scholarly journals Malakoplakia of the prostate masquerading as locally advanced prostate cancer on mpMRI

2015 ◽  
Vol 9 (11-12) ◽  
pp. 910 ◽  
Author(s):  
Robert Thomas Dale ◽  
Michael Metcalfe ◽  
Silvia Chang ◽  
Edward Jones ◽  
Peter Black
Keyword(s):  
Locally Advanced ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Locally Advanced Prostate Cancer ◽  
E Coli ◽  
Intravenous Antibiotics ◽  
Left Apex ◽  
Left Base ◽  
The Right ◽  
Extraprostatic Extension

A 66-year-old man was referred for urological evaluation for an abnormal digital rectal exam (cT2a, subtle nodule at left base, 121 cc prostate) and an elevated prostate specific antigen (PSA) of 8.0 ng/ml. Subsequent 12-core transrectal ultrasound (TRUS)- guided biopsy revealed Gleason 3+4 adenocarcinoma in seven of 12 cores, including all six cores on the right side and one core at the left apex. No extraprostatic extension was identified. Postbiopsy, the patient developed urinary retention requiring a catheter, as well as an Escherichia coli (E. coli) urinary tract infection (UTI) requiring hospitalization and intravenous antibiotics.

scholarly journals Prostatic ductal adenocarcinoma: an unusual case of a rare prostate cancer

2019 ◽  
Vol 9 (2) ◽  
pp. 28
Author(s):  
Rayan El Hassan ◽  
John Corr ◽  
Rajiv Pillai
Keyword(s):  
Locally Advanced ◽  
Specific Antigen ◽  
Transrectal Ultrasound ◽  
Ductal Adenocarcinoma ◽  
Flexible Cystoscopy ◽  
Open Radical Prostatectomy ◽  
Adenocarcinoma Of The Prostate ◽  
Papillary Lesions ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

A 65 year old gentleman was referred with symptoms of haematuria and haematospermia in association with an elevated prostate specific antigen (PSA). He was investigated with a flexible cystoscopy, Ultrasound scan and a computed tomography (CT) of his abdomen and pelvis. These failed to reveal any abnormality. Magnetic resonance imaging (MRI) revealed a Prostate Imaging Reporting and Data System PIRADS 2 lesion in the left peripheral gland and PIRADS 3 lesion on the right side posterolaterally at the level of mid gland of the prostate. He went on to have Transrectal ultrasound biopsies of his prostate (TRUS Bx) that excluded any pathology. On follow up visits his PSA continued to rise and he underwent Template biopsies of the prostate. The histological features had no evidence of any Prostatic intraepithelial carcinoma (PIN) or other malignancies. Flexible cystoscopy was repeated due to his persistent haematospermia. This showed prominent papillary lesions over his verumontanum and prostatic urethra. Biopsies from these areas revealed Ductal Adenocarcinoma of the Prostate (DACP). A subsequent staging MRI revealed unchanged appearance of the PIRADS2 nodule. There was however some low signal extending into the right seminal vesicle which is more pronounced than on the previous scan reported as PIRADS3. Subsequent mapping Template biopsies and Transurethral biopsies revealed a Gleason 4+4 DCAP. A staging CT and bone scan excluded any metastasis. He went on to receive an open radical prostatectomy and pelvic lymph node dissection as a curative treatment for his locally advanced disease.

Prostate Cystadenocarcinoma: A Rare Cystic Epithelial Lesion in an Unusual Clinical Setting

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S61-S61
Author(s):  
Sunjida Ahmed ◽  
Fang-Ming Deng ◽  
Jonathan Melamed
Keyword(s):  
Prostate Biopsy ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Elevated Serum ◽  
Urinary Symptoms ◽  
Resected Specimen ◽  
Current Case ◽  
Gleason Pattern ◽  
Cystic Tumors ◽  
The Right

