have a significantly worse 5-year BCRFS (25.1 vs. 17.1%, respectively). VDI was a significant predictor of BCR in multivariate Cox regression analysis (hazard ratio 1.39, 95% confidence interval 1.02-1.90; p = 0.039). CONCLUSIONS Our results shows that the prognosis of PCa with SVI might be further stratified by VDI status, thus suggesting the role of VDI either as a surrogate for poor prognosis or as a determinant for adjuvant therapy.
Collapse
Affiliation(s)
- Won Sik Jang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Cheol Yong Yoon
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ki Hong Kim
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Jin Kang
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Su-Jin Shin
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Hoon Cho
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Yong Lee
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kang Su Cho
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Sik Ham
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Koon Ho Rha
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Joon Hong
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea.
| |
Collapse
|
|
17
|
Lee YI, Lee HM, Jo JK, Lee S, Hong SK, Byun SS, Lee SE, Oh JJ. Association between Seminal Vesicle Invasion and Prostate Cancer Detection Location after Transrectal Systemic Biopsy among Men Who Underwent Radical Prostatectomy. PLoS One 2016; 11:e0148690. [PMID: 26848747 PMCID: PMC4743841 DOI: 10.1371/journal.pone.0148690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/20/2016] [Indexed: 11/26/2022] Open
Abstract
Background Our hypothesis is that the location of the seminal vesicles near the base of the prostate, the more positive cores are detected in the base, the greater the risk of seminal vesicle invasion. Therefore we investigate the clinical outcomes of base dominant prostate cancer (BDPC) in transrectal ultrasound (TRUS) -guided biopsies compared with anteromiddle dominant prostate cancer (AMPC). Methods From November 2003 to June 2014, a total of 990 intermediate and high risk prostate cancer (PCa) patients who underwent radical prostatectomy (RP) were enrolled and stratified into two groups according to proportion of positive cores–BDPC group had ≥ 33.3% ratio of positive cores from the prostate base among all positive cores and AMPC group < 33.3% in systemic biopsy. Between two groups, we compared the rate of pathologic outcomes and biochemical recurrence (BCR). We performed multivariate logistic regression model to confirm the significance of BDPC to seminal vesicle invasion (SVI) and Cox proportional hazard analysis to BCR. Results Among these 990 PCa patients, the 487 patients in BDPC group had more advanced clinical stage (p<0.001), a higher biopsy GS (p = 0.002), and a higher rate of extracapsular extension (ECE), SVI and BCR (all p<0.001) than AMPC group. The patients in BDPC group had poor BCR free survival rate via Kaplan-meier analysis (p<0.001). The ratio of the base positive cores was a significant predictor to SVI in multivariate analysis (p < 0.001) and significant predictor of BCR in multivariate Cox proportional analysis (hazard ratio: 1.466, p = 0.004). Conclusions BDPC in TRUS-guided prostate biopsies was significantly associated with SVI and BCR after adjusting for other clinical factors. Therefore, BDPC should be considered to be a more aggressive tumor despite an otherwise similar cancer profile.
Collapse
Affiliation(s)
- Young Ik Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hak Min Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Ki Jo
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
| |
Collapse
|
|
18
|
|
|
19
|
Troyer DA, Jamaspishvili T, Wei W, Feng Z, Good J, Hawley S, Fazli L, McKenney JK, Simko J, Hurtado-Coll A, Carroll PR, Gleave M, Lance R, Lin DW, Nelson PS, Thompson IM, True LD, Brooks JD, Squire JA. A multicenter study shows PTEN deletion is strongly associated with seminal vesicle involvement and extracapsular extension in localized prostate cancer. Prostate 2015; 75:1206-15. [PMID: 25939393 PMCID: PMC4475421 DOI: 10.1002/pros.23003] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/20/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Loss of the phosphatase and tensin homolog (PTEN) tumor suppressor gene is a promising marker of aggressive prostate cancer. Active surveillance and watchful waiting are increasingly recommended to patients with small tumors felt to be low risk, highlighting the difficulties of Gleason scoring in this setting. There is an urgent need for predictive biomarkers that can be rapidly deployed to aid in clinical decision-making. Our objectives were to assess the incidence and ability of PTEN alterations to predict aggressive disease in a multicenter study. METHODS We used recently developed probes optimized for sensitivity and specificity in a four-color FISH deletion assay to study the Canary Retrospective multicenter Prostate Cancer Tissue Microarray (TMA). This TMA was constructed specifically for biomarker validation from radical prostatectomy specimens, and is accompanied by detailed clinical information with long-term follow-up. RESULTS In 612 prostate cancers, the overall rate of PTEN deletion was 112 (18.3%). Hemizygous PTEN losses were present in 55/612 (9.0%) of cancers, whereas homozygous PTEN deletion was observed in 57/612 (9.3%) of tumors. Significant associations were found between PTEN status and pathologic stage (P < 0.0001), seminal vesicle invasion (P = 0.0008), extracapsular extension (P < 0.0001), and Gleason score (P = 0.0002). In logistic regression analysis of clinical and pathological variables, PTEN deletion was significantly associated with extracapsular extension, seminal vesicle involvement, and higher Gleason score. In the 406 patients in which clinical information was available, PTEN homozygous (P = 0.009) deletion was associated with worse post-operative recurrence-free survival (number of events = 189), pre-operative prostate specific antigen (PSA) (P < 0.001), and pathologic stage (P = 0.03). CONCLUSION PTEN status assessed by FISH is an independent predictor for recurrence-free survival in multivariate models, as were seminal vesicle invasion, extracapsular extension, and Gleason score, and preoperative PSA. Furthermore, these data demonstrate that the assay can be readily introduced at first diagnosis in a cost effective manner analogous to the use of FISH for analysis of HER2/neu status in breast cancer. Combined with published research beginning 17 years ago, both the data and tools now exist to implement a PTEN assay in the clinic.
