Long-term experience with an anatomical anterograde approach to radical prostatectomy: results in terms of positive margin rate.

PURPOSE: To evaluate the effect of an anterograde approach to radical retropubic prostatectomy (RRP) in terms of positive surgical margins (SM+). METHODS: 323 untreated patients underwent anterograde RRP for clinically localized prostate adenocarcinoma. Spearman coefficients, logistic univariate and multivariate analysis were used. RESULTS: The incidence of SM+ was 14.9% and, in particular, this was 4.5% for apical, 9.0% for lateral, 0.9% for other sites, and 2.8% for multiple SM+. Upon univariate analysis, prostate-specific antigen (PSA; r = 0.2073, p = 0.0002), pathological stage (r = 0.3777, p < 0.0001), and seminal vesicle invasion (r = 0.1453, p = 0.0089) were found to be significantly associated with SM+. Upon multivariate analysis, only PSA (p = 0.0090) and pathological stage (p < 0.0001) were significantly and independently associated with SM+ occurrence. CONCLUSION: In our experience, the anterograde approach to RRP is associated with low SM+ rates.

Establishment of an organotypic in vitro culture system and its relevance to the characterization of human prostate epithelial cancer cells and their stromal interactions.

Human prostatic adenocarcinoma fragments (1-6mm) were cultured on collagen sponges in medium supplemented or not supplemented with 4,5alpha-dihydrotesterone (DHT) until 3 weeks, maintaining the three-dimensional (3D) epithelial and stromal organization present in the tumor in vivo. With time, in the presence of DHT, locally progressive cribriform nests of neoplastic cells with proliferative rates higher than those inside the fragment developed on the surface, while the stroma became more dissociated, and fibrosis replaced the muscular component. The 3D-culture provides a promising approach for studying the development and phenotype of prostate epithelial tumor progenitor cells and their stromal interactions.

UDP-glucuronosyltransferases 1A expression in human urinary bladder and colon cancer by immunohistochemistry.

UDP-glucuronosyltrasferases (UGTs) are detoxifying enzymes, which convert endogenous substrates, dietary constituents and potential carcinogens to inactive hydrophilic glucuronides. Although the liver is considered the most important organ for glucuronidation, UGTs are also expressed in extrahepatic tissues. Since UGTs may be important to protect cells from cancer in organs naturally exposed to potential carcinogens such as smoking and diet derivatives, we investigated the UGT expression in normal and malignant tissues from urinary bladder and large intestine. The study was carried out by immunohistochemistry, using an antiserum recognizing all the UGT1A isoforms. Our results showed that UGTs were highly expressed on the surfaces of the normal bladder as well as in normal large bowel mucosa. The neoplastic counterpart showed a general protein down-regulation associated with a different cellular localization. We found that 3/11 papillary and 3/6 invasive urothelial carcinomas were virtually negative, whereas 2/2 papillomas and 8/11 papillary bladder carcinomas still expressed the protein. In colon cancer the enzyme down-regulation was even more dramatic. In fact, a faint diffused cytoplasmic expression or scattered cell positivity was observed only in adenomas with low grade dysplasia (5/5) and in 2/11 carcinomas. Interestingly, 5/5 adenomas with high grade dysplasia, 9 carcinomas, the lymph nodes and liver metastases were UGT-negative, suggesting that the loss of UGT is associated with the early phase of neoplastic transformation. Based on our results we suggest that UGTs constitutive expression in the normal mucosa could protect these organs from carcinogens released in the bladder or introduced directly with the diet in the colon.

Histopathological aspects of transitional cell carcinoma of the bladder: analysis of 20 years experience.

