The biopsy Gleason score 3+4 in a single core does not necessarily reflect an unfavourable pathological disease after radical prostatectomy in comparison with biopsy Gleason score 3+3: looking for larger selection criteria for active surveillance candidates.

BACKGROUND: To assess whether the addition of clinical Gleason score (Gs) 3+4 to the Prostate Cancer Research International: Active Surveillance (PRIAS) criteria affects pathologic results in patients who are potentially suitable for active surveillance (AS) and to identify possible clinical predictors of unfavourable outcome. METHODS: Three hundred and twenty-nine men who underwent radical prostatectomy with complete clinical and follow-up data and who would have fulfilled the inclusion criteria of the PRIAS protocol at the time of biopsy except for the addition of biopsy Gs=3+4 and with at least 10 cores taken have been evaluated. One experienced genitourinary pathologist selected those with real Gs=3+3 and 3+4 in only one core according to the 2005 International Society of Urological Pathology criteria. The primary end point was the proportion of unfavourable outcome (nonorgan confined disease or Gs⩾4+3). Logistic regressions explored the association between preoperative characteristics and the primary end point. RESULTS: Two hundred and four patients were evaluated and 46 (22.5%) patients harboured unfavourable disease at final pathology. After a median follow-up of 73.5 months, there was no cancer-specific death, and 4 (2.0%) patients had biochemical relapse. There were no significant differences in terms of high Gs, locally advanced disease, unfavourable disease and biochemical relapse-free survival among patients with clinical Gs=3+3 vs Gs=3+4. At multivariable analysis, the presence of atypical small acinar proliferation (ASAP) and lower number of core taken were independently associated with a higher risk of unfavourable disease. CONCLUSION: The inclusion of Gs=3+4 in patients suitable to AS does not enhance the risk of unfavourable disease after radical prostatectomy. Additional factors such as number of cores taken and the presence of ASAP should be considered in patients suitable for AS.

La preservación del esfínter interno vesical y la uretra proximal durante la prostatectomía radical retropúbica puede mejorar la recuperación temprana de la continencia en pacientes seleccionados / Preservation of the Internal Vesical Sphincter and Proximal Urethra During Retropubic Radical Prostatectomy may Improve Earlier Recovery of Continence in Selected Patients

Objetivos: Evaluar la influencia de la preservación del esfínter interno muscular y la uretra proximal en la recuperación de la continencia después de la prostatectomía radical (PR). Material y métodos: Cincuenta y cinco pacientes consecutivos con cáncer de próstata confinado al órgano se sometieron a PR con preservación del esfínter interno muscular y la uretra proximal (grupo 1), y se compararon con 55 pacientes sometidos a un procedimiento estándar (grupo 2). Las tasas de continencia se evaluaron mediante un cuestionario autoadministrado a los 3, 7 y 30 días y 3 y 12 meses después de la retirada del catéter. Resultados: El grupo 1 tuvo una recuperación más rápida de la continencia que el grupo 2 a los 3 días (50,9 vs. 25,5%; p = 0,005), a los 7 días (78,2 vs. 58,2%; p = 0,020), a los 30 días (80,0 vs. 61,8%; p = 0,029) y a los 3 meses (81,8 vs. 61,8%; p = 0,017); no hubo diferencia estadísticamente en términos de continencia a los 12 meses entre los 2 grupos. El análisis de regresión logística multivariante de la continencia mostró que la técnica quirúrgica se asoció significativamente con un tiempo temprano hasta la continencia a los 3 y 7 días. Ninguno de los 2 grupos presentó diferencias significativas en cuanto a márgenes quirúrgicos. Conclusiones: Nuestra técnica modificada de PR con preservación del esfínter interno muscular liso, así como de la uretra proximal durante la disección del cuello de la vejiga, dio como resultado un aumento de la continencia urinaria temprana a los 3, 7 y 30 días y 3 meses después de la retirada del catéter. La técnica no aumenta la tasa de márgenes positivos ni la duración del procedimiento

