The Impact of Clinical Stage on Prostate Cancer Survival Following Radical Prostatectomy.
ABSTRACT INTRODUCTION AND OBJECTIVE: Clinical stage has been incorporated into multiple risk stratification models for patients with newly-diagnosed prostate cancer. However, the independent prognostic value of this variable remains in debate. Here, then, we evaluated the association of clinical stage with death from prostate cancer in men undergoing radical prostatectomy, and assessed for changes in its prognostic value over time. METHODS: We reviewed 14,842 consecutive patients who underwent radical prostatectomy at our institution between 1970 and 2008 without preoperative hormone or radiation therapy. Postoperative disease recurrence was estimated using the Kaplan-Meier method and compared using the log rank test. Multivariate Cox proportional hazard regression models were used to analyze the association of clinical stage with outcome. RESULTS: In total, 5,725 (38.6%)men were classified as cT1, 8,160 (55.0%) cT2 tumors, and 957 (6.4%) cT3. On univariate analysis, clinical stage was significantly associated with postoperative biochemical recurrence, systemic progression, and death from prostate cancer (p<0.001 for each). Moreover, on multivariate analysis clinical stage was significantly associated with cancer death both for patients treated before (1.45, p=0.006) and during (1.92, p>0.001) the PSA era. Furthermore, incorporation of clinical stage into contemporary risk stratification improves prediction of cancer-specific survival (c statistic - 0.782 without and 0.802 with clinical stage). CONCLUSIONS: Clinical stage is significantly associated with systemic progression and death from prostate cancer. Inclusion of this variable into multivariate prediction models improves prediction of systemic progression and cancer specific survival.
SourceAvailable from: Quanlin Li[Show abstract] [Hide abstract]
ABSTRACT: To define the accuracy of multiparametric magnetic resonance imaging (MP-MRI) for identifying focal and established extracapsular extension (ECE) in various zones of the prostate. Between 2010 and 2013, 342 patients underwent MP-MRI of the prostate (3T, no endorectal coil with axial perfusion and diffusion images). The findings of the images were reported as negative, suspicious, or positive for ECE by a single expert radiologist. Radical prostatectomy specimens were reviewed to confirm the size and the location of ECE and further defined as focal or established ECE. Established ECE included extension that was multifocal or involving more than 5 glands. The accuracy of MRI in localizing focal and established ECE to each zone of the prostate was determined. Regression analyses were performed to identify predictors of ECE. We identified 112 patients who underwent prostate MP-MRI and radical prostatectomy. MRI findings considered suspicious or definite for ECE accurately predicted pathologic ECE (P<0.001). MP-MRI identified established ECE but not focal ECE. Sensitivity, specificity, positive predictive value, and negative predictive value of MP-MRI for established ECE were 70.7%, 90.6%, 57.1%, and 95.1%, respectively. MRI identified ECE to the left vs. right side as well as each zone of the prostate; however, sensitivity was lowest at the apex. On multivariate analysis, MRI was a significant predictor of ECE that was independent of prostate-specific antigen level, Gleason score, and clinical stage. MP-MRI is useful for identifying established but not focal ECE in all zones of the prostate. MRI was a significant independent predictor of established ECE and may be a useful adjunct in staging prostate cancer. Copyright © 2014 Elsevier Inc. All rights reserved.
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ABSTRACT: Intraductal carcinoma of the prostate (IDC-P) is an adverse prognostic factor for radical prostatectomy (RP). The endpoint in most IDC-P studies is increased prostate-specific antigen (PSA) levels. The aim of this study was to evaluate whether IDC-P in RP specimens is an adverse prognostic factor for progression-free survival (PFS) and cancer-specific survival (CSS). We retrospectively evaluated 206 high-risk prostate cancer patients treated with RP and analyzed data on age, serum PSA level at diagnosis, biopsy Gleason score (bGS), surgical margin (SM), clinical T stage (cT), extraprostatic extension (EPE), seminal vesicle invasion (SVI), lymph node metastasis (LN), and neoadjuvant therapy. An IDC-P component was found in 104 cases. Forty-four patients experienced clinical failure, and 20 patients died of the disease. Patients with IDC-P showed a higher bGS and stage (including cT, EPE, SVI, and LN) than those without IDC-P. In univariate analysis, IDC-P, PSA level, bGS, SM, cT, SVI, LN, and EPE (P < 0.0001) were significantly associated with PFS. IDC-P (P = 0.0004), PSA level (P < 0.0001), SM (P = 0.0013), cT (P = 0.0019), SVI (P = 0.0012), and LN (P = 0.0002) were significantly associated with CSS. In multivariate analysis, IDC-P (P = 0.0038), and cT (P = 0.0001) were significantly associated with PFS. IDC-P (P = 0.0238) and PSA level (P = 0.0112) were significantly associated with CSS. IDC-P in RP specimens was an independent risk factor for PFS and CSS and could predict clinical outcomes. Prostate © 2014 Wiley Periodicals, Inc.The Prostate 05/2014; 74(6). DOI:10.1002/pros.22786 · 3.57 Impact Factor
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ABSTRACT: Prostate cancer (PC) is one of the most common cancers in the male population worldwide. Focal therapy for PC is now considered an emerging alternative to active surveillance for the management of low-risk PC, with the overall aim of treating only areas of cancer, minimizing lifetime morbidity without compromising life expectancy. One option within focal therapy, high intensity focused ultrasound (HIFU), represents an innovative technique that may selectively ablate known the disease while preserving existing functions. In the last 10 years, the feasibility and the safety of US guided HIFU has been tested in a growing number of clinical studies. More recently, magnetic resonance imaging was combined with HIFU principle and was presented as a novel technique for focal ablation of PC. In this review we introduce the technology of Magnetic Resonance guided Focused Ultrasound (MRgFUS) and the current status of clinical applications in the therapy of PC.06/2013; 1(2). DOI:10.1007/s40134-013-0011-2