Pathologic findings in additional prostatic and periprostatic tissue removed during radical prostatectomy.

2013 ◽  
Vol 31 (6_suppl) ◽  
pp. 172-172
Author(s):  
Henry Chen ◽  
Richard J. Kahnoski ◽  
Brian R. Lane
Keyword(s):  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Prostate Gland ◽  
Prostate Tissue ◽  
Complete Excision ◽  
Incomplete Removal ◽  
Biopsy Gleason Score ◽  
Pathology Reports ◽  
Practice Methods ◽  
Benign Prostate

172 Background: Additional prostatic and periprostatic tissue (PPT) can be removed during radical prostatectomy (RP) when there is concern for incomplete removal of the entire prostate gland or residual extraprostatic extension of cancer. The presence of cancer in PPT during RP is largely unknown. We analyzed the rate of positive PPT findings during RP in a community-based health system to determine the yield of PPT resection to inform future clinical practice. Methods: Retrospective review of pathology reports from 976patients undergoing RP between 1998-2011 was performed. Demographic and pathologic data were collected in an IRB-approved database. Results: Of 976 RP, 267 patients (27%) had PPT excised (median: 1, range: 1-4). Median PSA was 5.0 (IQR: 3.9-7), clinical stage was T1c in 69%, and biopsy Gleason score was 6 or lower in 39%, 7 in 52% and 8 or higher in 9%. Pathologic stage was pT2 in 85%, T3 in 13%, and LN positive in 2.6%. Among 177 bladder neck biopsies, 31% contained benign prostate and 3.4% (n=6) had adenocarcinoma. Of 37 urethral biopsies, 46% contained benign prostate and 16% (n=6) had adenocarcinoma. Of 21 prostatic apical excisions, 86% contained benign prostate and 14% (n=3) contained adenocarcinoma. Of 35 excisions of suspected residual (or fragmented) prostate (posterior-lateral, median, base, capsule, pedicle), 94% contained prostate and 0% contained adenocarcinoma. No prostate tissue or cancer was present in 15 samples labeled as “periprostatic fat” and 9 “neurovascular bundle”. Conclusions: Complete excision of adenocarcinoma during RP remains the primary surgical objective. Clinical suspicion of incomplete excision of benign or cancer-containing prostate tissue may lead to removal of additional PPT samples. In this single-center study, prostate tissue was present in 45% of such samples overall, supporting this practice. However, cancer is rarely present in such samples (5.6% of cases with PPT removed, 1.5% of RP overall), with apical/urethral regions appearing to be at highest risk (~15% of samples).

MRI-guided fusion biopsy of the prostate resection bed among post-radical prostatectomy patients with rising PSA.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 208-208
Author(s):  
Cheyenne Williams ◽  
Nabila Khondakar ◽  
Michael Daneshvar ◽  
Luke P. O'Connor ◽  
Jillian Egan ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Prostate Gland ◽  
Lesion Size ◽  
Prostate Tissue ◽  
Gleason Grade ◽  
Fusion Biopsy ◽  
Grade Group ◽  
Prostate Bed ◽  
Gland Tissue ◽  
Benign Prostate

