Prostate cancers detected on repeat prostate biopsies show spatial distributions that differ from those detected on the initial biopsies
Okyaz EminağaReemt HinkelammertMahmoud AbbasUlf TitzeElke EltzeOlaf BettendorfFabian WötzelMartin BögemannAxel Semjonow
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To evaluate the spatial distribution of prostate cancer detected at a single positive biopsy (PBx) and a repeat PBx (rPBx).We evaluated 533 consecutive men diagnosed with prostate cancer who underwent radical prostatectomy using a clinical map document based on XML (cMDX©)-based map model of the prostate. We determined the number of cancer foci, relative tumour volume, Gleason score, zone of origin, localisation, and pathological stage after stratification according to the number of PBx sessions (PBx vs rPBx). The distribution of 3966 prostate cancer foci was analysed and visualised on heat maps. The colour gradient of the heat map was reduced to six colours representing the frequency classification of prostate cancer using an image posterisation effect. Additionally, the spatial distribution of organ-confined prostate cancer between PBx and rPBx was evaluated.Prostate cancer diagnosed on PBx was mostly localised to the apical portion and the peripheral zone of the prostate. Prostate cancer diagnosed on rPBx was more frequently found in the anterior portion and the base of the prostate. Organ-confined prostate cancer foci were mostly localised in the dorsolateral zone of the prostate in men at PBx, whereas men at rPBx had more prostate cancer foci in the anterior portion.The spatial distribution of prostate cancer with rPBx differs significantly from the spatial distribution of prostate cancer with PBx. The whole anterior portion of the prostate should be considered by rPBx.No AccessJournal of UrologyDiscussion1 Dec 2006Initial Therapy With Radical Prostatectomy for High Risk Localized Prostate Cancer James E. Montie James E. MontieJames E. Montie More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2006.06.073AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: This study provides a perspective on initial treatment in select patients with high risk, localized prostate cancer. Materials and Methods: A select literature review was done with commentary on the philosophy of initial surgery followed by adjuvant or salvage therapies. Results: Early detection and associated stage migration identify a cadre of men with unfavorable but apparently localized prostate cancer who historically would not have been viewed as appropriate candidates for radical prostatectomy. Decreased morbidity from radical prostatectomy and data demonstrating improved outcomes in some patients treated with multimodal therapy protocols provide a rationale for including radical prostatectomy as part of an aggressive treatment plan to achieve optimal local elimination of cancer. Data suggest that radical prostatectomy and adjuvant or possibly even salvage radiation therapy may provide the best elimination of large local cancers. Whether such an approach provides results that are better than or even as good as those of the common standard of radiation therapy plus androgen deprivation therapy remains to be seen and, if so, at what cost to the patient in terms of adverse effects. However, it is likely that optimal elimination of local disease is needed to achieve the maximum benefit from adjuvant systemic endocrine, chemotherapy or targeted treatments. In other words optimal local therapy may be necessary but not sufficient. Conclusions: Initial radical prostatectomy may have a role for treating high risk localized prostate cancer. References 1 : The changing face of prostate cancer. J Clin Oncol2005; 23: 8146. Google Scholar 2 : An evaluation of the decreasing incidence of positive surgical margins in a large retropubic prostatectomy series. J Urol2004; 171: 28. Google Scholar 3 : Cancer progression and survival rates following anatomical radical retropubic prostatectomy in 3,478 consecutive patients: long-term results. J Urol2004; 172: 910. Link, Google Scholar 4 : Improved biochemical relapse-free survival with increased external radiation doses in patients with localized prostate cancer: the combined experience of nine institutions in patients treated in 1994 and 1995. Int J Radiat Oncol Biol Phys2005; 612: 415. Google Scholar 5 : Factors affecting recurrence rates after prostatectomy or radiotherapy in localized prostate carcinoma patients with biopsy Gleason score 8 or above. Cancer2002; 95: 2302. Google Scholar 6 : Isolated seminal vesicle invasion imparts better outcomes after radical retropubic prostatectomy for clinically localized prostate cancer: prognostic stratification of pT3b disease by nodal and margin status. Urology2005; 66: 152. Google Scholar 7 : Radical prostatectomy for clinically advanced (cT3) prostate cancer since the advent of prostate-specific antigen testing: 15-year outcome. BJU Int2005; 95: 751. Google Scholar 8 : Long-term outcome following radical prostatectomy in men with clinical T3 prostate cancer. J Urol2005; 173: 662. Google Scholar 9 : Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases. J Clin Oncol2002; 20: 3199. Google Scholar 10 : Long term results of 3D conformal radiotherapy following radical prostatectomy. Urology2003; 62: 93. Google Scholar 11 : In 111-labeled capromab pendetide radioimmunoscintigraphy and prognosis for durable biochemical response to salvage radiation therapy in men after failed prostatectomy. J Clin Oncol2003; 21: 1715. Google Scholar 12 : Personal communication. : 2005. Google Scholar 13 : The precise location and nature of the nerves to the male human urethra: histological and immunohistochemical studies with three-dimensional reconstruction. Eur Urol2005; 48: 858. Google Scholar 14 : Prospective assessment of patient-reported urinary continence following radical prostatectomy. J Urol2000; 164: 774. Google Scholar 15 : Wide excision (nonnerve sparing) radical retropubic prostatectomy using an initial perirectal dissection. J Urol1997; 157: 251. Link, Google Scholar 16 : Introperative nerve stimulation with measurement of urethral sphincter pressure changes during radical retropubic prostatectomy: a feasibility study. J Urol2003; 169: 2225. Link, Google Scholar 17 : Nomograms are superior to staging and risk grouping systems for identifying high-risk patients: preoperative application in prostate cancer. Curr Opin Urol2003; 13: 111. Google Scholar 18 : Treatment of patients with high risk localized prostate cancer: results from Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE). J Urol2005; 173: 1557. Link, Google Scholar 19 : Validation of the Kattan preoperative nomogram for prostate cancer recurrence using a community based cohort: results from Cancer of the Prostate Strategic Urological Research Endeavor (CaPSURE). J Urol2004; 171: 2255. Link, Google Scholar 20 : Preoperative PSA velocity and the risk of death from prostate cancer after radical prostatectomy. N Engl J Med2004; 351: 125. Google Scholar Department of Urology, University of Michigan, Ann Arbor, Michigan© 2006 by American Urological AssociationFiguresReferencesRelatedDetails Volume 176Issue 6SDecember 2006Page: S27-S29 Advertisement Copyright & Permissions© 2006 by American Urological AssociationKeywordsprostatic neoplasmsprostatectomysalvage therapyriskprostateMetricsAuthor Information James E. Montie More articles by this author Expand All Advertisement PDF DownloadLoading ...
