BACKGROUND: The role of local therapies including radical prostatectomy (RP) in prostate cancer (PCa) patients with clinical lymphadenopathies on prostate-specific membrane antigen (PSMA) positron emission tomography/computerized tomography (PET/CT) has scarcely been explored. Limited data are available to identify men who would benefit from RP; on the contrary, those more likely to benefit already have systemic disease. OBJECTIVE: We aimed to assess the predictors of prostate-specific antigen (PSA) persistence in surgically managed PCa patients with lymphadenopathies on a PSMA PET/CT scan by integrating clinical, magnetic resonance imaging (MRI), and PSMA PET/CT parameters. DESIGN, SETTING, AND PARTICIPANTS: We identified 519 patients treated with RP and extended lymph node dissection, and who received preoperative PSMA PET between 2017 and 2022 in nine referral centers. Among them, we selected 88 patients with nodal uptake at preoperative PSMA PET (miTxN1M0). OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The outcome was PSA persistence, defined as a PSA value of ≥0.1 ng/ml at the first measurement after surgery. Multivariable logistic regression models tested the predictors of PSA persistence. Covariates consisted of biopsy International Society of Urological Pathology (ISUP) grade group, clinical stage at MRI, and number of positive spots at a PET/CT scan. A regression tree analysis stratified patients into risk groups based on preoperative characteristics. RESULTS AND LIMITATIONS: Overall, lymph node invasion (LNI) was detected in 63 patients (72%) and 32 (36%) experienced PSA persistence after RP. At multivariable analyses, having more than two lymph nodal positive findings at PSMA PET, seminal vesicle invasion (SVI) at MRI, and ISUP grade group >3 at biopsy were independent predictors of PSA persistence (all p < 0.05). At the regression tree analysis, patients were stratified in four risk groups according to biopsy ISUP grade, number of positive findings at PET/CT, and clinical stage at MRI. The model depicted good discrimination at internal validation (area under the curve 78%). CONCLUSIONS: One out of three miN1M0 patients showed PSA persistence after surgery. Patients with ISUP grade 2-3, as well as patients with organ-confined disease at MRI and a single or two positive nodal findings at PET are those in whom RP may achieve the best oncological outcomes in the context of a multimodal approach. Conversely, patients with a high ISUP grade and extracapsular extension or SVI or more than two spots at PSMA PET should be considered as potentially affected by systemic disease upfront. PATIENT SUMMARY: Our novel and straightforward risk classification integrates currently available preoperative risk tools and should, therefore, assist physician in preoperative counseling of men candidates for radical treatment for prostate cancer with positive lymph node uptake at prostate-specific membrane antigen positron emission tomography.
- MeSH
- lidé MeSH
- lymfadenopatie * patologie chirurgie MeSH
- lymfatické metastázy patologie MeSH
- lymfatické uzliny diagnostické zobrazování chirurgie patologie MeSH
- magnetická rezonanční tomografie MeSH
- nádory prostaty * diagnostické zobrazování chirurgie patologie MeSH
- PET/CT metody MeSH
- pozitronová emisní tomografie MeSH
- prostata diagnostické zobrazování chirurgie patologie MeSH
- prostatektomie MeSH
- prostatický specifický antigen MeSH
- semenné váčky patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Salvage radical prostatectomy (sRP) has historically been associated with high morbidity, whilst recently published multicentre series suggested a trend towards improved outcomes. Hence, we performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria to investigate the oncological and functional results and morbidity of sRP. We included 20 retrospective articles comprising 4175 men. Robotic procedures were performed in 40% and nerve sparing in up to 36% of men. Postoperative continence was preserved in 40.4% of patients and erectile function in <16%. High-grade complications were described in 6.6% of patients (rectal injuries 0.9%). At final sRP pathology, surgical margins were positive in 26.1%, 32.8% had seminal vesicle invasion, and International Society of Urological Pathology grade was >3 in 26.6%. Ten-year metastasis-free survival ranged from 72% to 77% and 5-yr cancer-specific survival ranged from 86.6% to 97.7%. Salvage radical prostatectomy shows durable oncological control and morbidity improved over recent years, despite remaining significant compared to and higher than that of primary radical prostatectomy. PATIENT SUMMARY: Salvage radical prostatectomy (sRP) shows improving oncological control and morbidity over time. The complications associated with sRP and its functional results seem to be acceptable and are continuously improving.
