-
[show abstract]
[hide abstract]
ABSTRACT: HintergrundEs wurde untersucht, ob Anastomoseninsuffizienzen nach radikaler retropubischer Prostatektomie (RRP) genauso sicher durch
eine transrektale Ultraschalluntersuchung identifiziert werden können, wie durch eine Zystographie.
Material und MethodenVon Oktober 2005 bis Februar 2006 wurden prospektiv 100 radikal prostatektomierte Patienten untersucht. Am 6. postoperativen
Tag (POD) nach RRP wurde die vesikourethrale Anastomose in einer kombinierten Untersuchung aus transrektalem Ultraschall (TRUS)
und einer Zystographie untersucht.
ErgebnisseBei der Mehrheit der Patienten (79%) war die Anastomose am 6. postoperativen Tag (POD) wasserdicht oder zeigte minimale Leckagen
(8%), die eine Katheterentfernung zuließen. Insgesamt wurden 21 Paravasate diagnostiziert, welche unterschiedliche Schweregrade
aufwiesen. Aufgrund kleiner (n=5), mäßiger (n=3) bzw. ausgeprägter Paravasate (n=5) wurde der Katheter am 9., 14. bzw. 21.
POD entfernt. Bezüglich der Paravasatdetektion war die Sensitivität des TRUS und der Zystographie identisch. Per TRUS wurden
2 falsch-positive Befunde erhoben.
SchlussfolgerungDie Anastomosenkontrolle nach radikaler Prostatektomie kann aufgrund gleicher Sensitivität mittels TRUS statt einer Zystographie
durchgeführt werden.
ObjectiveWe determined if transrectal ultrasound (TRUS) is as reliable as cystography in detecting vesicourethral extravasates after
radical retropubic prostatectomy (RRP).
Patients and methodsBetween October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesicourethral
anastomosis was proven 6days after operation by a combined investigation with TRUS and cystography.
ResultsIn the majority of patients (79%) the vesicourethral anastomosis was watertight on postoperative day 6 (POD) or showed minimal
leakage (8%) so that the urinary catheter was removed. Different degrees of paravasates were detected in 21 patients. Because
of small, moderate, or marked paravasations the indwelling catheter was removed on POD 9, 14, and 21 in 5, 3, and 5 patients,
respectively. Every paravasate documented by cystography had been detected by TRUS before. Therefore, TRUS showed no false-negative
result in detecting insufficient anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking anastomotic
paravasation, without confirmation by cystography.
ConclusionsTRUS can safely replace cystography to detect anastomotic leakage after radical prostatectomy.
Der Urologe 04/2012; 46(9):1112-1117. · 0.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In 2002 the ten Martin criteria were proposed which should be met when reporting complications following surgery. Only a few studies have evaluated complication rates after open retropubic radical prostatectomy using these criteria. In this study we report on complications of open retropubic radical prostatectomy using the standardized Clavien-Dindo reporting methodology.
The overall complication rate was 28.6% (907 of 3,172). We registered 1,069 medical or surgical complications in 907 patients. Of these, 714 complications were grade I (66.8%), 195 grade II (18.2%), 139 grade III (13%), and 17 grade IV (1.6%), respectively. The mortality rate (grade V) was 0.1% (4 of 3,172). Older age (hazard ratio 1.049, p=0.023) and a performed lymphadenectomy (hazard ratio 1.804, p=0.024) were independent predictors for high-grade complications (grade III or greater) on multivariate analysis.
Between 08/2003 and 06/2010 complications of 3172 consecutive men who underwent open retropubic radical prostatectomy at a single center were recorded prospectively. Complications which occurred within a period of 30 days postoperatively were graded retrospectively according to the Clavien-Dindo classification. Clinical and histopathological risk factors were statistically evaluated for an association with complication grades. All 10 Martin criteria were fulfilled.
Using the Clavien-Dindo classification as a standardized reporting methodology, we observed an acceptable overall complication rate of 28.6%. In the majority (85% of all complications) lower grade complications occurred. In this series older age and a lymphadenectomy were risk factors for high-grade complications (III-V). A patient's age remains an important factor when considering the indication for radical prostatectomy.
Der Urologe 07/2011; 50(11):1403-11. · 0.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We determined if transrectal ultrasound (TRUS) is as reliable as cystography in detecting vesicourethral extravasates after radical retropubic prostatectomy (RRP).
