BACKGROUND:The authors evaluated the effect of postoperative radiation therapy on freedom from biochemical failure (bNED) in men with prostate carcinoma who had pathologic seminal vesicle invasion after radical prostatectomy and negative pelvic lymph node dissection (pT3cN0). METHODS:Between 1989 and 1995, 375 men underwent radical prostatectomy at Thomas Jefferson University Hospital. Fifty-three men (13%) had pT3cN0 prostate carcinoma and were the subject of this analysis. Men in whom prostate specific antigen (PSA) could not be detected were deemed free of biochemical failure. RESULTS:Of the 53 men with pT3cN0 prostate carcinoma, 18 had an elevated PSA immediately after surgery and received salvage radiation therapy (RT). The 3-year bNED rate for this group was only 38%. At 3 months, PSA could not be detected in the other 35 men. Fifteen of those 35 men underwent early adjuvant RT, and the other 20 were observed for biochemical failure. The 3-year bNED rate for the 15 patients treated with immediate adjuvant RT was 86%, compared with 48% for the 20 men who were observed (P = 0.01). CONCLUSIONS:These data suggest that early adjuvant RT for men with pT3cN0 prostate carcinoma and no detectable PSA postoperatively reduces the likelihood of future biochemical failure. Men with pT3cN0 prostate carcinoma and a persistently elevated postoperative PSA level are less likely to benefit from RT and should be considered for systemic therapy.

OBJECTIVES:To determine the durable efficacy of early postoperative radiation therapy (RT) in patients with pT3N0 prostate cancer who were at an increased risk of biochemical failure. We also evaluated the long-term benefit derived from using higher RT doses.METHODS:Seventy-nine patients with pathologic Stage T3N0 prostate cancer and high-risk postoperative features underwent RT within 6 months after surgery. No patient received prior hormonal therapy. Fifty-nine patients had positive surgical margin, 29 had pathologic seminal vesicle invasion, and 27 had persistently elevated postoperative prostate-specific antigen (PSA) levels. Freedom from biochemical relapse (bNED) was defined as an undetectable (less than 0.2 ng/mL) PSA level. Median follow-up time was 39 months, and the median radiation dose was 64.8 Gy. All patients were followed for at least 2 years to be considered biochemically controlled.RESULTS:Patients receiving adjuvant RT for an undetectable pre-RT PSA level had a 3-year bNED rate of 90%, compared with 44% for those receiving salvage RT for a detectable level (P < 0.0001). In the group of adjuvant patients, RT doses more than 61.2 Gy resulted in a 3-year bNED rate of 90% compared with 64% for those receiving a lower dose (P=0.015). The salvage patients irradiated with a dose of 64.8 Gy or greater had a 3-year bNED rate of 52% compared with 18% for those irradiated with lower doses (P=0.048). Severe late RT-related complications were infrequent and did not correlate with dose.CONCLUSIONS:In patients with high-risk pT3N0 prostate cancer, an RT dose response may exist. Although some studies suggest limited durable efficacy for early postoperative RT, our data suggest that RT doses of 64.8 Gy or more appear superior to prevent future biochemical failures. A prospective randomized study evaluating a postoperative RT dose response is warranted.

