Effect of Clinical Parameters on Risk of Death from Cancer after Radical Prostatectomy in Men with Localized and Locally Advanced Prostate Cancer.

Background: The study aimed to assess predictors and to identify patients at increased risk of prostate-cancer-specific mortality (CSM) after radical prostatectomy (RP). Methods: A total of 2421 men with localized and locally advanced PCa who underwent RP in 2001−2017 were included in the study. CSM predictors were assessed using multivariate competing risk analysis. Death from other causes was considered a competing event. Cumulative CSM and other-cause mortality (OCM) were calculated in various combinations of predictors. Results: During the median 8 years (interquartile range 4.4−11.7) follow-up, 56 (2.3%) of registered deaths were due to PCa. Cumulative 10 years CSM and OCM was 3.6% (95% CI 2.7−4.7) and 15.9% (95% CI 14.2−17.9), respectively. The strongest predictors of CSM were Grade Group 5 (GG5) (hazard ratio (HR) 19.9, p < 0.0001), lymph node invasion (HR 3.4, p = 0.001), stage pT3b-4 (HR 3.1, p = 0.009), and age (HR 1.1, p = 0.0007). In groups created regarding age, stage, and GG, cumulative 10 years CSM ranged from 0.4−84.9%, whereas OCM varied from 0−43.2%. Conclusions: CSM after RP is related to GGs, pathological stage, age, and combinations of these factors, whereas other-cause mortality is only associated with age. Created CSM and OCM plots can help clinicians identify patients with the most aggressive PCa who could benefit from more intensive or novel multimodal treatment strategies.

Independent predictors of biochemical recurrence after radical prostatectomy: a single center experience.

INTRODUCTION: The aim of study was to establish pretreatment and postoperative factors which could predict the early biochemical recurrence after radical prostatectomy. MATERIALS AND METHOD: 754 patients had undergone radical prostatectomy since January 2002 to December 2008 in our department and were included in this prospective study. Exclusion criteria were: neoadjuvant or adjuvant treatment (radiation or hormonal treatment) and N+. Following parameters were evaluated: age, PSA at time of biopsy, time period from biopsy to operation, biopsy and postoperative Gleason score, stage, high grade intraepithelial neoplasias, perineural invasion. Biochemical recurrence was detected if PSA value after radical prostatectomy was ≥0.2 ng/ml. All factors likely to be predictive were evaluated by univariate analysis (Log-rank test). Multivariate analysis using Cox model was completed for all factors with p value <0.1 at univariate analysis. RESULTS: Final analysis was done using data of 496 patients. We detected 53 (10.7%) biochemical recurrences. Calculated actuarial biochemical recurrence free survival reached 64%. Multivariate analysis highlighted that PSA >10 ng/ml (HR 2.45, p = 0.008), pathological stage ≥pT3 (HR 2.371, p = 0.02), postoperative Gleason score ≥7 (HR 2.149, p = 0.049), positive surgical margins (HR 2.482, p = 0.014) and absence of high grade intraepithelial neoplasia in removed prostate (HR 0.358, p = 0.006) are independent factors influencing biochemical recurrence after radical prostatectomy. CONCLUSION: Patients with higher PSA, locally advanced disease, positive surgical margins, and Gleason score ≥7 are at the highest risk for biochemical recurrence.

[Importance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients]. / Pakartotiniu krastiniu sekstantiniu prostatos biopsiju reiksme nustatant prostatos vezi padidejusios rizikos pacientams.

UNLABELLED: Our purpose was to evaluate the relevance of repeat laterally directed sextant prostate biopsy for detection of prostate cancer in high-risk patients. MATERIAL AND METHODS: Our study included 195 men at high risk for prostate cancer (elevated prostate-specific antigen level and/or abnormal prostate detected by digital rectal examination). We consulted the patients in outpatient department of Kaunas University of Medicine Hospital during 2003-2007. We performed transrectal ultrasound-guided laterally directed sextant prostate biopsy in every patient. For the patients with benign histological findings and increased risk of prostate cancer, laterally directed sextant biopsies were repeated. RESULTS: Prostate cancer was detected in 30.3% of patients (59/195) on the first prostate biopsy, in 13.1% (11/84) on the second prostate biopsy, in 10.3% (4/39) on the third, and in 7.7% (1/13) on the forth biopsy. After all biopsies, prostate cancer was detected in 38.5% (75/195) of patients, and it differed significantly from the percentage of prostate cancer cases detected on the first biopsy (30.3%, P=0.04). We detected 78.7% (59/75) of all prostate cancer cases by the first laterally directed sextant prostate biopsy. The rest 21.3% (16/75) of cases we detected by repeat biopsies. The second laterally directed sextant prostate biopsy revealed additional 14.6% (n=11) of prostate cancer cases and increased the detection of prostate cancer to 93.3% (70/75). At the time of the first prostate biopsy, prostate cancer was diagnosed most frequently when patients had both risk factors: elevated prostate-specific antigen level and abnormal digital prostate examination; prostate cancer was diagnosed in 45.3% of these patients. The odds ratio to detect prostate cancer by the first biopsy in patients with elevated prostate-specific antigen level and abnormal digital prostate examination was 3.7, and odds ratio to detect prostate cancer by repeat biopsies was 4.7. CONCLUSIONS: Repeat ultrasound-guided laterally directed sextant prostate biopsies reveal more cases of prostate cancer as compared to the first prostate biopsy. The majority of prostate cancer cases (93.3%) are detected by the first and second laterally directed sextant prostate biopsies. After the first negative prostate biopsy, we recommend to repeat prostate biopsy in high-risk patients.