Between October 2005 and February 2006 we prospectively investigated 100 consecutive patients undergoing RRP. The vesicourethral anastomosis was proven 6 days after operation by a combined investigation with TRUS and cystography.
In the majority of patients (79%) the vesicourethral anastomosis was watertight on postoperative day 6 (POD) or showed minimal leakage (8%) so that the urinary catheter was removed. Different degrees of paravasates were detected in 21 patients. Because of small, moderate, or marked paravasations the indwelling catheter was removed on POD 9, 14, and 21 in 5, 3, and 5 patients, respectively. Every paravasate documented by cystography had been detected by TRUS before. Therefore, TRUS showed no false-negative result in detecting insufficient anastomosis. In two patients paraurethral fluid was detected by TRUS mimicking anastomotic paravasation, without confirmation by cystography.
TRUS can safely replace cystography to detect anastomotic leakage after radical prostatectomy.
Der Urologe 10/2007; 46(9):1112-7. · 0.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The golden standard for diagnosis of prostate cancer is transrectal ultrasound-guided systematic biopsy (TRUS-Bx). The optimal number of cylinders, sampling design, and indications for repeat biopsy are still in a state of flux. At the beginning of the 1980s, considerable doubts persisted regarding the benefit of ultrasound-guided punch biopsy for the diagnosis of prostate cancer. The examination on a chair with a fixed ultrasound head caused the patient substantial discomfort. Besides, in the pre-PSA era, most prostate carcinomas were detected by palpation and digitally guided biopsies were easily obtained. Indeed, the DRU procedure alone exhibited low sensitivity. Keetch et al. found that in only 25% of patients with abnormal palpatory findings and PSA between 4 and 20 ng/ml was a carcinoma revealed upon biopsy. On the other hand, patients with suspicious palpatory findings and proven malignancy suffered more frequently from locally advanced and systemic metastasizing tumors. As a result of restaging based on PSA, in most series more than half of the detected carcinomas presented normal palpatory findings. Ultrasound examination made precise imaging of zonal structures possible and thus offered the advantage of precision guidance for tissue biopsy despite lower sensitivity and specificity for diagnosis of suspicious lesions. Furthermore, calculation of prostate volume was possible. At the end of the 1980s, Hodge defined the systematic sextant biopsy as the first golden standard for early detection of prostate cancer. This meant the systematic removal of three punch cylinders from both lateral lobes of the prostate in the parasagittal midline at various levels (apex, middle, and base).
Der Urologe 10/2003; 42(9):1188-95. · 0.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Prostate-specific antigen (PSA) is by far the most important tumor marker in urology and has revolutionized early detection, staging, treatment, and aftercare of prostate cancer [77]. Despite these merits, inadequacies have surfaced which prohibit characterizing PSA as a perfect tumor marker. First, PSA is not a marker for prostate cancer as such:benign prostate hyperplasia, prostatitis [40,69], or prostatic manipulation [66] influence serum concentrations of PSA and lead to biopsies that are costly and potentially harmful. In the entire PSA range between 4 and 10 ng/ml, the specificity at a sensitivity of 95% continues to remain unsatisfactory. Furthermore, 30-40% of all men develop prostate cancer, but only 9-11% a clinically significant tumor burden, and 2.5-4.3% of all men die from prostate cancer. The vast majority of all carcinomas are thus in significant in terms of the patient's life expectancy. PSA is incapable of differentiating these clinically insignificant carcinomas from significant ones. Finally, prevalence of prostate cancer is increasing due to higher life expectancy. On the other hand, particularly patients aged 50-70 years are the ones who develop an aggressive form of carcinoma and profit from early detection and treatment. The global term "total PSA"encompasses a heterogeneous blend of bound and free molecular forms of PSA. Complexed PSA represents the major form of total PSA. The smaller portion, free PSA, is enzymatically inactive. In addition, different isoforms of free PSA exist Recent studies provide support for clinical application of these isoforms for early detection of prostate cancer. Clinical measurement of human glandular kallikrein 2 (hK2) serves as a complementary marker to PSA for early detection of prostate cancer and constitutes a considerable improvement over PSA as a staging marker for clinically localized prostate cancer. This overview summarizes established and potentially new forms of PSA and hK2 for early detection and staging of prostate cancer.