Purpose: The appropriate radiation dose has not been determined for postoperative radiation therapy (RT) of prostate cancer. Postoperative PSA level is a useful marker of local residual disease, and may allow evaluation of RT dose-response after radical prostatectomy.Methods and Materials: Between 1989 and 1996, 86 consecutive patients with pT3N0 prostate cancer who did not receive prior hormonal therapy or chemotherapy were irradiated postoperatively. All patients received 55.8 to 70.2 Gy (median = 64.8 Gy) to the prostatic/seminal vesicle bed. Patients were judged to be free of biochemical failure (bNED) if their PSA remained undetectable or decreased to undetectable level (< 0.2 ng/ml). The median follow-up time was 32 months from time of irradiation.Results: Univariate and multivariate analyses of variables showed that the preRT PSA level was the most significant predictor of improved bNED survival (p < 0.001), Actuarial analyses of radiation dose grouped with preRT PSA levels found higher radiation dose to be significant (p < 0.05). For the 52 patients with an undetectable preRT PSA level, the 3-year bNED rate was 91% for patients irradiated to 61.5 Gy or more and 57% for those irradiated to lower doses (p = 0.01), For the 21 patients with preRT PSA level > 0.2 and less than or equal to 2.0 ng/ml, the 3-year bNED rate was 79% for patients irradiated to 64.8 Gy or more and 33% for those irradiated to a lower dose (p = 0.02), No other preRT PSA interval or radiation dose level was associated with a dose-response function.Conclusion: In patients with pT3N0 prostate cancer after radical prostatectomy, a radiation dose-response function may be present and depends on the preRT PSA value. Patients with high postoperative PSA levels (> 2.0 ng/ml) may be less likely to benefit from higher doses of RT, and should be considered a group for which systemic therapy should be tested. (C) 1998 Elsevier Science Inc.

PURPOSE This study examines the effect of adjuvant radiation therapy (RT) on outcome in patients with pT3N0 prostate cancer and makes comparisons to a matched control group. METHODS AND MATERIALS At our center, 149 patients undergoing radical prostatectomy were found to have pT3N0 prostate cancer, had an undetectable postoperative prostate-specific antigen (PSA) level, and had no immediate hormonal therapy. Fifty-two patients received adjuvant RT within 3 to 6 months of surgery. Ninety-seven underwent radical prostatectomy alone and were observed until PSA failure. From these two cohorts, we matched patients 1:1 according to preoperative PSA (<10 ng/ml vs. >10 ng/ml), Gleason score (<7 vs. > or =7), seminal vesicle invasion, and surgical margin status. Seventy-two patients (36 pairs) were included in the analysis. Median follow-up time was 41 months. We calculated a matched-pairs risk ratio for cumulative risk of PSA relapse (a rise above 0.2 ng/ml). RESULTS After controlling for the prognostic factors by matching, there was an 88% reduction (95% confidence interval [CI]: 78-93%) in the risk of PSA relapse associated with adjuvant RT. The 5-year freedom from PSA relapse rate was 89% (95% CI: 76-100%) for patients receiving adjuvant RT as compared to 55% (95% CI: 34-79%) for those undergoing radical prostatectomy alone. CONCLUSIONS These data suggest that adjuvant RT for pT3N0 prostate cancer may significantly reduce the risk of PSA failure as compared to radical prostatectomy alone. Its effect on clinical outcome awaits further follow-up.

OBJECTIVES:We investigated the association of transrectal color Doppler imaging (CDI) signal detection in localized prostate cancer with biologic behavior as assessed by tumor Gleason grade, seminal vesicle invasion, capsular and margin status, and actuarial biochemical freedom from relapse.METHODS:From 1991 to 1996, transrectal ultrasound with CDI and biopsy was performed in 2718 men using a 7.0-MHz probe optimized to detect color-coded blood flow within the gland and along the capsular margin. Color flow was graded on a scale from 0 to 2+, with 0 and 1+ representing no detectable flow and normal flow, and 2+ indicating increased flow. Color flow maps were constructed in 47 men with clinically localized prostate cancer treated by radical prostatectomy (RP) and compared to their whole mount RP specimen step sections.RESULTS:Color flow detected within the index tumor was graded as 2+ in 22 of 47 patients and 0 or 1+ in the remaining 25. Tumors graded 2+ correlated with higher Gleason grade, higher incidence of seminal vesicle invasion, and higher relapse rate, with only 11 of 22 patients disease free based on undetectable prostate-specific antigen (PSA) levels. In contrast, 24 of 25 patients with tumors graded 0 or 1+ are free of biochemical relapse with a median follow-up of 30.9 months. Patients with increased flow were 10.2 times more likely to relapse even after correction for other prognostic variables. In addition, tumors with 2+ capsular flow correlated with a higher incidence of non-organ-confined disease.CONCLUSIONS:Color-coded Doppler flow within the tumor and overlying capsule appears to correlate with both tumor grade and stage, respectively. Detection and grading of color-coded flow within biopsy-proven cancers may identify patients with a high likelihood of biochemical relapse.

