Differing risk of cancer death among patients with lymph node metastasis after radical prostatectomy and pelvic lymph node dissection: identification of risk categories according to number of positive nodes and Gleason score.

OBJECTIVES: To evaluate the outcomes in patients with node-positive prostate cancer (PCa) after radical prostatectomy (RP) and pelvic lymph node dissection (PLND) according to the number of positive lymph nodes (LNs). To identify different risk groups among patients with node-positive PCa. PATIENTS AND METHODS: We evaluated 98 consecutive patients with pN1M0 PCa who underwent RP between November 1995 and May 2011. Kaplan-Meier and Cox proportional univariable and multivariable regression models were used to analyse the survival rates. Patients were divided into two groups according to number of positive LNs using the most informative positive LN theshold for predicting survival, then into three different risk groups according to number of positive LNs and pathological Gleason score (GS). RESULTS: Mean (range) follow-up was 68.4 (10-192) months. Patients with 1-3 positive LNs (n = 75; 76.5%) had significantly better cancer-specific survival (CSS) and overall survival (OS) compared with those with >3 positive nodes (n = 23; 23.4%; P < 0.01). Patients with 1-3 positive LNs and pathological GS ≤7 (Group 1) had significantly better CSS than those with >3 positive LNs or GS 8-10 (Group 2 [P = 0.015]). Group 2 patients, moreover, had significantly better CSS (P = 0.019) and OS (P = 0.021) than those with >3 positive LNs and GS 8-10 (Group 3). CONCLUSIONS: Patients with 1-3 positive LNs have higher CSS and OS rates than those with >3 metastatic LNs. Taking into account the pathological GS, as well as the number of positive nodes, three risk group categories with considerable differences in terms of survival can be found. Patients with LN-positive PCa should be stratified into different groups according to these two measures, to obtain a better prediction of oncological outcomes.

The extent of pelvic lymph node dissection correlates with the biochemical recurrence rate in patients with intermediate- and high-risk prostate cancer.

OBJECTIVE: • To assess the impact of pelvic lymph node dissection (PLND) and of the number of lymph nodes (LNs) retrieved during radical prostatectomy (RP) on biochemical relapse (BCR) in pNX/0/1 patients with prostate cancer according to the clinical risk of lymph node invasion (LNI). PATIENTS AND METHODS: • We evaluated 872 pT2-4 NX/0/1 consecutive patients submitted to RP between October 1995 and June 2009, with the following inclusion criteria: (i) a follow-up period ≥12 months; (ii) the avoidance of neoadjuvant hormonal therapy or adjuvant hormonal and/or adjuvant radiotherapy; (iii) the availability of complete follow-up data; (iv) no pathological T0 disease; (v) complete data regarding the clinical stage and Gleason score (Gs), the preoperative prostate-specific antigen (PSA) level and the pathological stage. • The patients were stratified as having low risk (cT1a-T2a and cGs ≤6 and PSA level < 10 ng/mL), intermediate risk (cT2b-T2c or cGs = 7 or PSA level = 10-19.9) or high risk of LNI (cT3 or cGs = 8-10 or PSA level ≥ 20). • The 872 patients were divided into two LN groups according to the number of LNs retrieved: group 1 had no LN or one to nine LNs removed; group 2 had 10 or more LNs. • The variables analysed were LN group, age, PSA level, clinical and pathological stage and Gs, surgical margin status, LN status and number of LN metastases; the primary endpoint was the BCR-free survival. RESULTS: • The mean follow-up was 55.8 months. • Of all the patients, 305 (35%) were pNx and 567 (65.0%) were pN0/1. • Of the 567 patients submitted to PLND, the mean number of LNs obtained was 10.9, and 49 (8.6%) were pN1. • In the 402 patients at low risk of LNI, LN group was not a significant predictor of BCR at univariate analysis, while in the 470 patients at intermediate and high risk of LNI, patients with ≥ 10 LNs removed had a significantly lower BCR-free survival at univariate and multivariate analysis. CONCLUSION: • In our study population, a more extensive PLND positively affects the BCR-free survival regardless of the nodal status in intermediate- and high-risk prostate cancer.

Accuracy of a new echographic method (RULES, radiofrequency ultrasonic local estimators) in prostate cancer diagnosis.

BACKGROUND: This study evaluated the accuracy of a new echographic method named RULES (radiofrequency ultrasonic local estimators) in the diagnosis of prostate cancer. PATIENTS AND METHODS: A double-blind prospective study was carried out on 105 patients mean age 66.6 years, prostate specific antigen (PSA) >4 ng/ml with clinical and/or biochemical suspicious of prostate cancer. Patients were submitted to transrectal prostate biopsy (8 to 12 cores) using a traditional echograph connected to a new hardware/ software platform named FEMMINA (fast echographic multiparameter multi image novel apparatus) that processes the echo signal by a RULES (radiofrequency ultrasonic local estimators) algorithm. Histological findings were compared to B-mode and RULES modality. RESULTS: Cancer was detected in 32/105 patients, of which 26/32 were determined as positive with the RULES method. RULES had better positive predictive value, negative predictive value, sensitivity, specificity and accuracy than B-mode. CONCLUSION: Results obtained with RULES are encouraging and, if further confirmed, could help to reduce the number of unnecessary prostatic biopsies.

A novel spectral ultrasonic differentiation method for marking regions of interest in biological tissues. In vivo preliminary results.