Der Urologe 10/2003; 42(9):1172-87. · 0.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Der "golden standard" zur Diagnosestellung des Prostatakarzinoms ist die ultraschallgesteuerte transrektale systematische Biopsie (TRUS-Bx). Die optimale Anzahl der Stanzzylinder, das Entnahmemuster und die Indikationen zur Re-Biopsie befinden sich im Fluss.Zu Beginn der 80er Jahre bestanden erhebliche Zweifel am Nutzen der ultraschallgesteuerten Stanzbiopsie zur Diagnostik des Prostatakarzinoms. Die Untersuchung auf einem Stuhl mit fixiertem Ultraschallkopf bedeutete erhebliche Unannehmlichkeiten fr den Patienten. Auerdem fielen in der Pr-PSA-ra die meisten Prostatakarzinome durch eine suspekte Tastuntersuchung auf und waren somit digital gesteuert problemlos zu biopsieren. Allerdings wies die DRU alleine eine geringe Sensitivitt auf. Keetch et al. fanden, dass nur 25% der Patienten mit abnormem Tastbefund und PSA zwischen 4–20ng/ml in der Biopsie ein Karzinom aufwiesen. Andererseits waren Patienten mit einem suspekten Tastbefund und Malignomnachweis hufiger an lokal fortgeschrittenen und systemisch metastasierten Tumoren erkrankt.Die PSA-bedingte Stadienverschiebung fhrte dazu, dass in den meisten Serien mehr als die Hlfte aller entdeckten Karzinome einen normalen Tastbefund aufwiesen. Der Ultraschall ermglichte eine przise Darstellung der zonalen Gliederung und bot so trotz geringer Sensitivitt und Spezifitt fr die Diagnosestellung suspekter Lsionen den Vorteil, Gewebeentnahmen sehr przise steuern zu knnen. Darber hinaus war eine Volumenberechnung der Prostata mglich.Hodge definierte Ende der 80er Jahre die systematische Sextantenbiopsie als den ersten "golden standard" zur Frherkennung des Prostatakarzinoms. Diese bedeutete die systematische Entnahme von 3 Stanzzylindern aus beiden Prostataseitenlappen in der Mittellinie parasagittal auf verschiedenen Hhen (Apex,Mitte,Basis).The golden standard for diagnosis of prostate cancer is transrectal ultrasound-guided systematic biopsy (TRUS-Bx). The optimal number of cylinders, sampling design, and indications for repeat biopsy are still in a state of flux.At the beginning of the 1980s, considerable doubts persisted regarding the benefit of ultrasound-guided punch biopsy for the diagnosis of prostate cancer. The examination on a chair with a fixed ultrasound head caused the patient substantial discomfort. Besides, in the pre-PSA era, most prostate carcinomas were detected by palpation and digitally guided biopsies were easily obtained. Indeed, the DRU procedure alone exhibited low sensitivity. Keetch et al. found that in only 25% of patients with abnormal palpatory findings and PSA between 4 and 20ng/ml was a carcinoma revealed upon biopsy. On the other hand, patients with suspicious palpatory findings and proven malignancy suffered more frequently from locally advanced and systemic metastasizing tumors.As a result of restaging based on PSA, in most series more than half of the detected carcinomas presented normal palpatory findings. Ultrasound examination made precise imaging of zonal structures possible and thus offered the advantage of precision guidance for tissue biopsy despite lower sensitivity and specificity for diagnosis of suspicious lesions. Furthermore, calculation of prostate volume was possible.At the end of the 1980s, Hodge defined the systematic sextant biopsy as the first golden standard for early detection of prostate cancer. This meant the systematic removal of three punch cylinders from both lateral lobes of the prostate in the parasagittal midline at various levels (apex, middle, and base).
