represents an independent predictor of CSM, and whether HS adds to the ability of other variables to predict CSM. The covariates comprised age, year of surgery, T stage, nodal status, M stage and Fuhrman grade. RESULTSIn a multivariable model predicting CSM, HS was an independent predictor ( P = 0.03), but failed to improve the accuracy of the model ( + 0.1% gain when HS was included in the model). CONCLUSIONAlthough we confirmed that HS is an independent predictor for CSM, there was no gain in accuracy when HS was added to standard predictors of CSM. From a practical perspective, this implies that patients with clear cell, papillary and chromophobe HS share similar natural histories after nephrectomy, provided that other cancer characteristics are accounted for. From a statistical perspective, in multivariable models of CSM, the clear cell, papillary and chromophobe HS might be included as a single entity.

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after RP. Multivariate models were complemented with SV to test its independent and multivariate statistical significance and to quantify its impact on the model's overall (and 200 bootstrap-corrected) predictive accuracy. RESULTSThe mean (range) SV was 201 (1-1293) RPs; the mean (median, range) rate of PSM was 20.2 (21.4, 0-32.9)%. In multivariate models, SV was a highly statistically significant independent predictor of PSM ( P < 0.001) and increased the predictive accuracy in multivariate models both before (2.0%) and after RP (1.5%, both P < 0.001). However, when the surgeon with the highest SV, who contributed to 1293 cases, was removed from the analyses, the multivariate independent prediction and the gains in predictive accuracy related to adding SV, disappeared in the models both before ( P = 0.9, accuracy gain 0.1%) and after ( P = 0.4, accuracy gain − 0.3%) RP. CONCLUSIONSThese results indicate that patients treated by surgeons with a very high volume can expect to have a significantly lower rate of PSM, after accounting for clinical and pathological casemix differences. However, SV is not a predictor of PSM when analyses are restricted to intermediate-and low-volume surgeons. KEYWORDSsurgical volume, positive surgical margins, radical prostatectomy OBJECTIVETo assess the association between surgical volume (SV) and the rate of positive surgical margins (PSM) after radical prostatectomy (RP) in a large single-institution European cohort of patients. PATIENTS AND METHODSIn all, 2402 men had a RP by a group of 11 surgeons, all of whom were trained by the surgeon with the highest SV; all surgeons used the same surgical technique. Variables assessed before RP were prostate-specific antigen (PSA) level, clinical stage and biopsy Gleason sum; variables assessed after RP were PSA level, extracapsular extension, seminal vesicle invasion, lymph node invasion and pathological Gleason sum. These were used to predict the rate of PSM in models before or

BACKGROUND: Relative to radical nephrectomy (RN), partial nephrectomy (PN) performed for renal cell carcinoma (RCC) may protect from non‐cancer‐related deaths. The authors tested this hypothesis in a cohort of PN and RN patients. METHODS: The Surveillance, Epidemiology, and End Results‐9 database allowed identification of 2198 PN (22.4%) and 7611 RN (77.6%) patients treated for T1aN0M0 RCC between 1988 and 2004. Analyses matched for age, year of surgery, tumor size, and Fuhrman grade addressed the effect of nephrectomy type (RN vs PN) on overall mortality (Cox regression models) and on non‐cancer‐related mortality (competing‐risks regression models). RESULTS: Relative to PN, RN was associated with 1.23‐fold (P = .001) increased overall mortality rate, which translated into a 4.9% and 3.1% absolute increase in mortality at 5 and 10 years after surgery, respectively. Similarly, non‐cancer‐related death rate was significantly higher after RN in competing‐risks regression models (P < .001), which translated into a 4.6% and 4.5% absolute increase in non‐cancer‐related mortality at 5 and 10 years after surgery, respectively. CONCLUSIONS: Relative to PN, RN predisposes to an increase in overall mortality and non‐cancer‐related death rate in patients with T1a RCC. In consequence, PN should be attempted whenever technically feasible. Selective referrals should be considered if PN expertise is unavailable Cancer 2009. © 2009 American Cancer Society.