BACKGROUND: "in vivo" application of a new echographic method able to better identify neoplastic tissue. The aim of this study was to evaluate its accuracy in the diagnosis of prostate cancer. MATERIALS AND METHODS: Double-blind prospective study on 60 patients (pts) submitted to both transrectal ultrasound (TRUS) of prostate with a traditional echograph connected to a new hardware/software platform named FEMMINA (Fast Echographic Multiparameter Multi Image Novel Apparatus) that processes the echo signal by RULES (Radiofrequency Ultrasonic Local EStimators) algorithm and to a prostatic biopsy (8 to 12 cores). Histological findings of biopsies were compared to B-mode and the new ultrasound method. RESULTS: Cancer was detected in 18/60 pts. 14 patients had positive images with RULES, 11 with B-mode modality. The positive predictive value (PPV) and negative predictive value (NPV) of B-mode were 42% and 79% while 77% and 90% of RULES. Sensitivity and specificity of B-mode were 61% and 79% while those of RULES were 77% and 90%. B-mode diagnostic accuracy was 63% and RULES accuracy was 86%. CONCLUSIONS: Results obtained with RULES are encouraging but they need further studies for its application in clinical practice.

Laparoscopic radical prostatectomy: 10 years of experience at a single institution.

BACKGROUND/AIM: The Urological Clinic of the S. Orsola-Malpighi University Hospital, Bologna has been carrying out laparoscopic radical prostatectomy since 2002. In this study, we report the results after 10 years of LRP, analyzing in particular the oncological and functional aspects. PATIENTS AND METHODS: Between March 2002 and August 2011, 400 patients underwent laparoscopic radical prostatectomy. Cancer control, recovery of continence and potency were evaluated at 1, 3, 6 and 12 months. All data were retrospectively collected on the basis of thorough clinical and pathological examination. RESULTS: Follow-up ranged from 10 to 122 months. Pathological examination revealed pT2 and pT3 cancers in 63.5% and 36.5% of patients, respectively. The incidence of positive surgical margins and biochemical relapse rate was 33.8% and 12.0%, respectively. CONCLUSION: 10 Years after the first laparoscopic radical prostatectomy was performed at our Center, we can state that it is a reliable alternative to traditional surgery, with satisfactory oncological and functional results.

Differing risk of cancer death among patients with pathologic T3a renal cell carcinoma: identification of risk categories according to fat infiltration and renal vein thrombosis.

OBJECTIVES: The study objectives were to evaluate the prognostic impact of fat infiltration and renal vein thrombosis in patients with pT3a renal cell carcinoma (RCC) and to identify new prognostic groups. MATERIAL AND METHODS: We analyzed 122 consecutive patients with pT3a who underwent radical nephrectomy for RCC between 2000 and 2011 at the University of Bologna. Cancer-specific survival (CSS) rates were estimated using Kaplan-Meier survival curves; univariable and multivariable analyses were performed with Cox analysis. RESULTS: The mean follow-up was 41.7 ± 35.4 months. Patients with peritumoral/hilar fat infiltration (n = 63) and patients with renal vein thrombosis (n = 18) experienced comparable CSS rates, whereas patients with both fat infiltration plus renal vein thrombosis (n = 41) showed worse survival outcomes than the first group (P = .026). Patients were divided in 2 groups: group A, with fat invasion or renal vein thrombosis, and group B, with concomitant fat invasion and renal vein invasion. Group B showed worse cancer-specific survival than group A (P = .024). At multivariate analysis, this new risk-group stratification was found to be an independent prognostic predictor of CSS (P < .05). CONCLUSIONS: Patients with T3a RCC with both fat invasion and renal vein thrombosis experience worse survival rates when compared with those patients with only 1 prognostic factor. The TNM classification should consider the concomitant presence of those parameters as a different prognostic predictor.

[Accuracy of endorectal Magnetic Resonance Imaging (MRI) and Dynamic Contrast Enhanced-MRI (DCE-MRI) in the preoperative local staging of prostate cancer]. / Accuratezza della RMN 1,5 T con bobina endorettale e della RMN dinamica (DCE MRI) nella stadiazione preoperatoria dei pazienti affetti da carcinoma prostatico.

BACKGROUND: The proper management of newly diagnosed prostate cancer (PCa) requires the choice of the appropriate treatment plan. A crucial factor is the accurate evaluation of the tumor local extension. The Magnetic Resonance Imaging (MRI) plays an important role in the local staging of prostate cancer, although its use in clinical practice is widely debated. Therefore, the purpose of our study was to evaluate the diagnostic accuracy of T2-weighted MR imaging in association with DCE-MRI, performed using an endorectal coil, in preoperative local staging of patients with prostate cancer, by using the histopathologic findings as the reference standard. MATERIALS AND METHODS: From April 2010 to May 2011, 65 patients (mean age, 65 years; range, 51-77 years) with clinical localized PCa, underwent radical prostatectomy at our institution, performed by 2 experienced surgeons. All patients were prospectively evaluated with eMRI in association with DCE-MRI prior to radical prostatectomy. In all patients MRI was performed at least 6 weeks after biopsy and within 2 weeks before Radical Prostatectomy (RP). Histologic analysis was our diagnostic "gold standard". To ensure that the histopathological findings matched with MR images, the assessment of radiological images and the RP specimens were performed dividing the prostate in 14 regions. RESULTS: First, we performed a "per-patient" analysis, considering the entire prostate as a single region. Then, we performed a "per-emigland" analysis, finally a "per-region" analysis. The sensitivity, specificity, PPV, NPV and AUC in predicting ECE in the analysis "per-emigland" were respectively 66.7, 95.7, 66.7, 95.7, 0.824. The evaluation of SVI reported similar results: 62.5, 97.5, 62.5, 97.5, 0.797. DCE-MRI did not improve the diagnostic accuracy of T1-T2-weighted MR images in the evaluation of ECE or SVI. CONCLUSIONS: T1-, T2-weighted MRI adds important information regarding the preoperative local staging of PCa. DCE-MRI does not improve the diagnostic accuracy of MRI in the local staging of PCa.