Biochemical recurrence rates are similar for pT2-positive surgical margins and pT3a

Objective Histological details of positive surgical margins in radical prostatectomy specimens have been related to outcome after surgery in rare studies recently published. Our objective is to assess whether the status of surgical margins, the extent and the Gleason score of positive margins, and the extent of the extraprostatic extension are predictive of biochemical recurrence post-radical prostatectomy.Materials and Methods Three hundred sixty-five radical prostatectomy specimens were analyzed. The length of the positive surgical margin and extraprostatic extension and the Gleason score of the margin were recorded. Statistical analyses examined the predictive value of these variables for biochemical recurrence.Results 236 patients were stage pT2R0, 58 pT2R1, 25 pT3R0 and 46 pT3R1. Biochemical recurrence occurred in 11%, 31%, 20% and 45.7% of pT2R0, pT2R1, pT3R0 and pT3R1, respectively. The extent of the positive surgical margins and the Gleason score of the positive surgical margins were not associated with biochemical recurrence in univariate analysis in a mean follow up period of 35.9 months. In multivariate analyses, only the status of the surgical margins and the global Gleason score were associated with biochemical recurrence, with a risk of recurrence of 3.1 for positive surgical margins and of 3.8 for a Gleason score > 7.Conclusion Positive surgical margin and the global Gleason score are significant risk factors for biochemical recurrence post-radical prostatectomy, regardless of the extent of the surgical margin, the extent of the extraprostatic extension, or the local Gleason score of the positive surgical margin or extraprostatic tissue. pT2R1 disease behaves as pT3R0 and should be treated similarly.

PGC and PSMA in prostate cancer diagnosis: tissue analysis from biopsy samples

Purpose The discovery of new diagnostic tools for the diagnosis of prostate cancer (PCa) has become an important field of research. In this study, we analyzed the diagnostic value of the expression of the pepsinogen C (PGC) and prostate-specific membrane antigen (PSMA) genes in tissue samples obtained from prostate biopsies. Materials and Methods This study was comprised of 51 consecutive patients who underwent transrectal ultrasound (TRUS)-guided prostate biopsies between January 2010 and March 2010. The biopsies were performed with 12 cores, and an additional core was randomly retrieved from the peripheral zone from each patient for study purposes. The expression of the PGC and PSMA genes was analyzed from the cDNA from the samples via the qRT-PCR technology. The expression patterns of patients with PCa were compared with those of patients without a PCa diagnosis. Results PSMA was overexpressed in only 43.4% of PCa cases, and PGC was overexpressed in 72.7% of cases. The median expression of PSMA was 1.5 times (0.1 to 43.9) and the median PGC expression was 8.7 times (0.1 to 50.0) the expression observed in prostatic tissue from TRUS-guided biopsies of normal patients. Analysis of patients with high-risk PCa indicated that PGC was overexpressed in 71.4% of cases (with a median expression of 10.6 times), and PSMA was overexpressed in only 35.7% of cases (with a median expression of 4.5 times). Among patients with low-risk PCa, PGC was also overexpressed in 71.4% of cases (with a median expression of 5.9 times), and PSMA was overexpressed in only 42.8% of cases (with a median expression of 2.5 times). Conclusions PGC gene expression is significantly higher in prostatic tissue in men affected by PCa when compared to normal prostates. Further analyses are necessary to confirm our results. .

The accuracy of pathological data for the prediction of insignificant prostate cancer

The widespread screening programs prompted a decrease in prostate cancer stage at diagnosis, and active surveillance is an option for patients who may harbor clinically insignificant prostate cancer (IPC). Pathologists include the possibility of an IPC in their reports based on the Gleason score and tumor volume. This study determined the accuracy of pathological data in the identification of IPC in radical prostatectomy (RP) specimens.

Of 592 radical prostatectomy specimens examined in our laboratory from 2001 to 2010, 20 patients harbored IPC and exhibited biopsy findings suggestive of IPC. These biopsy features served as the criteria to define patients with potentially insignificant tumor in this population. The results of the prostate biopsies and surgical specimens of the 592 patients were compared.

