Background: The objective of this study was to evaluate the prognostic significance of the local extent of prostate cancer in relation to the prostate capsule. Patients and methods: The series included 110 patients with prostate cancer who underwent radical retropubic prostatectomy in a single institution in Japan between September 1997 and February 2003. The resected prostatectomy specimens were investigated by whole-mount step section at 5 mm intervals. According to the pathological findings, patients were divided into three groups as follows: 44 with localized cancer tissues apart from the capsule (group A), 33 with capsular invasion without penetration (group B) and 33 with capsular penetration (group C). Several clinicopathological factors of these patients were analyzed in relation to the capsular status. Results: The capsular status was significantly related to lymph node metastasis, seminal vesicle invasion and tumor volume. During the observation period (median: 22 months), biochemical recurrence occurred in 13 patients (three in group A, two in group B and eight in group C), and the biochemical-recurrence free survival rate in group C was significantly lower than those in groups A and B. Patients with capsular penetration at more than one site were at significantly increased risk for biochemical recurrence compared with those with a single capsular penetration; however, there was no significant relationship between the location of capsular penetration and biochemical recurrence. Furthermore, the biochemical recurrence-free survival rate was significantly associated with capsular penetration, seminal vesicle invasion and tumor volume among various factors examined, nevertheless these three factors were not independent predictors for biochemical recurrence on multivariate analysis. Conclusion: Subclassification of patients undergoing radical prostatectomy according to the capsular status provides valuable prognostic information; that is, patients with capsular penetration, particularly at more than one site, have a significantly higher risk of biochemical recurrence than those without capsular involvement or with capsular invasion alone. Thus, careful follow-up and if necessary, additional treatment should be considered in cases demonstrating capsular penetration.
Background: The objective of this study was to establish simple and reliable predictive system for survival in patients with prostate cancer diagnosed as having bone metastasis on initial bone scintigraphy. Patients and methods: Ninety-four prostate cancer patients with bone metastasis included in this study were sub-classified into two groups according to the patterns of bone metastasis based on the findings of initial bone scan; that is, 33 patients with ≥5 metastases and with metastases to the appendicular skeleton (group A) and 61 with <5 metastases or with metastases to the axial skeleton alone (group B). Several clinico-pathological factors were analyzed according to this bone metastasis patterns. Results: There were no significant differences among these two groups in terms of age, Gleason score, serum prostate specific antigen (PSA), serum alkaline phosphatase and clinical stage, while nadir PSA value after androgen withdrawal therapy in group A was significantly higher than that in group B. Furth...
Background: The objectives of this study were to evaluate the effectiveness, the patients compliance and tolerability to bacillus Calmette-Guérin (BCG) intravesical instillation after transurethral resection of bladder tumour (TURBT) for stage Ta-T1, grade G1–G3 transitional cell carcinoma (TCC) of the urinary bladder. Methods: Between January 1995 and May 2002, 127 patients (110 males and 17 females) aged between 40 and 81 years (mean±SD 66.5±8.4 years) with Ta-T1, G1–G3 TCC of the urinary bladder were treated by TURBT and adjuvant intravesical instillation with BCG. The following details were recorded and evaluated: the disease-free survival rates, the tumour recurrence, age, gender, morphology, the size and number of tumours and side effects of BCG instillation. Results: Eighty (63%) and fourty seven (37%) patients were presented multifocality and monofocality at the baseline, respectively. Follow-up periods were 3–48 months (median, 18 months) for 110 of the 127 patients enrolled. At 3 months follow-up 40 multifocality patients (59.7%) and 27 monofocality patients (40.3%) were disease free. At 18 months follow-up, tumour disease-free survival rate was 63% while at 48 months we had 44 drop out and intravesical recurrence was noted in 43 patients (39.1%). We had 47 patients with side effects by BCG instillation in free disease patients and 15 in the not disease free ones. Twentyseven patients (40.3%) of the disease free patients had no side effects versus 28 patients (65.1%) in the not disease free ones. Of the patients, 28.3% were withdrawn for the side effects of therapy while 32.2% were discontinued for recurrence of disease. Conclusion: These findings confirm that intravesical instillation with BCG combined with TURBT is effective and safe for treatment of bladder cancer. This treatment facilitates bladder preservation by reducing recurrences and delaying the progression in many patients, however, further experience and longer follow-up studies of this treatment are required.
The recent downward shift in disease stage and patient age at diagnosis has led to an emphasis on definitive local therapy in patients with prostate cancer. However, patients with adverse prognostic factors (non-organ-confined disease, high prostate-specific antigen level, high Gleason score) have a significant risk of treatment failure. With our increasing ability to predict patients at high risk of failure, more patients are likely to receive adjuvant therapy. Adjuvant hormonal therapy extends overall survival after radiotherapy for locally advanced disease, while after surgery improved survival has been demonstrated in patients with node-positive disease. More recently, adjuvant chemotherapy has been investigated.
"The Tipping Point—How Little Things Can Make a Big Difference?Malcolm Gladwell (ed.), New York, Little, Brown and Company 2002, ISBN 0-316-34662-4." UroOncology, 4(3-4), p. 169
