Race and prostate weight as independent predictors for biochemical recurrence after radical prostatectomy.

We hypothesized that factors beyond pathological stage, grade, PSA and margin status would be important predictors of biochemical recurrence (BCR) after radical prostatectomy (RP). A cohort of 3194 patients who underwent RP between 1988 and 2007 and who had neither neoadjuvant therapy nor postoperative adjuvant hormonal therapy was retrieved from the Duke Prostate Center database. Age, prostate-specific antigen (PSA), pathological Gleason score (pG), lymph node status, seminal vesicle invasion (SVI), extracapsular extension (ECE), positive surgical margin (PSM) status, year of surgery, race, adjuvant radiation therapy (XRT), percent tumor involvement in the RP specimen and prostate weight were evaluated as possible predictors of BCR in multivariate Cox regression analysis.

Trainees do not negatively impact the institutional learning curve for robotic prostatectomy as characterized by operative time, estimated blood loss, and positive surgical margin rate.

Objectives: We evaluated the learning curves and perioperative outcomes of an experienced laparoscopic surgeon and his trainees to assess our structured teaching program.

Methods: We retrieved 383 patients undergoing robot-assisted laparoscopic prostatectomy (RALP) from our database. Trainees completed a structured teaching program and were categorized as early (days 0 to 232), mid (days 566 to 797), and late (days 825 to 1218) according to the time period in which they were working with the mentor.

Significant discrepancies between diagnostic and pathologic Gleason sums in prostate cancer: the predictive role of age and prostate-specific antigen.

Objectives: To assess the discrepancies between diagnostic and pathologic Gleason sums and the predictive role of age and prostate-specific antigen (PSA) level on Gleason sum discrepancies.

Methods: A total of 2963 patients receiving radical prostatectomy at Duke University from 1988 to 2006 were divided into two groups according to year of diagnosis: 1988 to 1999 and 2000 to 2006. The Gleason sum discrepancies were evaluated in the above groups.

Comparison of prostate-specific antigen recurrence-free survival in a contemporary cohort of patients undergoing either radical retropubic or robot-assisted laparoscopic radical prostatectomy.

Objectives: To compare the prostate-specific antigen (PSA) recurrence (PSAR) rates in patients undergoing robot-assisted laparoscopic radical prostatectomy (RALP) or radical retropubic prostatectomy (RRP).

Patients And Methods: Data from 797 consecutive patients who had RALP or RRP between August 2003 and January 2007 were retrieved from our database. Age, race, body mass index, PSA level, estimated blood loss (EBL), clinical and pathological stage, biopsy and pathological Gleason score, lymph node involvement, positive surgical margin (PSM) status, and prostate weight were compared between the groups.

Can prostate-specific antigen and prostate-specific antigen velocity be used for prostate cancer screening in men older than 70 years?

Objectives: We evaluated the lower threshold of prostate-specific antigen (PSA) and prostate-specific antigen velocity (PSAV) in a population of men over 70 years of age.

Methods: Between January 1988 and December 2005, 4038 men over 70 years of age including 605 African-American (AA) men and 3433 non-AA men from the Duke Prostate Center Outcomes database had determination of serum PSA and PSAV. We used receiver operating characteristic (ROC) curves to display the data graphically.

Use of local (111)in-capromab pendetide scan results to predict outcome after salvage radiotherapy for prostate cancer.

Purpose: The (111)In-capromab pendetide scan (ProstaScint; Cytogen Corp., Princeton NJ) is approved by the Food and Drug Administration to evaluate increasing prostate-specific antigen (PSA) levels after radical prostatectomy. This study evaluated the role of prostate bed (111)In-capromab pendetide scan findings to predict response to salvage radiotherapy (RT).

Prostate cancer in the Baby Boomer generation: results from CaPSURE.

Objectives: Baby Boomers (those born in 1946 to 1964) are thought to place a high value on quality of life, and have a higher propensity to consume healthcare services than previous generations. We sought to characterize prostate cancer (CaP) presentation among this group, and determine whether treatment patterns differ between Baby Boomers and the preceding generation.

Methods: We defined two birth cohorts: men born in 1927 to 1945 (pre-Boomers) and Baby Boomers.

A single-institution comparison between radical perineal and radical retropubic prostatectomy on perioperative and pathological outcomes for obese men: an analysis of the Duke Prostate Center database.

Objectives: To examine the association between body mass index (BMI) and operative time, estimated blood loss (EBL), and adverse pathologic features in patients undergoing either radical perineal prostatectomy (RPP) or radical retropubic prostatectomy (RRP).

Methods: We performed a retrospective analysis of 1006 patients treated with RPP or RRP at our institution from 1988 to 2005. Operative times and EBL were compared among BMI groups for both RPP and RRP.

Prostate cancer laterality does not predict prostate-specific antigen recurrence after radical prostatectomy.

Objectives: To evaluate biologic behaviors of unilateral cancers compared with bilateral cancers on prostate-specific antigen (PSA) recurrence after radical prostatectomy.

Methods: Analysis included demographic, clinical, and pathologic parameters of 1184 men who underwent RP for clinically localized prostate cancer at our institution between 2002 and 2006. Final pathologic assessment was performed with particular attention to laterality and percentage of tumor involvement, along with other routine parameters.

Rising PSA in nonmetastatic prostate cancer.