208 Background: Following treatment of prostate cancer with radical prostatectomy (RP), biochemical recurrence (BCR) can be detected with elevated PSA. This may be attributed to either cancer recurrence or retained benign prostatic gland tissue. Options for detecting malignancy after RP currently entail diagnostic imaging and biopsy with transrectal ultrasound (TRUS). TRUS alone has limited accuracy in detecting recurrence in the prostate bed. MRI fusion-guided biopsy (Fbx) may be a more accurate method of detecting post-RP local recurrence. We hypothesize that Fbx for diagnosing benign versus malignant recurrence in the prostate bed is feasible and produces clinically meaningful results. Methods: Our institutional database was queried for patients who received RP and demonstrated BCR between February 2015 and July 2020. All patients with evidence of prostate bed recurrence on mpMRI were included in this analysis. Cancer detection via mpMRI-guided fusion biopsy using the UroNav platform was evaluated and patient variables including final Gleason Grade group (GG), margin involvement, PSA at BCR, and prostate bed lesion size were analyzed with univariate logistic regression. Results: 40 patients (median age = 68) with BCR underwent post-RP mpMRI. 25/40 (62.5%) patients had MRI-visible lesions, and among those, 17/25 (68%) patients underwent Fbx of the prostate bed. 15/17 (88.2%) Fbxs detected prostate tissue (either benign or cancer), 11/17 (64.7%) contained cancer, and 4/17 (23.5%) contained benign prostate glands. Median cores per biopsy was 4 (IQR 4-6). Among the 83 cores obtained, 57 (68.6%) cores contained prostate gland tissue and 26 (31.3%) contained fibromuscular tissue. Of those 57 with gland tissue, 33 (57.9%) cores contained cancer, and 24 (42.1%) contained benign prostate tissue. Among patients with benign biopsies, none had further evidence of metastasis at median follow-up of 13.5 months after Fbx and 182 months after RP. On final RP pathology, 4 patients had GG1 disease, 4 had GG2, 4 had GG3, 2 had GG4, and 3 had GG5. 6/17 (35%) patients had positive RP margins. Median prostate bed lesion size was 1.3 cm (IQR 0.9-1.5). Prostate bed lesion size (cm) was the only variable significantly associated with cancer on Fbx (OR = 2.20, 95% CI:1.29-3.76, p = 0.011). Conclusions: mpMRI-Fbx is a feasible method for reliably targeting prostate bed lesions. With this technique, we found improved accuracy for biopsy-proven recurrence in the prostate bed. This technique will help direct treatment planning of salvage therapies among patients with detectable PSA post-RP. [Table: see text]

Planned nerve preservation modifications to reduce positive surgical margins during robotic-assisted laparoscopic radical prostatectomy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15599-15599
Author(s):  
K. Zorn ◽  
O. N. Gofrit ◽  
S. Lin ◽  
G. D. Steinberg ◽  
G. Zagaja ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Gleason Score ◽  
Clinical Stage ◽  
Laparoscopic Radical Prostatectomy ◽  
Wide Resection ◽  
Control Group ◽  
Positive Surgical Margin ◽  
Robotic Assisted ◽  
Nerve Preservation ◽  
Biopsy Gleason Score

15599 Background: Robotic-assisted laparoscopic radical prostatectomy (RLRP) is increasingly being utilized for the treatment of localized prostate cancer at many centers. The main objective of RLRP is cancer control and preservation of erectile function with reduced positive surgical margin (PSM) rates. We evaluated the effect of a side-specific nerve preservation (NP)protocol which was implemented in June 2006 to help further reduce PSM rates. Methods: Between June-November 2006, 150 consecutive RLRPs were performed using select ipsilateral, NP techniques (interfascial, extrafascial and wide resection) based on pre-operative risk factors (clinical stage, biopsy Gleason score (GS), percentage of core number positive and maximal core cancer percentage). Prior to June 2006, only interfascial and wide resection were performed. The NP protocol, included ipsilateral extrafascial dissection in all patients with GS=7 with non-palpable disease. All patients with GS≤6, non-palpable disease and whose biopsy pathology demonstrated <33% of ipsilateral cores positive for cancer were offered interfascial dissection. Wide resection was performed for patients with palpable disease, GS≥8 and ≥66% of all ipsilateral biopsy cores positive for cancer. Pathological outcomes were compared with the 245 consecutive RLRP cases performed prior to June 2006, where more liberal interfascial NP was performed. Results: Relative to the modified NP group, mean patient age (60 vs 59, p= 0.21), PSA (6.7 vs 6.8, p=0.77), clinical stage (p=0.93), biopsy Gleason score (p=0.51), pathologic Gleason score (p=0.32) and stage (p=0.65) were similar to the control group. Mean total number of positive cores involved with cancer were also comparable between groups (3.5 vs 3.3, p=0.31). Overall PSM rate was significantly lower in the modified NP group (12.6% vs 20.4%,p=0.04). Specific pT2-PSM rates were significantly lower (8.3% vs 15%, p=0.04) while only a trend was observed for pT3-PSM rates (34.5% vs 40.4%, p=0.60) in the modified NP group. Conclusions: Modifying ipsilateral nerve preservation for patients undergoing RLRP, based on specific pre-operative variables has significantly helped further reduce overall and pT2-specific PSM rates. No significant financial relationships to disclose.

scholarly journals Radical prostatectomy for high-risk clinically localized prostate cancer: a prospective single institution series

2013 ◽  
Vol 5 (6) ◽  
pp. 156
Author(s):  
Anthony J. Koupparis ◽  
Jeremy P. Grummet ◽  
Antonio Hurtado-Coll ◽  
Robert H. Bell ◽  
Nicholas Buchan ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Facteurs De Risque ◽  
Single Institution ◽  
Psa Recurrence ◽  
Biochemical Progression ◽  
Biopsy Gleason Score