Abstract Introduction Cystic tumors of prostate are rare and their clinicopathologic significance remains to be defined. The tumors present with either obstructive urinary symptoms or elevated serum prostate-specific antigen (PSA). Here we report a multilocular cystadenocarcinoma in a patient without significant urologic symptoms. Case Report A 71-year-old male with prior abnormal prostate biopsy, 6 years previously (unknown pathology), was referred for prekidney transplant workup. His symptom of oliguria and proteinuria was associated with end-stage renal disease without any obstructive urinary symptoms. Serum PSA detected 5.5 ng/mL. Magnetic resonance imaging (MRI) of the pelvis demonstrated a multilocular cystic lesion measuring 6.2 × 4.6 cm, arising from the right peripheral zone of prostate. The patient underwent MRI-guided prostate needle biopsy. Histology of prostate biopsy revealed glands and cystic structures lined by cuboidal to columnar epithelial cells with basally located hyperchromatic nuclei, pseudostratification, and focal papillary architecture. The cyst wall was immunoreactive for Cam 5.2, NKX 3.1, and AMACR, while negative for PAX8 and 34BE12 and p63, suggesting a diagnosis of primary prostate cystadenocarcinoma. The patient underwent robotic prostatectomy. The resected specimen showed a soft periprostatic mass, 6.8 × 5.0 cm at the right posterolateral aspect. Cut sections showed multiple multilocular cysts, with papillary projections, involving the right posterior-lateral surfaces with extensive extraprostatic extension. Histology showed multilocular cysts with papillary lining. Immunohistochemical studies showed strong reactivity of the cyst lining for NKX3.1, AMACR, weak CDX-2, and absent 34be12, p63, and ERG reactivity. The microscopic and immunohistochemical evidence supported a diagnosis of prostate cystadenocarcinoma, stage pT3a with free resection margin. Conclusion Cystadenocarcinoma is a variant of prostate carcinoma associated with obstructive urinary symptoms and potential for locally advanced growth. This case and other published reports of prostate cystadenocarcinoma show histologic features similar to the ductal variant of prostate adenocarcinoma, and therefore we suggest to grade it as Gleason pattern 4. The current case of prostate cystadenocarcinoma was an incidental diagnosis in an asymptomatic patient with mildly elevated PSA (T1c).

Body mass index and mortality in men treated for locally advanced prostate cancer: An analysis of RTOG 85–31

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 5128-5128
Author(s):  
J. A. Efstathiou ◽  
K. Bae ◽  
W. U. Shipley ◽  
G. E. Hanks ◽  
M. V. Pilepich ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Body Mass Index ◽  
Body Mass ◽  
Advanced Prostate Cancer ◽  
Cox Regression ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Phase Iii ◽  
Locally Advanced Prostate Cancer ◽  
All Cause Mortality

5128 Background: Greater body mass index (BMI) is associated with shorter time to prostate-specific antigen (PSA) failure following radical prostatectomy. We investigated whether BMI is associated with prostate cancer-specific mortality (PCSM) in a large randomized trial of men treated with radiation therapy (RT) and androgen deprivation therapy (ADT) for locally advanced prostate cancer. Methods: Between 1987 and 1992, 945 eligible men with locally advanced prostate cancer were enrolled on a phase III trial (RTOG 85- 31) and randomized to RT and immediate goserelin (Arm I) or RT alone followed by goserelin at relapse (Arm II). Height and weight data were available at baseline for 788 (83%) subjects. Cox regression analyses were performed to evaluate the relationships between BMI and all-cause mortality, PCSM, and non-prostate cancer mortality. Covariates included age, race, treatment arm, history of prostatectomy, nodal involvement, Gleason score, clinical stage, and BMI. Results: The 5-year PCSM rate for men with BMI<25kg/m2 was 6.5%, compared to 13.1% and 12.2% in men with BMI=25-<30 and BMI=30, respectively (Gray’s p=0.005). In multivariable analyses, as shown in the Table , greater BMI was significantly associated with higher PCSM [for BMI=25-<30, hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.02–2.27, p=0.04; for BMI=30, HR 1.65, 95% CI 1.02–2.66, p=0.04]. BMI was not associated with non-prostate cancer or all-cause mortality. Conclusions: Greater baseline BMI is independently associated with higher PCSM in men with locally advanced prostate cancer. Further studies are warranted to evaluate the mechanism(s) for increased mortality and to assess whether weight loss after prostate cancer diagnosis alters disease course. [Table: see text] No significant financial relationships to disclose.

scholarly journals Final Report of the Intergroup Randomized Study of Combined Androgen-Deprivation Therapy Plus Radiotherapy Versus Androgen-Deprivation Therapy Alone in Locally Advanced Prostate Cancer