BACKGROUND: In this study we used histopathological examinations performed over a 20-year period to describe the characteristics of newly diagnosed transitional cell carcinoma (TCC) of the bladder in relation to patient age, and to verify changes in the TCC over different periods of observation or in relation to patient age. METHODS: We reviewed all histopathological examinations performed from January 1979 to December 1998 in patients undergoing surgery who were newly diagnosed with TCC of the bladder. All examinations were performed by the same pathologist and reviewed by two pathologists. In each case analyzed, we evaluated T classification of the tumor, histological grade, size, localization, growth type, multiplicity and carcinoma in situ (CIS). RESULTS: The study population included 3113 men and 620 women. The mean patient age was 66.31 +/- 10.84 years. A high percentage of Ta (52.2%) and T1 (27.7%) tumors were found. The number of cases observed and, in particular, the percentage of Ta tumors increased significantly and progressively from the first (1979-1983 = 376 cases; Ta = 37.8%) to the last (1994-1998 = 1732 cases; Ta = 56.3%) period of observation (P < 0.001). A significant difference in the distribution of histological grade and T classification in the different age decades was apparent (P < 0.001); in particular, for G1 and Ta tumors there was a trend to decrease, whereas for G3, T1 and T2 tumors there was a tendency to increase with age decades. CONCLUSION: In our analysis, age of patient and the period of examination significantly influenced different pathological characteristics of newly diagnosed TCC of the bladder.

Distribution of inflammation, pre-malignant lesions, incidental carcinoma in histologically confirmed benign prostatic hyperplasia: a retrospective analysis.

OBJECTIVES: We analyze our experience on BPH through 20 years of histopathological examinations performed by the same pathologist. METHODS: We retrospectively reviewed all histopathological examinations performed from January 1979 to December 1998 in patients undergoing surgery in our urological clinic who were diagnosed with BPH. We limited our evaluation to the following variables in each BPH case analyzed: inflammatory aspects associated with BPH, presence of focal acinar atrophy, atypical adenomatous hyperplasia (AAH), prostatic intraepithelial neoplasia (PIN), incidental prostate carcinoma (IC). These histological variables were analyzed according to some clinical parameters such as age, prostate volume and serum PSA. RESULTS: The study population was comprised of 3942 cases with histological diagnosis of BPH. The mean patient age was 68.85+/-7.67 years. In particular, inflammatory aspects were associated with BPH in a high percentage of cases (43.1% =1700 cases), predominantly as chronic inflammation. Observation of focal acinar atrophy significantly increased according to patient decade of age (p=0.027). There was a significant trend to increase with age decades (p=0.036) for high grade PIN. A significant difference was found in IC (T1a, T1b) distribution in the different decades of age and especially in regards to both T1a and T1b tumors, there was a trend to increase with patient age (p=0.020 and p=0.025, respectively). On the contrary, the distribution of inflammatory aspects (p<0.001) and AAH (p=0.003) significantly varied according to prostate volume, and particularly in regards to chronic inflammation, there was a trend to increase depending on the prostate volume (p=0.002). Only the presence of T1b tumor but not of the other histological parameters associated to BPH, was able to significantly influence serum PSA. CONCLUSION: In our analysis different histological variables associated to BPH are differently influenced by the age of patients and prostate volume, and they differently influence serum PSA levels.

Preneoplastic non-papillary lesions and conditions of the urinary bladder: an update based on the Ancona International Consultation.

BACKGROUND AND AIMS: This paper summarizes the work done by the members of the Committee no. 2 at the International Consultation on the Diagnosis of Non-Invasive Urothelial Neoplasms held in Ancona, Italy (11-12 May 2001). The committee members discussed and reached consensus regarding the optimal contemporary diagnosis and classification of the preneoplastic non-papillary lesions of the urothelium. An important objective was to promote a precise terminology and to use it consistently in daily practice in pathology and urology. RESULTS AND CONCLUSIONS: The result of the meeting is represented by a refined classification of the non-papillary intraepithelial lesions and conditions of the urothelium. This classification includes epithelial abnormalities (reactive urothelial atypia and flat urothelial hyperplasia), presumed preneoplastic lesions and conditions (keratinizing squamous and glandular metaplasia, and malignancy-associated cellular changes), as well as preneoplastic (dysplasia) and neoplastic non-invasive (carcinoma in situ) lesions. Each of these lesions is defined with strict morphological criteria in order to provide more accurate information to urologists in managing patients.