Collapse
Affiliation(s)
- Dean A Troyer
- Eastern Virginia Medical School, Pathology and Microbiology and Molecular BiologyNorfolk, Virginia
- Department of Pathology, University of Texas Health Science Center at San AntonioSan Antonio, Texas
| | - Tamara Jamaspishvili
- Department of Pathology and Molecular Medicine, Queen’s UniversityKingston, Ontario, Canada
| | - Wei Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer CenterHouston, Texas
| | - Ziding Feng
- Department of Biostatistics, The University of Texas MD Anderson Cancer CenterHouston, Texas
| | - Jennifer Good
- Department of Pathology and Molecular Medicine, Queen’s UniversityKingston, Ontario, Canada
| | - Sarah Hawley
- Canary FoundationCanary Center at Stanford, 3155 Porter DrivePalo Alto
| | - Ladan Fazli
- The Prostate Center at Vancouver General Hospital, University of British ColumbiaVancouver, British Columbia, Canada
| | | | - Jeff Simko
- Department of Pathology, University of California San FranciscoSan Francisco, California
- Department of Urology, University of California San FranciscoSan Francisco, California
| | - Antonio Hurtado-Coll
- The Prostate Center at Vancouver General Hospital, University of British ColumbiaVancouver, British Columbia, Canada
| | - Peter R Carroll
- Department of Urology, University of California San FranciscoSan Francisco, California
| | - Martin Gleave
- The Prostate Center at Vancouver General Hospital, University of British ColumbiaVancouver, British Columbia, Canada
| | - Raymond Lance
- Department of Urology, Eastern Virginia Medical SchoolNorfolk, Virginia
| | - Daniel W Lin
- Department of Urology, University of WashingtonSeattle, Washington
| | - Peter S Nelson
- Division of Human Biology, Fred Hutchinson Cancer Research CenterSeattle, Washington
| | - Ian M Thompson
- Department of Urology, University of Texas Health Science Center at San AntonioSan Antonio, Texas
| | - Lawrence D True
- Department of Pathology, University of Washington Medical CenterSeattle, Washington
| | - James D Brooks
- Department of Urology, Stanford UniversityStanford, California
| | - Jeremy A Squire
- Department of Pathology and Molecular Medicine, Queen’s UniversityKingston, Ontario, Canada
- Department of Pathology and Forensic Medicine, University of São Paulo at Ribeirão PretoBrazil
- * Correspondence to: Dr. Jeremy A. Squire, PhD, Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada; Department of Pathology and Forensic Medicine, University of São Paulo at Ribeirão Preto, Brazil. E-mail:
| |
Collapse
|
|
20
|
Qi X, Gao XS, Asaumi J, Zhang M, Li HZ, Ma MW, Zhao B, Li FY, Wang D. Optimal contouring of seminal vesicle for definitive radiotherapy of localized prostate cancer: comparison between EORTC prostate cancer radiotherapy guideline, RTOG0815 protocol and actual anatomy. Radiat Oncol 2014; 9:288. [PMID: 25526901 PMCID: PMC4299806 DOI: 10.1186/s13014-014-0288-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 12/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background Intermediate- to-high-risk prostate cancer can locally invade seminal vesicle (SV). It is recommended that anatomic proximal 1-cm to 2-cm SV be included in the clinical target volume (CTV) for definitive radiotherapy based on pathology studies. However, it remains unclear whether the pathology indicated SV extent is included into the CTV defined by current guidelines. The purpose of this study is to compare the volume of proximal SV included in CTV defined by EORTC prostate cancer radiotherapy guideline and RTOG0815 protocol with the actual anatomic volume. Methods Radiotherapy planning CT images from 114 patients with intermediate- (36.8%) or high-risk (63.2%) prostate cancer were reconstructed with 1-mm-thick sections. The starting and ending points of SV and the cross sections of SV at 1-cm and 2-cm from the starting point were determined using 3D-view. Maximum (D1H, D2H) and minimum (D1L, D2L) vertical distance from these cross sections to the starting point were measured. Then, CTV of proximal SV defined by actual anatomy, EORTC guideline and RTOG0815 protocol were contoured and compared (paired t test). Results Median length of D1H, D1L, D2H and D2L was 10.8 mm, 2.1 mm, 17.6 mm and 8.8 mm (95th percentile: 13.5mm, 5.0mm, 21.5mm and 13.5mm, respectively). For intermediate-risk patients, the proximal 1-cm SV CTV defined by EORTC guideline and RTOG0815 protocol inadequately included the anatomic proximal 1-cm SV in 62.3% (71/114) and 71.0% (81/114) cases, respectively. While for high-risk patients, the proximal 2-cm SV CTV defined by EORTC guideline inadequately included the anatomic proximal 2-cm SV in 17.5% (20/114) cases. Conclusions SV involvement indicated by pathology studies was not completely included in the CTV defined by current guidelines. Delineation of proximal 1.4 cm and 2.2 cm SV in axial plane may be adequate to include the anatomic proximal 1-cm and 2-cm SV. However, part of SV may be over-contoured.
Collapse
Affiliation(s)
- Xin Qi
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
| | - Xian-Shu Gao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
| | - Junichi Asaumi
- Department of Oral and Maxillofacial Radiology, Field of Tumor Biology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
| | - Min Zhang
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
| | - Hong-Zhen Li
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
| | - Ming-Wei Ma
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
| | - Bo Zhao
- Department of Radiation Oncology, Peking University First Hospital, Beijing, China.
| | - Fei-Yu Li
- Department of Radiology, Peking University First Hospital, Beijing, China.
| | - Dian Wang
- Department of Radiation Oncology, Rush University Medical Center, Chicago, IL, USA.
| |
Collapse
|
|
21
|
Miyai K, Kristiansen A, Egevad L, Pina-Oviedo S, Divatia MK, Shen SS, Miles BJ, Ayala AG, Park YW, Ro JY. Seminal vesicle intraepithelial involvement by prostate cancer: putative mechanism and clinicopathological significance. Hum Pathol 2014; 45:1805-12. [DOI: 10.1016/j.humpath.2014.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/05/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
|
|
22
|
Saar M, Kamradt J, Sauer C, Stöckle M, Grobholz R. Margin status of the vas deferens in radical prostatectomy specimens: relevant or waste of time? Histopathology 2014; 65:45-50. [PMID: 24428685 DOI: 10.1111/his.12369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 01/10/2014] [Indexed: 11/29/2022]
Abstract
AIMS Positive surgical margins (PSM) after radical prostatectomy are of great interest, but investigation of the vas deferens (VD) is not recommended. This study examined the VD margins in radical prostatectomy patients to report the incidence of PSM and their clinical staging. METHODS AND RESULTS A total of 2701 consecutive specimens (1995-2009) were reviewed for tumour infiltration of the VD margin and correlated with clinicopathological data. Forty-one of 2701 cases (1.5%) had a positive VD margin. Thirteen cases had bilateral infiltration. All tumours were locally advanced [pT3a (n = 1), pT3b (n = 34), pT4 (n = 6)]; 15 (37%) had lymph node metastases. While Gleason scores ranged from 7 to 9, mean PSA was 22.3 ng/ml (1.68-127 ng/ml). In all cases with seminal vesicle infiltration (40 of 41) the PSM of the VD was seen ipsilaterally. In 11 of 15 patients (73%) with pN1 status, seminal vesicle infiltration and PSM of the VD were seen on the same side. In 16 cases (39%) the VD was the only PSM. CONCLUSIONS A PSM of the VD is an infrequent finding, but might appear as the only PSM. Histological evaluation of the VD therefore seems reasonable, especially as biochemical recurrence has been reported with positive VD margins, and awareness of them might assist in making clinical decisions for adjuvant therapy.
