Whole Organ Mapping of Radical Prostatectomy Specimens

Scardino, Peter T.; Cantini, Madeline

doi:10.1016/s0022-5347(17)75633-9

Cited by 6 publications

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“…New developments in recent years provide a hope that the outcome will be improved for patients with PC. These devel opments include the following: (a) Increasing evidence of the usefulness of prostate-specific antigen (PSA) as a tumor mar ker in screening programs and in monitoring of treatment results [2]: (b) better knowledge of the anatomy of the pros tate, leading to an improved understanding of the importance of the site of origin and the volume of the tumor [4][5][6][7][8][9][10][11][12][13][14][15]; (c) improvement in transrectal ultrasound (TRUS)-related tech nology. allowing better imaging of the prostate and more accu rate biopsies and determination of the local extent of the disease [16][17][18][19][20][21][22][23][24][25][26]: (d) nerve-sparing prostatectomy, which can preserve sexual potency in more than 50% of patients [27]; (e) three-dimensional radiotherapeutic techniques, with the possi bility that the toxicity associated with radiotherapy (RT) will be decreased [28][29][30][31][32][33][34][35][36].…”

Section: Introductionmentioning

confidence: 99%

Guidelines for Defining Target Volumes in Radiation Therapy of Prostate Cancer: a Review and Perspective

et al. 1993

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No definite objective guidelines for selecting patients for pelvic nodal or seminal-vesicle irradiation exist in radical radiotherapy for prostate cancer. Developing such guidelines will aid in decreasing unnecessary irradiation of normal tissues in patients in whom involvement of pelvic nodes and seminal vesicles is unlikely. The development of objective criteria will also be of help in successful planning of dose-escalation studies with 3D conformal radiotherapy. Some recent advances are useful in the development of such guidelines. Based on whole-mount, morphometric studies from radical prostatectomy specimens, a new understanding of the zonal anatomy of the prostate has emerged. The three glandular zones are the transitional, central, and peripheral zones; the fourth zone is a nonglandular, fibromuscular one situated anteriorly. The majority of stage A tumors arise in the transitional zone, whereas stage B tumors arise from the peripheral zone. A tumor arising from the transitional or nontransitional zone usually does not cross the boundary between zones unless the tumor volume exceeds about 4 cm3. The tumor volume influences the following: (a) formation of pelvic nodal me-tastases; (b) seminal-vesicle involvement; (c) capsular extension, and (d) the extent of the Gleason pattern 4-5 component. In general, tumors smaller than 4 cm3 tend not to involve regional nodes or seminal vesicles; they have a negligible Gleason pattern 4-5 component, and this is a favorable prognostic factor. Tumor volume estimates can be obtained from transrectal ultrasound. In addition, transrectal ultrasound has significant potential in the identification of patients with gross seminal-vesicle involvement. Transrectal ultrasound slightly underestimates tumor volumes, and about 20% of tumors may not be visible sonographically, but these shortcomings can be remedied by measurement of the prostate specific antigen level. The level of this antigen, a very useful tumor marker in prostate cancer, depends on the tumor cell burden. Studies show that nodal and seminal-vesicle involvement is unlikely if the prostate specific antigen level (determined by a monoclonal antibody method) is less than 10 ng/ml, and that it is highly likely with levels above 20 ng/ml. In patients with prostate specific antigen levels between 10 and 20 ng/ml, ultrasonographic findings as well as the stage and grade of the tumor can help the radiotherapist to determine the extent of the target volume. For treatment planning, decision trees are developed based on stage, grade, tumor volume determination, and prostate specific antigen levels. A significant difference in the volumes of irradiation to the rectum and bladder with or without pelvic nodal/seminal vesicle irradiation is illustrated with dose-volume histograms. The margin around the target in the definition of the planning target (i.e., the margin from prostate to block) due to day-to-day set-up variations and physiologic movement must be about 1-2 cm. Prospective use of the objective criteria developed here ca...

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Section: Introductionmentioning

confidence: 99%

Guidelines for Defining Target Volumes in Radiation Therapy of Prostate Cancer: a Review and Perspective

et al. 1993

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The Distribution of Residual Cancer in Radical Prostatectomy Specimens in Stage a Prostate Cancer

et al. 1991

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To assess the volume and distribution of residual cancer after transurethral resection of the prostate in stage A cancer patients 42 step-sectioned radical prostatectomy specimens were examined, and the volume, location, grade and extracapsular extension of the residual tumor were recorded. A total of 13 patients had stage A1 tumors (5% or less tumor in the transurethral resection specimen and a Gleason sum of 7 or less) and 29 had stage A2 disease. Residual cancer was present in the radical prostatectomy specimen in 41 patients (98%) with a mean volume of 1.28 cc. The location of residual cancer, that is multifocal (76%), peripheral (81%) and distal to the verumontanum (66%), makes complete removal or even identification of residual tumor (restaging) by repeat transurethral resection improbable. Of the stage A1 cancer patients 4 (30%) had more than 1 cc residual tumor volume, extracapsular extension or seminal vesicle invasion. On the other hand, 14 of the stage A2 cancer patients (48%) had less than 1 cc residual tumor completely confined to the gland. Foci of residual cancer were found in the transition zone in 67% and in the peripheral zone in 90% of the patients. The grade of the residual peripheral zone cancer was significantly higher than that of the transition zone cancer in the same gland (p = 0.0004). Eight of 13 instances of extracapsular extension and all 5 of seminal vesicle invasion were directly attributable to peripheral zone cancer. These observations imply that the greatest threat to patients with stage A prostate cancer may be a separate, associated cancer in the peripheral zone rather than the primary transition zone cancer incidentally removed at transurethral resection.

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Transrectal ultrasound in management of prostate cancer

Scardino¹

1989

Urology

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Whole Organ Mapping of Radical Prostatectomy Specimens

Cited by 6 publications

References 0 publications

Guidelines for Defining Target Volumes in Radiation Therapy of Prostate Cancer: a Review and Perspective

Guidelines for Defining Target Volumes in Radiation Therapy of Prostate Cancer: a Review and Perspective

The Distribution of Residual Cancer in Radical Prostatectomy Specimens in Stage a Prostate Cancer

Transrectal ultrasound in management of prostate cancer

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