Background. The authors assessed the interest and the value of Fuhrman's nuclear grade as a possible prognostic factor for renal cell carcinoma (RCC). Methods. An 11‐year retrospective study of 190 patients with RCC treated by radical nephrectomy was performed. The distribution by grade was: Grade I, 54 patients; Grade II, 58; Grade III, 58; and Grade IV, 20. The distribution of the patients by tumor stage according to the TNM15 classification was: pT1, 56 patients; pT2, 41; pT3a, 55; pT3b, 25; pT3c + pT3d + pT4b, 5; and pT4a, 8. Significant correlations with other prognostic parameters were noted. Survival curves by grade were evaluated by the Kaplan‐Meier method. Results. Nuclear grade was correlated with tumor stage (P = 0.0001), synchronous metastases (P = 0.003), lymph node involvement (P = 0.0001), renal vein involvement (P = 0.0001), tumor size (P = 0.0001), and perirenal fat involvement (P = 0.001). No correlation was found between nuclear grade and tumor multicentricity (P = 0.14) and cell type (P = 0.2). Nuclear grade was an effective parameter in predicting development of distant metastases after nephrectomy. Among the 54 patients who presented with Grade I tumors, only one tumor did metastasize during the 5‐year follow‐up, whereas 17% of the Grade III and 30% of the Grade IV tumors metastasized. The 5‐year actuarial survival rates of the patients with Grade I, II, III, and IV tumors was 76%, 72%, 51%, and 35%, respectively. The comparison of the survival curves by grade showed a statistically significant difference between the curves when Grade I and II tumors were compared with Grade III and IV tumors (P = 0.001). Conclusion. In this study, nuclear grade was found to have prognostic significance and seems to be an important criterion when considering the outcome of patients with RCC.
Study Type – Therapy (individual cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Seminal vesicle invasion in prostate cancer has a poor prognosis. Nowadays, there is no consensus about the best adjuvant treatment after radical prostatectomy when seminal vesicle invasion is observed in the specimen. To our knowledge, this is the first comparative study between different adjuvant treatments after radical prostatectomy when seminal vesicle invasion is observed in the specimen. OBJECTIVE • To evaluate the biochemical‐failure free survival according to different adjuvant treatments in patients who underwent radical prostatectomy (RP) with seminal vesicle invasion (SVI). PATIENTS AND METHODS • Between 1994 and 2008, 4090 men underwent RP in nine centres. Of these, 310 men had a SVI. • Exclusion criteria were: detectable postoperative prostate‐specific antigen, lymph node metastases and follow‐up <18 months. • Therefore, the study group included 199 patients. Of these, 41 received adjuvant radiotherapy (RT) only, 26 received adjuvant androgen deprivation therapy (ADT) only, 50 received adjuvant ADT combined with RT and 82 were monitored. The endpoint for this analysis was biochemical no evidence of disease (bNED). • Preoperative prostate‐specific antigen level, specimen Gleason score, age, clinical stage, surgical margin status and adjuvant treatment were evaluated in a multivariable analysis with respect to bNED survival. RESULTS • After a mean (range) follow‐up of 60.3 (18–185) months, 88 (44.2%) patients had a biochemical relapse. • The estimated 5‐ and 7‐year bNED survival were 32.6% and 25.9% for the observation group, 44.4% and 28.6% for the RT only group, 48.4% and 32.3% for the ADT only group and 82.8% and 62.1% for the adjuvant ADT combined with RT group. • On multivariate analysis, only adjuvant ADT combined with RT (P < 0.001) was an independent prognostic factor of biochemical relapse. CONCLUSIONS • RP appeared to be insufficient as a single treatment for patients with SVI. • The findings of the present study suggest that adjuvant ADT combined with RT after RP for patients with SVI confers a substantial benefit on 5‐year bNED survival.
A total of 71 patients with clinically localized prostatic cancer underwent preoperative biopsy of each seminal vesicle. Group 1 (67 patients) underwent 2 seminal vesicle biopsies before lymph node dissection and vesiculo-prostatectomy, while group 2 (4 patients) underwent seminal vesicle biopsy and lymph node dissection before radiation therapy. In group 1 there were 11 positive biopsies (16.5%) with a median prostate specific antigen (PSA) level of 24 ng./ml. (range 11 to 45). Of the biopsies 56 were normal, with a median PSA level of 11.8 (range 3.5 to 88, p < 0.008). Histological examination of the seminal vesicles on the prostatectomy specimen revealed 18 cases of seminal vesicle invasion (sensitivity 61%, specificity 100%, positive predictive value 100% and negative predictive value 87.5%). A positive biopsy was correlated with the mean tumor volume (10.3 cc with positive biopsies versus 4.9 cc with negative biopsies) and local invasion (positive margins in 36% versus 9%, respectively, and capsular perforation in 81% versus 25%, respectively). In group 2 the 4 seminal vesicle biopsies and lymph node dissections were positive. Overall (groups 1 and 2), positive seminal vesicle biopsies were predictive of lymph node involvement in 47% of the cases versus 7% when biopsies were negative (p > 0.001). The postoperative course was significantly different (local recurrence and metastases in 45% versus 9%, respectively, and median interval 8.8 months versus 18.3 months, respectively, p < 0.001). Seminal vesicle biopsy appears to have a satisfactory yield only in cases with a PSA level of greater than 10 ng./ml. A positive seminal vesicle biopsy confirms the presence of extraprostatic invasion of clinically localized cancer in a given patient. Seminal vesicle biopsy allows for better staging of prostatic cancer.
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