Collapse
Affiliation(s)
- Matthias Saar
- Department of Urology and Pediatric Urology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | | | | | | |
Collapse
|
|
23
|
Lewis H, Lance R, Troyer D, Beydoun H, Hadley M, Orians J, Benzine T, Madric K, Semmes OJ, Drake R, Esquela-Kerscher A. miR-888 is an expressed prostatic secretions-derived microRNA that promotes prostate cell growth and migration. Cell Cycle 2013; 13:227-39. [PMID: 24200968 DOI: 10.4161/cc.26984] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
MicroRNAs (MiRNAs) are a growing class of small non-coding RNAs that exhibit widespread dysregulation in prostate cancer. We profiled miRNA expression in syngeneic human prostate cancer cell lines that differed in their metastatic potential in order to determine their role in aggressive prostate cancer. miR-888 was the most differentially expressed miRNA observed in human metastatic PC3-ML cells relative to non-invasive PC3-N cells, and its levels were higher in primary prostate tumors from cancer patients, particularly those with seminal vesicle invasion. We also examined a novel miRNA-based biomarker source called expressed prostatic secretions in urine (EPS urine) for miR-888 expression and found that its levels were preferentially elevated in prostate cancer patients with high-grade disease. These expression studies indicated a correlation for miR-888 in disease progression. We next tested how miR-888 regulated cancer-related pathways in vitro using human prostate cancer cell lines. Overexpression of miR-888 increased proliferation and migration, and conversely inhibition of miR-888 activity blocked these processes. miR-888 also increased colony formation in PC3-N and LNCaP cells, supporting an oncogenic role for this miRNA in the prostate. Our data indicates that miR-888 functions to promote prostate cancer progression and can suppress protein levels of the tumor suppressor genes RBL1 and SMAD4. This miRNA holds promise as a diagnostic tool using an innovative prostatic fluid source as well as a therapeutic target for aggressive prostate cancer.
Collapse
Affiliation(s)
- Holly Lewis
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - Raymond Lance
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA; Department of Urology; Eastern Virginia Medical School and Urology of Virginia; Norfolk, VA USA
| | - Dean Troyer
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - Hind Beydoun
- Graduate Program in Public Health; Eastern Virginia Medical School; Norfolk, VA USA
| | - Melissa Hadley
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - Joseph Orians
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - Tiffany Benzine
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - Kenya Madric
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - O John Semmes
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - Richard Drake
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| | - Aurora Esquela-Kerscher
- Department of Microbiology & Molecular Cell Biology; Leroy T. Canoles Jr. Cancer Research Center; Eastern Virginia Medical School; Norfolk, VA USA
| |
Collapse
|
|
24
|
Fairey AS, Daneshmand S, Skinner EC, Schuckman A, Cai J, Lieskovsky G. Long-term cancer control after radical prostatectomy and bilateral pelvic lymph node dissection for pT3bN0M0 prostate cancer in the prostate-specific antigen era. Urol Oncol 2013; 32:85-91. [PMID: 24183191 DOI: 10.1016/j.urolonc.2013.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We evaluated long-term cancer control outcomes of radical prostatectomy and bilateral pelvic lymph node dissection (RP) for pT3bN0M0 prostate cancer in the era of prostate-specific antigen (PSA) screening. MATERIALS AND METHODS A retrospective analysis of prospectively collected data from the University of Southern California Prostate Cancer Database was performed. Between 1987 and 2008, 229 men underwent open RP for pT3bN0M0 prostate cancer. The cohort was divided into early (1987-1997) and contemporary (1998-2008) PSA eras. The Kaplan-Meier method and Cox proportional regression models were used to analyze clinical recurrence (CR) and biochemical recurrence (BCR). RESULTS The median follow-up duration was 14.5 years (range, 0.2-21.1y). The predicted 10-year freedom from CR and BCR rates for men treated in the early and contemporary PSA eras were 73% and 95% (Log-rank P = 0.001) and 65% and 73% (Log-rank P = 0.055), respectively. Multivariable analysis showed that pathologic Gleason grade 8-10 (CR: hazard ratio [HR] = 5.11; 95% confidence interval [CI] = 1.72-15.20; P = 0.003; BCR: HR = 3.47; 95% CI = 1.60-7.48; P = 0.002) and contemporary PSA era (CR: HR = 0.15; 95% CI = 0.06-0.41; P<0.001; BCR: HR = 0.49; 95% CI = 0.28-0.86; P = 0.013) were independently associated with cancer control. Adjuvant radiation therapy and positive surgical margins were not independently associated with outcomes. CONCLUSIONS RP conferred long-term cancer control in men with pT3bN0M0 prostate cancer treated in the PSA era. Pathologic Gleason grade 8-10 and treatment in the early PSA era were independently associated with poorer cancer control outcomes.
Collapse
Affiliation(s)
- Adrian S Fairey
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Siamak Daneshmand
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Eila C Skinner
- Department of Urology, Stanford University, Stanford, CA
| | - Anne Schuckman
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Jie Cai
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA
| | - Gary Lieskovsky
- USC Institute of Urology, Keck Medical Center of USC, University of Southern California, Los Angeles, CA.
| |
Collapse
|
|
25
|
Khalifa J, Commandeur F, Bachaud JM, de Crevoisier R. Radiothérapie conformationnelle prostatique : quelles marges ? Cancer Radiother 2013; 17:461-9. [DOI: 10.1016/j.canrad.2013.06.031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/07/2013] [Indexed: 11/24/2022]
|
|
26
|
Seminal vesicle biopsies: an useful staging procedure-exposure of seminal vesicle biopsies protocol and review of the literature. Int Urol Nephrol 2013; 46:297-302. [PMID: 24036934 DOI: 10.1007/s11255-013-0473-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Although new MRI techniques have a high sensitivity but varying specificity with regard to diagnosing the seminal vesicle invasion (SVI) of prostate cancer, the low availability and high cost involved demands incorporating an inexpensive and accessible technique that might support adequate staging. Currently, uniformity does not exist with regard to the indication criteria of seminal vesicle biopsies (SVBs). Our objective is to analyse the protocol of SVBs at Morales Meseguer Hospital and conduct an exhaustive review of the literature in this field. METHODS AND MATERIALS SVBs were performed in patients who were amenable to a curative treatment and who showed at least one of the following indication criteria: prostate-specific antigen greater than or equal to 15 ng/ml, a prostate cancer nodule in the base of the prostate, or ultrasound abnormalities suggestive of vesicular involvement. SVBs were performed in 70 patients. RESULTS These results revealed a rate of SVI of 15.7 and 25.58 % among all patients and patients diagnosed with prostate cancer, respectively. All biopsied patients who tested positive for the three indication criteria had T3b prostate cancer. Patients with a prostate cancer that altered the base of the prostate according to either digital rectal examination or ultrasound showed a T3b rate of 53.8 %. CONCLUSIONS SVBs should be considered a complementary procedure for prostate cancer staging because provide important information and it is easy, inexpensive and has few complications.
