Clinically high-risk prostate cancer patients comprise a relevant number of cancers with overall favorable tumor characteristics.

PURPOSE: We hypothesized that a relevant number of patients with clinically high-risk prostate cancer (PCA) indeed harbor overall favorable tumor characteristics (OFTC) (i.e., pT2a-c and Gleason score ≤3 + 4 = 7 and pN0/X) and that in these patients radical prostatectomy (RP) alone is most likely curative. METHODS: Between June 1, 1997, and October 31, 2011, 2,346 patients with biopsy-detected PCA underwent RP. According to D'Amico, 1,767 patients presented low-/intermediate-risk PCA, and 579 presented high-risk PCA. We compared the incidence of OFTC between low-/intermediate-risk and high-risk patients, and between high-risk patients with different risk factor constellations. Furthermore, overall survival (OS), cancer-specific survival (CSS) and biochemical progression-free survival (BFS) were calculated for low-/intermediate-risk and high-risk patients with and without OFTC. RESULTS: High-risk patients were less likely to harbor OFTC (17.3 vs. 58.2 %; p < 0.001). That means, however, that nearly one in five patients with clinically high-risk PCA indeed had OFTC. Particularly, the subgroup with PSA >20 ng/ml or cT2c-3 tumor as sole high-risk factor showed a considerable proportion of OFTC in 30.2 and 26.1 % of cases, respectively. While the entire high-risk group had shorter OS, CSS and BFS than the low-/intermediate-risk group, high-risk patients with OFTC had comparably good OS, CSS and BFS as low-/intermediate-risk patients with OFTC. CONCLUSIONS: Nearly, one in five patients assumed to have high-risk PCA indeed had OFTC. Particularly, patients with PSA >20 ng/ml or cT2c-3 tumor as sole high-risk factor were often misclassified. However, these misclassified patients achieve excellent survival and have a reasonable chance of cure with RP alone.

[Surgical trends in secondary hypospadias]. / Operative Trends bei sekundären Hypospadien.

The severity of secondary hypospadias can range from a mild cosmetic problem to severe functional impairment. Accordingly, surgical management of the defect can be either simple or extremely demanding. During the operation the penis should always be regarded as a functional unit so that the treatment goal of a good cosmetic and functional result can be achieved. In addition, the surgeon should have an extensive repertoire of operative techniques at his disposal and should be well versed in skin grafting methods so that he is able to adapt the procedure optimally to the intraoperative findings as necessary. If certain do's and don'ts of hypospadias correction are additionally observed good results can usually be obtained even in complicated hypospadias patients with multiple previous operations. Unreflected treatment, on the other hand, usually leads to further worsening of the problem resulting in the so-called hypospadias cripple.

[An artificial neural network as a tool in risk evaluation of prostate cancer. Indication for biopsy with the PSA range of 2-20 microg/l]. / Nutzung von artifiziellen neuronalen Netzwerken zur Risikoabschätzung eines Prostatakarzinoms. Biopsieindikationen im PSA-Bereich von 2-20 microg/l.

In this prospective study covering 5.5 years we evaluated the diagnostic power of an artificial neural network (ANN) based on PSA, %fPSA, and clinical data in the PSA range 2-20 microg/l as prostate biopsy indicator. A total of 944 patients with prostate cancer or benign hyperplasia (BPH) were analyzed. The calculation of the individual patient's risk before prostate biopsy was performed at the 90% and 95% specificity and sensitivity levels within the PSA ranges 2-4, 4.1-10, and 10.1-20 microg/l. For the low PSA range 2-4 microg/l, we recommend a first time biopsy at an ANN specificity level of 95%. For PSA range 4.1-10 microg/l, we recommend a first time biopsy at an ANN sensitivity level of 95%. A rebiopsy at the PSA range 10.1-20 micro g/l should be performed based on a 95% sensitivity level. The use of an ANN at PSA 2-20 microg/l enhances the specificity and sensitivity of %fPSA by 9-39%. The application of an ANN based on %fPSA and clinical data improves the diagnostic performance compared to %fPSA only.