scholarly journals Case: Spontaneous regression of post-radical prostatectomy prostate-specific antigen elevation without adjuvant therapy in a patient with lymph node metastasis

2017 ◽  
Vol 11 (7) ◽  
pp. E315-7
Author(s):  
Taehyoung Lee ◽  
Yanbo Guo ◽  
Saahil Vij ◽  
Rahul Bansal ◽  
Nathan C. Wong ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Adjuvant Therapy ◽  
Gleason Score ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Lymph Node Involvement ◽  
Complete Regression

Prostate cancer remains the most frequently diagnosed cancer among men. The combination of clinical stage, serum prostatespecific antigen (PSA), and Gleason score (biopsy) assists in predictive assessment of pathological stage and prognosis. Furthermore, pathological criteria, including Gleason score, surgical margin status, extracapsular extension, seminal vesicle invasion, and lymph node involvement, provide prognostication in patients undergoing radical prostatectomy (RP). In this paper, we present a case of a patient with high-risk prostate cancer with persistent PSA elevation post-RP who experiences a complete regression of PSA without any adjuvant therapy. To the authors’ knowledge, such a finding has not been described in the literature previously.

scholarly journals Preoperative Prostate Health Index predicts adverse pathology and Gleason score upgrading after radical prostatectomy for prostate cancer

2020 ◽  
Author(s):  
Vojtěch Novák ◽  
Štěpán Veselý ◽  
Hana Lukšanová ◽  
Richard Průša ◽  
Otakar Čapoun ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Health Index ◽  
Cancer Aggressiveness ◽  
Prostate Health Index ◽  
Prostate Health

Abstract Background: We aimed to explore the utility of prostate specific antigen (PSA) isoform [-2]proPSA and its derivatives for prediction of pathological outcome after radical prostatectomy (RP).Methods: Preoperative blood samples were prospectively and consecutively analyzed from 472 patients treated with RP for clinically localized prostate cancer at four medical centers. Measured parameters were PSA, free PSA (fPSA), fPSA/PSA ratio, [-2]proPSA (p2PSA), p2PSA/fPSA ratio and Prostate Health Index (PHI) (p2PSA/fPSA)*√PSA]. Logistic regression models were fitted to determine the accuracy of markers for prediction of pathological Gleason score (GS) ≥7, Gleason score upgrading, extracapsular extension of the tumor (pT3) and the presence of positive surgical margin (PSM). Results: Of 472 patients undergoing RP, 339 (72%) were found to have pathologic GS ≥ 7, out of them 178 (53%) experienced an upgrade from their preoperative GS=6. The findings of pT3 and PSM were present in 132 (28%) and 133 (28%) cases, respectively. At univariable analysis of all the preoperative parameters, PHI was the most accurate predictor of pathological GS ≥7, GS upgrading, pT3 disease and the presence of PSM. Adding of PHI into the base multivariable model increased significantly the accuracy for prediction of pathological GS and GS upgrading by 4.4% (p=0.015) and 5.0% (p=0.025), respectively. Conclusion: We found that PHI provides the highest accuracy in predicting prostate cancer aggressiveness and expansion of the tumor detected at final pathology. The ability of PHI to predict the risk of Gleason score upgrade may help to identify potentially high-risk patients among men with biopsy proven insignificant prostate cancer.

Role of Bilateral Pelvic Lymphadenectomy in Prostatic Cancer

1997 ◽  
Vol 64 (3) ◽  
pp. 348-350
Author(s):  
A. Fandella ◽  
L. Maccatrozzo ◽  
F. Merlo ◽  
L. Faggiano ◽  
P. Cecchin ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Elevated Serum ◽  
Lymph Node Involvement ◽  
Radical Retropubic Prostatectomy ◽  
Low Risk ◽  
Retropubic Prostatectomy ◽  
Node Involvement

Objectives: to identify a group of patients with prostate cancer for whom open staging pelvic lymph node dissection (PLND) could be superfluous. Methods: the medical records of all patients presenting with prostate cancer from January 1992 to December 1996 were reviewed. A total of 118 patients with clinically localized disease were selected to undergo radical retropubic prostatectomy (RRP) preceded by open PLND. Final nodal status was correlated with the value of the preoperative serum prostate specific antigen (PSA) concentration, clinical stage (TNM), and grading (by OMS) to evaluate the predictivity of nodal involvement. We identified 3 groups: PSA <10 ng/ml, T1–2, G1-2, = 1st very low risk, PSA 10 −15, T1-2 - G1-2 = 2nd low risk, PSA <15 T3 or G3 or PSA >15 every T and G = 3rd high risk. Results: overall, only 21 patients (18%) had lymph node metastases. Lymph node involvement was significantly correlated with elevated serum PSA values, high grading, and advanced clinical stage. 35 patients belonged to the first 2 groups, presenting with low PSA and favorable clinical stage and grade, none with lymph node involvement. These patients could have avoided PLND with a very low risk of missing something. Conclusions: open staging PLND may no longer be justified on a routine basis in patients undergoing radical retropubic prostatectomy.

