Biological Selection Criteria for Radical Prostatectomy

Abstract

Tumors clinically confined to the prostate gland (T1‐2) are heterogeneous with respect to pathological staging and outcome after definitive radical surgery (radical prostatectomy). The preoperative prognostic factors that could predict pathological stage and outcome of individual patients with clinically localized prostate cancer are reviewed. New preoperative factors have been identified by histological analysis of needle biopsy prostate specimens in addition to Gleason grading score, serum markers (PSA), and clinical staging. These factors are related to tumor volume, zonal origin of the tumor, and spread into the gland and surrounding tissues. Other biological factors are identified by molecular and immunohistochemical analysis (neuroendocrine differentiation, DNA content, microvessel density, and perineural invasion). Biomolecular factors can also be assessed preoperatively on serum samples (free/total PSA ratio, PSA RT‐PCR). Although only a few of these factors have a role in predicting treatment failure and/or disease recurrence, the neural network analysis seems to be the most important tool for identifying patients with more aggressive disease. A combination of these new factors, also using neural networks, could be relevant in the preoperative management of patients with prostate cancer to identify those with confined disease and to select those suitable for a “nerve sparing radical prostatectomy” to preserve sexual function and to achieve definitive cancer control.

Combining multiple serum tumor markers improves detection of stage I epithelial ovarian cancer

“…There have been a large number of reports on the use of ANN for clinical diagnosis (18), staging and prognosis (19), and management of cancers (20). In a previous study, an ANN-based composite diagnostic index derived using a panel of four serum markers, CA 125II, CA 72-4, CA 15-3, and lipid-associated sialic acid (LASA), was evaluated for it ability to discriminate malignant from benign pelvic masses (21).…”

Hyaluronic Acid and Hyaluronidase in Prostate Cancer: Evaluation of Their Therapeutic and Prognostic Potential

“…Certain genes and their products that associate with CaP growth and metastasis have shown potential in predicting biochemical recurrence following surgery (8; 44). Since both HA and HYAL1 are likely to be involved in tumor metastasis and angiogenesis (45)(46)(47)(48)(49)(50), it is not surprising that we found HA, HYAL1 and combined HA-HYAL1 staining inferences to have prognostic significance in predicting biochemical recun-ence. It is noteworthy that, although in this study we eliminated 3 CaP specimens from patients who had positive lymph nodes, all showed high-grade HA and HYAL1 staining, suggesting again that these molecules are associated with CaP progression.…”

“…Urinary HAase levels together with HA levels (i.e. HA-HAase test) are sensitive and specific in detecting bladder cancer and monitoring its recurrence (18,45). We have also shown that both invasive bladder and prostate cancer cells secrete high levels of HAase activity, and HYALl is the major HAase expressed in these carcinomas (17,30,46).…”

“…PSA screening has resulted in the detection of more clinically localized CaP, which has the potential to be cured by radical prostatectomy or radiation therapy (1)(2)(3)(4). However, within the first 10 years following surgery, CaP recurs (defined as PSA failure (biochemical relapse), local/systemic recurrence) in about 10-50% of cases depending upon a variety of prognostic factors (5)(6)(7).…”

Salvage Cryosurgery for Recurrent Prostate Carcinoma after Radiotherapy

“…32 The use of anticoagulants, the presence of a pacemaker or significant heart disease, respiratory failure, and ASA class 3 do not exclude the use of cryosurgery, which can be performed without the risk of significant bleeding. A rectal-wall thickness Ͼ6 mm is not a contraindication for cryosurgery, as it is for high-intensity focused ultrasound (HIFU) treatment.…”