A comparative study of tissue ω-6 and ω-3 polyunsaturated fatty acids (PUFA) in benign and malignant pathologic stage pT2a radical prostatectomy specimens.

OBJECTIVE: To analyze different polyunsaturated fatty acid (PUFA) tissue levels in malignant compared with benign prostatic tissue from the same prostate specimens. MATERIALS AND METHODS: Fresh frozen benign and malignant prostatic tissue was obtained from radical prostatectomy specimens in 49 men with pathologic stage pT2a prostate cancer. Histopathologic examination confirmed that all tissues from each prostate being analyzed were either completely benign or almost totally malignant. The PUFA composition in these tissues was determined by gas-liquid chromatography on a capillary column. The relative amount of each PUFA (% of total fatty acids) was quantified by integrating the area under the peak and dividing the result by the total area of all fatty acids. RESULTS: Tissue levels of dihomo-γ-linolenic acid, (C20:3w6), an ω-6 PUFA and a major precursor of ω-6 PUFA metabolites, were significantly higher in malignant compared with benign tissues (P = 0.002). Tissue levels of the downstream ω-6 metabolites, arachidonic acid (AA) (20:4ω6), and adrenic acid, (22:4ω6), were significantly lower in cancer tissues, (P < 0.0001 and P = 0.013, respectively). Overall, the total levels of ω-6 PUFA were lower in cancer (P = 0.001). CONCLUSION: We found that the ω-6 PUFA AA and adrenic acid are decreased in malignant prostatic tissues compared with benign tissues from the same prostates. These findings provide additional evidence that dietary fat is associated with prostatic carcinogenesis.

Erectile function after robotic nerve sparing and semi-sparing of the neurovascular bundles.

We set out to present potency results after bilateral, unilateral, and semi-sparing of the neurovascular bundles after robotic prostatectomy. Two hundred and twenty-five consecutive robotic-assisted laparoscopic radical prostatectomies were performed by one surgeon (NPW) from the start of our robotic program in January 2002 until December 2005. Patient demographics, operative, and postoperative data were prospectively entered into a database. We have functional data for 183, 150, and 109 patients followed for 3, 6, and 12 months, respectively. Of 49 preoperatively potent patients 36 (73%, 95% CI 59-85%) had erections sufficient for intercourse at 12 month follow-up. If bilateral nerve sparing was performed, 13 (87%, 95% CI 59-85%) of the patients showed a return of potency sufficient for intercourse. In preoperatively potent patients who did not undergo a traditional nerve sparing due to a high-risk disease, semi-sparing of the neurovascular bundles showed a return of potency in 10 (53%, 95% CI 29-76%). After one-year follow-up, 66 of 71 (93%, 95% CI 84-98%) had no need for protective pads and two (3%) used more than one pad a day. In the first 100 patients there were 24 (24%) positive surgical margins and for the last 125 patients there were 18 (14%). Based on these data, we hypothesize that certain subgroups, e.g., men wanting to preserve their sexual potency but having a tumor that hinders a traditional nerve-sparing approach, may be particularly helped by robot-assisted laparoscopic surgery as compared with other techniques.