Objectives. There is interest in treating prostate cancer with induction androgen deprivation prior to radical prostatectomy. Data on long-term prostate-specific antigen (PSA)-based survival analyses among patients treated with neoadjuvant hormonal therapy (NHT) and prostatectomy are limited. In 1991 we instituted a pilot study for T3 disease based on endorectal coil magnetic resonance imaging (eMRI), mandatory negative laparoscopic nodal dissection prior to hormonal manipulation, and prostatectomy followed by pathologic and PSA-based outcome determinations,Methods. Of 26 patients, 21 had negative laparoscopic lymphadenectomy followed by 4 months of NHT (leuprolide +/- flutamide) prior to radical prostatectomy. eMRI was performed at the time of diagnosis and following hormonal treatment. Serum PSA was determined at 3-month intervals. Prostatectomy specimens were evaluated by 3-mm whole-mount step sections.Results. Prior to prostatectomy, biochemical response was documented in all patients and downsizing was observed by eMRI in 57%. Pathologic downstaging to a lower stage (T2c or lower)was achieved In 48%. However, the actuarial 3-year freedom from biochemical relapse rate was only 24%.Conclusions. Using laparoscopy to exclude node-positive patients and 4 months of NHT appears to result in pathologic and initial biochemical evidence of regression. These factors have not translated into improved freedom from biochemical relapse among patients with Stage T3 disease treated with NHT and prostatectomy. Recent data strongly suggest a beneficial effect in patients with clinical T2 disease treated with NHT and radical prostatectomy. The NHT and radical prostatectomy approach appeared to offer no clear advantage when compared with PSA-based benchmarks achieved with conformal irradiation or NHT followed by external beam treatment among patients with clinical T3 disease.

PURPOSE:To assess the accuracy of using several criteria to evaluate endorectal coil magnetic resonance (MR) images for penetration of the prostatic capsule.MATERIALS AND METHODS:Thirty patients with prostate carcinoma underwent MR imaging and prostatectomy. Specified sites of potential capsular penetration on MR images were blindly evaluated by three readers for six diagnostic criteria. These evaluations were compared with pathologic findings of capsular penetration and were analyzed by means of receiver operating characteristic (ROC) analysis.RESULTS:The area under the ROC curve (Az) for the readers' overall impression of capsular penetration varied from .72 to .77. Highest mean Az's were for the criteria of capsular thickening (.74) and nodular extracapsular tumor (.72), although the latter finding had poor sensitivity (15%). Interobserver variation was low for all findings.CONCLUSION:Sensitivity and specificity were generally low for the diagnostic criteria. The usefulness of endorectal coil MR imaging in staging prostate cancer may be limited by the lack of diagnostic signs that uniformly identify extracapsular penetration.

We analyzed by flow cytometry the deoxyribonucleic acid content of 13 paraffin embedded, formalin-fixed Leydig cell tumors of the testis. Of the tumors 10 were clinically benign (9 diploid and 1 aneuploid) and 3 were malignant (aneuploid). The benign aneuploid tumor showed moderate cellular atypia and a low mitotic count (less than 2 per 10 high power fields). Our study suggests that the majority of Leydig cell tumors are diploid and the less common malignant tumors are typically aneuploid, and that deoxyribonucleic acid flow cytometric findings can be useful as a prognostic indicator in these tumors.

We present a rare example of hemangioma of the renal capsule. This benign mesenchymal tumor can present diagnostic difficulties, since it can radiographically and macroscopically simulate more common tumors of the kidney, including renal cell carcinoma. If the diagnosis is made or suspected preoperatively or during surgery a more conservative surgical approach should be considered.