Collapse
|
|
27
|
Kristiansen A, Wiklund F, Wiklund P, Egevad L. Prognostic significance of patterns of seminal vesicle invasion in prostate cancer. Histopathology 2013; 62:1049-56. [DOI: 10.1111/his.12104] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 01/23/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Anna Kristiansen
- Department of Oncology and Pathology; Karolinska Institutet; Stockholm; Sweden
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics; Karolinska Institutet; Stockholm; Sweden
| | - Peter Wiklund
- Department of Surgical Science; Karolinska Institutet; Stockholm; Sweden
| | - Lars Egevad
- Department of Oncology and Pathology; Karolinska Institutet; Stockholm; Sweden
| |
Collapse
|
|
28
|
Sapre N, Pedersen J, Hong MK, Harewood L, Peters J, Costello AJ, Hovens CM, Corcoran NM. Re-evaluating the biological significance of seminal vesicle invasion (SVI) in locally advanced prostate cancer. BJU Int 2012. [DOI: 10.1111/j.1464-410x.2012.11477.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
|
29
|
Nguyen DP, Giannarini G, Seiler R, Schiller R, Thoeny HC, Thalmann GN, Studer UE. Local recurrence after retropubic radical prostatectomy for prostate cancer does not exclusively occur at the anastomotic site. BJU Int 2012. [PMID: 23186331 DOI: 10.1111/j.1464-410x.2012.11506.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
UNLABELLED What's known on the subject? and what does the study add?: Local recurrence after radical prostatectomy (RP) for clinically organ-confined prostate cancer is largely assumed to occur at the anastomotic site, as reflected in European and North American guidelines for adjuvant and salvage radiotherapy after RP. However, the exact site of local recurrence often remains undetermined. The present study shows that roughly one out of five patients with local recurrence after RP has histologically confirmed tumour deposits at the resection site of the vas deferens, clearly above the anastomotic site. This should be considered when offering 'blind' radiotherapy to the anastomotic site in patients with biochemical recurrence alone. OBJECTIVE To determine the anatomical pattern of local recurrence and the corresponding clinical and pathological variables of patients treated with retropubic radical prostatectomy (RRP). PATIENTS AND METHODS In all, 41 patients with biopsy confirmed local recurrence after extended pelvic lymph node dissection and RRP performed between January 1992 and December 2009 at a single tertiary referral academic centre were retrospectively studied. The site of local recurrence as assessed on computed tomography or magnetic resonance imaging was reviewed. Two sites were identified: the vesicourethral anastomotic site and the cranial resection margin of the surgical bed, where the vas deferens was transected and clipped. Age and serum prostate-specific antigen (PSA) level at RRP, pathological tumour and nodal stage, Gleason score, tumour location, surgical margin status, age and serum PSA level at the time of local recurrence, and time to diagnosis of local recurrence were assessed for the two sites and compared with the chi-square or Wilcoxon rank sum tests as appropriate. RESULTS Local recurrence occurred at the anastomotic site in 31/41 (76%) patients and at the resection site of the vas deferens in nine of 41 (22%) patients. One patient had distinct lesions at both sites. There was no significant difference in any of the clinical and pathological variables between patients with local recurrence in the former and latter site. CONCLUSION Most local recurrences after RRP occur exclusively at the anastomotic site. However, 22% of locally recurrent cases had tumour at the resection site of the vas deferens. This should be taken into account when considering adjuvant or salvage radiation therapy.
Collapse
Affiliation(s)
- Daniel P Nguyen
- Department of Urology, University of Berne, Inselspital, Berne, Switzerland
| | | | | | | | | | | | | |
Collapse
|
|
30
|
Osunkoya AO, Grignon DJ. Practical issues and pitfalls in staging tumors of the genitourinary tract. Semin Diagn Pathol 2012; 29:154-66. [DOI: 10.1053/j.semdp.2011.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
|
31
|
Lughezzani G, Zorn KC, Budäus L, Sun M, Lee DI, Shalhav AL, Zagaya GP, Shikanov SA, Gofrit ON, Thong AE, Albala DM, Sun L, Cronin A, Vickers AJ, Karakiewicz PI. Comparison of three different tools for prediction of seminal vesicle invasion at radical prostatectomy. Eur Urol 2012; 62:590-6. [PMID: 22561078 DOI: 10.1016/j.eururo.2012.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 04/03/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Statistical prediction tools are increasingly common, but there is considerable disagreement about how they should be evaluated. Three tools--Partin tables, the European Society for Urological Oncology (ESUO) criteria, and the Gallina nomogram--have been proposed for the prediction of seminal vesicle invasion (SVI) in patients with clinically localized prostate cancer who are candidates for a radical prostatectomy. OBJECTIVES Using different statistical methods, we aimed to determine which of these tools should be used to predict SVI. DESIGN, SETTINGS, AND PARTICIPANTS The independent validation cohort consisted of 2584 patients treated surgically for clinically localized prostate cancer at four North American tertiary care centers between 2002 and 2007. INTERVENTIONS Robot-assisted laparoscopic radical prostatectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was the presence of SVI. Traditional (area under the receiver operating characteristic [ROC] curve, calibration plots, the Brier score, sensitivity and specificity, positive and negative predictive value) and novel (decision curve analysis and predictiveness curves) statistical methods quantified the predictive abilities of the three models. RESULTS AND LIMITATIONS Traditional statistical methods (ie, ROC plots and Brier scores) could not clearly determine which one of the three SVI prediction tools should be preferred. For example, ROC plots and Brier scores seemed biased against the binary decision tool (ESUO criteria) and gave discordant results for the continuous predictions of the Partin tables and the Gallina nomogram. The results of the calibration plots were discordant with those of the ROC plots. Conversely, the decision curve indicated that the Partin tables represent the best strategy for stratifying the risk of SVI, resulting in the highest net benefit within the whole range of threshold probabilities. CONCLUSIONS When predicting SVI, surgeons should prefer the Partin tables over the ESUO criteria and the Gallina nomogram because this tool provided the highest net benefit. In contrast to traditional statistical methods, decision curve analysis gave an unambiguous result applicable to both continuous and binary models, providing an insight into clinical utility.
