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.

Variations in blood ghrelin levels in prostate cancer patients submitted to hormone suppressive treatment.

BACKGROUND: Ghrelin is a natural growth hormone segretagogue (GHS), involved in the biology of a number of diseases such as lung cancer and prostate cancer. The aim of this study is to assess the relationship existing between ghrelin and testosterone, insulin, and PSA in prostate adenocarcinoma. PATIENTS AND METHODS: A patient population and a control population were studied. The former consisted of 18 individuals, age range 50-75 years, with a primary histological diagnosis of prostate adenocarcinoma that were divided into two equal groups of 9 patients each. The control population consisted of 40 normogonadic healthy males aged between 23 and 77 years (average age 43). The first group was treated with oral bicalutamide with a daily dose of 150 mg, while the second group was treated with an intramuscular injection of 11.25 mg of leuprorelin every three months. Total ghrelin was measured with a radio immunological direct method using Phoenix's ghrelin human RIA kit. Intra-assay variance was 8.2% and inter-assay variance was 11.4% . Acylated-ghrelin was measured by applying an extraction method using C18 columns followed by radio immunological dosage with antibody and peninsula tracer. Intra-assay variance was 6.1% and inter-assay variance was 8.7% . All other blood parameters were analysed at the central laboratory of the S. Orsola-Malpighi Polyclinic in Bologna. PSA and testosterone were used to assess response to treatment. The PSA monitoring was achieved with a chemio-luminescence assay method (Roche Modular analytics E 170). Free T was also measured using a direct RIA kit (Diagnostic Systems Laboratories, Inc.). RESULTS: In the four months during which patients underwent pharmacological treatment, testosterone values varied significantly (p<0.05) in both groups. No variations (p>0.05) were found for ghrelin, acylated-ghrelin and insulin. CONCLUSION: It is concluded that in patients with prostate neoplasms there is no correlation between the variations of circulating levels of ghrelin and those of testosterone.

Perioperative complications and mortality after radical cystectomy when using a standardized reporting methodology.

PURPOSE: To evaluate, by using a standardized reporting methodology, the perioperative complications and mortality in patients who underwent radical cystectomy. MATERIALS AND METHODS: We retrospectively reviewed all data of 404 consecutive patients who underwent radical cystectomy from 1995 to 2009 for nonmetastatic bladder cancer at the same academic center. Perioperative complications and perioperative mortality were defined as any adverse event or death from any cause within 90 days of surgery. All perioperative complications were reported according to the Martin criteria and were graded according to the Clavien system (grade 1-5). Univariate and multivariate analyses for the clinical and pathologic characteristics were used to evaluate predictors of complications. RESULTS: A total of 296 complications occurred in 209 (51.7%) patients. Among them, 139 (34.4% of the entire population) had only a '"minor"' (grade 1-2) complication, whereas 70 (17.3%) had a "major" (grade 3-5) complication. Eighteen (4.5%) patients died within 90 days after surgery. At univariate analysis, age ≥75 years (2P = .018), serum creatinine level ≥1.4 mg/dL (2P = .025), American Society of Anesthesiologists (ASA) score of 3 to 4 (2P < .001) were significant predictors of complications after 30 days from surgery; conversely, the ASA score was the only significant predictor of complications after 90 days. At multivariate analysis, only the ASA score was independently correlated with the development of complications at 30 and 90 days of follow-up (2P < .001). CONCLUSIONS: Radical cystectomy is one of the most complex procedures in urology, with a high rate of complications and mortality. The use of a standardized methodology is the only way to estimate the actual rate and the severity of complications.

Prognostic value of lymphovascular invasion in bladder cancer in patients treated with radical cystectomy.

BACKGROUND: Bladder cancer is the fourth most frequently diagnosed cancer among males and the eleventh among females. At present, radical cystectomy is considered the standard therapy in patients with muscle invasive disease or in some cases of high-grade superficial cancer. TNM classification includes as independent predictors of disease-specific survival the grade, the pathological stage and the presence of lymph node involvement, whilst the prognostic value of lymphovascular invasion (LVI) still remains controversial. The aim of the study was to assess the prognostic role of LVI at final pathology. PATIENTS AND METHODS: From June 1995 to January 2007, 340 consecutive patients underwent radical cystectomy. Surgical specimens were examined according to our pathological protocol. Patients with a non-transitional cell carcinoma or submitted to a salvage procedure or neoadjuvant/adjuvant chemo-radiotherapy were excluded. The follow-up consisted of abdominal ultrasound every 3 months, blood sampling every six months and both computerized tomography and urethroscopy yearly. RESULTS: The median patient age was 69 years. Of the 265 patients, 218 were males and 47 females. LVI was present in 77 pathological specimens (29.1%). LVI was not significantly associated with age (p=0.908) or sex (p=0.382), but was significantly associated with high pathological grade (p=0.028) and stage (p<0.001), and the presence of node metastasis (p<0.001). At the multivariate analysis, pathological staging, presence of LVI and node metastasis were independent significant prognostic factors for disease-specific survival. CONCLUSION: In our series, LVI is an independent prognostic factor for disease specific survival in patients who underwent radical cystectomy for transitional cell carcinoma.