The twenty patients who had IPC in both biopsy and RP were considered real positive cases. All patients were divided into groups based on their diagnoses following RP: true positives (n = 20), false positives (n = 149), true negatives (n = 421), false negatives (n = 2). The accuracy of the pathological data alone for the prediction of IPC was 91.4%, the sensitivity was 91% and the specificity was 74%.

The identification of IPC using pathological data exclusively is accurate, and pathologists should suggest this in their reports to aid surgeons, urologists and radiotherapists to decide the best treatment for their patients. .

The use of immunohistochemistry for diagnosis of prostate cancer

PURPOSE: Atypical glands (ASAP) are diagnosed in 5.0 percent of prostate biopsies, and cancer identification in a rebiopsy is higher than 40.0 percent. The use of antibodies to mark basal cells is currently a common practice, in order to avoid rebiopsies. There has been no reported study that has reviewed characteristics of radical prostatectomies (RPs) when immunohistochemistry (IHC) was necessary for definitive diagnosis. MATERIALS AND METHODS: Out of 4127 biopsies examined from 2004 to 2008, 144 (3.5 percent) were diagnosed with ASAP. IHC was performed using antibody anti-34ßE12 and p63. The results of surgical specimens of 27 patients treated by RP after the diagnosis of prostate cancer (PC) was made using IHC (Group 1) were compared with 1040 patients where IHC was not necessary (Group 2). RESULTS: IHC helped to diagnose PC in 103 patients (71.5 percent). Twenty-seven (26.2 percent) underwent RP. In Group 1, two (7.4 percent) adenocarcinomas were insignificant versus 29 (2.9 percent) for Group 2. Patients from Group 1 were younger (p = 0.039), had lower Gleason scores (GS) (p < 0.001), lower percentage of Gleason pattern 4 (p < 0.001), and smaller tumors (p < 0.001). CONCLUSION: The use of IHC did not lead to diagnosis of insignificant tumors as illustrated by absence of differences in pathological stage or positive surgical margins in men submitted to RP. Therefore, our results suggest that this modality should be routinely used for a borderline biopsy and ASAP cases.

Histopathological findings in extended prostate biopsy with PSA ≤ 4 ng/mL

OBJECTIVE: Cancer detection has been reported in up to 27 percent of patients when lowering the PSA cutoff to 2.5 ng/mL. Although this practice could increase the number of biopsies performed, it also could lead to more frequent detection of significant prostate cancers at an organ-confined stage and/or a less aggressive state. This study describes the incidence of malignancy and tumor characteristics in extended prostate biopsies with PSA ≤ 4 ng/mL. MATERIALS AND METHODS: Prostate biopsies from 1081 patients where examined, 275 (25.4 percent) patients had PSA level ≤ 4 ng/mL. RESULTS: Cancer was diagnosed in 32.0 percent and 35.7 percent of patients with PSA ≤ 4 ng/mL and > 4 ng/mL, respectively (p = 0.906). The median Gleason score was 7 independent of PSA > or ≤ 4 ng/mL (p = 0.078). The median number of cores positive for tumor was 4 and 3, respectively, for PSA > 4 ng/mL and PSA ≤ 4 ng/mL (p = 0.627). There was a difference in the total percent of tumors involving all cores, 11 percent and 7 percent for PSA > or ≤ 4 ng/mL (p = 0.042). Fifty-six patients underwent radical prostatectomy, 12 had PSA ¡Ü 4 ng/mL. In both groups, a diagnosis of cancer was accurate with no differences in Gleason score, tumor volume or staging for both groups. CONCLUSION: When PSA is below 4 ng/mL, cancer is detected in a proportion equal to the proportion diagnosed with a PSA > 4 ng/mL, and tumor characteristics are similar between the two groups. Only clinically significant tumors were diagnosed following radical prostatectomy.