Collapse
Affiliation(s)
- Giovanni Lughezzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
32
|
Prognostic factors in prostate cancer. Key elements in structured histopathology reporting of radical prostatectomy specimens. Pathology 2011; 43:410-9. [DOI: 10.1097/pat.0b013e328348a6b3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
|
33
|
Pierorazio PM, Ross AE, Schaeffer EM, Epstein JI, Han M, Walsh PC, Partin AW. A contemporary analysis of outcomes of adenocarcinoma of the prostate with seminal vesicle invasion (pT3b) after radical prostatectomy. J Urol 2011; 185:1691-7. [PMID: 21419448 DOI: 10.1016/j.juro.2010.12.059] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE Despite earlier detection and stage migration, seminal vesicle invasion is still reported in the prostate specific antigen era and remains a poor prognostic indicator. We investigated outcomes in men with pT3b disease in the contemporary era. MATERIALS AND METHODS The institutional radical prostatectomy database (1982 to 2010) of 18,505 men was queried and 989 with pT3b tumors were identified. The cohort was split into pre-prostate specific antigen (1982 to 1992), and early (1993 to 2000) and contemporary (2001 to present) prostate specific antigen eras. Of the 732 men identified in the prostate specific antigen era 140 had lymph node involvement and were excluded from study. The Kaplan-Meier method was used to determine biochemical recurrence-free, metastasis-free and prostate cancer specific survival. Proportional hazard models were used to determine predictors of biochemical recurrence-free, metastasis-free and cancer specific survival. RESULTS In the pre-prostate specific antigen, and early and contemporary prostate specific antigen eras, 7.7%, 4.3% and 3.3% of patients, respectively, had pT3bN0 disease (p >0.001). In pT3bN0 cases, the 10-year biochemical recurrence-free survival rate was 25.8%, 28.6% and 19.6% (p = 0.8), and the cancer specific survival rate was 79.9%, 79.6% and 83.8% (p = 0.6) among the eras, respectively. In pT3bN0 cases in the prostate specific antigen era, prostate specific antigen, clinical stage T2b or greater, pathological Gleason sum 7 and 8-10, and positive surgical margins were significant predictors of biochemical recurrence-free survival on multivariate analysis while clinical stage T2c or greater and Gleason 8-10 were predictors of metastasis-free and cancer specific survival. CONCLUSIONS Despite a decreased frequency of pT3b disease, and lower rates of positive surgical margins and lymph nodes, patients with seminal vesicle invasion continue to have low biochemical recurrence-free survival. Advanced clinical stage, intermediate or high risk Gleason sum at pathological evaluation and positive surgical margins predict biochemical recurrence. High risk clinical stage and Gleason sum predict metastasis-free and cancer specific survival.
Collapse
Affiliation(s)
- Phillip M Pierorazio
- The James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA.
| | | | | | | | | | | | | |
Collapse
|
|
34
|
Berney DM, Wheeler TM, Grignon DJ, Epstein JI, Griffiths DF, Humphrey PA, van der Kwast T, Montironi R, Delahunt B, Egevad L, Srigley JR. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes. Mod Pathol 2011; 24:39-47. [PMID: 20818343 DOI: 10.1038/modpathol.2010.160] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coordinated by working group 4. There was a consensus that complete blocking of the seminal vesicles was not necessary, although sampling of the junction of the seminal vesicles and prostate was mandatory. There was consensus that sampling of the vas deferens margins was not obligatory. There was also consensus that muscular wall invasion of the extraprostatic seminal vesicle only should be regarded as seminal vesicle invasion. Categorization into types of seminal vesicle spread was agreed by consensus to be not necessary. For examination of lymph nodes, there was consensus that special techniques such as frozen sectioning were of use only in high-risk cases. There was no consensus on the optimal sampling method for pelvic lymph node dissection specimens, although there was consensus that all lymph nodes should be completely blocked as a minimum. There was also a consensus that a count of the number of lymph nodes harvested should be attempted. In view of recent evidence, there was consensus that the diameter of the largest lymph node metastasis should be measured. These consensus decisions will hopefully clarify the difficult areas of pathological assessment in radical prostatectomy evaluation and improve the concordance of research series to allow more accurate assessment of patient prognosis.
Collapse
Affiliation(s)
- Daniel M Berney
- Department of Molecular Oncology and Imaging, St Bartholomew's Hospital Queen Mary University of London, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
35
|
Reis LO, Zani EL, Billis A, Prudente A, Denardi F, Ferreira U. The triple clinicopathologic features to seminal vesicle-sparing radical prostatectomy. J Endourol 2010; 24:1535-1539. [PMID: 20804433 DOI: 10.1089/end.2009.0655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE With the widespread early detection programs for prostate cancer, there has been a downward stage migration and a marked decrease in the percentage of men with seminal vesicle invasion (SVI) compared with previous data. We evaluated clinicopathologic findings that are associated with SVI to select patients for potential seminal vesicle-sparing surgery. PATIENTS AND METHODS We reviewed our radical prostatectomy database from 1997 to 2006 to evaluate the incidence and clinical correlates of SVI. Variables analyzed included serum prostate-specific antigen (PSA) level, clinical stage, percentage of positive cores with cancer, Gleason score on biopsy, age, prostate weight, and urethral and vesical surgical margins. Statistical analysis included univariate and multivariate logistic regressions. RESULTS Of 267 patients, 32 (12%) had SVI. Preoperative PSA level, biopsy Gleason score, and percentage of positive cores were highly predictive of SVI on multivariate analysis. SVI was present in only 1/98 patients (1.02 %) with biopsy Gleason score ≤6, 0/23 patients (0%) with serum PSA level <4 ng/mL, and only 1 patient with ≤12.8% of positive cores on biopsy. In all cases of distal SVI, there was proximal involvement. CONCLUSION Serum PSA level, Gleason score, and percentage of positive cores on biopsy are statistically significant predictors of SVI on multivariate analysis. Seminal vesiculectomy does not benefit almost 99% of patients with biopsy Gleason score ≤6, PSA level <4 ng/mL, and with <12% cores with cancer. In cases of seminal vesicle-sparing surgery, frozen section of the proximal portion may be of adjunct usefulness for the triple.
