Does a tertiary Gleason pattern 4 or 5 influence the risk of biochemical relapse after radical prostatectomy for clinically localized prostate cancer?

OBJECTIVE: The presence of a tertiary Gleason grade (TGG) pattern 4 or 5 in radical prostatectomy (RP) specimens has been reported with adverse pathology and a higher biochemical relapse rate after RP. This study investigated the impact of a TGG pattern 4 or 5 on biochemical and pathological outcome in men operated with RP. MATERIAL AND METHODS: The study reviewed 151 consecutive cases treated at the hospital between 1985 and 2006; 148 were included in the study. All prostatectomy specimens were re-examined by a genitourinary pathologist and among others parameters the presence of TGG pattern 4 or 5 was recorded. The hospital files were examined retrospectively for clinical follow-up data. Prostate-specific antigen (PSA) relapse was defined as two subsequent rising measurements above 0.20 ng/ml. The influence of a TGG pattern 4 or 5 on prognosis was assessed in a Cox proportional hazards regression model controlling for pathological stage, surgical margin (SM) status, seminal vesicle invasion (SVI) and extraprostatic extension (EPE). RESULTS: Fifty-six patients (38%) experienced PSA relapse during follow-up. Twenty-one patients (58%) with a TGG pattern 4 or 5 had a biochemical relapse compared with 35 patients (31%) without TGG pattern 4 or 5. In the Cox regression model, TGG pattern 4 or 5 was an independent predictor of biochemical failure (p = 0.020). CONCLUSIONS: In patients undergoing RP the presence of a TGG pattern 4 or 5 is an independent predictor for biochemical relapse. Consequently, the RP specimens should routinely be investigated for TGG pattern 4 or 5.

Blood loss and postoperative complications associated with transurethral resection of the prostate after pretreatment with dutasteride.

OBJECTIVE: To determine whether pretreatment with dutasteride, a dual 5alpha-reductase inhibitor (5ARI), reduces surgical blood loss or postoperative complications in patients with benign prostatic hyperplasia (BPH) who undergo transurethral resection of the prostate (TURP). PATIENTS AND METHODS: This double-blind, randomized, placebo-controlled, multicentre study comprised 214 patients with BPH. Placebo was compared with dutasteride 0.5 mg/day 2 weeks before and after TURP, or 4 weeks before and 2 weeks after TURP. Surgical blood loss was measured using a haemoglobin photometer (HemoCue AB, Angelholm, Sweden) and postoperative adverse events were recorded. Microvessel density (MVD) was calculated by immunostaining and light microscopy of the prostatic chips. RESULTS: Although dutasteride reduced serum dihydrotestosterone (DHT) by 86-89% in 2-4 weeks, and intraprostatic DHT was approximately 10 times lower than in the placebo group, the (adjusted) mean haemoglobin (Hb) loss during surgery was 2.15-2.55 g Hb/g resectate with no significant difference in blood loss between the groups either during or after TURP. Clot retention occurred in 6-11% and urinary incontinence in 14-15% of patients during the 14 weeks after TURP, with no difference between the groups. The MVD at TURP was also similar for all groups. CONCLUSION: There were no significant reductions in blood loss during or after TURP or complications afterward with dutasteride compared with placebo, despite significant suppression of intraprostatic DHT. Blood loss and transfusion rates in the placebo group were lower than those previously reported in studies where there was a beneficial effect of a 5ARI, relative to placebo, on bleeding during TURP.

Presumed radically treated renal cell carcinoma--recurrence of the disease and prognostic factors for subsequent survival.

OBJECTIVE: To gain knowledge about when, where and how metastases after presumed radical treatment for renal cell carcinoma (RCC) are detected, and to use this information to establish a follow-up programme for radically treated RCC. Further aims were to establish survival rates, together with identifying prognostic factors influencing survival for different groups of patients after recurrence of the disease. MATERIAL AND METHODS: A retrospective study of 305 pT1-4N0M0/pT1-4NxM0 (clinically N0) tumours treated with nephrectomy was performed. RESULTS: A total of 89 patients (29.2%) developed metastases, with a median time to recurrence of 25.1 months. Within 5 years, 80% of the metastases had been detected. The lungs were the commonest metastatic site. A total of 34.8% of the recurrences were diagnosed as a result of routine follow-up. Median cancer-specific survival (CSS) after recurrence was 9.8 months. For patients with a disease-free interval (DFI) > or =24 months the median CSS was 35 months. In a univariate analysis, performance status, DFI > or =24 months, metastases in a single organ, primary tumour size < or =70 mm, primary tumour stage pT1-2 and age <65 years were all associated with better survival. In a multivariate analysis, performance status, DFI and number of organs affected were independent predictors of survival. CONCLUSION: The information from this material is used to suggest a simple, but adequate, follow-up protocol. Easily accessible information can be used to identify groups with different prognoses regarding survival after recurrence of the disease.

[Renal cancer--a retrospective study of 368 patients]. / Nyrekreft--en retrospektiv undersøkelse av 368 pasienter.

BACKGROUND: We wanted to evaluate our treatment results for renal cell carcinoma (RCC). MATERIAL AND METHODS: A retrospective study of 368 patients operated with nephrectomy between 1978 and 2000 was carried out. RESULTS: 29% of the renal cell carcinomas were diagnosed incidentally and we observed a significant increase in this respect between the first and second half of the study. 18% had postoperative complications and 3% had major complications needing reoperation. 2% of the nephrectomies on the left side were complicated with splenectomy. 11 patients (3%) died within 30 days, most of the deaths occurring in the early part of the study period. Five-year cancer-specific survival rates were: 92% for stage 1; 83% for stage 2; 67% for stage 3; and 16% for stage 4. No differences were encountered between transabdominal and retroperitoneal surgical approaches in terms of cancer-specific survival. INTERPRETATION: Increasing numbers of incidentally detected tumours have been observed. Our survival, complication and mortality rates are comparable to those in other reports.

Renal cell carcinoma: gender difference in incidental detection and cancer-specific survival.

OBJECTIVE: To look for an increase in the incidental detection of renal cell carcinoma (RCC) over the last two decades and to see if different patterns of healthcare use for men and women have implications for tumour detection and survival. MATERIAL AND METHODS: We present an historical series of 368 consecutive patients treated with nephrectomy for RCC during the period 1978-2000. The patients were classified according to detection mode (incidental or symptomatic disease), TNM stage and cancer-related death. RESULTS: The frequency of incidentally detected RCC (IRCC) increased from 21.1% to 34.7% between the first and second decades of the study. The IRCC group had significantly more low-stage (I-II) tumours (p = 0.002), a smaller tumour size (p < 0.0001) at operation and significantly better cancer-specific survival (p = 0.0048) than the symptomatic renal cell carcinoma (SRCC) group. The frequency of women was significantly higher in the IRCC group than in the SRCC group (p = 0.02). Females had significantly more low-stage (I-II) tumours (p = 0.02) and better cancer-specific survival (p = 0.05) than males. CONCLUSIONS: The number of incidentally discovered renal tumours is increasing. IRCC have lower TNM-stage and are smaller than SRCC. IRCC have better long term cancer specific survival than SRCC. The better survival rate found in females may be due to more extensive use of the healthcare system by females than males.