Long-Term Oncologic Outcome of an Initial Series of Laparoscopic Radical Prostatectomy for Clinically Localized Prostate Cancer After a Median Follow-up of 10 Years.

INTRODUCTION: When laparoscopic radical prostatectomy (LRP) was introduced as a novel treatment option for prostate cancer, it had to compete with the established open techniques. The short- and intermediate-term oncologic and functional outcomes were encouraging and comparable to those with retropubic radical prostatectomy. However, the long-term oncologic safety for LRP has yet to be fully elucidated. We evaluated the long-term oncologic outcomes of an initial series of patients who had undergone LRP. PATIENTS AND METHODS: An initial unselected and consecutive series of 100 patients who had undergone LRP for clinically localized prostate cancer from 1999 to 2001 was identified. The pre-, intra-, and postoperative data were collected. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value of ≥ 0.2 ng/mL. The outcome measures were cancer control (CC), BCR-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS: The mean patient age was 64 ± 7 years, and the mean preoperative PSA level was 9.6 ± 8.3 ng/mL. Of the 100 patients, 79 (79%) had stage pT2 and 15 (15%) had stage pT3 disease. Positive surgical margins were found in 25 patients (25%; 16.4% for pT2 and 40% for pT3). The median follow-up time was 126 months (range, 60-176 months). The 5-year CC rate was 82%. The estimated 10-year BCRFS was 83% and 80% for patients with stage pT2 and pT3 tumors, respectively. The median time to BCR was 52 months (range, 6-144 months). The estimated 10-year CSS and OS was 98% and 93%, respectively. CONCLUSION: Our long-term follow-up data from an initial unselected patient cohort have indicated that LRP offers excellent long-term oncologic control for patients with localized prostate cancer.

KPNA2 expression is an independent adverse predictor of biochemical recurrence after radical prostatectomy.

PURPOSE: To analyze rates of expression of karyopherin alpha 2 (KPNA2) in different prostate tissues and to evaluate the prognostic properties for patients with primary prostate cancer. EXPERIMENTAL DESIGN: Tissue microarrays (TMA) contained 798 formalin-fixed, paraffin-embedded prostate tissue cores from two different institutes of pathology. TMAs were stained immunohistochemically for KPNA2 and NBS1. SiRNA technologies were used to inhibit KPNA2 expression in vitro, and the effect of this inhibition on cellular viability was determined. Efficiency of knockdown experiments was determined by Western blot analysis. RESULTS: KPNA2 expression was significantly upregulated in carcinomas of the prostate, especially in metastatic and castration-resistant prostate cancer samples. Positive nuclear KPNA2 immunoreactivity was identified as a novel predictor of biochemical recurrence after radical prostatectomy (n = 348), and was independent of the well-established predictive factors preoperative PSA value, Gleason score, tumor stage, and surgical margin status. These results were validated by analyzing a second and independent prostate cancer cohort (n = 330). Further, in vitro experiments showed that the cell proliferation and viability of PC3 cells was significantly reduced when KPNA2 expression was inhibited. KPNA2 knockdown did not induce PARP cleavage as marker for apoptosis. No significantly increased sub-G(1) fraction could be found by FACS analysis. CONCLUSIONS: KPNA2 is a novel independent prognostic marker for disease progression after radical prostatectomy. This allows to identify patients who need more aggressive treatment. It can moreover be speculated that patients not suited for surveillance regimens might be identified at initial biopsy by a positive KPNA2 immunohistochemistry.

Laser fibre deterioration and loss of power output during photo-selective 80-w potassium-titanyl-phosphate laser vaporisation of the prostate.

BACKGROUND: The potassium-titanyl-phosphate (KTP) laser technique for photo-selective vaporisation of the prostate (PVP) has been regularly improved over the last decade. Nonetheless, decreasing efficiency of tissue vaporisation during the course of the operation and macroscopic alterations of the laser fibre's tip are regularly observed and seem to affect the outcome of this procedure. OBJECTIVE: To investigate the course of power output and to determine the type and extent of fibre deterioration during PVP. DESIGN, SETTING, AND PARTICIPANTS: Forty laser fibres were investigated during PVP in 35 consecutive patients with prostatic bladder outflow obstruction between January 2007 and August 2007 in a university hospital. INTERVENTION: All patients underwent PVP performed by three different surgeons using the 80-W KTP laser. MEASUREMENTS: Power output was measured at the beginning and regularly throughout PVP and throughout in vitro vaporisation without fibre-tissue contact. Microscopic documentation of the fibre tip was performed after the procedure. RESULTS AND LIMITATIONS: Carbonisation and melting of the fibre tip was regularly visible and appeared to be more pronounced as more energy was applied. Additionally, 90% of the fibres showed a significant decrease of power output during PVP, resulting in an end-of-lifespan (ie, 275-kilojoule) median power output of 20% of the initial value. Final median power output after in vitro vaporisation was 83% of the starting value. The extent of the structural and functional changes might only be valid for the operative technique performed in this investigation. CONCLUSIONS: Fibre deterioration caused significant reduction of power output during PVP. This finding is an explanation for the often observed decreasing efficiency of tissue ablation and may also be responsible for some of the typical drawbacks and complications of PVP. Hence, improvements in fibre quality are necessary to advance the efficiency of this technique.

Patients' knowledge about risk factors for erectile dysfunction is poor.

INTRODUCTION: Well informed and educated patients ideally manage to prevent or delay the onset of severe chronic diseases. With respect to erectile dysfunction (ED) this is of importance because ED is considered to herald debilitating cardiovascular diseases like coronary artery disease. AIM: This survey aimed to assess patient's knowledge about risk factors (RF) for ED and to identify their preferred source of information. MAIN OUTCOME MEASURES: Knowledge of RF for ED and sources used to gather information about ED as reported by patients with ED. METHODS: Between July 2004 and June 2006, 126 patients who presented at our outpatient clinic for an assessment of their ED were prospectively evaluated. The patients received a questionnaire about their demographic and socioeconomic circumstances, their strategies to gather information about ED, and their knowledge of specific RF for this disease. The questionnaire was completed by 81 patients (64%). RESULTS: Forty-one patients (51%) could not name one single RF for ED. Three men knew more than three RF. The two most popular sources of information were the Internet and general practitioners. Well-educated patients were significantly better informed than others. Patients using the Internet as source for health information were significantly younger and had a better knowledge about RF for ED compared to those not using the Internet. CONCLUSIONS: Patients' knowledge about RF for ED is poor. The Internet seems to be the most useful information source for patients with ED and is predominantly used by younger and better educated patients. Given that ED is considered to be a precursor of severe cardiovascular diseases, patient information and education deserves more attention.