Can We Predict Real T3 Stage Prostate Cancer in Patients with Clinical T3 (cT3) Disease before Radical Prostatectomy?

Lee, Hye Won; Seo, Seong Il; Jeon, Seong Soo; Lee, Hyun Moo; Choi, Han Yong

doi:10.3349/ymj.2010.51.5.700

Cited by 9 publications

(12 citation statements)

References 35 publications

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“…Although cancer has generally been identified as a low signal in T2-weighted images, there are numerous false positives (e.g., inflammation, scars and post-radiotherapy appearance), and infiltrating cancers may not show a typical appearance. Among these factors, post-biopsy hemorrhage is the most common obstacle 1718. High-signal-intensity changes on post-biopsy T1-weighted imaging has been demonstrated in 28%–77% of patients 1920.…”

Section: Discussionmentioning

confidence: 99%

The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

Song

Moon

et al. 2014

Asian J Androl

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The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging (MRI) on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI. A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6 days. The accuracy of the MRI for simplified tumor location (right, left, bilateral and none) was 44.6%. In the group with discordant pathologic and MRI findings, the most common reason recorded was ‘MRI predicted a unilateral lesion, but pathology revealed bilateral lesions’ (58.3%), followed by ‘MRI predicted no lesion, but pathology revealed the presence of a lesion’ (32.0%). Multivariable analysis showed that the discordant group had a shorter interval (25.0 ± 14.3 vs 38.1 ± 20.6 days, P < 0.01) preceding the MRI and a higher rate of hemorrhage as observed by MRI (80.4% vs 54.8%, P < 0.01) in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 (P < 0.001). At the MRI interval's cutoff of 28.5 days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28 days, the accumulated accuracy was only 26.1% (23/88); however, when it was performed after 28 days, the reversely accumulated accuracy was 61.5% (59/96). These data support a waiting period of at least 4 weeks after a biopsy before performing an MRI for the purposes of surgical refinement.

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Section: Discussionmentioning

confidence: 99%

The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

Song

Moon

et al. 2014

Asian J Androl

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“…The clinical staging of prostate cancer has limitations. Clinical overstaging is well known and has been reported from 27% 10 to 79% 11 . Therefore, it is crucial that cT3 patients should not be denied surgery based on clinical grounds alone, as this option could potentially be curative.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of minimally invasive radical prostatectomy in prostate cancer patients with high prostate‐specific antigen: Feasibility and 1‐year outcomes

Ragavan

Dietel

et al. 2012

Int J of Urology

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Abbreviations & AcronymsObjectives: Urologists are cautious to offer minimally invasive radical prostatectomy in prostate cancer patients with high prostate-specific antigen (and therefore anticipated to have locally advanced or metastatic disease) because of concerns regarding lack of complete cure after minimally invasive radical prostatectomy and of worsening of continence if adjuvant radiotherapy is used. Methods: A retrospective review of our institutional database was carried out to identify patients with PSA Ն20 ng/mL who underwent minimally invasive radical prostatectomy between January 2002 and October 2010. Intraoperative, pathological, functional and short-term oncological outcomes were assessed. Results: Overall, 233 patients met study criteria and were included in the analysis. The median prostate-specific antigen and prostate size were 28.5 ng/mL and 47 mL, respectively. Intraoperative complications were the following: rectal injury (0.86%) and blood transfusion (1.7%). Early postoperative complications included prolonged (>6 days) catheterization (9.4%), hematoma (4.7%), deep venous thrombosis (0.86%) and lymphocele (5.1%). Late postoperative complications included cerebrovascular accident (0.4%) and anastomotic stricture (0.8%). Pathology revealed poorly differentiated cancer in 48.9%, pT3/pT4 disease in 55.8%, positive margins in 28.3% and lymph node disease in 20.2% of the cases. Adverse pathological findings were more frequent in patients with prostatespecific antigen >40 ng/mL and (or) in those with locally advanced disease (pT3/pT4). In 62.2% of the cases, adjuvant radiotherapy was used. At 1-year follow up, 80% of patients did not show evidence of biochemical recurrence and 98.8% of them had good recovery of continence. Conclusion: Minimally invasive radical prostatectomy might represent a reasonable option in prostate cancer patients with high prostate-specific antigen as a part of a multimodality treatment approach.

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“…Our nomogram is simple and easily applicable to patients because these variables are not difficult to be gathered clinically before the surgery. These are also useful to predict prostate cancer stage 23. The strength of our nomogram for predicting IPC is constructed chiefly from analysis of a systematic extended biopsy scheme.…”

Section: Discussionmentioning

confidence: 99%

Nomogram to Predict Insignificant Prostate Cancer at Radical Prostatectomy in Korean Men: A Multi-Center Study

et al. 2011

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PurposeDue to the availability of serum prostate specific antigen (PSA) testing, the detection rate of insignificant prostate cancer (IPC) is increasing. To ensure better treatment decisions, we developed a nomogram to predict the probability of IPC.Materials and MethodsThe study population consisted of 1,471 patients who were treated at multiple institutions by radical prostatectomy without neoadjuvant therapy from 1995 to 2008. We obtained nonrandom samples of n = 1,031 for nomogram development, leaving n = 440 for nomogram validation. IPC was defined as pathologic organ-confined disease and a tumor volume of 0.5 cc or less without Gleason grade 4 or 5. Multivariate logistic regression model (MLRM) coefficients were used to construct a nomogram to predict IPC from five variables, including serum prostate specific antigen, clinical stage, biopsy Gleason score, positive cores ratio and maximum % of tumor in any core. The performance characteristics were internally validated from 200 bootstrap resamples to reduce overfit bias. External validation was also performed in another cohort.ResultsOverall, 67 (6.5%) patients had a so-called "insignificant" tumor in nomogram development cohort. PSA, clinical stage, biopsy Gleason score, positive core ratio and maximum % of biopsy tumor represented significant predictors of the presence of IPC. The resulting nomogram had excellent discrimination accuracy, with a bootstrapped concordance index of 0.827.ConclusionOur current nomogram provides sufficiently accurate information in clinical practice that may be useful to patients and clinicians when various treatment options for screen-detected prostate cancer are considered.

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Can We Predict Real T3 Stage Prostate Cancer in Patients with Clinical T3 (cT3) Disease before Radical Prostatectomy?

Cited by 9 publications

References 35 publications

The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

Feasibility of minimally invasive radical prostatectomy in prostate cancer patients with high prostate‐specific antigen: Feasibility and 1‐year outcomes

Nomogram to Predict Insignificant Prostate Cancer at Radical Prostatectomy in Korean Men: A Multi-Center Study

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