Radical Prostatectomy For Incidental (Stage T1a-T1b) Prostate Cancer: Analysis Of Predictors For Residual Disease And Biochemical Recurrence

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 07 Aug 2008 - 2:00 PST

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UroToday.com - Patients with the stages pT1a or pT1b prostate cancer (CaP) by definition are found to have CaP on simple open prostatectomy or TURP performed for BPH. These patients must decide if they then need definitive therapy. In the online issue of European Urology, Dr. Umberto Capitanio and associates reported that PSA measured before and after surgery for BPH and Gleason score in the BPH specimen was a significant predictor of the presence of residual cancer at radical retropubic prostatectomy (RP).

A total of 126 patients treated with surgery for BPH between 1995 and 2007 were identified. Stage T1a was found in 75 men and T1b in 51 men. CaP was diagnosed at TURP in 84, at simple open prostatectomy in 23 patients, and at laser enucleation f the prostates in 19 men. All patients with an abnormal DRE or elevated PSA underwent prostate biopsy prior to their BPH surgery. All patients had RP performed within 6 months of their BPH surgery.

Only PSA before BPH surgery was significantly different with a mean of 4.9ng/ml for stage T1a patients and 7.2ng/ml for stage T1b patients. At RP, 21 men (16.7%) had no residual CaP. Of the remaining 105 men, 98 (77.7%) had organ confined CaP and 7 (5.6%) had extracapsular extension. Stage pT3b CaP was found in 2 men. Only one patient had lymph node involvement.

Patients with a low PSA value after BPH surgery (<1ng/ml) and Gleason score <6 at BPH surgery are likely (83.2%) to not have residual CaP at RP. However, the authors suggest that this data is not definitive enough to apply to general clinical practice. At a followup of 57 months, 7 patients demonstrated biochemical recurrence; 4 stage T1a and 3 stage T1b prior to RP.

PSA after BPH surgery was the most predictive factor for biochemical recurrence for all men who experienced PSA recurrence after BPH surgery with a PSA above 1.0ng/ml.

Capitanio U, Scattoni V, Freschi M, Briganti A, Salonia A, Gallina A, Colombo R, Karakiewicz PI, Rigatti P, Montorsi F
Eur Urol. 2008 Jul;54(1):118-25
10.1016/j.eururo.2008.02.018

Reported by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS

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