Der Urologe 08/2003; 42(9):1188-1195. · 0.50 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Die Entwicklung des prostataspezifischen Antigens (PSA) erfolgte nach bescheidenem Beginn durch Extraktion aus Seminalplasma als potentieller Marker in der Forensik ber die Identifizierung in Prostatagewebe und nachfolgend im Serum. Jedoch konnte erst die Entwicklung von Immunoassays zur Bestimmung der PSA-Konzentration im Serum das einzigartige Potential des PSA in der Behandlung des Prostatakarzinoms offenbaren. Heute ist das PSA der mit Abstand wichtigste Tumormarker in der Urologie, wenn nicht in der gesamten Onkologie und hat Frherkennung, Staging, Behandlung und Nachsorge des Prostatakarzinoms in jeder Beziehung revolutioniert.Trotz dieser Verdienste des PSA treten dessen Unzulnglichkeiten immer deutlicher zutage, die dem PSA das Charakteristikum eines perfekten Tumormarkers verbieten. Erstens ist PSA—trotz hoher Organspezifitt—kein Marker fr Prostatakarzinome: benigne Prostatahyperplasie, Prostatitis oder prostatische Manipulation beeinflussen die PSA-Serumkonzentration und fhren zu einer hohen Anzahl kostspieliger und potentiell morbidittsbehafteten Biopsien. Weiterhin ist im Gesamt-PSA-Bereich zwischen 4 und 10ng/ml bei einer erforderlichen Sensitivitt von 95% die Spezifitt des PSA nicht zufriedenstellend. Darber hinaus—ein einmaliges Charakteristikum des Prostata-Ca—entwickeln zwar 30–40% aller Mnner ein Prostatakarzinom, jedoch nur 9–11% eine klinisch signifikante Tumorlast und noch weniger (2,5–4,3% aller Mnner) versterben an einem Prostatakarzinom. Mit anderen Worten sind der berwiegende Teil aller Karzinome fr die Lebenserwartung des Betroffenen ohne Bedeutung und mssen daher u.U. weder diagnostiziert, noch behandelt werden. Das PSA ist nicht in der Lage, diese sog. klinisch nichtsignifikanten von den signifikanten Karzinomen zu unterscheiden. Schlielich steigt die Prvalenz des Prostatakarzinoms durch die hhere Lebenserwartung jenseits der 7. Dekade an. Andererseits sind es v.a. die Patienten im Alter von 50–70Jahren, die ein aggressiv wachsendes Karzinom entwickeln und von frh eingeleiteter invasiver Diagnostik und Therapie profitieren werden.Was generell unter dem Oberbegriff "Gesamt-PSA" subsummiert wird, ist in Wirklichkeit eine komplexe, in der Zusammensetzung der einzelnen Subformen heterogene Mischung aus gebundenen und freien molekularen PSA-Formen. Komplexiertes PSA (cPSA) stellt die dominierende Variante des Gesamt-PSA dar, hiervon besteht wiederum der grte Teil (ca 98%) aus PSA in 1/1 molarem Verhltnis kovalent an 1-Antichymotrypsin gebunden (ACT-PSA). Der kleinere Anteil, das freie PSA (fPSA) im Serum, ist enzymatisch inaktiv ohne mit dem berschuss an Antiproteasen im Serum zu reagieren. Darber hinaus existieren verschiedene Isoformen des fPSA, die spezifisch im Serum bestimmt werden knnen. Neuere Studien untersttzen die Hypothese einer klinischen Verwendung dieser Isoformen des fPSA in der Frherkennung des Prostatakarzinoms.Die klinische Evaluierung des humanen glandulren Kallikrein2 (hK2) untersttzt eine dem PSA komplementre Rolle in der Frherkennung des Prostatakarzinoms und als Stagingserummarker fr das klinisch lokalisierte Prostatakarzinom eine signifikante Verbesserung gegenber dem PSA.In dieser bersicht werden die etablierten und potentiell neuen PSA-Varianten und das hK2 fr Diagnostik und Staging des Prostatakarzinoms zusammengefasst.It was a modest beginning of the unique career of PSA when Hara et al. extracted a protein from human seminal fluid and proposed it to serve as a forensic tool followed by purification from prostate tissue, and subsequently in serum. However, only due to the development of immunoassays for detection of PSA in blood has the unique potential of PSA as a marker for prostate cancer become evident. Today, as a tumor marker, PSA has outperformed any other urologic marker and, as enthusiastically stated by others, any other tumor marker in oncology.Nowadays, we are challenged by limitations of PSA, which fail to make it an ideal marker for the detection of prostate cancer. First, despite a high degree of organ specificity, PSA is not a true prostate cancer marker. Benign prostatic hyperplasia, inflammation, and other conditions also increase serum concentrations of PSA leading to a substantial number of unnecessary and costly invasive diagnostic procedures. Second, unique to prostate cancer, about 9–11% of men will develop clinically manifest disease in their lifetime and about 2.6–4.3% will actually die of the disease. In other words, about 30–40% of cancers have direct impact on the life span of the affected men, hence may not need to be detected. PSA fails to discriminate between these clinically insignificant and significant cancers. Finally, the prevalence of prostate cancer is increasing due to a demographic shift to longevity; however, typically younger men carry aggressive prostate cancer with a high potential for progression to metastases and an urgent need for treatment.What is generally summarized under the global term "total immunoreactive PSA" or simply "PSA" is in fact a heterogeneous blend of different complexed and free molecular forms of PSA. Complexed PSA contributes the major proportion of total PSA, a stable covalent complex of PSA linked to alpha-1-antichymotrypsin (PSA-ACT) and constitutes the vast majority (98%) of the immunodetected PSA complexes, whereas free PSA is inert and unable to interact with the large excess of antiproteases in blood. Moreover, there is evidence that the free PSA forms consist of several subfractions and there are now increasing data reported that selective measurements of at least some of these free PSA subfractions may further enhance discrimination of benign from malignant prostatic diseases.Clinical evaluation of hK2 showed promising results as a complementary marker to PSA to improve sensitivity and specificity of PCA detection and preliminary superior results as a staging marker for clinically localized PCA. It may be concluded that further evaluation of hK2 might improve the armamentarium for better management of prostate cancer.In this chapter, we will describe clinically established and potentially valuable forms of PSA and human glandular kallikrein 2 for early detection and staging of prostate cancer.