O padrão 4 de Gleason e o volume tumoral no prognóstico do carcinoma da próstata / Well differentiated localized prostate carcinoma: prognostic relevance of tertiary Gleason pattern 4 and tumor volume

OBJETIVOS: A introdução de terapia adjuvante pós-prostatectomia radical foi recentemente proposta na literatura na tentativa de se obter melhores taxas de sobrevida em pacientes com câncer de próstata com maior risco de recidiva da doença. Alguns parâmetros anatomopatológicos têm sido considerados bons determinantes dos riscos de recorrência local ou à distância desses tumores. Recentemente o volume tumoral e a presença de padrão terciário de Gleason menos diferenciado foram apresentados como os melhores indicadores do comportamento do carcinoma da próstata. A proposta deste estudo é avaliar a importância da presença e porcentagem do padrão 4 de Gleason e do volume tumoral na evolução de pacientes portadores da adenocarcinoma bem diferenciado de próstata, tratados com prostatectomia radical. MÉTODOS: Setenta e sete pacientes portadores de adenocarcinoma bem diferenciado da próstata, Gleason 6 ou menos, submetidos a prostatectomia radical entre 1995 e 1997 foram estudados. Trinta e sete pacientes sofreram recidiva bioquímica (PSA > 0,4 ng/ml), e 40 pacientes permaneceram livres de doença após seguimento mínimo de cinco anos. A presença e porcentagem do padrão 4 de Gleason, a porcentagem de tumor comprometendo a glândula (considerado como "volume tumoral"), a infiltração capsular e a invasão do tecido extraprostático foram submetidos a análise uni e multivariada para determinação da associação destes parâmetros com a recidiva bioquímica. RESULTADOS: O volume tumoral foi o parâmetro mais importante para determinação da recorrência bioquímica em análises uni e multivariadas. A mediana do volume foi de 25 por cento nos pacientes que sofreram recidiva e 11,5 por cento naqueles que permaneceram livres de doença (p=0,003). A porcentagem de padrão 4 de Gleason foi importante apenas em análise univariada. A mediana da porcentagem de Gleason 4 foi de 7,5 por cento para os pacientes que não sofreram recidiva e de 19 por cento naqueles que recidivaram (p=0,046). CONCLUSÃO: O volume do adenocarcinoma de próstata é um parâmetro objetivo, de fácil avaliação e importante na previsão da recidiva bioquímica no carcinoma bem diferenciado da próstata. Por outro lado, a porcentagem do padrão menos diferenciado de Gleason também serve para prever recidiva à distância. Ambos os parâmetros devem ser incorporados em estudos futuros de terapias adjuvantes para o carcinoma da próstata.

Repeat prostate biopsies following diagnoses of prostate intraepithelial neoplasia and atypical small gland proliferation

OBJECTIVE: To assess the incidence of diagnosis of high-grade intraepithelial neoplasia or prostate intraepithelial neoplasia (PIN), and atypical small gland proliferation (ASAP) at a uropathology reference center. To assess the indexes and findings on repeat biopsies. MATERIALS AND METHODS: Diagnoses of PIN, ASAP or PIN + ASAP established between January 1, 2001 and December 31, 2003 were searched in our database. We studied repeat biopsies performed up to August 31, 2004. RESULTS: Of 1420 biopsies, ASAP was diagnosed in 26 (1.8 percent) patients, PIN in 142 (10 percent) and PIN + ASAP in 40 (2.8 percent). Repeat biopsies were performed in 98 patients, 16 (61.5 percent) with ASAP, 53 (37.3 percent) with PIN and 29 (72.5 percent) with PIN + ASAP. Carcinoma was diagnosed in 7 cases (43.8 percent) following a diagnosis of ASAP, 12 (41.4 percent) of PIN + ASAP and 7 (13.2 percent) of PIN. The mean interval between repeat biopsies was 299.6 days. There was no difference between groups where cancer was or was not diagnosed on repeat biopsy in relation to age and serum PSA levels. CONCLUSION: Despite explicit recommendations of repeat biopsy on pathology reports and the high incidence of adenocarcinoma on repeat biopsy, re-intervention rates following a diagnosis of PIN, ASAP, PIN + ASAP are low in our setting. The diagnosis that most frequently led to repeat biopsy was PIN + ASAP. Adenocarcinoma was most often diagnosed after the initial diagnosis of ASAP.