Rising prostate-specific antigen (PSA) in nonmetastatic prostate cancer occurs in two main clinical settings: (1) rising PSA to signal failed initial local therapy and (2) rising PSA in the setting of early hormone-refractory prostate cancer prior to documented clinical metastases. Most urologists and radiation oncologists are very familiar with the initial very common clinical scenario, commonly called "biochemical recurrence." In fact, up to 70,000 men each year will have a PSA-only recurrence after failed definitive therapy.

Significance of tertiary Gleason pattern 5 in Gleason score 7 radical prostatectomy specimens.

Purpose: The Gleason grading system in reporting prostate cancer accounts for the primary and secondary Gleason pattern. The clinical significance of a higher tertiary (third most prevalent) grade is largely unrecognized.

Materials And Methods: Radical prostatectomy specimens from 300 patients with Gleason score 7 (3 + 4 or 4 + 3) prostate cancer were pathologically reexamined for the presence of a tertiary grade 5 pattern as well as the association with pathological stage and biochemical recurrence-free survival.

Obesity-related plasma hemodilution and PSA concentration among men with prostate cancer.

Context: Recent studies have suggested that obese men have lower serum prostate-specific antigen (PSA) concentrations than nonobese men. Because men with higher body mass index (BMI) have greater circulating plasma volumes, lower PSA concentrations among obese men may be due to hemodilution.

Objective: To determine the association between hemodilution and PSA concentration in obese men with prostate cancer.

Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?

The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.

Targeted prostate biopsy using statistical image analysis.

In this paper, a method for maximizing the probability of prostate cancer detection via biopsy is presented, by combining image analysis and optimization techniques. This method consists of three major steps. First, a statistical atlas of the spatial distribution of prostate cancer is constructed from histological images obtained from radical prostatectomy specimen.

Prostate cancer laterality as a rationale of focal ablative therapy for the treatment of clinically localized prostate cancer.

Background: Early detection of small-volume prostate cancer (PCa) has led to the concept of focal therapy to treat PCa as an organ-sparing, minimally invasive procedure. The authors sought to determine the frequency of unilateral cancers in the contemporary prostate-specific antigen (PSA) era to determine the percentage of patients who would be candidates for hemiablation of the prostate by using focal therapy while preserving the contralateral lobe.

Methods: Paraffin-embedded radical prostatectomy specimens (1184 specimens) from consecutive patients between 2002 and 2006 with pathologic organ confined PCa were analyzed.

Erectile function outcome reporting after clinically localized prostate cancer treatment.

Purpose: In conjunction with the assignment to update the Guidelines for Management of Clinically Localized Prostate Cancer, the American Urological Association Prostate Cancer Guideline Update Panel performed a side analysis of the reporting of erectile function outcomes in this clinical context as published in the medical literature.

Materials And Methods: Four National Library of Medicine PubMed(R) Services literature searches targeting articles published from 1991 through early 2004 were done to derive outcome reporting (efficacy or side effects) for the treatment of clinical stage T1 or T2 N0M0 prostate cancer. A database was constructed containing descriptions relating to erectile function as well as numerical frequency rates of complete erectile dysfunction, and partial and intact erectile function for various treatments.

Prostate cancer-specific mortality after radical prostatectomy or external beam radiation therapy in men with 1 or more high-risk factors.

Background: Estimates of prostate cancer-specific mortality (PCSM) were determined after radical prostatectomy (RP) or radiation therapy (RT) in men with >or=1 high-risk factors.

Methods: The study cohort comprised 948 men who underwent RP (N = 660) or RT (N = 288) for localized prostate cancer between 1988 and 2004 and had at least 1 of the following high-risk factors: a prostate-specific antigen (PSA) velocity >2 ng/mL/year during the year before diagnosis, a biopsy Gleason score of >or=7, a PSA level of >or=10 ng/mL, or clinical category T2b or high disease. Grays regression was used to evaluate whether the number and type of high-risk factors were associated with time to PCSM.

Prostate specific antigen recurrence after definitive therapy.

Purpose: We estimate that approximately 70,000 men yearly have prostate specific antigen-only recurrence after failed definitive therapy. The ideal salvage therapy for these men is not clear. Treatment must be individualized based on the patient risk of progression, the likelihood of success and the risks involved with the therapy.

Timely diagnosis of testicular cancer.

Early detection of testicular tumors has been touted as beneficial for more than 100 years. In earlier eras, early detection was virtually the only way to improve outcomes. According to statistics that have been tracked in the literature, however, the delay from initial symptoms to definitive diagnosis by radical orchiectomy has averaged 4 to 5 months.

Novel techniques for the treatment of localized prostate cancer: evidence of efficacy?

Radical retropubic prostatectomy and radiation therapy remain the mainstay of treatment for localized prostate cancer. However, with the advent of the Internet, more patients are arriving in physicians' offices questioning novel techniques for their treatment that they otherwise would not have discovered. This paper discusses several of these techniques, including focal cryotherapy, high-intensity focused ultrasound, robotic-assisted laparoscopic prostatectomy, diets, supplements, and hormonal therapy.

Systemic strategies for prostate cancer.

Systemic therapy beyond hormonal therapy for advanced prostate cancer includes chemotherapy, antiangiogenic therapy, signal transduction inhibitors, immunomodulatory therapy, and other experimental therapeutics. This review will discuss the state of systemic therapy for advanced prostate cancer in 2007, with an emphasis on therapy in the neoadjuvant, adjuvant, and metastatic setting. As chemotherapy gains greater acceptance in the urologic oncology community for use in men with hormone-refractory disease, evaluating the role of systemic therapy in earlier disease states is essential given the success in other solid tumors for advancing cure rates.