Objective: The objective of this paper is to report on the pathologicand biochemical progression-free outcomes of patients whounderwent radical prostatectomy for high-risk localized prostatecancer.Methods: Data was collected prospectively from 299 patients whounderwent radical prostatectomy for high-risk clinically localizedprostate cancer by 2 surgeons at a single institution. High risk wasdefined as 1 or more of 3 adverse factors: prostate-specific antigen(PSA) >20, biopsy Gleason score 8 to 10 and clinical stage T3. PSArecurrence was defined as PSA >0.4 ng/mL or any salvage therapy.Results: Median age was 63.3 years (46.1-75.9). Median followupwas 4.7 years (range 0.5-17.3 years). PSA at diagnosis was>20 ng/mL in 31.4%. Biopsy Gleason score was 8 to 10 in 66.9%.Clinical stage was T3 in 24.4%. 81.6% of patients had a singlebaseline risk factor, 15.7% had 2 risk factors and 2.7% had all 3risk factors. Neoadjuvant therapy was administered to 184 patients(61.5%). Pathologic stage was organ-confined in 39.6%, specimenconfinedin 26%, non-specimen-confined in 26.4%, and 8% hadlymph node positive disease. Overall survival, cancer-specificsurvival and biochemical progression-free survival was 99%,99.67% and 70.2%, respectively. Univariate analysis showed thatPSA at diagnosis, percentage of cores positive and number of riskfactors were predictors of PSA recurrence (p < 0.05). Multivariateanalysis showed that PSA at diagnosis was an independent predictorof PSA recurrence (p < 0.05).Conclusion: Radical prostatectomy is associated with favourablebiochemical progression-free, clinical and overall survival inselected men with high-risk localized prostate cancer, and shouldtherefore be considered an option in these patients. Baseline PSA>20 ng/mL is a significant independent predictor of PSA recurrence.Objectif : L’objectif de cet article est de faire rapport sur les résultatsquant à la survie sans progression pathologique et biochimique despatients ayant subi une prostatectomie radicale pour traiter uncancer de la prostate localisé à risque élevé.Méthodologie : Les données ont été recueillies de manièreprospective chez 299 patients ayant subi une prostatectomieradicale réalisée par 2 chirurgiens dans un même établissementpour traiter un cancer de la prostate à risque élevé cliniquementlocalisé. Un risque élevé était défini comme au moins 1 des 3facteurs négatifs suivants : taux d’antigène prostatique spécifique(APS) > 20, score de Gleason de 8 à 10 à la biopsie, stade cliniqueT3. Une récidive avec anomalie de l’APS a été définie comme untaux d’APS > 0,4 ng/mL ou le recours à tout traitement de sauvetage.Résultats : L’âge médian était de 63,3 ans (46,1 à 75,9). Le suivimédian était de 4,7 ans (0,5 à 17,3 ans). Le taux d’APS au momentdu diagnostic était > 20 ng/mL chez 31,4 % des patients. Le scorede Gleason à la biopsie était de 8 à 10 dans 66,9 % des cas. Lestade clinique était de T3 dans 24,4 % des cas; 81,6 % des patientsprésentaient un seul facteur de risque au départ, 15,7 % présentaient2 facteurs de risque et 2,7 % présentaient les 3 facteurs de risque.Un traitement néoadjuvant a été administré à 184 patients(61,5 %). Le stade pathologique était confiné à l’organe dans39,6 % des cas, confiné à l’échantillon dans 26 % des cas, et nonconfiné à l’échantillon dans 26,4 % des cas; 8 % des patientsprésentaient une atteinte des ganglions lymphatiques. La survieglobale, la survie spécifique au cancer et la survie sans progressionbiochimique étaient de 99 %, 99,67 % et 70,2 %, respectivement.L’analyse univariée a montré que le taux d’APS au moment dudiagnostic, le pourcentage de carottes biopsiques positives et lenombre de facteurs de risque étaient des facteurs prédictifs derécidive avec anomalie de l’APS (p < 0,05). L’analyse multivariéea montré que le taux d’APS au moment du diagnostic était unfacteur prédictif indépendant de récidive avec anomalie de l’APS(p < 0,05).Conclusion : La prostatectomie radicale est associée à unesurvie sans progression biochimique, une survie clinique et unesurvie globale favorables chez des patients sélectionnés atteintsd’un cancer de la prostate localisé à risque élevé, et devrait êtreconsidérée comme une option de traitement chez ces patients.Un taux d’APS au départ > 20 ng/mL est un facteur de prédictionindépendant significatif de récidive avec anomalie de l’APS.

