UroToday – Percent Tumor Involvement and Risk of Biochemical Progression After Radical Prostatectomy

From UroToday:

We examined the association between percent tumor involvement in the radical prostatectomy specimen and the outcome measures of pathological stage and biochemical progression using multivariate logistic regression and Cox proportional hazards analysis, respectively, in 2,220 patients from the Duke Prostate Center radical prostatectomy database.

This was a study that showed that if you had more cancer in the prostate, you had a higher risk of the cancer coming back after surgery. Although this is obvious, it is important to show these type of things with studies.

Would I would like to see is if patients with the same gleason score and stage (meaning the extent of cancer spread) have different rates of recurrences.

For example, 2 men with organ confined prostate cancer that both have gleason 6 cancers. If 1 man has 1% of tumor volume in his prostate and the other 30%, I would imagine the man with 30% would be more likely to have a recurrence. I am not aware of any studies that have looked at this.

Surgical experience affects prostate cancer control ‘regardless of risk’

From MedWire News – Oncology –

Prostate cancer control after radical prostatectomy improves with increasing surgeon experience, regardless of patients’ risk, say US scientists who suggest that the primary reason for recurrence in low-risk patients is inadequate surgical technique.
The team, led by Eric Klein from the Cleveland Clinic in Ohio, previously discovered that open radical prostatectomy has a learning curve, and other studies have indicated that patients treated by higher-volume surgeons have shorter hospital stays, fewer peri-operative complications, and better urinary continence than those treated by lower-volume surgeons.

This study was done for open radical prostatectomy patients.
My guess is that we will have similar results for robotic surgeons, but I think novice robotic surgeons that have vast experience with laparoscopic or open prostate cancer surgery will have better results than those who do not.

– Oncology – High saturated fat diet linked to postop biochemical failure

From MedWire News

Among prostatectomy patients, those with diets high in high saturated fat (HSF) are almost twice as likely to experience biochemical failure as those who consume a low saturated fat (LSF) diet, say US scientists.
Several studies have indicated that obesity is associated with an increased risk of biochemical failure after treatment with radical prostatectomy or external beam radiation for localized prostate cancer.

Patients at risk of prostate cancer and thosewith prostate cancer should reduce their fat intake.

Surgical volume related to cancer cure rates after prostate cancer surgery

UroToday – AUA 2007 – The Effect of Surgical Volume on the Rate of Seconday Treatment After Radical Prostatectomy

They conclude that surgical volume is a determinant of treatment-failure when evidenced by the use of secondary therapies. Surgeons performing 24 RPs per year had the lowest rate of secondary treatment use.

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Prostate Cancer: Prostate cancer can metastasize after surgery with even low PSAs rarely

UroToday – Prostate Cancer Progression in the Presence of Undetectable or Low Serum Prostate-Specific Antigen Level

beige_quote.bmpOverall, 10 (22%) had undetectable serum PSA levels and 30 patients (65%) had PSA of less than 1ng/ml at the time of disease progression. Of the 25 men who had undergone radical prostatectomy, 7 were hormone na�ve at the time of progression. The median increase in PSA was 0.25ng/ml at the time of progression. In 19 patients, there was no increase in PSA from the nadir level at the time of progression. The median PSA doubling time for the cohort was 7.6 months.
Atypical variants of CaP were identified in 21 of 46 patients; including 9 with ductal CaP, 8 with small cell variant, 2 with neuroendocrine tumors and 2 men with sarcomatoid tumors. Metastatic progression was most commonly in the bones, followed by liver, retroperitoneal lymph nodes and lungs. Progression was identified by bone scans, CT or MRI.
In patients with CaP variants, monitoring in addition to PSA may have value.

Cancer 2006;109(2): 198-204

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