Histological and Clinical Findings in 896 Consecutive Prostates Treated Only With Radical Retropubic Prostatectomy: Epidemiologic Significance of Annual Changes

Stamey, Thomas A.; Donaldson, Ana Nora; Yemoto, Cheryl; McNeal, John E.; Sözen, Sinan; Gill, Harcharan

doi:10.1016/s0022-5347(01)62201-8

Cited by 138 publications

(77 citation statements)

References 13 publications

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“…Although positive surgical margin rates have improved, a rate of 30% is still higher than the 14 -19% reported in most other RP series (Stamey et al, 1998;Hull et al, 2002;Han et al, 2003). Although most authors have reported a reduction of the positive surgical margin rate as a reflection of improved case selection over time (Stamey et al, 1998;Han et al, 2003), others could not demonstrate this (Freedland et al, 2003).…”

Section: Discussionmentioning

confidence: 85%

“…Although most authors have reported a reduction of the positive surgical margin rate as a reflection of improved case selection over time (Stamey et al, 1998;Han et al, 2003), others could not demonstrate this (Freedland et al, 2003). It may be that English urologists still operate on larger volume cancers because screening healthy asymptomatic men (and finding asymptomatic, low volume cancers) is currently discouraged by the Department of Health.…”

Section: Discussionmentioning

confidence: 99%

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Contemporary update of cancer control after radical prostatectomy in the UK

et al. 2004

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5Bristol Royal Inf irmary, UK Despite a significant increase of the number of radical prostatectomies (RPs) to treat organ-confined prostate cancer, there is very limited documentation of its oncological outcome in the UK. Pathological stage distribution and changes of outcome have not been audited on a consistent basis. We present the results of a multicentre review of postoperative predictive variables and prostaticspecific antigen (PSA) recurrence after RP for clinically organ-confined disease. In all, 854 patient's notes were audited for staging parameters and follow-up data obtained. Patients with neoadjuvant and adjuvant treatment as well as patients with incomplete data and follow-up were excluded. Median follow-up was 52 months for the remaining 705 patients. The median PSA was 10 ng ml À1 . A large migration towards lower PSA and stage was seen. This translated into improved PSA survival rates. Overall Kaplan -Meier PSA recurrence-free survival probability at 1, 3, 5 and 8 years was 0.83, 0.69, 0.60 and 0.48, respectively. The 5-year PSA recurrence-free survival probability for PSA ranges o4, 4.1 -10, 10.1 -20 and 420 ng ml À1 was 0.82, 0.73, 0.59 and 0.20, respectively (log rank, Po0.0001). PSA recurrence-free survival probabilities for pathological Gleason grade 2 -4, 5 and 6, 7 and 8 -10 at 5 years were 0.84, 0.66, 0.55 and 0.21, respectively (log rank, Po0.0001). Similarly, 5-year PSA recurrence-free survival probabilities for pathological stages T2a, T2b, T3a, T3b and T4 were 0.82, 0.78, 0.48, 0.23 and 0.12, respectively (log rank, P ¼ 0.0012). Oncological outcome after RP has improved over time in the UK. PSA recurrence-free survival estimates are less optimistic compared to quoted survival figures in the literature. Survival figures based on pathological stage and Gleason grade may serve to counsel patients postoperatively and to stratify patients better for adjuvant treatment.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Contemporary update of cancer control after radical prostatectomy in the UK

et al. 2004

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“…With widespread screening, men are diagnosed with CaP at a younger age, exhibit lower stage disease and smaller tumors, and have lower serum PSA, Gleason score 6 or 7, and nonpalpable disease (75%) [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. While a great number of men are still diagnosed with advanced disease and approximately 25% of all CaP patients detected will recur [2,4,12], approximately 25% of men undergoing PSA testing in referral and screened populations will have well differentiated (Gleason score <7), small volume (<0.5 cc) tumors known to demonstrate a long natural history [8,9,15].…”

