No abstract

Background and Objective: The literature lacks knowledge about information preferences and decisionmaking in young prostate cancer patients. This study provides insight into information sources consulted and factors dictating treatment decision-making in young prostate cancer patients. Methods: Subjects were identified from pathology consult service of a National Center of Excellence. Questionnaires were mailed to 986 men, under 50 years of age, diagnosed with Gleason score 6 prostate cancer between 2001 and 2005. Results: Four hundred ninety-three men responded. The most common primary therapies were surgery 397 (81.4%), radiation 52 (10.7%), and active surveillance (AS) 26 (5.3%). Participants with at least some college education (P = 0.003) or annual income > $100,000 (P = 0.003) were more likely to consult three or more doctors. Amongst all treatments, "doctor's recommendation" was the most influential information source, although relatively less important in the AS group. Internet was the second most frequent information source. Participants with higher education (P = 0.0003) and higher income (P = 0.002) considered sexual function more important while making a treatment choice. Only 2% of the men preferred a passive role in the decision-making. Informed decision-making was preferred more by patients who chose radiation and AS while shared decision-making was preferred more by surgery patients (P < 0.05). The majority (89%) of the respondents did not regret their decision. No difference in satisfaction levels was found between different treatment modalities.

Urological Survey 790 features and a malignant or benign diagnosis. The sensitivity, specificity, and positive and negative predictive values of progressive enhancement for a diagnosis of benignity were 60%, 73%, 43%, and 84%. Conclusion: In the evaluation of enhancing small solid renal lesions without fat, no CT criteria were of substantial help in differentiating malignant from benign lesions. Editorial CommentPre-operative characterization of small solid enhancing renal lesion containing no macroscopic fat is a difficult task. Although the CT characteristics of benign solid renal lesion overlap with those of renal cell carcinoma, we encourage radiologists from our institution to narrow the differential diagnosis whenever it is possible. The pre-operative radiologic impression of renal tumor histology is of particular value when affects therapeutic management. During the nephrographic (90-100 seconds) and excretory phase (180 seconds), some renal tumors subtypes demonstrate significant different degrees of enhancement. Clear cell of renal carcinoma can be suggested by the presence of strong and heterogeneous contrast enhancement and rapid washout. Papillary renal cell carcinoma is usually homogeneously hipovascular similarly to the rare benign metanephric adenoma. Solid homogeneously hypervascular renal mass can be observed in oncocytoma and angiomyolipoma without macroscopic fat. Thus, depending on the clinical scenario, percutaneous biopsy is performed particularly when its results will influence therapeutic management

Purpose: There have been only a few contradictory publications assessing whether Gleason score 4 + 3 = 7 has a worse prognosis than 3 + 4 = 7 on biopsy material in predicting pathological stage and biochemical recurrence. Older studies predated the use of the modified Gleason grading system established in 2005. Materials and Methods: We retrospectively studied 1,791 cases of Gleason score 7 on prostatic biopsy to determine whether the breakdown of Gleason score 7 into 3 + 4 vs 4 + 3 has prognostic significance in the modern era. Results: There was no difference in patient age, preoperative serum prostate specific antigen, maximum tumor percent per core or the number of positive cores between Gleason score 3 + 4 = 7 and Gleason score 4 + 3 = 7. Gleason score 4 + 3 = 7 showed an overall correlation with pathological stage (organ confined, focal extraprostatic extension, nonfocal extraprostatic extension, seminal vesicle invasion/lymph node metastases, p = 0.005). On multivariate analysis Gleason score 4 + 3 = 7 (p = 0.03), number of positive cores (p = 0.002), maximum percent of cancer per core (p = 0.006) and preoperative serum prostate specific antigen (p = 0.03) all correlated with pathological stage. Gleason score 4 + 3 = 7 on biopsy was also associated with an increased risk of biochemical progression after radical prostatectomy (p = 0.0001). On multivariate analysis Gleason score 4 + 3 = 7 (p = 0.001), maximum percent of cancer per core (p < 0.0001) and preoperative serum prostate specific antigen (p < 0.0001) but not number of positive cores correlated with the risk of biochemical progression after radical prostatectomy. Conclusions: Our study further demonstrates that Gleason score 7 should not be considered a homogenous group for the purposes of disease management and prognosis.

Am J Surg Pathol. 2011; 35: 1351-5. Currently, there is no consensus as to the optimal method for measuring tumor length or percentage of cancer on a core when there are 2 or more foci of prostate cancer in a single core separated by benign intervening stroma. One option is to measure discontinuous foci of cancer as if they were 1 single continuous focus. The other option is to add the measurements of the individual separate foci of cancer, ignoring the extent of the intervening benign prostate tissue. The surgical pathology database at The Johns Hopkins Hospital was searched for outside consult cases of prostate needle biopsies reviewed between 2005 and 2010 when the patient came to our institution for radical prostatectomy (RP). Cases were restricted to those with biopsy Gleason score 6 in which there was at least 15% discordance between the outside and our institution in terms of the reported highest percentage of cancer per core per case. One hundred and nine patients were identified fulfiling our inclusion criteria. Seventy-nine showed the same Gleason score in the RP, and 30 had an upgrade to Gleason ≥ 7. Including all cases (scores 6, 7, and 8 at RP), there was no significant association between the maximum percentage of cancer per core with organ-confined disease or risk of positive surgical margins, regardless if the cores were measured at Hopkins or at the outside institutions. For cases with no upgrade at RP, the differences between the maximum percentage of cancer per core per case recorded at Hopkins and the outside institutions ranged from 15% to 80%, in which the mean and median differences were 35% and 30%, respectively. The maximum percentages of tumor involvement on a core per case given at our institution more strongly correlated with the presence of organ-confined disease (P = 0.004) compared with the percentages given at the outside institutions (P = 0.027). Surgical margin positivity was also associated with the maximum percentages of tumor involvement per core given at our institution (P = 0.004), whereas the outside percentages were not significant predictors of margin status (P = 0.2). In a multivariable analysis, maximum percentage of cancer per core per case measured at Hopkins which includes intervening benign prostate tissue in the measurement was also more predictive of stage and margins than ignoring intervening benign tissue. In summary, our study demonstrated