Radical prostatectomy for adenocarcinoma of the prostate: The influence of preoperative and pathologic findings on biochemical disease-free outcome

Zietman, Anthony L.; Edelstein, Robert A.; Coen, John J.; Babayan, Richard K.; Krane, Robert J.

doi:10.1016/0090-4295(94)90144-9

Cited by 151 publications

(38 citation statements)

References 19 publications

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“…35 Therefore, seminal vesicle involvement appears to carry an especially ominous prognosis with respect to treatment failure and biochemical disease recurrence. 36,37 Furthermore, in multivariable models for mortality, biochemical disease recurrence has been shown to be an independent predictor of death due to prostate carcinoma, 38 -42 but this association remains controversial. 43 In this context, our observation of an inverse association between PUFA content in prostate tissue specimens and risk of seminal vesicle involvement suggests that this dietary factor influences the course and prognosis of early-stage prostate carcinoma.…”

Section: Discussionmentioning

confidence: 99%

Inverse association between prostatic polyunsaturated fatty acid and risk of locally advanced prostate carcinoma

Freeman

Meydani

Hur

et al. 2004

Cancer

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BACKGROUNDAn effect of fatty acids has been implicated in men with advanced‐stage prostate carcinoma and in men who have died of the disease. To evaluate the influence of fatty acids in men with prostate carcinoma at earlier stages, the authors examined the relation between prostatic concentrations of fatty acids and locally advanced prostate carcinoma in men with clinically organ‐confined disease.METHODSFatty acids were measured by capillary gas chromatography in fresh, nonmalignant prostate tissue specimens collected during surgery from 196 men undergoing radical prostatectomy for localized prostate carcinoma. Two‐sided, two‐sample Student t tests compared mean concentrations in men with extraprostatic disease (pT3–4N0–1M0) with control men with organ‐confined disease. Logistic regression accounted for clinical stage, prostate‐specific antigen level, Gleason sum, and other factors.RESULTSPercent total prostatic polyunsaturated fatty acid (PUFA) was found to be inversely associated with risk of locally advanced prostate carcinoma (n = 52) (odds ratio [OR] = 0.93, 95% confidence interval [95% CI], 0.87–0.99; P = 0.035). Risk of seminal vesicle involvement accounted for this association (OR = 0.86, 95% CI, 0.78–0.95; P = 0.003). Percent ω‐3 fatty acid (eicosapentanoic + docosahexanoic acids) and percent arachidonic acid also were found to be inversely related to the risk of seminal vesicle involvement (OR = 0.52, 95% CI, 0.30–0.90; P = 0.02; and OR = 0.84, 95% CI,; 0.75–0.95; P = 0.005, respectively).CONCLUSIONSProstatic PUFA levels appear to influence the risk of locally advanced prostate carcinoma in men with clinically organ‐confined disease. This association may be mediated through the immune system. Cancer 2004. © 2004 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

Inverse association between prostatic polyunsaturated fatty acid and risk of locally advanced prostate carcinoma

Freeman

Meydani

Hur

et al. 2004

Cancer

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“…Worldwide an increasing number of radical prostatectomies are performed with the intention to cure clinically localised prostate cancer and yet 16-42% [1][2][3][4] have positive resection margins and up to 56% [5][6][7] do show disease recurrence. There has been a sharp increase of the number of radical prostatectomies in the US mirrored with some delay in the UK.…”

Section: Introductionmentioning

confidence: 99%

Learning curve and stage migration of a radical retropubic prostatectomy series over a 10-y period

Winkler

Gillatt

2004

Prostate Cancer Prostatic Dis

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Objective: To show the impact of learning curve and patient selection on complication rate and biochemical recurrence-free survival of a UK radical prostatectomy series for localised prostate cancer and to model the influence of common preoperative variables on biochemical recurrence after controlling for learning curve. Patients and Methods: From 1989 to 1999, 280 of 350 patients who underwent anatomical radical retropubic prostatectomy (RRP) at our institution had complete records and follow-up of at least 1 y. After exclusions of preoperative staging, factors reflecting the learning curve, early complications and prostate-specific antigen (PSA) outcome were recorded on 217 patients. Procedures before 1995 were compared with procedures after 1995. Results: Comparison of the two groups showed a significant decrease in operating time (mean 152 vs 130 min), blood loss (mean 1500 vs 1000 ml), transfusion rate (83 vs 42%) and hospital stay (mean 7 vs 6 days). Median preoperative PSA changed significantly from 13.2 to 11.5 ng/ml. Only 17% were diagnosed by rectal examination compared to 27% in the early years. The number of clinical T1 tumours increased from 33 to 47%. This did lead to an increase of organ-confined tumours on pathological staging by 25%. Biochemical recurrence-free survival improved significantly after 1995. After controlling for the learning curve PSA and clinical stage were significant predictors of PSA recurrence. Conclusion: Time trends of case selection, stage migration and a steep learning curve are shown over a 10-y period. Factors associated with the learning curve as well as case selection have a significant impact on outcome. There may be other as yet not specified factors over time, which have a significant impact on PSA recurrence-free survival. Patients with a PSA of 20 ng/ml and above have a poor outcome and do not appear to be suitable candidates for RRP.

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“…However, PSA levels of >10 ng/ml, and high Gleason grade (>7) are associated with an increased risk of progression as determined by PSA failure (i.e. detectable PSA) after radical prostatectomy [7, 16, 17, 18, 19, 20, 21]. Other pathological risk factors include high clinical stage, positive surgical margins, the presence of extracapsular disease, seminal vesicle invasion, or involvement of pelvic lymph nodes (i.e.…”

Section: Indicators and Detection Of Recurrencementioning

confidence: 99%

Rising PSA after a Radical Treatment

Carroll¹

2001

Eur Urol

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Radical prostatectomy for adenocarcinoma of the prostate: The influence of preoperative and pathologic findings on biochemical disease-free outcome

Cited by 151 publications

References 19 publications

Inverse association between prostatic polyunsaturated fatty acid and risk of locally advanced prostate carcinoma

Inverse association between prostatic polyunsaturated fatty acid and risk of locally advanced prostate carcinoma

Learning curve and stage migration of a radical retropubic prostatectomy series over a 10-y period

Rising PSA after a Radical Treatment

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