Pathology

Abstract

370Urological Survey names, correctly (I believe) determined that most severely injured kidneys healed without the need for surgery. Even 6 patients with gunshot wound were given a trial of conservative therapy -all of them successfully. Only those who where actively bleeding to death (in the estimation of the attending general surgeon) had renal surgery, and that was a speedy nephrectomy in all cases. In this way, these surgeons have turned classic urologic trauma teaching on its head, reducing the operative rate over that reported in previous urologic series, and most importantly decreasing the rate of nephrectomy towards 0% for Grade I-IV injuries. This series mirrors the general trend towards conservative therapy in trauma, and reports like it must be closely followed by anyone with an interest in treating renal injury. Less is turning out to be more in the field of renal trauma. While it takes more courage to observe the patient than go to the operating room, it may ultimately turn out to be the best treatment in the majority of patients. The capacity of perineural invasion by carcinoma in prostate needle biopsy tissue to independently predict pathologic stage in radical prostatectomy tissues remains uncertain. We sought to determine, in a prostate specific antigen-based screening population, the ability of needle biopsy histologic grade, tumor extent, and perineural invasion to independently predict pathologic stage and margin status in the whole prostate gland. Perineural invasion, Gleason grade, percentage Gleason pattern 4/5 carcinoma, and multiple measures of needle biopsy tumor extent, including number of positive cores, percentage of positive cores, total percentage of carcinoma, greatest percentage of carcinoma in a single core, and total carcinoma length in millimeters, were captured for 215 men from a prostate specific antigen-based screening program diagnosed with prostate cancer in a median of six procured needle biopsy cores. Pathologic stage and surgical margin status were evaluated in corresponding completely embedded radical prostatectomy specimens. A logistic regression model was used to relate the endpoints of extraprostatic extension by carcinoma and/or positive margins to needle biopsy tissue findings. In univariate analyses, total percentage of carcinoma (p = 0.003), greatest percentage of carcinoma in a single core (p = 0.004), total tumor length in millimeters (p = 0.009), and fraction of positive cores (p = 0.02) were all significantly associated with extraprostatic (pT3) carcinoma, whereas all five measures of carcinoma extent in needle biopsy tissue were related to positive margins. Correlation coefficient determinations showed that all five measures of needle biopsy carcinoma extent were highly interrelated. In multivariate analyses, total percentage of carcinoma was significantly related to pathologic T stage (p = 0.003) and positive margins (p = 0.0002). In a multivariate model with the radical prostatectomy whole gland endpoint of either pT3 disease or positive margins, fractio...