Collapse
Affiliation(s)
- Leonardo Oliveira Reis
- Department of Surgery (Urology), School of Medicine, University of Campinas (UNICAMP), Campinas, Sao Paolo, Brazil.
| | | | | | | | | | | |
Collapse
|
|
36
|
Samaratunga H, Samaratunga D, Perry-Keene J, Adamson M, Yaxley J, Delahunt B. Distal seminal vesicle invasion by prostate adenocarcinoma does not occur in isolation of proximal seminal vesicle invasion or lymphovascular infiltration. Pathology 2010; 42:330-3. [DOI: 10.3109/00313021003767330] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
|
37
|
Mazaheri Y, Hricak H, Fine SW, Akin O, Shukla-Dave A, Ishill NM, Moskowitz CS, Grater JE, Reuter VE, Zakian KL, Touijer KA, Koutcher JA. Prostate tumor volume measurement with combined T2-weighted imaging and diffusion-weighted MR: correlation with pathologic tumor volume. Radiology 2009; 252:449-57. [PMID: 19703883 DOI: 10.1148/radiol.2523081423] [Citation(s) in RCA: 158] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively determine the accuracy of diffusion-weighted (DW) magnetic resonance (MR) imaging for identifying cancer in the prostate peripheral zone (PZ) and to assess the accuracy of tumor volume measurements made with T2-weighted imaging and combined T2-weighted and DW MR imaging by using surgical pathologic examination as the reference standard. MATERIALS AND METHODS The institutional review board issued a waiver of informed consent for this HIPAA-compliant study. Forty-two patients underwent endorectal MR at 1.5 T before undergoing radical prostatectomy for prostate cancer and had at least one PZ tumor larger than 0.1 cm(3) at surgical pathologic examination. On T2-weighted images, an experienced radiologist outlined suspected PZ tumors. Two apparent diffusion coefficient (ADC) cutoff values were identified by using the Youden index and published literature. Image cluster analysis was performed on voxels within the suspected tumor regions. Associations between volume measurements from imaging and from pathologic examination were assessed by using concordance correlation coefficients (CCCs). The sensitivity and specificity of ADCs for identifying malignant PZ voxels were calculated. RESULTS In identifying malignant voxels, respective ADC cutoff values of 0.0014 and 0.0016 mm(2)/sec yielded sensitivity of 82% and 95% and specificity of 85% and 65%, respectively. Sixty PZ cancer lesions larger than 0.1 cm(3) were found at pathologic examination; 43 were detected by the radiologist. CCCs between imaging and pathologic tumor volume measurements were 0.36 for T2-weighted imaging, and 0.46 and 0.60 for combined T2-weighted and DW MR imaging with ADC cutoffs of 0.0014 and 0.0016 mm(2)/sec, respectively; the CCC of combined T2-weighted and DW MR imaging (ADC cutoff, 0.0016 mm(2)/sec) was significantly higher (P = .006) than that of T2-weighted imaging alone. CONCLUSION Adding DW MR to T2-weighted imaging can significantly improve the accuracy of prostate PZ tumor volume measurement. SUPPLEMENTAL MATERIAL http://radiology.rsnajnls.org/cgi/content/full/252/2/449/DC1.
Collapse
Affiliation(s)
- Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, Room C-278, New York, NY 10065, USA.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
38
|
Gofrit ON, Zorn KC, Shikanov SA, Zagaja GP, Shalhav AL. Is seminal vesiculectomy necessary in all patients with biopsy Gleason score 6? J Endourol 2009; 23:709-13. [PMID: 19335331 DOI: 10.1089/end.2008.0577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Radiotherapists are excluding the seminal vesicles (SVs) from their target volume in cases of low-risk prostate cancer. However, these glands are routinely removed in every radical prostatectomy. Dissection of the SVs can damage the pelvic plexus, compromise trigonal, bladder neck, and cavernosal innervation, and contribute to delayed gain of continence and erectile function. In this study we evaluated the oncological benefit of routine removal of the SVs in currently operated patients. MATERIALS AND METHODS A total of 1003 patients (mean age, 59.7 years) with prostate cancer underwent robot-assisted radical prostatectomy between February 2003 and July 2007. RESULTS Seminal vesicle invasion (SVI) was found in 46 of the operated patients (4.6%). Biopsy Gleason score (BGS), preoperative serum PSA, clinical tumor stage, percent of positive cores, and maximal percentage of cancer in a core had all a significant impact on the risk of SVI. Only 4/634 patients (0.6%) with BGS < or =6 suffered from SVI, as opposed to 42/369 (11.4%) with higher Gleason scores. CONCLUSIONS Seminal vesiculectomy does not benefit more than 99% of the patients with BGS < or =6. Considering the potential neural and vascular damage associated with seminal vesiculectomy, we suggest that routine removal of these glands during radical prostatectomy in these cases is not necessary.
Collapse
Affiliation(s)
- Ofer N Gofrit
- Section of Urology, Department of Surgery, University of Chicago Hospitals, Chicago, Illinois 60637, USA.
| | | | | | | | | |
Collapse
|
|
39
|
Robot-assisted laparoscopic radical prostatectomy: an athermal anterior approach to the seminal vesicle dissection. J Robot Surg 2008; 2:223-6. [PMID: 27637791 DOI: 10.1007/s11701-008-0117-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 10/22/2008] [Indexed: 10/21/2022]
Abstract
The seminal vesicles, particularly the lateral aspect and tips, are among the closest structures to the cavernous nerves and pelvic plexus. Given this proximity it is essential that the seminal vesicle dissection be performed in an athermal and atraumatic fashion during robot-assisted laparoscopic prostatectomy (RALP). Traditionally the seminal vesicle dissection during RALP is performed by dividing the vas deferens and following it proximally to locate the tip of the seminal vesicle. Here we describe a modification to the traditional anterior approach to seminal vesicle dissection. Our modification allows the dissection to be performed athermally and efficiently with use of minimal traction. The dissection proceeds medially between the two terminal vas deferens to identify the medial surface of one of the seminal vesicles. This medial surface is avascular and can be developed easily along the length of the vesicle using blunt dissection. Once its tip is identified it is elevated with the fourth arm medially between the two vas deferens. The ipsilateral vas can then be clipped and divided below the level of the elevated seminal vesicle. The vascular supply to the seminal vesicle is then simply identified entering the lateral aspect of its tip. A hemolock clip is placed directly beneath the tip of the seminal vesicle to control its vasculature. The remainder of the dissection can be performed with sharp dissection. Using this technique the seminal vesicle can be excised entirely with minimal traction and no thermal energy. By elevating the tip medially away from the location of the pelvic plexus and cavernous nerves, inadvertent damage to these neural structures is avoided when placing the hemolock clips.
