UROLOGICAL SURVEY
Yamamoto S; Yonese J; Kawakami S; Ohkubo Y; Tatokoro M; Komai Y; Takeshita H; Ishikawa Y; Fukui I
Department of Urology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
Eur Urol. 2007; 52: 696-701
OBJECTIVES: Preoperative low serum testosterone (TS) level has been reported to be associated with adverse pathologic results in patients with clinically localized prostate cancer (pCA) treated with radical prostatectomy (RP). However, prior studies failed to show prognostic impact of preoperative low TS in these patients. The aim of this study was to investigate the relationship between preoperative TS and prostate-specific antigen (PSA) failure in these patients.
METHODS: Of 304 patients diagnosed with clinically localized pCA who had been treated with RP alone, 272 patients whose preoperative TS level had been measured were eligible for this analysis. Postoperative TS levels were also available in 222 of the 272 patients. Cox proportional hazard model was used to elucidate factors predictive for PSA failure.
RESULTS: Of the 272 patients 49 had low (< 300 ng/dl) and 223 had normal preoperative TS level. In a stepwise multivariate analysis, preoperative TS (p = 0.021) was an independent and significant predictor of PSA failure along with RP Gleason score (p = 0.006), surgical margin status (p = 0.0001), and PSA (p = 0.0001). Five-year PSA failure-free survival rate of the patients with preoperative low TS (67.8%) was significantly worse than that with normal TS (84.9%) (p=0.035). Serum TS levels increased significantly after RP (p < 0.0001). The increment of TS level in preoperative low TS group was significantly greater than that in preoperative normal TS group (p = 0.0003).
CONCLUSIONS: The current results demonstrated that preoperative TS level is an independent and significant predictor of PSA failure after RP in patients with clinically localized pCA. European Association of Urology.
Editorial Comment
Testosterone levels and prostate cancer are a topic that attracts much attention and stirs controversy. This contribution from Tokyo, Japan adds to the multifaceted database. With a cut-off at 300 ng/dL total testosterone the authors found an inverse correlation of testosterone level and prostate cancer aggressivity as measured by Gleason score, positive surgical margins, PSA, and 5-year postoperative PSA failure status.
Most interestingly, testosterone levels increased after radical prostatectomy. The postoperative increment of testosterone levels was significantly higher in the group with preoperative low testosterone. Clearly, these data deserve confirmation from other groups and elucidation of the mechanisms involved in testosterone level variation after radical prostatectomy.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
Concomitant carcinoma in situ is a feature of aggressive disease in patients with organ-confined TCC at radical cystectomy.
Shariat SF; Palapattu GS; Karakiewicz PI; Rogers CG; Vazina A; Bastian PJ; Schoenberg MP; Lerner SP; Sagalowsky AI; Lotan Y
Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
Eur Urol. 2007; 51: 152-60
OBJECTIVES: Carcinoma in situ (CIS) is a nonpapillary, high-grade, potentially aggressive, and unpredictable manifestation of transitional cell carcinoma (TCC) of the bladder. The aim of this study was to assess whether presence of concomitant CIS has a detrimental effect on cancer control after radical cystectomy.
METHODS: The records of 812 consecutive patients who underwent radical cystectomy and pelvic lymphadenectomy for bladder TCC at three US academic centres were reviewed. Ninety-nine of 812 (12%) patients had CIS only at radical cystectomy and were excluded from the analyses.
RESULTS: Three hundred thirty of the 713 (46.3%) patients had concomitant CIS at radical cystectomy. Patients with TCC involvement of the urethra were more likely to have concomitant CIS than not (61% vs. 40%, p=0.018). Concomitant CIS was significantly more common in patients with lower cystectomy stages and higher tumour grades. In univariate, but not multivariate, analysis, patients with concomitant CIS versus those without were at increased risk of disease recurrence (p=0.0371). In patients with organ-confined disease, concomitant CIS was an independent predictor of disease recurrence (p=0.048 and p=0.012, respectively) but not bladder cancer-specific mortality (p=0.160 and p=0.408, respectively) after adjusting for the effects of standard postoperative features.
CONCLUSIONS: Concomitant CIS in the cystectomy specimen is common, and patients with concomitant CIS are at increased risk of urethral TCC involvement. The presence of concomitant CIS appears to confer a worse prognosis in patients with non-muscle-invasive TCC treated with radical cystectomy.
Editorial Comment
The outcome of patients with bladder cancer of any stage and concomitant CIS was analyzed in this retrospective study on 713 patients undergoing radical cystectomy. Several issues deserve comments: The percentage of CIS present increased over the years from 33% in the eighties to 52% in period from 2001 to 2003. The majority of patients had grade 3 tumors (82.5%) and/or pT2 and pT3 disease (60.8%). Roughly, half of the patients had lymphovascular invasion, one-fourth (24.9%) had lymph node metastases. Accordingly, after 5 years, half of the patients with concomitant CIS had recurrences and half of the patients with concomitant CIS had died from bladder cancer. Patients without concomitant CIS fared better than those with concomitant CIS (7-year recurrence-free survival 58.1% and 41.5%, respectively). Interestingly, the incidence of concomitant CIS was highest in patients with organ-confined disease (pTa excluded) and higher in lower-stage and higher grade disease. Involvement of the urethra was more common in CIS patients.
The authors state correctly, that presence of concomitant CIS worsens the outcome significantly. In practical terms, early radical treatment should be considered if CIS is present.
Dr. Andreas Bohle
Professor of Urology
HELIOS Agnes Karll Hospital
Bad Schwartau, Germany
Urological Oncology
Publication Dates
-
Publication in this collection
29 Feb 2008 -
Date of issue
Oct 2007