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We analyzed the levels of selected micro-RNAs in normal prostate tissue to assess their potential to indicate tumor foci elsewhere in the prostate. Histologically normal prostate tissue samples from 31 prostate cancer patients and two cancer negative control groups with either unsuspicious or elevated prostate specific antigen (PSA) levels (14 and 17 individuals, respectively) were analyzed. Based on the expression analysis of 157 microRNAs in a pool of prostate tissue samples and information from data bases/literature, we selected eight microRNAs for quantification by real-time polymerase chain reactions (RT-PCRs). Selected miRNAs were analyzed in histologically tumor-free biopsy samples from patients and healthy controls. We identified seven microRNAs (miR-124a, miR-146a & b, miR-185, miR-16 and let-7a & b), which displayed significant differential expression in normal prostate tissue from men with prostate cancer compared to both cancer negative control groups. Four microRNAs (miR-185, miR-16 and let-7a and let-7b) remained to significantly discriminate normal tissues from prostate cancer patients from those of the cancer negative control group with elevated PSA levels. The transcript levels of these microRNAs were highly indicative for the presence of cancer in the prostates, independently of the PSA level. Our results suggest a microRNA-pattern in histologically normal prostate tissue, indicating prostate cancer elsewhere in the organ.
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To evaluate the spatial distribution of prostate cancer detected at a single positive biopsy (PBx) and a repeat PBx (rPBx).We evaluated 533 consecutive men diagnosed with prostate cancer who underwent radical prostatectomy using a clinical map document based on XML (cMDX©)-based map model of the prostate. We determined the number of cancer foci, relative tumour volume, Gleason score, zone of origin, localisation, and pathological stage after stratification according to the number of PBx sessions (PBx vs rPBx). The distribution of 3966 prostate cancer foci was analysed and visualised on heat maps. The colour gradient of the heat map was reduced to six colours representing the frequency classification of prostate cancer using an image posterisation effect. Additionally, the spatial distribution of organ-confined prostate cancer between PBx and rPBx was evaluated.Prostate cancer diagnosed on PBx was mostly localised to the apical portion and the peripheral zone of the prostate. Prostate cancer diagnosed on rPBx was more frequently found in the anterior portion and the base of the prostate. Organ-confined prostate cancer foci were mostly localised in the dorsolateral zone of the prostate in men at PBx, whereas men at rPBx had more prostate cancer foci in the anterior portion.The spatial distribution of prostate cancer with rPBx differs significantly from the spatial distribution of prostate cancer with PBx. The whole anterior portion of the prostate should be considered by rPBx.
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Objective To investigate the expressions of mitosis regulative factor STK-15 in prostate cancer and the relationship between STK-15 and the biological behavior of prostate cancer.Methods The expressions of STK-15 were examined by using immunohistochemical staining on 63 cases of prostate cancer and 16 cases of normal prostate tissues.And the expressions of STK-15 mRNA were detected by using RT-PCR in 14 cases of prostate cancer,BPH,and normal prostate tissues respectively.Results The STK15 protein was expressed in 98%(62/63) of prostate cancer tissue and in 19%(3/16) of normal prostate tissues.The difference between these expression rates was significant(P0.001).Meanwhile,the positive expression rates of STK-15 mRNA in prostate cancer,BPH,and normal prostate tissue were 93%(13/14),21%(3/14) and 14%(2/14) respectively.Compared with those in BPH and normal prostate tissue,the STK-15 mRNA expression rate in prostate cancer was significantly high(P0.001).Meanwhile,there was no significant difference between those in BPH and normal prostate tissue(P0.05).Conclusion The expressions of STK-15 increase in prostate cancer tissues which may contribute to the prostate carcinogenesis.
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