Collapse
|
|
40
|
Prognostic Significance of Cancer Volume Involving Seminal Vesicles in Patients With pT3bpN0 Prostate Cancer. Urology 2008; 72:1224-8. [DOI: 10.1016/j.urology.2008.06.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2008] [Revised: 06/15/2008] [Accepted: 06/28/2008] [Indexed: 11/17/2022]
|
|
41
|
|
|
42
|
Vaishampayan U, Hussain M. Update in systemic therapy of prostate cancer: improvement in quality and duration of life. Expert Rev Anticancer Ther 2008; 8:269-81. [PMID: 18279067 DOI: 10.1586/14737140.8.2.269] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Overall survival benefit with a docetaxel and prednisone regimen in metastatic androgen-independent prostate cancer marked a major advance in the management of prostate cancer. Immunotherapy, antiangiogenic therapies and targeted agents are areas of active research interest. Simultaneous progress in palliative and supportive care has enabled us to improve the quality of life of advanced prostate cancer patients. Multiple predictors of outcome have been reported, and systemic therapy is being actively explored in localized disease. This review attempts to summarize the risk profiling strategy in prostate cancer and the existing therapies in high-risk prostate cancer, including some of the novel agents under investigation.
Collapse
|
|
43
|
Local staging of Prostate Cancer Using Endoretal Coil Magnetic Resonance Imaging. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
|
44
|
Bayman NA, Wylie JP. When should the seminal vesicles be included in the target volume in prostate radiotherapy? Clin Oncol (R Coll Radiol) 2007; 19:302-7. [PMID: 17448647 DOI: 10.1016/j.clon.2007.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Revised: 02/17/2007] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
External beam radiotherapy to the prostate and seminal vesicles as a radical treatment for prostate cancer can result in a significant dose being delivered to the rectum. This can be reduced if the target volume includes the prostate only. Using a Medline search, published studies are reviewed to show that the risk of seminal vesicle involvement can be accurately predicted using readily available pre-treatment parameters. We recommend when to exclude the seminal vesicles from a target volume, and the proportion of seminal vesicles that should be included in a target volume in higher risk patients.
Collapse
Affiliation(s)
- N A Bayman
- Department of Clinical Oncology, Christie Hospital, Wilmslow Road, Manchester M20 4BX, UK.
| | | |
Collapse
|
|
45
|
Billis A, Teixeira DA, Stelini RF, Quintal MM, Guimarães MS, Ferreira U. Seminal vesicle invasion in radical prostatectomies: which is the most common route of invasion? Int Urol Nephrol 2007; 39:1097-102. [PMID: 17431809 DOI: 10.1007/s11255-007-9189-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 01/22/2007] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Very few studies have been published on seminal vesicle invasion (SVI), and these have obtained conflicting results. The aim of the present investigation was to determine the most frequent of three possible routes of seminal vesicle invasion: (1) extraprostatic extension (EPE) into soft tissue adjacent to the seminal vesicle and then into the wall of the seminal vesicle, (2) invasion via the sheath of the ejaculatory duct, penetrating the muscular wall of the ejaculatory duct or extending up the ejaculatory duct into the seminal vesicle muscle wall, or (3) discontinuous metastases. MATERIALS AND METHODS The surgical specimens of 230 consecutive patients submitted to radical prostatectomy were histologically evaluated by complete embedding and whole-mount processing. RESULTS Of the surgical specimens obtained from 230 patients, 28 (12.17%) showed the presence of either unilateral or bilateral SVI. The routes of SVI in these 28 specimens were: (1) only via the sheath of the ejaculatory duct (0/28; 0%); (2) discontinuous metastases (3/28; 11%), (3) both EPE and via the sheath of the ejaculatory duct (6/28; 21%), and (4) only EPE (19/28; 68%). One-half (14/28; 50%) of the 28 seminal vesicles involved had unilateral invasion and, in most of these cases (42.85%), EPE was unilateral and ipsilateral. CONCLUSION Our results suggest that the most important and most frequent route of SVI is extraprostatic extension of prostate carcinoma into the soft tissue adjacent to the ipsilateral seminal vesicle and then into the wall of the seminal vesicle.
Collapse
Affiliation(s)
- Athanase Billis
- Anatomic Pathology, School of Medicine, State University of Campinas, Caixa Postal 6111, Campinas, 13084-971, Brazil.
| | | | | | | | | | | |
Collapse
|
|
46
|
Baccala A, Reuther AM, Bianco FJ, Scardino PT, Kattan MW, Klein EA. Complete Resection of Seminal Vesicles at Radical Prostatectomy Results in Substantial Long-Term Disease-Free Survival: Multi-institutional Study of 6740 Patients. Urology 2007; 69:536-40. [PMID: 17382160 DOI: 10.1016/j.urology.2006.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 09/19/2006] [Accepted: 12/12/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To estimate the disease-specific survival of patients with complete removal of the seminal vesicles (SVs) at radical prostatectomy and to develop a nomogram for the prediction of SV invasion (SVI). METHODS An analysis of 6740 patients from three institutions was performed. The primary outcome was biochemical failure analyzed according to the presence or absence of SVI using the Kaplan-Meier method and Cox proportional hazards model. The variables analyzed included age, biopsy Gleason score, clinical T stage, margin status, extracapsular extension, SVI, surgical Gleason score, initial prostate-specific antigen level, and institution. Logistic regression analysis was used to determine the preoperative factors predicting for SVI and create the model for the nomogram. RESULTS Of the 6740 patients, 566 (8.4%) had positive SVs. The median follow-up was 33.4 months (range 1 to 239). The 5 and 10-year biochemical relapse-free survival rate was 38.0% and 25.6%, respectively, for patients with positive SVs and 85.7% and 77.2%, respectively, for patients with negative SVs (P <0.0001). In the multivariate model, all variables, except for biopsy Gleason score and T stage, were significant predictors of biochemical failure (P <0.05), and all variables, except for age, were predictors of SVI. The nomogram achieved an area under the curve of 0.80. CONCLUSIONS These results have demonstrated that a substantial number of patients with SVI are disease free at 5 and 10 years after complete excision without adjuvant therapy. These findings suggest the therapeutic efficacy of complete SV excision and can identify those with a nomogram-predicted increased risk of SVI who might benefit from complete excision.