Der Urologe 08/2003; 42(9):1172-1187. · 0.50 Impact Factor
-
M Graefen,
H Augustin,
P I Karakiewicz,
P G Hammerer,
A Haese, J Palisaar,
S Fernandez,
J Noldus,
A Erbersdobler,
I Cagiannos,
P T Scardino,
M W Kattan,
H Huland
[show abstract]
[hide abstract]
ABSTRACT: In patients suffering from prostate cancer, preoperative nomograms, which predict the risk of recurrence may provide a helpful tool in regard to the counselling and planning of an appropriate therapy. The best known nomograms were published by the Baylor College of Medicine, Houston and the Harvard Medical School, Boston. We investigated these nomograms derived in the U.S. when applied to German patients. Data from 1003 patients who underwent radical prostatectomy at the University-Hospital Hamburg were used for validation. Nomogram predictions of the probability for 2-years (Harvard nomogram) and 5-years (Kattan nomogram) freedom from PSA recurrence were compared with actual follow-up recurrence data using areas under the receiver-operating-characteristic curves (AUC). The recurrence free survival after 2 and 5 years was 78% and 58%, respectively. The AUC of the Harvard nomogram predicting 2-years probability of freedom from PSA recurrence was 0.80 vs. Kattan-Nomogram 5-years prediction of 0.83. Thereby, the Kattan nomogram showed a significant higher predictive accuracy (p=0.0274). For that reason preoperative nomograms derived in the U.S. can be applied to german patients. However, we would recommend the utilization of the Kattan nomogram due to its higher predictive accuracy.
Der Urologe 06/2003; 42(5):685-92. · 0.50 Impact Factor
-
M. Graefen,
H. Augustin,
P. Karakiewicz,
P. Hammerer,
A. Haese, J. Palisaar,
S. Fernandez,
J. Noldus,
A. Erbersdobler,
I. Cagiannos,
P. Scardino,
M. Kattan,
H. Huland
[show abstract]
[hide abstract]
ABSTRACT: Zusammenfassung Properative Nomogramme zur Vorhersage der Rezidivwahrscheinlichkeit ermglichen eine gezielte Therapieplanung und Beratung eines an Prostatakrebs erkrankten Patienten. Die bekanntesten Nomogramme wurden vom Baylor College of Medicine, Houston sowie der Harvard-Universitt in Boston publiziert. Wir untersuchten, ob diese in den USA entwickelten Nomogramme auf deutsche Patienten bertragbar sind. Daten von 1003 in der Universittsklinik Hamburg-Eppendorf radikal prostatektomierten Patienten wurden zur Validierung benutzt. Die durch das Nomogramm vorhergesagte Wahrscheinlichkeit des PSA-rezidiv-freien berlebens zum 2-Jahreszeitpunkt (Harvard-Nomogramm) bzw. 5-Jahreszeitpunkt (Kattan-Nomogramm) wurde mit dem tatschlichen rezidivfreien berleben anhand der Flche (AUC) unter einer "receiver-operator-characteristic-curve" verglichen. Die rezidivfreie berlebensrate nach 2 bzw. 5 Jahren betrug 78% bzw. 58%. Die AUC fr das Harvard-Nomogramm betrug zum 2-Jahreszeitpunkt 0,80, jene fr das Kattan-Nomogramm zum 5-Jahreszeitpunkt 0,83. Dabei erreichte das Kattan-Nomogramm eine signifikant hhere prdiktive Genauigkeit (p<0,01). In den USA entwickelte Nomogramme knnen somit auch auf deutsche Patienten bertragen werden, wobei die Anwendung des Kattan-Nomogramms auf Grund der hheren Vorhersagegenauigkeit empfohlen wird. Abstract In patients suffering from prostate cancer, preoperative nomograms, which predict the risk of recurrence may provide a helpful tool in regard to the counselling and planning of an appropriate therapy. The best known nomograms were published by the Baylor College of Medicine, Houston and the Harvard Medical School, Boston. We investigated these nomograms derived in the U.S. when applied to German patients. Data from 1003 patients who underwent radical prostatectomy at the University-Hospital Hamburg