Benign adrenocortical masses often contain lipid; metastases and pheochromocytomas do not. Standard and lipid-sensitive (chemical shift) magnetic resonance (MR) images of the adrenal glands in 31 patients with 45 adrenal masses were reviewed to determine if simple visual analysis of these images would increase diagnostic specificity. Lipid was considered present if signal intensity of the adrenal mass relative to other tissues decreased on chemical shift images relative to comparable standard images. Both myelolipomas and 26 of 27 benign cortical masses displayed a loss of signal intensity on at least one chemical shift image; all 12 metastases, the three hemorrhages, and a cyst did not. Opposed-phase images were slightly more sensitive than fat-suppressed images in depicting lipid within benign cortical masses. All masses had higher signal intensity than that of the liver on standard T2-weighted MR images. Chemical shift MR imaging can demonstrate lipid within benign adrenocortical masses and thus increase specificity, potentially obviating biopsy and aggressive follow-up.

No AccessJournal of UrologyClinicopathological Conference1 Mar 1986Cystic Pelvic Mass A. Richard Kendall, Barry S. Stein, Francis J. Shea, Robert O. Petersen, and Bruce Senay A. Richard KendallA. Richard Kendall Professor and Chairman, Department of Urology. More articles by this author , Barry S. SteinBarry S. Stein Associate Professor, Department of Urology. More articles by this author , Francis J. SheaFrancis J. Shea Professor, Department of Radiology. More articles by this author , Robert O. PetersenRobert O. Petersen Clinical Associate Professor, Department of Pathology. More articles by this author , and Bruce SenayBruce Senay Chief Resident, Department of Urology. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)45733-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1986 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTIJARE J, SHRIKHANDE A and SHRIKHANDE V (2018) PHYLLODES TYPE OF ATYPICAL PROSTATIC HYPERPLASIAJournal of Urology, VOL. 162, NO. 3 Part 1, (803-804), Online publication date: 1-Sep-1999.Kevwitch M, Walloch J, Waters W and Flanigan R (2018) Prostatic Cystic Epithelial-Stromal Tumors: A Report of 2 New CasesJournal of Urology, VOL. 149, NO. 4, (860-864), Online publication date: 1-Apr-1993.Lim D, Hayden R, Murad T, Nemcek A and Dalton D (2018) Multilocular Prostatic Cystadenoma Presenting as a Large Complex Pelvic Cystic MassJournal of Urology, VOL. 149, NO. 4, (856-859), Online publication date: 1-Apr-1993.Reese J, Lombard C, Krone K and Stamey T (2018) Phyllodes Type of Atypical Prostatic Hyperplasia: A Report of 3 New CasesJournal of Urology, VOL. 138, NO. 3, (623-626), Online publication date: 1-Sep-1987. Volume 135Issue 3March 1986Page: 550-553 Advertisement Copyright & Permissions© 1986 by The American Urological Association Education and Research, Inc.MetricsAuthor Information A. Richard Kendall Professor and Chairman, Department of Urology. More articles by this author Barry S. Stein Associate Professor, Department of Urology. More articles by this author Francis J. Shea Professor, Department of Radiology. More articles by this author Robert O. Petersen Clinical Associate Professor, Department of Pathology. More articles by this author Bruce Senay Chief Resident, Department of Urology. More articles by this author Expand All Advertisement PDF downloadLoading ...

Immunoperoxidase localization of prostatic tissue antigens has become useful in identifying the prostate as the origin of metastatic disease. Much research has been aimed at investigating the presence of these antigens in the adult prostate gland in benign and neoplastic states. Few studies have been done to determine the presence of these markers before puberty. We studied the prostate gland of 42 children of varying ages to determine the presence of these antigens at all age ranges to puberty. Sequential sections of the prostate were cut for prostate specific antigen, prostatic acid phosphatase, and hematoxylin and eosin staining. The degree of immunoperoxidase stain was graded from 0 to 4. The results showed that staining levels of prostate specific antigen and prostatic acid phosphatase were high at birth, decreased by age 6 months, reappeared by age 10 years and increased to puberty. Thus, the levels of prostate specific antigen and prostatic acid phosphatase appear to follow the testosterone levels, suggesting a hormonal dependence.