The influence of antegrade scrotal sclerotherapy on the diameter of the spermatic cord veins in men with varicocele.

OBJECTIVE: To assess the influence of antegrade scrotal sclerotherapy on diameter of veins of the pampiniform plexus of the spermatic cord by comparison of the vein diameter before and after the operation in patients with varicocele; to evaluate the rate of recurrence of the disorder after antegrade scrotal sclerotherapy and significance of color Doppler ultrasonography in the diagnosis of varicocele; and to estimate the efficacy of the treatment. MATERIAL AND METHODS: Forty-one patients with various degrees of varicocele treated by antegrade scrotal sclerotherapy were included in the study. The size of the pampiniform plexus of veins of the patients was evaluated clinically during physical examination, and its diameter was measured by color Doppler ultrasonography before and after the operation in the upright and the supine positions during the Valsalva maneuver and without it. RESULTS: After antegrade scrotal sclerotherapy, the diameter of the studied veins was found reliably decreased while examined in all four patient's examining positions, independently of the degree of the preoperative varicocele and recurrence of the disorder. The postoperative decrease of diameter of veins was inversely proportional to the degree of varicocele, i. e. the diameter of veins in the third degree varicocele became most reduced. The recurrence of varicocele after antegrade scrotal sclerotherapy was revealed in 21.9% of the operated patients. The diameter of veins in the recurrent varicocele, assessed by physical examination, and venous blood reflux, detected by ultrasound, reliably decreased in the upright position of patients (p<0.005), whereas in the supine position, diameter of the studied veins remained almost the same as it was before the operation (p=0.9). CONCLUSIONS: After antegrade scrotal sclerotherapy, the diameter of the varicocele vein decrease was statistically significant. It was mostly expressed after the operation in the cases of the third degree varicocele. The postoperative diameter of veins in the recurrent varicocele of the examined patients in the upright position was also reliably smaller than before the operation, but it practically did not differ from the preoperative diameter when the patients were examined in the supine position.

[Incidence of varicocele measured by echoscopy]. / Varikoceles daznumas vyrams po echoskopijos.

UNLABELLED: Varicocele should be diagnosed and treatment should be started in boys under 10-14, because at an older age it will interfere with the development of the testicle. The objective of the study is to establish the rate of varicocele. The study material and methods. One hundret of patients aged from 20 to 87 (SD=17) have been studied: the thickness of veins of plexus pampiniformis was measured by echoscopy, funiculus spermaticus was palpated. RESULTS: Varicocele was diagnosed in 24 (24%) of patients. CONCLUSION: The incidence rate of this disease is high.

[Treatment of superficial transitional cell bladder carcinoma. Long-term results of trial comparing transurethral resection alone and adjuvant chemotherapy with Doxorubicin]. / Pavirsiniu slapimo pusles pereinamojo epitelio lasteliu naviku gydymas (rezultatu palyginimas atlikus tik transuretrine slapimo pusles rezekcija, slapimo pusles rezekcija bei palaikomaja chemoterapija doksorubicinu).

OBJECTIVE: We compared the efficacy of transurethral resection alone or transurethral resection followed by bladder instillations of Doxorubicin for 1 year in patients with superficial bladder carcinoma, and followed them long term for the incidence of recurrence and progression to muscle invasion. MATERIALS AND METHODS: Between December 1998 and December 2000 a total of 69 patients with superficial transitional cell carcinoma of bladder participated in this prospective study. Final analysis of treatment results included 64 patients. Doxorubicin was administered to 25 patients, 39 patients were treated only by TUR. Patients were followed by control cystoscopy. RESULTS: The mean follow-up was 22.95 months; SD 7.79. Mean time to first recurrence in Doxorubicin group was 14.14 months; SD 7.84, in TUR alone group - 7.61 months; SD 4.4; p>0.05. Disease free survival was significantly prolonged in Doxorubicin group; p<0.05. There are no significant difference to comparison recurrence rate and progression rate between two groups. CONCLUSIONS: In regard to time of first recurrence and disease free survival this study indicates that adjuvant chemotherapy with Doxorubicin is superior to transurethral resection alone. However, progression in stage or recurrence rate was not influenced by the treatment regimen.