scholarly journals Incidence of pelvic lymph node metastasis in radical prostatectomy

2006 ◽  
Vol 63 (12) ◽  
pp. 1011-1014
Author(s):  
Nebojsa Jeremic ◽  
Snezana Cerovic ◽  
Goran Brajuskovic ◽  
Sasa Tomovic ◽  
Vinka Maletic-Vukovic
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Clinical Stage ◽  
Prostate Gland ◽  
Specific Antigen ◽  
Cancer Control ◽  
Pelvic Lymphadenectomy ◽  
Low Risk ◽  
Significant Difference ◽  
Cancer Multiple

Background/Aim. Radical prostatectomy (RP) provides the best cancer control in patients with clinically prostate gland confined cancer. Multiple models and nomograms combining preoperative prostate-specific antigen (PSA) serum level, clinical stage and Gleason score have been developed to predict the probability of metastatic disease. In prostate cancer (PC) the presence of metastases to the pelvic lymph nodes (PLNs) is recognized widely as an unfavorable prognostic factor. Currently, PLNs dissection is not done in a low-risk group of prostate cancer patients. The aim of this study was to analyze PLN metastases in PC patients, in clinically localized stages of PC. Methods. Radical prostatectomy specimens with pelvic lymphadenectomy specimens from 82 PC patients were reviewed. In this group of patients, serum preoperative PSA values ranged from 2 to 23 ng/ml. Results. We diagnosed 11/82 (13.4%) patients with PLN metastases. There were 8 (72%) patients with pT3c pathological stage, and 3 (28%) patients with pT4a stage. PSA below 4 ng/ml was detected in 2/5 (40%) patients with PLN metastases. There was no statistically significant difference between preoperative PSA values and postoperative T stage, and PLN metastases. A statistically significant correlation between PLN metastases and the stage was found in the patients with pT4 and the patients with pT3c PC stages (p < 0.05). Conclusion. Recent RP series indicate PLN metastases to be less than 10%. We demonstrated higher detection of PLN metastases (13.4%) in our RP series. Our results suggest that PLNs dissection should be performed even in patients with low-risk PC.

3: Impact of Prostate Gland Size on Urinary Quality of Life Indices after Laparoscopic Radical Prostatectomy

2007 ◽  
Vol 177 (4S) ◽  
pp. 1-2
Author(s):  
Adam W. Levinson ◽  
Richard E. Link ◽  
Lynda Z. Mettee ◽  
Soroush Rais-Bahrami ◽  
Devesh Agarwal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radical Prostatectomy ◽  
Prostate Gland ◽  
Laparoscopic Radical Prostatectomy ◽  
Gland Size

Advantages and disadvantages of main surgical approaches for robot-assisted radical prostatectomy

2020 ◽  
Vol 10 (4) ◽  
pp. 347-354
Author(s):  
Dmitriy M. Il’in ◽  
Vladimir A. Makeev
Keyword(s):  
Radical Prostatectomy ◽  
Abdominal Cavity ◽  
Prostate Gland ◽  
Clinical Situation ◽  
Surgical Approaches ◽  
Robot Assisted ◽  
Scientific Databases ◽  
Advantages And Disadvantages ◽  
Robotic Assisted Surgery ◽  
History Of

The introduction of robotic-assisted surgery into clinical practice has opened up new possibilities for the surgical treatment of urological patients. Robot-assisted radical prostatectomy (RARP) is one of the most commonly performed robot-assisted surgery. The review is devoted to the main surgical approaches for RARP. An analysis of publications on this topic was carried out using the search engines of the scientific databases PubMed, Medscape, Google Scholar, eLibrary when writing the article The article presents an overview of the advantages and disadvantages of the existing four access options for RARP: anterior, perineal, lateral and posterior, as well as oncological and functional outcomes of operations. It has been shown that a surgeon with different approaches can choose the most suitable one for a given clinical situation, focusing on the stage of the disease, the patients age, anatomical features of the prostate gland, the state of the patients erectile function, and the history of operations on the abdominal cavity and pelvic organs.

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