Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome

Introduction Positive surgical margins (PSMs) are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP). However, not all of these cases will evolve to biochemical (BCR) or clinical (CR) recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP), between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%). Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%), and CR in 10 (4.38%). Univariate analysis showed statistically significant associations (p < 0.001) between presence of PSMs with BCR, but not with CR (p = 0.05). At follow-up of the 161 patients with PSMs, only 61(37.8%) presented BCR, while 100 (62.8%) did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate ...

Análise do gene PTEN por hibridização in situ fluorescente no carcinoma de células renais / Analysis of PTEN gene by fluorescent in situ hybridization in renal cell carcinoma

OBJETIVO: avaliar a frequência de deleção do gene PTEN no carcinoma de células renais e o impacto da deleção nas taxas de sobrevida global e livre de doença. MÉTODOS: foram analisados 110 pacientes portadores de carcinoma de células renais submetidos à nefrectomia radical ou parcial entre os anos de 1980 e 2007. Em 53 casos foi possível a análise do gene PTEN pelo método de hibridização in situ fluorescente através da técnica de "tissue microarray". Para a análise estatística, os pacientes foram classificados em dois grupos, de acordo com a presença ou ausência de deleção. RESULTADOS: o tempo médio de seguimento foi de 41,9 meses. Deleção hemizigótica foi identificada em 18 pacientes (33,9%), ao passo que deleção homozigótica esteve presente em três (5,6%). Em aproximadamente 40% dos casos analisados havia deleção. Monossomia e trissomia foram detectadas, respectivamente, em nove (17%) e dois pacientes (3,8%). Em 21 pacientes (39,6%), a análise por hibridização in situ do gene PTEN foi normal. Não houve diferenças estatisticamente significativas nas taxas de sobrevida global (p=0,468) e livre de doença (p=0,344) entre os pacientes portadores ou não de deleção. Foram fatores independentes para a sobrevida global: estádio clínico TNM, sintomatologia ao diagnóstico, alto grau de Fuhrmann performance status (Ecog) e recorrência tumoral. A livre de doença foi influenciada unicamente pelo estádio clínico TNM. CONCLUSÃO: deleção do gene PTEN no CCR foi detectada com frequência de aproximadamente 40% e sua presença não foi determinante de menores taxas de sobrevida, permanecendo os fatores prognósticos tradicionais como determinantes da evolução dos pacientes.

OBJECTIVE: To evaluate the frequency of deletion of the PTEN gene in renal cell carcinoma (RCC) and its impact on the rates of overall and disease-free survival. METHODS: We analyzed 110 patients with renal cell carcinoma who underwent radical or partial nephrectomy between 1980 and 2007. In 53 cases it was possible to analyse the PTEN gene by the method of fluorescent in situ hybridization using the technique of tissue microarray. For statistical analysis, patients were classified in two groups according to the presence or absence of the deletion. RESULTS: The mean follow-up time was 41.9 months. Hemizygous deletion was detected in 18 patients (33.9%), while the homozygous one was present in three (5.6%). Deletion was present in approximately 40% of the analyzed cases. Monosomy and trisomy were detected in nine (17%) and two patients (3.8%), respectively. In 21 patients (39.6%) the analysis of the PTEN gene by in situ hybridization was normal. There were no statistically significant differences in overall (p = 0.468) and disease-free (p = 0.344) survival rates between patients with or without deletion. Factors which were independent for overall survival: TNM clinical stage, symptoms at diagnosis, high Fuhrmann grade, performance status (ECoG) and tumor recurrence. Disease-free survival was influenced only by the clinical TNM stage. CONCLUSION: Deletion of the PTEN gene in RCC was detected with a frequency of approximately 40% and its presence was not determinant of lower survival rates, the traditional prognostic factors remaining as determinants of outcome.

