to identify preoperative predictors of PSMs and BCR. The estimated 5-year risk of BCR was calculated using the Kaplan-Meier method.
RESULTSIn all, 128 (9.8%) men had one or more PSMs. The mean body mass index, mean preoperative serum PSA level, the distributions of clinical stage and biopsy Gleason scores, and the presence or absence of biopsy perineural invasion were significantly different between men with or with no PSMs. In multivariate analysis, baseline serum PSA level, Gleason score and perineural invasion were independent preoperative predictors of PSMs. The 5-year actuarial BCR rates were dependent on the site of the PSM ( P = 0.035) and not the number of PSMs ( P = 0.18). The rank order of estimated 5-year BCR rates according to the site of PSMs were base > anterior > posterolateral > apex ≈ posterior.
CONCLUSIONSAbout half of the men with PSMs in the RP surgical specimen in our prospective series did not develop BCR. The risk of BCR was dependent on the site and not the number of PSMs. Adjuvant therapy should be considered in cases with anterior and basilar PSMs due to the very high risk of BCR.
A warm ischemia time of 40 minutes appears to be an appropriate cutoff, after which a significantly greater decrease in renal function occurs after laparoscopic partial nephrectomy. The preoperative glomerular filtration rate was the only independent predictor of an increased risk of renal insufficiency following laparoscopic partial nephrectomy.
This paper reviews the current literature on both the pathophysiology and treatment options for ureteropelvic junction obstruction (UPJO). A medical literature search using Pubmed/Medline that addressed both the pathophysiology of UPJO and the different treatment options for the adult and pediatric population with UPJO was performed. The pathophysiology of UPJO is still unknown but appears to be multifactorial. Perhaps future molecular studies will give us an answer to the etiology and also a pathway in preventing UPJO. Treatment options have been studied in-depth, and the gold standard is open pyeloplasty. In both the pediatric and adult population, laparoscopic or robotic pyeloplasty has similar success rates to open pyeloplasty with the benefits of minimally invasive surgery. In the pediatric population, however, further studies need to be done. Endopyelotomy also has a role in the treatment of UPJO but should have strict selection criteria.
Purpose:To evaluate the safety and efficacy of oral Apatone ® (Vitamin C and Vitamin K 3 ) administration in the treatment of prostate cancer in patients who failed standard therapy. Materials and Methods: Seventeen patients with 2 successive rises in PSA after failure of standard local therapy were treated with (5,000 mg of VC and 50 mg of VK 3 each day) for a period of 12 weeks. Prostate Specific Antigen (PSA) levels, PSA velocity (PSAV) and PSA doubling times (PSADT) were calculated before and during treatment at 6 week intervals. Following the initial 12 week trial, 15 of 17 patients opted to continue treatment for an additional period ranging from 6 to 24 months. PSA values were followed for these patients. Results: At the conclusion of the 12 week treatment period, PSAV decreased and PSADT increased in 13 of 17 patients (p ≤ 0.05). There were no dose-limiting adverse effects. Of the 15 patients who continued on Apatone after 12 weeks, only 1 death occurred after 14 months of treatment. Conclusion: Apatone showed promise in delaying biochemical progression in this group of end stage prostate cancer patients.
invasion (PNI), prostate volume, number of positive cores, and percentage of positive cores. Final surgical pathology was evaluated for unilateral cancer. Univariate analysis was used (logistic regression method) to identify independent predictors of unilateral disease on the RP specimen. A subset analysis was done in men with low-risk disease, defined as clinical stage T1C, Gleason score < 7 and a PSA level of < 10 ng/mL.
RESULTSOf 590 men with unilateral disease on biopsy, 163 (27.3%) had unilateral disease on the RP specimen. Pathological features, including HGPIN ( P = 0.714), Gleason score ( P > 0.608), PNI ( P = 0.714), number of positive cores ( P = 0.076), percentage of cores positive ( P = 0.056), prostate volume ( P = 0.285), and PSA level ( P = 0.062) did not improve the prediction of unilateral disease.When men with unilateral cancer were further stratified to include only those with low-risk disease, 28.4% had unilateral disease on the RP specimen. None of the biopsy or clinical features evaluated were predictors of unilateral disease on the RP specimen.
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