Sarcomas of the spermatic cord are rare, with only approximately 200 such tumors reported in the literature. Of those cases only 3 fit the definition of malignant mesenchymoma: a mesenchymal tumor with 2 or more malignant elements other than fibrosarcoma. We report the fourth such case treated by local excision alone. The patient was free of disease 6 years after treatment.

We present what, to our knowledge, is the first reported case of nephrogenic metaplasia of the ureter. Nephrogenic metaplasia involves the transitional epithelium of the urinary tract and results in the formation of epithelial tubules, which are histologically similar to renal tubules. Special stains demonstrated both intracellular and intraluminal mucin. Ultrastructurally, the lesion consisted of epithelial cells with sparse microvilli and a thick basal lamina. The criteria for diagnosis and differentiation from carcinoma are discussed.

Immunoperoxidase staining for prostate specific antigen (PSA) and prostatic acid phosphatase (PAP) help to identify patients with prostatic carcinoma presenting as metastatic disease from an occult primary source. To clarify further the reliability of these prostatic tissue antigens, we have examined the primary tumor and metastatic sites in 16 autopsy cases. Eleven of these had diffusely positive findings for PSA and PAP in the primary and all metastatic sites, and 1 case lacked both antigens in all locations. Four cases demonstrated variability between these antigens and among various sites. Prostatic primary lesions contained PAP and PSA in 13 (81%) and 12 (75%) cases, respectively. The most reliable metastatic sites were lymph nodes, seminal vesicles, lung, bone, and kidney; while liver, adrenal, and colorectal sites were less reliable. No relationship existed between serum PAP levels and tissue detectability of PAP. The use of both PAP and PSA increases the likelihood of properly identifying the prostate as the organ of origin of metastatic disease. In spite of the use of both markers, however, three primary lesions would have been misdiagnosed, and 1 case lacked both antigens in all metastatic sites as well. In poorly differentiated lesions, the lack of both antigens does not unequivocally eliminate the possibility of prostatic carcinoma.

We studied 103 random biopsies from patients with overt transitional cell carcinoma of the bladder for specific red cell adherence. We evaluated 62 random biopsies from patients whose primary tumors were positive for specific red cell adherence and 100 per cent of the biopsies in these patients also were positive for specific red cell adherence regardless of the pathologic finding in the random biopsy. We evaluated 41 random biopsies from patients whose primary bladder tumors were negative for specific red cell adherence and only 27 per cent of all biopsies in this group of patients were positive for specific red cell adherence. Thus, we found that in 92 of the 103 random biopsies (89 per cent) the specific red cell adherence of the biopsy agreed with that of the primary tumor. The loss of red cell antigens in random biopsies that are histologically normal may prove to be the earliest measurable changes of the malignant potential of the urothelium.

No AccessJournal of UrologyClinicopathological Conference1 Aug 1980Incidentally Found Renal Mass A. Richard Kendall, Howard M. Pollack, Robert O. Petersen, and Barry S. Stein A. Richard KendallA. Richard Kendall Professor and Chairman, Department of Urology, Temple University. More articles by this author , Howard M. PollackHoward M. Pollack Professor of Radiology, University of Pennsylvania More articles by this author , Robert O. PetersenRobert O. Petersen Professor of Pathology, Temple University. More articles by this author , and Barry S. SteinBarry S. Stein Assistant Professor of Urology, Temple University. More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)55403-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1980 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMorra M and Das S (2018) Renal Oncocytoma: A Review of Histogenesis, Histopathology, Diagnosis and TreatmentJournal of Urology, VOL. 150, NO. 2 Part 1, (295-302), Online publication date: 1-Aug-1993. Volume 124Issue 2August 1980Page: 269-273 Advertisement Copyright & Permissions© 1980 by The American Urological Association Education and Research, Inc.MetricsAuthor Information A. Richard Kendall Professor and Chairman, Department of Urology, Temple University. More articles by this author Howard M. Pollack Professor of Radiology, University of Pennsylvania More articles by this author Robert O. Petersen Professor of Pathology, Temple University. More articles by this author Barry S. Stein Assistant Professor of Urology, Temple University. More articles by this author Expand All Advertisement PDF downloadLoading ...