Objectives: To evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy (RP). Materials and methods: Fifty-five consecutive patients with organ confined prostate cancer were submitted to RP with the preservation of muscular internal sphincter and the proximal urethra (group 1) and compared to 55 patients submitted to standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7, 30 days and 3, 12 months after removal of the catheter. Results: Group 1 had a faster recovery of continence than group 2 at 3 days (50.9% vs. 25.5%; p = 0.005), at 7 days (78.2% vs. 58.2%; p = 0.020), at 30 days (80.0% vs. 61.8%; p = 0.029) and at 3 months (81.8% vs. 61.8%; p = 0.017); there were no statistical difference in terms of continence at 12 months among the two groups. Multivariate logistic regression analysis of continence showed that surgical technique was significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins. Conclusions: Our modified technique of RP with preservation of smooth muscular internal sphincter as well as of the proximal urethra during bladder neck dissection resulted in significantly increased early urinary continence at 3, 7, 30 days and 3 months after catheter removal. The technique does not increase the rate of positive margins and the duration of the procedure

Survival, Continence and Potency (SCP) recovery after radical retropubic prostatectomy: a long-term combined evaluation of surgical outcomes.

OBJECTIVE: To offer a comprehensive account of surgical outcomes on a defined series of patients treated with radical retropubic prostatectomy (RRP) for prostate cancer in a single European Center after 5-year minimum follow-up according to the Survival, Continence and Potency (SCP) system. MATERIAL AND METHODS: We evaluated our Institutional database of patients who underwent RRP from November 1995 to September 2008. Oncological and functional outcomes were reported according to the recently proposed SCP system. RESULTS: The 5- and 10-year biochemical recurrence-free survival rates were 80.1% and 55.8%, respectively. At the end of follow-up, 611 (78.5%) patients were fully continent (C0), 107 (13.8%) used 1 pad for security (C1) and 60 (7.7%) patients were incontinent (C2). Of the 112 patients who underwent nerve-sparing RRP, 22 (19.6%) were fully potent without aids (P0), 13 (11.6%) were potent with assumption of PDE-5 inhibitors (P1) and 77 (68.8%) experienced erectile dysfunction (P2). The combined SCP outcomes were reported together only in 95 (12.2%) evaluable patients. In patients preoperatively continent and potent, who received a nerve-sparing and did not require adjuvant therapy, oncological and functional success was attained by 29 (30.5%) patients. In the subgroup of 508 patients not evaluable for potency recovery, oncological and continence outcomes were obtained in 357 patients (70.3%). CONCLUSION: Survival, Continence and Potency (SCP) classification offer a comprehensive report of surgical results, even in those patients who do not represent the best category, thus allowing to provide a much more accurate evaluation of outcomes after RP.

Preservation of the internal vesical sphincter and proximal urethra during retropubic radical prostatectomy may improve earlier recovery of continence in selected patients.

OBJECTIVES: To evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy (RP). MATERIAL AND METHODS: Fifty-five consecutive patients with organ confined prostate cancer were submitted to RP with the preservation of muscular internal sphincter and the proximal urethra (group 1) and compared to 55 patients submitted to standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7, 30 days and 3, 12 months after removal of the catheter. RESULTS: Group 1 had a faster recovery of continence than group 2 at 3 days (50.9% vs. 25.5%; P=.005), at 7 days (78.2% vs. 58.2%; P=.020), at 30 days (80.0% vs. 61.8%; P=.029) and at 3 months (81.8% vs. 61.8%; P=.017); there were no statistically difference in terms of continence at 12 months among the two groups. Multivariate logistic regression analysis of continence showed that surgical technique was significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins. CONCLUSIONS: Our modified technique of RP with preservation of smooth muscular internal sphincter as well as of the proximal urethra during bladder neck dissection resulted in significant increased early urinary continence at 3, 7, 30 days and 3 months after catheter removal. The technique does not increase the rate of positive margins and the duration of the procedure.