Section: Introductionmentioning

confidence: 99%

Using nuclear morphometry to predict the need for treatment among men with low grade, low stage prostate cancer enrolled in a program of expectant management with curative intent

Makarov¹,

Marlow²,

Epstein

et al. 2007

The Prostate

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PURPOSE-We assessed the use of quantitative clinical and pathologic information to predict which patients would eventually require treatment for prostate cancer (CaP) in an expectant management (EM) cohort.EXPERIMENTAL DESIGN-We identified 75 men having prostate cancer with favorable initial biopsy characteristics; 30 developed an unfavorable biopsy (Gleason grade >6, >2 cores with cancer, >50% of a core with cancer, or a palpable nodule) requiring treatment and 45 maintained favorable biopsies throughout a median follow-up of 2.7years. Demographic, clinical data and quantitative tissue histomorphometry determined by digital image analysis were analyzed.RESULTS-Logistic regression (LR) modeling generated a quantitative nuclear grade (QNG) signature based on the enrollment biopsy for differentiation of Favorable and Unfavorable groups using a variable LR selection criteria of P z < 0.05. The QNG signature utilized 12 nuclear morphometric descriptors (NMDs) and had an area under the receiver operator characteristic curve (ROC-AUC) of 87% with a sensitivity of 82%, specificity of 70% and accuracy of 75%. A multivariable LR model combining QNG signature with clinical and pathological variables yielded an AUC-ROC of 88% and a sensitivity of 81%, specificity of 78% and accuracy of 79%. A LR model using prostate volume, PSA density, and number of pre-diagnosis biopsies resulted in an AUC-ROC of 68% and a sensitivity of 85%, specificity of 37% and accuracy of 56%.CONCLUSIONS-QNG using EM prostate biopsies improves the predictive accuracy of LR models based on traditional clinicopathologic variables in determining which patients will ultimately develop an unfavorable biopsy. Our QNG-based model must be rigorously, prospectively validated prior to use in the clinical arena.Keywords prostate cancer; expectant management; quantitative nuclear grade; prostate biopsy; low grade and low stage cancer

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“…For example, expanded PSA testing through the 1990s has increased the percentage of men with organ confined disease. [10][11][12][13] Similarly the 10-y actuarial risk of non-PSA recurrence in a highly selected University practice has changed from 67% (1982)(1983)(1984)(1985)(1986)(1987)(1988) to 80% (1989-1991). 14 Although the significance of a nondetectable PSA following RP is well established, the exact clinical significance of a PSA recurrence is controversial.…”

Section: Discussionmentioning

confidence: 99%

Long-term outcome of detectable PSA levels after radical prostatectomy

Ahlering

Skarecky

2005

Prostate Cancer Prostatic Dis

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Detectable prostate-specific antigen levels (PSA) following radical prostatectomy (RP) are believed to represent treatment failure. In this retrospective review, we characterize long-term PSA outcomes following RP (n ¼ 204) in a nonreferral hospital performed between 1984 and 1994. With an average follow-up of 10 y, 90 (44%) patients developed a PSA recurrence: 15 (17%) died of prostate cancer despite hormonal intervention, 39 (43%) responded to hormonal therapy with stable remission and 36 (40%) were observed without intervention. Following RP many patients may have a detectable PSA that does not require treatment. PSA doubling time (o12 months) was the best predictor of disease progression.

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Histological and Clinical Findings in 896 Consecutive Prostates Treated Only With Radical Retropubic Prostatectomy: Epidemiologic Significance of Annual Changes

Cited by 138 publications

References 13 publications

Contemporary update of cancer control after radical prostatectomy in the UK

Contemporary update of cancer control after radical prostatectomy in the UK

Using nuclear morphometry to predict the need for treatment among men with low grade, low stage prostate cancer enrolled in a program of expectant management with curative intent

Long-term outcome of detectable PSA levels after radical prostatectomy

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