Can digital rectal examination or transrectal ultrasonography biopsy findings predict the side of nodal metastasis in prostate cancer?

PURPOSE: To assess the use of several preoperative parameters in predicting the side of pelvic lymph node metastasis in patients with prostate cancer. MATERIALS AND METHODS: A retrospective chart review (January 1982 to February 2004) identified 106 men with pathology proven lymph node positive prostate cancer for whom complete medical records were available. RESULTS: The median serum prostate-specific antigen at diagnosis was 11 ng/ml with the clinical stage T1C in 9 patients, T2 in 68, and T3 in 29. The Gleason score on transrectal ultrasonography (TRUS) biopsy was < or =6 in 13, 7 in 41, and > or =8 in 52. A total of 93 patients had documented pretreatment digital rectal examination (DRE) findings: 54 had a unilaterally suspicious DRE, and 31 had a bilaterally suspicious DRE. Of patients with a unilaterally positive DRE, 30 had ipsilateral lymph node metastasis, 16 contralateral, and 8 bilateral. DRE showed a 71% sensitivity and 29% false-negative rate in predicting the side of nodal metastasis. A total of 98 patients had documented TRUS biopsy findings: 37 had unilaterally positive TRUS biopsies and 61 bilaterally positive biopsies. Of patients with unilaterally positive TRUS biopsies, 20 had ipsilateral lymph node metastasis, 11 contralateral, and 6 bilateral. TRUS biopsies showed an 86% sensitivity and 14% false-negative rate in predicting the side of nodal metastasis. CONCLUSIONS: DRE and TRUS biopsies do not accurately predict the side of pelvic lymph node metastasis and should not determine the extent of the pelvic lymphadenectomy.

Timing of return to normal activities after orbital floor fracture repair.

BACKGROUND: Orbital floor fractures are among the most common facial fractures, and patients and surgeons often ask when the patient can resume normal activities after surgical treatment. This study attempted to address this basic issue by examining wound strength and histologic characteristics after orbital floor fracture repair with three commonly used materials. METHODS: Twenty-one female goats were anesthetized under general anesthesia. A systematic approach was used to fracture both orbits (n = 42 orbits) and measure the energy required to create the fractures. The orbits were repaired with one of three different materials. One-third of the orbits were then refractured at 10, 24, or 45 days after the initial injury. The energy required to fracture the orbit was measured, and histopathologic samples were taken. RESULTS: Preoperative fracture strength was largely regained after 10 days and before 24 days following the initial injury and repair, regardless of fracture repair material. LactoSorb and polyamide sheeting were associated with a lower incidence of postoperative seroma formation and thicker capsule formation than was Silastic sheeting. Wound strength in orbits repaired with Silastic sheeting during the initial postoperative period was inferior compared with orbits repaired with LactoSorb or polyamide sheeting. However, in the longer term, wound strength was not statistically different for any of the materials used in fracture repair. CONCLUSIONS: Orbital floor strength is regained 24 days after repair. The authors now let patients resume normal activities approximately 3 weeks after uncomplicated orbital floor fracture repair. This is one of many clinical factors in assessing the return to normal activities. In addition, LactoSorb and polyamide sheeting are adequate for the repair of simple floor fractures.

Surgically managed lymph node-positive prostate cancer: does delaying hormonal therapy worsen the outcome?

OBJECTIVES: To review our experience with the surgical management of lymph node-positive prostate cancer and to determine if there is a benefit to treating such patients with immediate rather than delayed hormonal therapy (HT). PATIENTS AND METHODS: A retrospective analysis from January 1982 to January 2001 identified 100 patients treated by radical retropubic prostatectomy (RP) either alone (70, 23 later received delayed HT) or combined with adjuvant (immediate) HT (30), with the overall median follow-up being 5.2 years. RESULTS: The median patient age at diagnosis was 58.7 years, with 20% having clinical T3 disease, and the median prostate specific antigen (PSA) level at presentation was 10 ng/mL. In 41% of patients the Gleason score on prostatic biopsy was > or = 8. After RP, 30 patients received immediate HT used as an adjuvant after surgery in the absence of any evidence of disease progression, whereas 23 received delayed HT the use of which was provoked secondary to biochemical failure (PSA threshold of 0.2-5.0 ng/mL) with no evidence of metastatic disease. A comparison of the clinical variables between the groups showed a higher median PSA level at diagnosis (P = 0.027) and biopsy Gleason score (P = 0.052) in the delayed HT group. The immediate and delayed HT groups had similar metastatic-free (P = 0.549), disease-specific (P = 0.843) and overall survival (P = 0.843). Overall, biochemical failure developed in half the patients and distant metastasis in 13%, with only nine patients dying from disease. CONCLUSIONS: Immediate and delayed HT provide similar treatment outcomes in patients with surgically managed lymph node-positive prostate cancer.