were used for validation. Nomogram predictions of the probability for 2-years (Harvard nomogram) and 5-years (Kattan nomogram) freedom from PSA recurrence were compared with actual follow-up recurrence data using areas under the receiver-operating-characteristic curves (AUC). The recurrence free survival after 2 and 5 years was 78% and 58%, respectively. The AUC of the Harvard nomogram predicting 2-years probability of freedom from PSA recurrence was 0.80 vs. Kattan-Nomogram 5-years prediction of 0.83. Thereby, the Kattan nomogram showed a significant higher predictive accuracy (p=0.0274). For that reason preoperative nomograms derived in the U.S. can be applied to german patients. However, we would recommend the utilization of the Kattan nomogram due to its higher predictive accuracy.
Der Urologe 04/2003; 42(5):685-692. · 0.50 Impact Factor
-
Der Onkologe 09/2002; 8(10):1072-1079. · 0.17 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Prostate carcinomas located in the transition zone are suspected to behave differently from the more frequent peripheral zone cancers. In this study, large transition zone prostate cancers were investigated for pathological and clinical features. From 365 consecutive radical prostatectomy specimens, 73 cases were disclosed with tumours larger than 10 cm(3). Of these, 14 were predominantly (>70% tumour area) located in the transition zone. Pathological investigations included a complete histological work-up, immunohistochemistry for p53 and bcl-2, and interphase cytogenetics for chromosomes 7, 8, 17, and X. Despite large tumour volumes and high preoperative prostate specific antigen (PSA)-values, most tumours showed quite favourable pathological features. Only two of these patients suffered from a postoperative PSA-recurrence during a median follow-up of 50 months. For comparison, 36 cases that contained tumours predominantly located in the peripheral zone mostly displayed adverse prognostic signs and 68.8% of these patients suffered from postoperative PSA-recurrence. We conclude that the peculiar pathological and clinical characteristics of large prostate cancers in the transition zone might be important for prognostic considerations.
Prostate Cancer and Prostatic Diseases 01/2002; 5(4):279-84. · 2.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was the longitudinal comparison of % f-PSA in patients before radical prostatectomy and after PSA relapse. Is % f-PSA a consistent tumor specific parameter or does this ratio change during untreated tumor progression?
In this study 41 out of 420 patients with untreated increasing PSA-progression (> 0.5 ng/ml) were analysed. Patients with neoadjuvant or adjuvant hormonal therapy were excluded. T-PSA were f-PSA were analyzed by Immulite DPC (Diagnostic Products Coop., CA) and Abbott Axsym (Abbott Park, Il, USA).
Pre-operative % f-PSA ratio was 10.6% (range 4.6-22%; Std. dev.: 4.9); T-PSA concentration was 26.4 ng/ml (range 5.5-10.2 ng/ml Std. dev.: 20.3). In men with PSA relapse after radical prostatectomy % f-PSA ratio was 14.73% (range 2.2-4.5% Std. dev.: 9.7). Repeated post-operative % f-PSA measurements resulted in 12.94% f-PSA (range 2.7-3.8% Std. dev.: 9.9%) with a regression of R = 0.57. All men with pre-operative elevated % f-PSA (> 15%) had post-operative elevated % f-PSA.
The data indicates that post-operative % f-PSA is a constant tumor specific parameter in men with untreated PSA relapse after radical prostatectomy. Post-operative % f-PSA was higher compared with pre-operative % f-PSA concentrations. No correlation with Gleason score or pathological stage was found.
Anticancer research 20(6D):5253-5. · 1.73 Impact Factor