Evaluation of prostate specific antigen in the prognosis of patients with advanced prostate cancer

Objective: To evaluate the survival rate of patients with advanced prostate cancer in a univariate form, according to the preoperative and first postoperative determination of PSA levels. Materials and Methods: From February 1987 to June 1995, 92 patients were submitted to maximum blockage androgen (subcapsular and antiadrogen orchiectomy), independent of clinical symptons shown upon admission to the Cancer Hospital. The antiandrogens (ciproterone acetate and flutamide) were administered until the patient present progression of the disease. Results: The age of patients varied from 44 to 89, with a median of 70 years old. In the 6th, 36th and 60th months the global survival rate was 80 percent, 38 per cent and 20 per cent, respectively. The preoperative PSA ranged from 2 to 4017 ng/ml, with a median of 98 ng/ml (98 per cent had PSA greater than or equal to 10 ng/ml). The first postoperative PSA ranged from 1 to 3840 ng/ml, with a median of 20 ng/ml. There was a tendency towards a better survival rate only in patients with initial PSA from 2 to 99 ng/ml (p=0.06745). The survival rate of patients at 36 months after initial total blockage androgen, with first PSA level from 1 to 4, 5 to 49 and over 49 ng/ml was 72 per cent, 48 per cent and 8 per cent, respectively (p=0.00004). In the final examination, 34 (37 per cent) patients were considered stable and 58 (63 per cent) had disease progression. Conlusion: The PSA determination performed on the 30th postoperative day is important in the evaluation of advanced prostate cancer prognosis.

Bacilo Calmette-Guérin intravesical em pacientes com carcinoma superficial de bexiga: atualizaçäo / Intravesical bacillus Calmette-Guérin in patients with superficial bladder carcinoma: up to date

O carcinoma de células transitional de bexiga superficial é uma doença multipotencial e a sua evoluçäo natural algumas vezes näo pode ser prevista precisamente. Tumor, grau e estádio da doença fornecem as mais importantes informaçöes até hoje. Há uma grande pesquisa e um enorme desafio nesta área, como os biomarcadores moleculares para indicar os fatores prognósticos nos pacientes de alto risco. As principais metas no tratamento do câncer superficial da bexiga säo: erradicaçäo da doença existente, profilaxia contra novas recorrências e prevençäo da progressäo da doença. O melhor tratamento é a imunoterapia com BCG liofilizado e uma resposta duradoura pode ser alcançada quando aplicada a manutençäo da terapia, mas há alguns tumores agressivos que devem ser tratados com cistectomia radical precoce. Os efeitos antitumorais do BCG intravesical contra o câncer urotelial parecem estar ligados com mecanismos efetores imunológicos, com aumento dos linfócitos T por infiltraçäo na lâmina própria da bexiga.

Correlaçäo interobservadora da graduaçäo de Gleason: avaliaçäo de 50 carcinomas de próstata / Interobserver correspondence of Gleason's grading: evaluation of 50 prostatic carcinomas

O sistema de Gleason tem grande aceitaçäo entre os urologistas devido a boa correlaçäo com o prognóstico dos pacientes portadores de câncer de próstata. Sua reprodutibilidade interobservadora é pouco questionada na literatura e, por este motivo, foram avaliados os resultados de dois patologistas entre 50 casos tratados pelo Serviço Urologia do Hospital A. C. Camargo. A concordância (reprodutibilidade) do Gleason primário e do escore de Gleason foi de 66 e 48 por cento respectivamente. Concluímos que boa reprodutibilidade pode ser alcançada no sistema de Gleason desde que utilizado por patologista experiente e familiarizado com a classificaçäo, caso contrário poderia haver sub ou supragraduaçäo, prejudicando o planejamento terapêutico

Carcinoma "in situ" urotelial: atualizaçäo no diagnóstico e na conduta terapêutica / Urothelial carcinoma \"in situ\": up to date in diagnose and therapeutic

Carcinoma "in situ" (CIS) urotelial é definido como uma neoplasia superficial, intra-epitelial de alto grau histológico. O comportamento biológico do CIS é heterogêneo. A característica clínica mais importante säo os sintomas de irritabilidade vesical. Os carcinomas "in situ" säo primários ou associados a tumores vesicais. O melhor tratamento é o realizado com BCG liofilizado, com resposta completa observada em 70 porcento dos casos. A citologia oncótica urinária após o tratamento indica a presença de carcinoma urotelial, especialmente o CIS. Estes pacientes devem ser avaliados para detecçÝo de carcinoma ou CIS tanto na bexiga como em sítios extravesicais, próstata e trato superior. Atualmente, a immunoistoquímica e a biologia molecular podem ajudar na avaliaçäo de pacientes de alto risco para progressäo da doença.