Solitary fibrous tumor in bladder wall

The solitary fibrous tumor is a rare mesenchymal tumor, occurring preferentially in pleura, which has recently been described in extrathoracic sites. There are 6 reports on primary solitary fibrous tumor of bladder. They affect preferably men with mean age around 57 years, are usually asymptomatic and, despite eventually presenting morphologic features of malignancy, tumor resection is considered curative. We report the seventh case of solitary fibrous tumor in bladder wall, discussing differential diagnoses, and call the attention to this rarely occurring entity, which has benign behavior and should be managed conservatively.

Primary lymphoma of the bladder

Primary lymphomas of bladder are rare, have a good prognosis and present good response to chemotherapy. We report a case of primary lymphoma affecting the bladder of an 89-year old female patient who, despite full response to chemotherapy, presented recurrence and death 1 year after concluding the treatment. The authors emphasize the differential diagnosis due to the great differences concerning prognosis and therapeutic approach.

Quantification of tumor extension in prostate biopsies: importance in the identification of confined tumors

OBJECTIVE: To assess the importance of quantifying the adenocarcinoma in prostate biopsies when determining the tumor's final stage in patients who undergo radical prostatectomy. To identify the best methodology for obtaining such data. PATIENTS AND METHODS: Prostate biopsies from 132 patients were examined, with determination of Gleason histological grade and tumor volume in number of involved fragments, tumor extent of the fragment mostly affected by the tumor and the total percentage of tumor in the specimen. Theses parameters were statistically correlated with the neoplasia's final stage following the evaluation of radical prostatectomy specimens. RESULTS: An average of 12 and a median of 14 biopsy fragments were evaluated per patient. In the univariate analysis the Gleason histological grade, the largest tumor extent in one fragment and the total percentage of tumor in the specimen were correlated with tumor stage of the surgical specimen. In the multivariate analysis, the Gleason histological grade and the total percentage of tumor were strongly correlated with the neoplasia's final stage. The risk of the tumor not being confined was 3 for Gleason 7 tumors and 10.6 for Gleason 8 tumors or above. In cases where the tumor involved more than 60 percent of the specimen, the risk of non-confined disease was 4.4 times. Among 19 patients with unfavorable histological parameters, Gleason > 7 and extension greater than 60 percent the tumor final stage was pT3 in 95 percent. CONCLUSION: When associated to the Gleason histological grade, tumor quantification in prostate biopsies is an important factor for determining organ-confined disease, and among the methods, total percentage of tumor is the most informative one. Such data should be included in the pathological report and must be incorporated in future nomograms.

Instabilidade de microssatélites em portadores de câncer colo-retal / Microsatelite instability in colorectal cancer

Embora considerado uma das mais importantes síndromes de predisposição ao câncer, o câncer colo-retal hereditário não-polipose (HNPCC) permanece um desafio na prática clínica diária. Os critérios de Amsterdam (CA), embora altamente específicos, têm valor muito limitado, inclusive para nossa população, pois são extremamente restritivos. Assim, foram propostos os critérios de Bethesda, menos restritivos, com o intuito de levantar a suspeita de HNPCC e a utilização de testes laboratoriais, como a instabilidade de microssatélites, para auxiliar a definir um maior número de famílias de risco para HNPCC. Objetivo: Avaliar o impacto dos CB no rastreamento de famílias de risco para HNPCC através do teste de instabilidade de microssatélites (MSI).Materiais e métodos: 47 pacientes portadores de câncer colo-retal que preenchiam pelo menos um dos CB e cuja história familiar pôde ser coletada, foram submetidos ao teste de MSI. Resultados: MSI-H foi identificada em 16 (34por cento) dos pacientes e se correlacionou com: idade precoce de aparecimetno do tumor (47,6 vs 58,9 anos no grupo não MSI-H; p=0,012), com os critérios de Amsterdam (p=0,001), com a história de câncer colo-retal ou endometrial em um parente com idade inferior a 45 anos (p=0,004) e com a presença de 2 ou mais CB em um mesmo indivíduo (p<0,001). Conclusões: Estas variáveis são capazes de identificar famílias de alto risco para HNPCC, as quais devem ser submetidas à aconselhamento genético e análise mutacional dos genes de reparo do DNA.