Estudio de diagnóstico por imagen de recidiva tras el tratamiento radical de cáncer de próstata: ¿cómo distinguir entre la enfermedad local y la enfermedad a distancia? Punto de vista del urólogo / Diagnostic imaging work-up for disease relapse after radical treatment for prostate cancer: How to differentiate local from systemic disease? The urologist point of view

Alrededor del 40% de los pacientes que se someten a tratamiento radical de cáncer localizado de próstata (CaP) desarrollan una recidiva bioquímica (RB) a lo largo de su vida, aunque únicamente el 10–20% de ellos manifestará recidivas clínicamente detectables. El lecho prostático, los ganglios pélvicos o retroperitoneales y los huesos (principalmente la columna) son los emplazamientos en los que debemos centrar nuestra atención durante la fase inicial de la recidiva del cáncer de próstata. El tiempo transcurrido hasta la recidiva del PSA, la cinética del PSA, la puntuación patológica de Gleason y el estadio patológico son los principales factores relacionados con la probabilidad de una recidiva local frente a una recidiva a distancia. Antes de realizar un estudio diagnóstico amplio en pacientes con RB, es imperativo comprender si existe o no una consecuencia terapéutica para el paciente. Las técnicas actuales de imagen tienen algún potencial, aunque todavía se siguen encontrando muchos límites en el diagnóstico de la recidiva de la enfermedad. La ecografía transrectal (TRUS) y la resonancia magnética multiparamétrica son poco precisas para la detección de la recidiva. Hoy en día, el PET/TAC de Colina puede visualizar el emplazamiento de la recurrencia de forma más temprana, con una mejor precisión que la imagen convencional, en un único paso e incluso en presencia de un bajo nivel de PSA. En los últimos años, se ha propuesto el nuevo radiotrazador 18F-FACBC como una posible alternativa radio-farmacéutica para la detección de la recidiva del CaP. Desde un punto de vista clínico, los primeros estudios clínicos mostraron unos resultados muy prometedores y reproducibles, con una mejora de la sensibilidad de alrededor de un 20–25% con respecto al PET/TAC de Colina, lo que convierte al FACBC en el posible radiotrazador del futuro para el CaP. En conclusión, se han logrado recientemente muchas mejoras en cuanto a técnicas de imagen para la re-estadificación del CaP, principalmente en Medicina Nuclear y RM, aunque persisten los resultados negativos en muchos casos. La baja sensibilidad, los costes, la disponibilidad de las tecnologías y la confirmación de los resultados siguen siendo las principales limitaciones en muchos casos(AU)

About 40% of all patients undergoing radical treatment for localized prostate cancer (PCa) develop biochemical relapse (BCR) during lifetime but only 10–20% of them will show clinically detectable recurrences. Prostatic bed, pelvic or retroperitoneal lymph nodes (LN) and bones (especially the spine) are the sites where we must focus our attention in the early phase of PSA relapse. Time to PSA relapse, PSA kinetics, pathological Gleason score and pathological stage are the main factors related to the likelihood of local vs. distant relapse. Before an extensive diagnostic work-up in patients with BCR, is mandatory to understand if there is a therapeutic consequence or not for the patient. Current imaging techniques have some potential but many limits are yet encountered in the diagnosis of disease relapse. Transrectal ultrasound (TRUS) and Multiparametric Magnetic Resonance Imaging (MRI) have low accuracy in the detection of the recurrence. Today, Choline PET/CT may visualize the site of recurrence earlier, with better accuracy than conventional imaging, in a single step and even in the presence of low PSA level. In recent years, the new radiotracer 18F-FACBC has been proposed as a possible alternative radiopharmaceutical to detect PCa relapse. From a clinical point of view, first clinical studies showed very promising and reproducible results with an improvement in sensitivity is about 20–25% with respect to Choline PET/CT, rendering the FACBC the possible radiotracer of the future for PCa. In conclusion, many improvements have been recently achieved in imaging techniques for PCa restaging, essentially in Nuclear Medicine and MRI, but negative results remain in many cases. Low sensitivity, costs, availability of technologies and confirmation of the results remain the major limitations in most cases(AU)

Diagnostic imaging work-up for disease relapse after radical treatment for prostate cancer: how to differentiate local from systemic disease? The urologist point of view.

