Correlation between upgrading of prostate biopsy and biochemical failure and unfavorable pathology after radical prostatectomy.

OBJECTIVE: To evaluate whether upgrading of the biopsy after radical prostatectomy (RP) affects disease outcome in terms of unfavorable pathology and biochemical failure. PATIENTS AND METHODS: We retrospectively evaluated the records of 174 patients who underwent RP. Prostate biopsy and RP specimen Gleason scores (GSs) and correlative clinical data were recorded, and a multivariate analysis was applied. RESULTS: Overall (138 patients), the disease of 69 men (50.0%) was upgraded, in 19 (13.8%) it was downgraded, and in 50 (36.2%) it had an identical biopsy and pathological GS. Accuracy rates were significantly higher for GS 8-10 compared to low GSs, with a concordance of 50.0 and 12.2%, respectively (p < 0.01). Multivariate analysis revealed the single independent prognostic factor for a non-organ-confined disease as a RP GS 8-10 (p = 0.035). The factors associated with a positive surgical margin were a biopsy GS 8-10 (p < 0.001) and the presence of biopsy score upgrading (p = 0.02). Biopsy GS >or=8 (p < 0.001) and presence of biopsy score upgrading (p = 0.009) were the two independent predictors of relapse after RP. CONCLUSION: This study demonstrated that biopsy upgrading was present in almost half of the patients who underwent RP and it was significantly related to positive surgical margins and biochemical relapse after RP.

The correlation between metabolic syndrome and prostatic growth in patients with benign prostatic hyperplasia.

OBJECTIVES: To evaluate the relationship between metabolic syndrome and annual prostatic growth rates in benign prostatic hyperplasia (BPH) patients. METHODS: The 78 BPH patients with lower urinary tract symptoms included in this prospective study were divided into two groups according to whether they had a diagnosis of metabolic syndrome. This diagnosis was made according to the most recent consensus report of the National Cholesterol Education Program's Third Adult Treatment Panel. Blood pressure, body weight, body height, and waist and hip circumferences were measured. The body mass index (BMI) and waist-to-hip ratio (WHR) were calculated. Biochemical analyses including serum glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), insulin, and prostate-specific antigen (PSA) were performed. Total prostate (TP) volume and transitional zone (TZ) volume were measured by transrectal ultrasound. Annual TP and TZ growth rates were calculated. RESULTS: BPH patients with metabolic syndrome (first group) had significantly higher median body weight, BMI, serum glucose, serum triglyceride, and PSA levels but lower serum HDL-C level, compared with BPH patients without metabolic syndrome (second group, p<0.05). Median annual TP growth rate (1.0 ml/yr) and median annual TZ growth rate (1.25 ml/yr) were significantly higher in the first group versus the second group (0.64 ml/yr and 0.93 ml/yr, respectively, p<0.05). CONCLUSIONS: The present study demonstrates a further increase in prostate growth in BPH patients with metabolic syndrome. Future studies are needed to confirm our results and to explain underlying mechanisms.