scholarly journals Predictors of time to biochemical recurrence in a radical prostatectomy cohort within the PSA-era

2016 ◽  
Vol 10 (1-2) ◽  
pp. 17 ◽  
Author(s):  
Ahva Shahabi ◽  
Raj Satkunasivam ◽  
Inderbir S. Gill ◽  
Gary Lieskovsky ◽  
Sia Daneshmand ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Competing Risks ◽  
Gleason Score ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Localized Prostate Cancer ◽  
Positive Surgical Margin ◽  
Clinical Recurrence

Introduction: We sought to determine predictors for early and late biochemical recurrence following radical prostatectomy among localized prostate cancer patients.Methods: The study included localized prostate cancer patients treated with radical prostatectomy (RP) at the University of Southern California from 1988 to 2008. Competing risks regression models were used to determine risk factors associated with earlier or late biochemical recurrence, defined using the median time to biochemical recurrence in this population (2.9 years after radical prostatectomy).Results: The cohort for this study included 2262 localized prostate cancer (pT2-3N0M0) patients who did not receive neoadjuvant or adjuvant therapies. Of these patients, 188 experienced biochemical recurrence and a subset continued to clinical recurrence, either within (n=19, 10%) or following (n=13, 7%) 2.9 years after RP. Multivariable stepwise competing risks analysis showed Gleason score ≥7, positive surgical margin status, and ≥pT3a stage to be associated with biochemical recurrence within 2.9 years following surgery. Predictors of biochemical recurrence after 2.9 years were Gleason score 7 (4+3), preoperative prostate-specific antigen (PSA) level, and ≥pT3a stage.Conclusions: Higher stage was associated with biochemical recurrence at any time following radical prostatectomy. Particular attention may need to be made to patients with stage ≥pT3a, higher preoperative PSA, and Gleason 7 prostate cancer with primary high-grade patterns when considering longer followup after RP.

scholarly journals Preoperative Prostate Health Index predicts adverse pathology and Gleason score upgrading after radical prostatectomy for prostate cancer.

2020 ◽  
Author(s):  
Vojtech Novak ◽  
Stepan Vesely ◽  
Hana Luksanova ◽  
Richard Prusa ◽  
Otakar Capoun ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Specific Antigen ◽  
Surgical Margin ◽  
Positive Surgical Margin ◽  
Health Index ◽  
Cancer Aggressiveness ◽  
Prostate Health Index ◽  
Prostate Health

Abstract Background: We aimed to explore the utility of prostate specific antigen (PSA) isoform [-2]proPSA and its derivatives for prediction of pathological outcome after radical prostatectomy (RP).Methods: Preoperative blood samples were prospectively and consecutively analyzed from 472 patients treated with RP for clinically localized prostate cancer at four medical centers. Measured parameters were PSA, free PSA (fPSA), fPSA/PSA ratio, [-2]proPSA (p2PSA), p2PSA/fPSA ratio and Prostate Health Index (PHI) (p2PSA/fPSA)*√PSA]. Logistic regression models were fitted to determine the accuracy of markers for prediction of pathological Gleason score (GS) ≥7, Gleason score upgrading, extracapsular extension of the tumor (pT3) and the presence of positive surgical margin (PSM). Results: Of 472 patients undergoing RP, 339 (72%) were found to have pathologic GS ≥ 7, out of them 178 (53%) experienced an upgrade from their preoperative GS=6. The findings of pT3 and PSM were present in 132 (28%) and 133 (28%) cases, respectively. At univariable analysis of all the preoperative parameters, PHI was the most accurate predictor of pathological GS ≥7, GS upgrading, pT3 disease and the presence of PSM. Adding of PHI into the base multivariable model increased significantly the accuracy for prediction of pathological GS and GS upgrading by 4.4% (p=0.015) and 5.0% (p=0.025), respectively. Conclusion: We found that PHI provides the highest accuracy in predicting prostate cancer aggressiveness and expansion of the tumor detected at final pathology. The ability of PHI to predict the risk of Gleason score upgrade may help to identify potentially high-risk patients among men with biopsy proven insignificant prostate cancer.

scholarly journals First Nomogram Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients Undergoing Radioisotope Guided Sentinel Lymph Node Dissection

2015 ◽  
Vol 95 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Alexander Winter ◽  
Thomas Kneib ◽  
Martin Rohde ◽  
Rolf-Peter Henke ◽  
Friedhelm Wawroschek
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Predictive Accuracy ◽  
Clinical Stage ◽  
Specific Antigen ◽  
Lymph Node Involvement ◽  
High Rate ◽  
Node Dissection ◽  
Node Involvement