About 40% of all patients undergoing radical treatment for localized prostate cancer (PCa) develop biochemical relapse (BCR) during lifetime but only 10-20% of them will show clinically detectable recurrences. Prostatic bed, pelvic or retroperitoneal lymph nodes (LN) and bones (especially the spine) are the sites where we must focus our attention in the early phase of PSA relapse. Time to PSA relapse, PSA kinetics, pathological Gleason score and pathological stage are the main factors related to the likelihood of local vs. distant relapse. Before an extensive diagnostic work-up in patients with BCR, is mandatory to understand if there is a therapeutic consequence or not for the patient. Current imaging techniques have some potential but many limits are yet encountered in the diagnosis of disease relapse. Transrectal ultrasound (TRUS) and Multiparametric Magnetic Resonance Imaging (MRI) have low accuracy in the detection of the recurrence. Today, Choline PET/CT may visualize the site of recurrence earlier, with better accuracy than conventional imaging, in a single step and even in the presence of low PSA level. In recent years, the new radiotracer (18)F-FACBC has been proposed as a possible alternative radiopharmaceutical to detect PCa relapse. From a clinical point of view, first clinical studies showed very promising and reproducible results with an improvement in sensitivity is about 20-25% with respect to Choline PET/CT, rendering the FACBC the possible radiotracer of the future for PCa. In conclusion, many improvements have been recently achieved in imaging techniques for PCa restaging, essentially in Nuclear Medicine and MRI, but negative results remain in many cases. Low sensitivity, costs, availability of technologies and confirmation of the results remain the major limitations in most cases.

The dilemma of localizing disease relapse after radical treatment for prostate cancer: which is the value of the actual imaging techniques?

Only few patients with PSA relapse after radical treatment will show clinically detectable disease. Although the natural history of recurrent prostate cancer is often one of the slowly progressing diseases, in some men it can be rapid and may need a salvage treatment. In general, time to PSA relapse, PSA velocity and PSA doubling time are useful in patient assesment. In patients with PCa disease relapse after primary therapy, salvage treatment for a local recurrence should only be offered to patients with little risk of already having metastases. In these patients a systemic imaging negative for metastases is mandatory, a positive biopsy is not always necessary before radiotherapy, but is mandatory before salvage prostatectomy. In patients with a high risk of distant metastases and suitable for systemic salvage therapy, a positive lesion must be obviously visualized with one of the currently available imaging techniques. Transrectal ultrasound has low accuracy in the detection of the recurrence. Multiparametric Magnetic Resonance Imaging may have a role in the early phase of PSA relapse. Conventional imaging, such as bone scan and CT, are not suggested in the initial phase of BCR. Today, it has been reported that PET/CT allows changing the therapeutic strategy (from palliative to curative treatment and vice-versa) in about 20% of cases. In recent years, the new radiotracer 18F-FACBC has been proposed as a possible alternative radiopharmaceutical to detect PCa relapse. The aim of the present paper is to evaluate the management of patients with BCR after radical treatment of PCa from the urologist point of view.

Constraints on new physics from the quark mixing unitarity triangle.

The status of the unitary triangle beyond the standard model including the most recent results on Deltam[s] on dilepton asymmetries and on width differences is presented. Even allowing for general new physics loop contributions the unitarity triangle must be very close to the standard model result. With the new measurements from the Fermilab Tevatron, we obtain for the first time a significant constraint on new physics in the Bs sector. We present the allowed ranges of new physics contributions to DeltaF=2 processes and of the time-dependent CP asymmetry in Bs-->J/psivarphi decays.

Barkas effect for antiproton stopping in H2.

We report the stopping power of molecular hydrogen for antiprotons of kinetic energy above the maximum (approximately 100 keV) with the purpose of comparing with the proton one. Our result is consistent with a positive difference in antiproton-proton stopping powers above approximately 250 keV and with a maximum difference between the stopping powers of 21%+/-3% at around 600 keV.