Primary renal lymphoma: An incidental finding in an elderly male.

Primary renal lymphoma (PRL) is a rare disease process which represents less than 1% of all renal masses and is an uncommon type of Non-Hodgkin's Lymphoma. PRL is of clinical significance due to the fact that unlike the more commonly seen renal cell carcinoma, PRL is treated with neoadjuvant chemotherapy followed by nephrectomy. This challenges the long held notion that preoperative biopsies are not necessary prior to nephrectomy for renal masses. In this paper, we present a case of a primary renal lymphoma and discuss its clinical significance.

The prognostic significance of Gleason Grade in patients treated with permanent prostate brachytherapy.

PURPOSE: To assess the difference in biochemical freedom from relapse (BFR) between patients with clinically localized prostate cancer having Gleason Grade (GG) 3 + 4 vs. 4 + 3 disease treated with permanent prostate brachytherapy (PPB). METHODS AND MATERIALS: One thousand twenty-nine consecutive T1/T2 patients underwent PPB with Gleason sum 6, 7, or 8 adenocarcinoma of the prostate. Treatment consisted of transperineal ultrasound-guided implant as monotherapy or in combination with external beam radiation and/or neoadjuvant androgen ablation (NAAD). The Kattan modification of the ASTRO consensus definition that censors patients with rising follow-up PSA values early was used to measure BFR. Kaplan-Meier actuarial survival was calculated and compared using the log-rank test. Cox proportional hazards regression was performed to assess the role of Gleason grade, initial PSA value, stage, the addition of external beam radiotherapy, and the addition of NAAD. RESULTS: The median follow-up for all 1029 patients is 46 months (range: 3-108 months) with a BFR at 5 years of 78.2% and at 7 years of 76.2%. The 7-year BFR for patients with GG 3 + 3 was 81.8%, GG 3 + 4 was 78.4%, GG 4 + 3 was 56.7%, and GG 4 + 4 was 50.7% (p < 0.0001). Cox regression analysis identified that the Gleason grade (p < 0.0001), initial PSA value (p = 0.001), D90% (p < 0.0001), and clinical stage (p = 0.016) were associated with biochemical recurrence, whereas NAAD (p = 0.057) and external beam radiotherapy (p = 0.356) were not. CONCLUSIONS: Gleason sum 7 tumors in patients treated with PPB represent a heterogeneous group of patients based on the differentiation of Gleason Grade 3 + 4 tumors vs. 4 + 3 disease. This information confirms similar conclusions identified in patients treated with external beam radiation and is useful when determining prognosis after PPB.

A comprehensive and novel predictive modeling technique using detailed pathology factors in men with localized prostate carcinoma.

BACKGROUND: The purpose of the current study was to evaluate modeling strategies using sextant core prostate biopsy specimen data that would best predict biochemical control in patients with localized prostate carcinoma treated with permanent prostate brachytherapy (PPB). METHODS: One thousand four hundred seventy-seven patients underwent PPB between 1992 and 2000. The authors restricted analysis to those patients who had sextant biopsies (n = 1073). A central pathology review was undertaken on all specimens. Treatment consisted of PPB with either I-125 or Pd-103 prescribed to 144 Gy or 140 Gy, respectively. Two hundred twenty-eight patients (21%) received PPB in combination with external radiotherapy and 333 patients (31%) received neoadjuvant hormones. In addition to clinical stage, biopsy Gleason sum, and pretreatment prostate specific antigen (pretx-PSA), the following detailed biopsy variables were considered: mean percentage of cancer in an involved core; maximum percentage of cancer; mean primary and secondary Gleason grades; maximum Gleason grade (primary or secondary); percentage of cancer in the apex, mid, and base; percent of cores positive; maximum primary and secondary Gleason grades in apex, mid, and base; maximum percent cancer in apex, mid, and base; maximum Gleason grade in apex, mid, and base; maximum primary Gleason grade; and maximum secondary Gleason grade. In all, 23 biopsy variables were considered. Four modeling strategies were compared. As a base model, the authors considered the pretx-PSA, clinical stage, and biopsy Gleason sum as predictors. For the second model, the authors added percent of cores positive. The third modeling strategy was to use stepwise variable selection to select only those variables (from the total pool of 26) that were statistically significant. The fourth strategy was to apply principal components analysis, which has theoretical advantages over the other strategies. Principal components analysis creates component scores that account for maximum variance in the predictors. RESULTS: The median followup of the study cohort was 36 months (range, 6-92), and the Kattan modification of the American Society for Therapeutic Radiology and Oncology (ASTRO) definition was used to define PSA freedom from recurrence (PSA-FFR). The four models were compared in their ability to predict PSA-FFR as measured by the Somers D rank correlation coefficient. The Somers D rank correlation coefficients were then corrected for optimism with use of bootstrapping. The results for the four models were 0.32, 0.34, 0.37, and 0.39, respectively. CONCLUSIONS: The current study shows that the use of principal components analysis with additional pathology data is a more discriminating model in predicting outcome in prostate carcinoma than other conventional methods and can also be used to model outcome predictions for patients treated with radical prostatectomy and external beam.