Biopsy-derived Gleason artifact and prostate volume: experience using ten samples in larger prostates.

PURPOSE: To verify whether a significant relationship between the risk of Gleason upgrading and the prostate volume remains when the number of biopsies is increased for larger prostate volumes. MATERIALS: A total of 281 biopsy-proven prostate adenocarcinoma cases who underwent radical prostatectomy (RRP) formed the cohort for this study. Change in transrectal ultrasound of the prostate (TRUS) biopsies number based on total gland volume was made simply by increasing the number of biopsies from 6 to 10 when prostate volume was >50 cc. The total number of cancers with Gleason pattern 4 or greater on biopsy and on RRP was tabulated over TRUS volume categories and tests for trend. RESULTS: The proportion of Gleason score (GS) > or =7 at biopsy was 44.5% whereas, at RRP, it was 68.3%. The rate of upgrading from Gleason <7 at biopsy to GS > or =7 at RRP was 46.8%. No significant difference in terms of age, serum PSA, prostate volume and pT stage was found between not upgraded and upgraded cases (p > 0.05). As prostate volume categories increase, the number of cancers upgraded at RRP slightly increases in particular from prostate volume 30-39 to 40-49 cc (where only 6 biopsies were performed). However, either at biopsy or at RRP, the percentage of GS > or =7 tumors does not show a significant trend in changing (p > 0.05). CONCLUSIONS: We verified that the relationship between the risk of Gleason upgrading and prostate volume does not become significant simply by increasing the number of laterally directed biopsies from 6 to 10.

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.

Comparison of chromogranin A, insulin-like growth factor 1 and prostate-specific antigen serum markers in prostate adenocarcinoma and benign prostatic hyperplasia.

BACKGROUND/AIM: To compare serum chromogranin A (CgA) and insulin-like growth factor 1 (IGF-1) with the classical prostate-specific antigen (PSA) marker in clinically localized prostate adenocarcinomas. MATERIALS AND METHODS: This is a prospective single-center study that included 64 consecutive men with newly diagnosed clinically localized prostate adenocarcinoma and 20 consecutive men with histologically confirmed benign prostatic hyperplasia (BPH). A blood sample for the determination of serum total PSA, CgA and IGF-1 levels (RIA) was obtained from all cases. Analysis of variance was performed to evaluate their variations according to disease and the pathological characteristics of prostate adenocarcinoma. RESULTS: Only serum PSA levels (p < 0.0001) and not IGF-1 (p = 0.5475) or CgA (p = 0.5043) were significantly higher in the prostate cancer (PCa) group as compared to the BPH group. A significant variance between BPH and PCa divided on the basis of pT stage was found for PSA levels (p < 0.0001) but not for CgA (p = 0.0869) and IGF-1 (p = 0.6883) levels. Dividing PCa on the basis of Gleason score, a significant variance was found for CgA (p = 0.0100) and for PSA (p < 0.001), but not for IGF-1 (p = 0.6895) levels. CONCLUSIONS: In our population the quantification of PSA and CgA serum levels and not of IGF-1 provides independent significant information in the diagnosis and aggressiveness of PCa, respectively.