Introduction: Existing nomograms predicting lymph node involvement (LNI) in prostate cancer (PCa) are based on conventional lymphadenectomy. The aim of the study was to develop the first nomogram for predicting LNI in PCa patients undergoing sentinel guided pelvic lymph node dissection (sPLND). Materials and Methods: Analysis was performed on 1,296 patients with PCa who underwent radioisotope guided sPLND and retropubic radical prostatectomy (2005-2010). Median prostate specific antigen (PSA): 7.4 ng/ml (IQR 5.3-11.5 ng/ml). Clinical T-categories: T1: 54.8%, T2: 42.4%, T3: 2.8%. Biopsy Gleason sums: ≤6: 55.1%, 7: 39.5%, ≥8: 5.4%. Multivariate logistic regression models tested the association between all of the above predictors and LNI. Regression-based coefficients were used to develop a nomogram for predicting LNI. Accuracy was quantified using the area under the curve (AUC). Results: The median number of LNs removed was 10 (IQR 7-13). Overall, 17.8% of patients (n = 231) had LNI. The nomogram had a high predictive accuracy (AUC of 82%). All the variables were statistically significant multivariate predictors of LNI (p = 0.001). Univariate predictive accuracy for PSA, Gleason sum and clinical stage was 69, 75 and 69%, respectively. Conclusions: The sentinel nomogram can predict LNI at a sPLND very accurately and, for the first time, aid clinicians and patients in making important decisions on the indication of a sPLND. The high rate of LN+ patients underscores the sensitivity of sPLND.

Use of the Prostate Health Index for the Detection of Aggressive Prostate Cancer at Radical Prostatectomy

2015 ◽  
Vol 95 (4) ◽  
pp. 390-399 ◽  
Author(s):  
Luigi Mearini ◽  
Elisabetta Nunzi ◽  
Carla Ferri ◽  
Guido Bellezza ◽  
Carolina Lolli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lymph Node ◽  
High Risk ◽  
Radical Prostatectomy ◽  
Gleason Score ◽  
Health Index ◽  
Final Pathology ◽  
High Risk Disease ◽  
Prostate Health Index ◽  
Prostate Health

Introduction: In current study, we compared the accuracy of the PSA isoform p2PSA and its derivatives, the percentage of p2PSA to free PSA (%p2PSA) and the Prostate Health Index (PHI) in the detection of prostate cancer (PC) characteristics at the final pathology with respect to reference standards. Materials and Methods: This was an observational prospective study evaluating 43 consecutive PC patients treated with laparoscopic/robotic radical prostatectomy (RP). Logistic regression models were fitted to test the predictors of pT3 stage, pathologic Gleason score ≥8 or Gleason score upgrading, margin status, lymph node invasion, and the presence of high-risk disease (pT3 disease and/or Gleason score ≥8 and/or positive lymph node). The comparative base model included tPSA, clinical stage, biopsy Gleason score, and percentage of positive core. Results: Seventeen patients (39.5%) were affected by pT3 disease or had a pathologic Gleason score ≥8; positive margins were detected in 12 patients (27.9%), lymph node invasion was found in 2 patients (4.7%), and 15 patients (34.8%) harbored high-risk disease. In the univariate analysis, p2PSA, %p2PSA, and PHI were significant predictors of pT3 disease, pathologic Gleason score, and the presence of high-risk disease (all p < 0.05), whereas only PHI was an independent predictor of pT3 disease, margin status, and presence of high-risk disease, increasing the accuracy of a base multivariable model by 6.3% (p < 0.05) and 4.2% (p < 0.05) for the prediction of pT3 and high-risk disease, respectively. Conclusions: p2PSA and its derivatives, primarily PHI, were significant predictors of unfavorable PC characteristics as detected at the final pathology, thus improving the clinical performance of standard prognostic factors for aggressive disease.

Biochemical Recurrence after Radical Prostatectomy

2018 ◽  
Author(s):  
Dunia Khaled ◽  
Scott Delacroix ◽  
Brian Chapin
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Lymph Node ◽  
Radical Prostatectomy ◽  
Prostate Specific Antigen ◽  
Lymph Node Dissection ◽  
Biochemical Recurrence ◽  
Specific Antigen ◽  
Node Dissection ◽  
Salvage Lymph Node Dissection

After receiving local treatment, many patients will develop a biochemical recurrence (BCR) in the absence of detectable distant disease (cM0) and comprise a significant proportion (20.1%) of prostate cancer disease states. The natural history of patients with BCR ranges from those with indolent, nonprogressive, slow prostate-specific antigen (PSA)-only progression to those ultimately destined to develop metastases and progress to a cancer-specific death. Pathologic predictors of BCR, clinical progression, and cancer-specific mortality are well established in the literature, although multiple novel predictors are emerging, which are highlighted. Traditional imaging cannot reliably distinguish local versus distant microscopic metastasis at the PSA levels that have been shown to confer survival advantage for salvage radiation therapy. We review past and present imaging standards and discuss novel imaging modalities, which may improve staging and offer opportunity for novel salvage therapies, including salvage lymph node dissection and stereotactic beam radiation therapy. With an emphasis on BCR after radical prostatectomy, both curative and palliative treatments are reviewed. This review contains 7 figures, 6 tables and 73 references Key words: biochemical recurrence, clinically undetectable metastases, molecular imaging, monitoring treatment response, prostate cancer, radical prostatectomy, rising prostate-specific antigen, salvage lymph node dissection, salvage radiation  

Sign in / Sign up

Export Citation Format

Share Document