A nomogram to predict seminal vesicle invasion by the extent and location of cancer in systematic biopsy results.
ABSTRACT We determined whether systematic biopsy results increases the accuracy of standard clinical information in predicting seminal vesicle invasion (SVI).
We analyzed a retrospective cohort of 763 patients with clinical stages T1c-T3 prostate cancer who were diagnosed by systematic biopsy and treated with radical prostatectomy. We recorded the location of each biopsy core and measured the length of cancer and total length of each core. Using logistic regression analysis we constructed and internally validated a nomogram to predict SVI.
A total of 60 patients (7.9%) had SVI. Cancer was present in a biopsy core from the base in 437 patients, of whom 12.8% had SVI compared with only 1.2% of the 326 without cancer at the base. None of the 275 patients with prostate specific antigen (PSA) 10 ng/ml or less and no cancer at the base had SVI. On multivariate analysis serum PSA (p <0.0005), primary Gleason grade (p = 0.028) and percent cancer at the base (p <0.005) were the only significant predictors of SVI. The predictive accuracy of a standard model that included only stage, grade and PSA was maximally enhanced by including the percent cancer at the base (p = 0.0013). A nomogram that incorporated this variable produced probabilities of SVI that differed from the standard model by +/- 10% in 68% of the cases.
The presence and amount of cancer in systematic needle biopsy cores from the base of the prostate strongly predicts the presence of SVI. Systematic biopsy results enhance the accuracy of nomograms to predict SVI.
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ABSTRACT: We identified risk factors associated with urinary incontinence after radical retropubic prostatectomy. The time from operation until urinary continence was achieved was determined by chart review and questionnaire in 581 patients who were continent before undergoing radical retropubic prostatectomy between 1983 and 1994. Using univariate and multivariate analyses of data gathered prospectively, we examined risk factors associated with incontinence in these patients. The actuarial rate of urinary continence at 24 months was 91% for the entire patient population and 95% for those treated after 1990. Many factors were associated with the risk of incontinence in univariate Cox proportional hazards regression analysis (patient age and weight, degree of obstructive voiding symptoms, prior transurethral resection of the prostate, clinical stage, intraoperative blood loss, resection of neurovascular bundles, postoperative anastomotic stricture and technique of vesicourethral anastomosis). However, in a multivariate analysis the factors that were independently associated with increased chance of regaining continence were decreasing age, a modification in the technique of anastomosis (introduced in 1990), preservation of both neurovascular bundles and absence of an anastomotic stricture. With introduction of the new surgical technique in 1990 the median time to continence decreased from 5.6 to 1.5 months and the rate of continence at 24 months increased from 82 to 95%. While the risk of urinary incontinence after radical prostatectomy is related to the uncontrollable factor of patient age, it is also sensitive to the surgical technique used.The Journal of Urology 12/1996; 156(5):1707-13. · 3.70 Impact Factor
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ABSTRACT: We previously presented nomograms combining preoperative serum prostate-specific antigen (PSA), clinical (TNM) stage, and biopsy Gleason score to provide the likelihood of various final pathologic stages at radical retropubic prostatectomy. The data for the original nomograms were collected from men treated between 1982 and 1996. During the past 10 years, the stage at presentation has shifted, with more men presenting with Stage T1c, Gleason score 5 to 6, and serum PSA levels less than 10.0 ng/mL. In this work, we update the "Partin Tables" with a more contemporary cohort of men treated since 1994 and with revised PSA and Gleason categories. Multinomial log-linear regression analysis was used to estimate the likelihood of organ-confined disease, extraprostatic extension, seminal vesicle or lymph nodal status from the preoperative PSA stratified as 0 to 2.5, 2.6 to 4.0, 4.1 to 6.0, 6.1 to 10.0, and greater than 10 ng/mL, clinical (AJCC-TNM, 1992) stage (T1c, T2a, T2b, or T2c), and biopsy Gleason score stratified as 2 to 4, 5 to 6, 3 + 4 = 7, 4 + 3 = 7, or 8 to 10 among 5079 men treated with prostatectomy (without neoadjuvant therapy) between 1994 and 2000 at Johns Hopkins Hospital. The average age was 58 years. In this cohort, more than 60% had T1c, more than 75% had Gleason score of 6, more than 70% had PSA greater than 2.5 and less than 10.0 ng/mL, and more than 60% had organ-confined disease. Nomograms of the robust estimated likelihoods and 95% confidence intervals were developed from 1000 bootstrap analyses. The probability of organ-confined disease improved across the groups, and further stratification of the Gleason score and PSA level allowed better differentiation of individual patients. These updated "Partin Tables" were generated to reflect the trends in presentation and pathologic stage for men newly diagnosed with clinically localized prostate cancer at our institution. Clinicians can use these nomograms to counsel individual patients and help them make important decisions regarding their disease.Urology 01/2002; 58(6):843-8. · 2.42 Impact Factor
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ABSTRACT: The aim of this study was to develop an endorectal MRI strategy for prostatic cancer. We evaluated the MR images from 44 consecutive prostatic cancer patients treated by radical prostatectomy. Each sequence from every examination was assessed separately with a specific tumor map drawn. Tumor localization, capsular penetration, and seminal vesicle invasion were marked on maps on the basis of T2 and DESS (dual-echo steady-state) sequences. Thirty patients also had T1-weighted images, and these were assessed with regard to possible tumor outgrowth. The maps were compared with histopathological findings from radical prostatectomy specimens. According to our study, DESS equaled T2 in every respect. No statistically significant differences between the sequences were found with respect to detecting either tumor localization, outgrowth, or seminal vesicle invasion. DESS is a potential new sequence in prostatic MRI as it has been proven to parallel the routinely used T2-weighted imaging.European Radiology 02/2001; 11(2):236-41. · 3.55 Impact Factor