2015 ◽  
Vol 33 (19) ◽  
pp. 2143-2150 ◽  
Author(s):  
Malcolm D. Mason ◽  
Wendy R. Parulekar ◽  
Matthew R. Sydes ◽  
Michael Brundage ◽  
Peter Kirkbride ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Overall Survival ◽  
Androgen Deprivation Therapy ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Androgen Deprivation ◽  
Final Report ◽  
Locally Advanced Prostate Cancer

Purpose We have previously reported that radiotherapy (RT) added to androgen-deprivation therapy (ADT) improves survival in men with locally advanced prostate cancer. Here, we report the prespecified final analysis of this randomized trial. Patients and Methods NCIC Clinical Trials Group PR.3/Medical Research Council PR07/Intergroup T94-0110 was a randomized controlled trial of patients with locally advanced prostate cancer. Patients with T3-4, N0/Nx, M0 prostate cancer or T1-2 disease with either prostate-specific antigen (PSA) of more than 40 μg/L or PSA of 20 to 40 μg/L plus Gleason score of 8 to 10 were randomly assigned to lifelong ADT alone or to ADT+RT. The RT dose was 64 to 69 Gy in 35 to 39 fractions to the prostate and pelvis or prostate alone. Overall survival was compared using a log-rank test stratified for prespecified variables. Results One thousand two hundred five patients were randomly assigned between 1995 and 2005, 602 to ADT alone and 603 to ADT+RT. At a median follow-up time of 8 years, 465 patients had died, including 199 patients from prostate cancer. Overall survival was significantly improved in the patients allocated to ADT+RT (hazard ratio [HR], 0.70; 95% CI, 0.57 to 0.85; P < .001). Deaths from prostate cancer were significantly reduced by the addition of RT to ADT (HR, 0.46; 95% CI, 0.34 to 0.61; P < .001). Patients on ADT+RT reported a higher frequency of adverse events related to bowel toxicity, but only two of 589 patients had grade 3 or greater diarrhea at 24 months after RT. Conclusion This analysis demonstrates that the previously reported benefit in survival is maintained at a median follow-up of 8 years and firmly establishes the role of RT in the treatment of men with locally advanced prostate cancer.

scholarly journals Treatment of locally advanced prostatic cancer

2010 ◽  
Vol 63 (9-10) ◽  
pp. 689-695 ◽  
Author(s):  
Goran Marusic ◽  
Sasa Vojinov ◽  
Ivan Levakov
Keyword(s):  
Prostate Cancer ◽  
Surgical Treatment ◽  
Radical Prostatectomy ◽  
Lymph Nodes ◽  
Hormonal Therapy ◽  
Advanced Prostate Cancer ◽  
Locally Advanced ◽  
Specific Antigen ◽  
Seminal Vesicles ◽  
Locally Advanced Prostate Cancer

Introduction. A locally advanced prostate cancer is defined as a malignant process spreading beyond the prostate capsule or in seminal vesicles but without distant metastasis or regional lymph nodes invasion. Clinical classification, prediction and treatment of prostate cancer. An exact staging of clinical T3 stadium is usually difficult because of the frequent over and under staging. The risk prognostic stratification is performed through nomograms and ANN (artificial neural networks). The options for treatment are: radical prostatectomy, external radiotherapy and interstitial implantation of radioisotopes, hormonal therapy by androgen blockade. Radical prostatectomy is considered in patients with T3 stage but extensive dissection of lymph nodes, dissection of neurovascular bundle (on tumor side), total removal of seminal vesicle and sometimes resection of bladder neck are obligatory. Postoperative radiotherapy is performed in patients with invasion of seminal vesicles and capsular penetration or with prostate specific antigen value over 0.1 ng/ml, one month after the surgical treatment. Definitive radiotherapy could be used as the best treatment option considering clinical stage, Gleason score, age, starting prostate specific antigen (PSA) value, concomitant diseases, life expectancy, quality of life, through multidisciplinary approach (combined with androgen deprivation). Hormonal therapy in intended for patients who are not eligible for surgical treatment or radiotherapy. Conclusion. Management of locally advanced prostate cancer is still controversial and studies for better diagnosis and new treatment modalities are ongoing.

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