Collapse
Affiliation(s)
- Angelo Baccala
- Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, Ohio 44122, USA.
| | | | | | | | | | | |
Collapse
|
|
47
|
Gallina A, Chun FKH, Briganti A, Shariat SF, Montorsi F, Salonia A, Erbersdobler A, Rigatti P, Valiquette L, Huland H, Graefen M, Karakiewicz PI. Development and split-sample validation of a nomogram predicting the probability of seminal vesicle invasion at radical prostatectomy. Eur Urol 2007; 52:98-105. [PMID: 17267098 DOI: 10.1016/j.eururo.2007.01.060] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 01/05/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Seminal vesicle preservation may have a beneficial impact on erectile and urinary function after radical prostatectomy (RP). We hypothesized that contemporary patients, at very low risk of seminal vesicle invasion (SVI), can be highly accurately identified with an equally contemporary SVI nomogram. MATERIALS AND METHODS A nomogram predicting SVI was developed in a cohort study of 666 men diagnosed with 10 or more biopsy cores and treated with RP. Biopsy Gleason sum, prostate-specific antigen, clinical stage, and percentage of positive cores represented predictors in multivariable logistic regression models and formed the basis for the nomogram. The regression coefficient-based nomogram was then externally validated in a split-sample cohort of 230 patients. This cohort also served for a head-to-head comparison of external validity of the novel nomogram with two existing tools, namely Partin's SVI predictions and Koh's SVI nomogram. RESULTS Split-sample validation of the novel SVI nomogram demonstrated 79.2% accuracy versus 75.6% for Partin versus 77.7% for Koh. Our nomogram cutoff of 3% or less had 96.2% negative predictive value for identifying men at very low risk of SVI. This cutoff could have safely allowed omitting the removal of seminal vesicles in 45.2% of RP candidates, if incorrect classification of 1.7% of patients was judged acceptable. CONCLUSIONS The potential benefits of SV preservation can be safely accomplished in virtually 50% of contemporary men subjected to RP, if our tool's predictions are applied.
Collapse
Affiliation(s)
- Andrea Gallina
- Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
|
48
|
Sala E, Akin O, Moskowitz CS, Eisenberg HF, Kuroiwa K, Ishill NM, Rajashanker B, Scardino PT, Hricak H. Endorectal MR Imaging in the Evaluation of Seminal Vesicle Invasion: Diagnostic Accuracy and Multivariate Feature Analysis. Radiology 2006; 238:929-37. [PMID: 16424250 DOI: 10.1148/radiol.2383050657] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To retrospectively determine the accuracy of endorectal magnetic resonance (MR) imaging in demonstrating seminal vesicle invasion (SVI) and to investigate the MR imaging features that can predict SVI. MATERIALS AND METHODS The Institutional Review Board granted exempt status for this retrospective study, with waiver of informed consent; patient data were collected and handled in accordance with HIPAA regulations. Fifty-one men (age range, 44-73 years) with SVI and 303 men (age range, 40-76 years) without SVI who underwent endorectal MR imaging before radical prostatectomy between January 2000 and October 2004 were included in the study. Endorectal MR images were retrospectively and independently analyzed by two radiologists for SVI, tumor at prostate base, extracapsular extension, and other features considered indicative of SVI. Areas under the receiver operating characteristic curves (AUCs) were used to assess the accuracy of detecting SVI at endorectal MR imaging. A multiple logistic regression was used to explore the combinations of MR imaging features that might facilitate the detection of SVI. RESULTS Readers 1 and 2 had an AUC of 0.93 and 0.81, respectively, for the detection of SVI. For both readers, the features that had the highest sensitivity and specificity were low signal intensity within the seminal vesicle and lack of preservation of seminal vesicle architecture. At multiple regression analysis, tumor at the prostate base that extended beyond the capsule and low signal intensity within a seminal vesicle that has lost its normal architecture were highly predictive of SVI. CONCLUSION Endorectal MR imaging is accurate in demonstrating SVI prior to radical prostatectomy, and recognition of the most predictive features may facilitate the use of this modality.
Collapse
Affiliation(s)
- Evis Sala
- Departmens of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
|
49
|
Guzzo TJ, Vira M, Wang Y, Tomaszewski J, D'amico A, Wein AJ, Malkowicz SB. Preoperative parameters, including percent positive biopsy, in predicting seminal vesicle involvement in patients with prostate cancer. J Urol 2006; 175:518-21; discussion 521-2. [PMID: 16406985 DOI: 10.1016/s0022-5347(05)00235-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2005] [Indexed: 11/22/2022]
Abstract
PURPOSE Complete dissection of the SVs during RP can contribute to increased morbidity including erectile dysfunction and incontinence. Therefore we evaluated the clinical parameters associated with a positive SV finding on final pathology and identified those patients with a minimal risk of SV involvement for potential SV sparing surgery. MATERIALS AND METHODS We retrospectively reviewed our RP database from 1991 to 1999 to evaluate the incidence and clinical correlates of SV invasion. Variables studied included preoperative total serum PSA, percent positive biopsy cores, DRE and biopsy Gleason score. Statistical analysis included univariate, multivariate regression analysis and ROC curves. RESULTS Of our 1,056 patients 79 (7.4%) had SV involvement. Of the 356 patients with less than 17% positive biopsies, only 2 (0.5%) had SV involvement on final pathology. Preoperative PSA, biopsy Gleason score and percent positive biopsies were all highly predictive of SV invasion on multivariate analysis. Percent positive biopsy was found to be the single best predictor of seminal vesicle invasion (p <0.0001). CONCLUSIONS In our series percent positive biopsy was the single best predictor of SV invasion at the time of RP. An analysis of preoperative parameters including percent positive biopsy, biopsy Gleason score and preoperative PSA may define a subset of patients in which prospective studies could be used to determine the value and safety of SV sparing surgery.
Collapse
Affiliation(s)
- Thomas J Guzzo
- Department of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | | | | | | | | | | | | |
Collapse
|
|
50
|
Puech P, Villers A, Mouton D, Leroy X, Lemaître L. Cancer de la prostate : les aspects cliniques, biologiques et histopathologiques utiles au radiologue. ACTA ACUST UNITED AC 2006; 87:189-200. [PMID: 16484944 DOI: 10.1016/s0221-0363(06)73993-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Medical imaging has an important role in the diagnosis and treatment options of prostate cancer (TRUS guided biopsies, MRI). The knowledge of the different types of cancers, their preferred topography, imaging features, extension pattern, and also the important items that may help the surgical procedure (or any other treatment) are as many crucial key points for optimal management of patients.
Collapse
Affiliation(s)
- P Puech
- Service de Radiologie urogénitale et ORL, CHRU de Lille, rue Michel-Polonowski, 59037 Lille.
| | | | | | | | | |
Collapse
|