Many investigators suggested that obesity predisposes to adverse prostate cancer characteristics and outcomes. We tested the effect of obesity on the rate of aggressive prostate cancer at either prostate biopsy or radical prostatectomy (RP). Clinical and pathological data were available for 1,814 men. Univariable and multivariable logistic regression models addressed the rate of high grade prostate cancer (HGPCa) at either biopsy or final pathology. Clinical stage, prostate-specific antigen (PSA), percentage of free PSA and prostate volume were the base predictors. All models were fitted with and without body mass index (BMI), which quantified obesity. BMI and its reciprocal (InvBMI) were coded as cubic splines to allow nonlinear effects. Predictive accuracy (PA) was quantified with area under curve estimates, which were subjected to 200 bootstrap resamples to reduce overfit bias. Gains in PA related to the inclusion of BMI were compared using the MantelHaenszel test. HGPCa at biopsy was detected in 562 (31%) and HGPCa at RP pathology was present in 931 (51.3%) men. In either univariable or multivariable models predicting HGPCa at biopsy, BMI or InvBMI failed to respectively reach statistical significance or add to multivariable PA (BMI gain 5 0%, p 5 1.0; InvBMI gain 5 20.2%, p 5 0.9). Conversely, in models predicting HGPCa at RP, BMI and InvBMI represented independent predictors but failed to increase PA (BMI gain 5 0.7%, p 5 0.6; InvBMI gain 5 0.5, p 5 0.7%). Obesity does not predispose to more aggressive prostate cancer at biopsy. Similarly, obesity does not change the ability to identify those who may harbor HGPCa at RP. ' 2007 Wiley-Liss, Inc.

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Purpose:The desirable outcomes after open radical prostatectomy (RP) for localized prostate cancer (PC) are to: a) achieve disease recurrence free, b) urinary continence (UC), and c) maintain sexual potency (SP). These 3 combined desirable outcomes we called it the "Trifecta". Our aim is to assess the likelihood of achieving the Trifecta, and to analyze the influencing the Trifecta . Materials and Methods: A total of 1738 men with localized PC underwent RP from 1992-2007 by a single surgeon. The exclusion criteria for this analysis were: preoperative hormonal or radiation therapy, preoperative urinary incontinence or erectile dysfunction, follow-up less than 24 months or insufficient data. Post-operative Trifecta factors were analyzed, including biochemical recurrence (BR).. We defined: BR as PSA ≥ 0.2 ng/mL, urinary continence as wearing no pads, and sexual potency as having erections sufficient for intercourse with or without a phosphodiesterase-5 inhibitor.Results: A total of 831 patients met the inclusion criteria. The mean age of the entire cohort was 59 years old. The median follow-up was 52 months (mean 60, range . The BR, UC and SP rates were 18.7%, 94.5%, and 71% respectively. Trifecta was achieved in 64% at 2 year follow-up, and 61% at 5 year follow-up. Multivariate analysis revealed age at time of surgery, pathologic Gleason score (PGS), pathologic stage, specimen weight, and nerve sparing (NS) were independent factors. Conclusions: Age at time of surgery, pathologic GS, pathologic stage, specimen weight and NS were independent predictors to achieve the Trifecta following radical prostatectomy. This information may help patients counseling undergoing radical prostatectomy for localized prostate cancer.Key words: Radical Prostatectomy; treatment outcome; prostate cancer; recurrence Int Braz J Urol. 2011; 37: 320-327 INTRODUCTIONOpen Radical prostatectomy (RP) is an effective treatment for clinically localized prostate cancer. In the era of PSA screening, patients are often diagnosed with low grade, low stage prostate cancer. Consequently, disease free survival (DFS) rates approach 90% at 5 years post TP. (1). Other approaches, like radiation therapy, provide similar DFS. Treatments with comparable DFS rates should be evaluated in terms of quality of life (QoL) including continence and erectile function, as well as cancer control.Better knowledge of pelvic anatomy, improvements in surgical technique (2), and early detection (PSA), have led to improved oncological results and reduced adverse functional outcomes (3). Full continence, erectile function, and absence of biochemical recurrence (BR) represent the Trifecta, the most desired outcomes following TP (4). BR is assessed with serial serum PSA measurements. However, QoL outcomes being subjective in nature are tabulated as an objective endpoint. Although the methodology of assessing the outcome is critical, there are no universally accepted guidelines for Several endpoints have been used to evaluate postoperative UC. The rates following RP var...