- MeSH
- lidé MeSH
- lokální recidiva nádoru patologie MeSH
- nádory prostaty * patologie MeSH
- prostatektomie metody MeSH
- retrospektivní studie MeSH
- semenné váčky * patologie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
PURPOSE: To investigate pathological stage at radical prostatectomy (RP) using the "Partin tables" approach in NCCN high-risk (HR) prostate cancer (PCa) patients. MATERIALS AND METHODS: Within the SEER 2010 to 2016 database, we identified 7,718 NCCN HR PCa patients. Cross-tabulation was used to illustrate the distribution of organ confined disease (OC, pT2), extra-prostatic extension (EPE, pT3a), seminal vesicles invasion (SVI, pT3b), lymph node invasion (LNI, pT2N1), extra-prostatic and lymph node invasion (EPE + LNI, pT3aN1), and seminal vescicale and lymph node invasion (SVI + LNI, pT3bN1), according to preoperative criteria, which consisted in PSA, clinical T stage, biopsy Gleason Score (GS). Binomial 95%CI was constructed for the reported proportions. RESULTS: Median (IQR) PSA levels was 9 (6-20) ng/ml. The majority of patient harbored cT1c (51%) followed by cT2 (35%) and cT3 (14%) stage. Most patients exhibited GS 4+4 (43%). Overall, 87 vs. 15 vs. 2% of patients harbored only 1 vs. 2 vs. all 3 HR criteria. At RP, OC, EPE, SVI, and LNI rates were respectively 36%, 27%, 17%, and 19%. Highest levels of OC were recorded for cT1c, PSA <10 ng/mL and biopsy GS4+4. Conversely, EPE, SVI and LNI were the highest in patients with cT3, PSA ≥20 ng/mL and GS 5+5. After stratification according to clinical stages, OC rates decreased with increasing PSA levels and GS. Conversely, EPE, SVI and LNI rates increased with increasing PSA and GS. CONCLUSION: We provide a lookup table to illustrate the relationship between clinical and pathological characteristics in NCCN HR PCa patients.
- MeSH
- lidé MeSH
- nádory prostaty * patologie chirurgie MeSH
- prostatektomie MeSH
- prostatický specifický antigen MeSH
- semenné váčky * patologie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Severní Amerika MeSH
BACKGROUND: Contemporary seminal vesicle invasion (SVI) rates in National Cancer Comprehensive Network (NCCN) high-risk prostate cancer (PCa) patients are not well known but essential for treatment planning. We examined SVI rates according to individual patient characteristics for purpose of treatment planning. MATERIALS AND METHODS: Within Surveillance, Epidemiology, and End Results (SEER) database (2010-2015), 4975 NCCN high-risk patients were identified. In the development cohort (SEER geographic region of residence: South, North-East, Mid-West, n = 2456), we fitted a multivariable logistic regression model predicting SVI. Its accuracy, calibration, and decision curve analyses (DCAs) were then tested versus previous models within the external validation cohort (SEER geographic region of residence: West, n = 2519). RESULTS: Out of 4975 patients, 28% had SVI. SVI rate ranged from 8% to 89% according to clinical T stage, prostate-specific antigen (PSA), biopsy Gleason Grade Group and percentage of positive biopsy cores. In the development cohort, these variables were independent predictors of SVI. In the external validation cohort, the current model achieved 77.6% accuracy vs 73.7% for Memorial Sloan Kettering Cancer Centre (MSKCC) vs 68.6% for Gallina et al. Calibration was better than for the two alternatives: departures from ideal predictions were 6.0% for the current model vs 9.8% for MSKCC vs 38.5% for Gallina et al. In DCAs, the current model outperformed both alternatives. Finally, different nomogram cutoffs allowed to discriminate between low versus high SVI risk patients. CONCLUSIONS: More than a quarter of NCCN high-risk PCa patients harbored SVI. Since SVI positivity rate varies from 8% to 89%, the currently developed model offers a valuable approach to distinguish between low and high SVI risk patients.
- MeSH
- biopsie MeSH
- invazivní růst nádoru patologie MeSH
- lidé MeSH
- nádory prostaty * patologie MeSH
- nomogramy MeSH
- prostatektomie * metody MeSH
- prostatický specifický antigen MeSH
- semenné váčky patologie MeSH
- staging nádorů MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Zinnerův syndrom (ZS), spojení cysty semenných váčků v kombinaci s ipsilaterální agenezí ledviny, je extrémně vzácná vrozená malformace. Prezentujeme kazuistiku šestiletého pacienta s ZS. Vyšetření pomocí magnetické rezonance (MR) břicha a pánve potvrdilo agenezi ledviny a objasnilo cystickou dilataci ipsilaterálního semenného váčku, který komprimoval a dislooval močový měchýř. Vzhledem k obrovské velikosti cysty byla doporučena chirurgická excize.
Zinner's syndrome (ZS), an association of a cyst of seminal vesicles in combination with ipsilateral agenesis of the kidney, is an extremely rare congenital malformation. We present a case report of a six-year-old patient with ZS. Magnetic resonance (MR) examination of the abdomen and pelvis confirmed renal agenesis and elucidated the cystic dilatation of the ipsilateral seminal vesicle, which compressed and dislocated the bladder. Due to the huge size of the cyst, surgical excision was recommended.
- Klíčová slova
- ipsilateralní renální ageneze, Zinnerův syndrom,
- MeSH
- cysty * chirurgie diagnóza komplikace MeSH
- dítě MeSH
- inkontinence moči etiologie MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- semenné váčky * patologie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
NKX3.1 is considered a reliable immunohistochemical marker of prostatic origin with high specificity and sensitivity. However, NKX3.1 positivity has been described in other neoplastic and non-neoplastic tissues, such as mesenchymal chondrosarcoma, sex-cord stromal tumors, rete testis adenocarcinoma, lobular and ductal carcinoma of the breast, salivary glands, peribronchial submucosal glands, and Sertoli cells. We analyzed expression of two antibodies (mono and polyclonal) of NKX3.1 in a total of 63 non-neoplastic seminal vesicles. We used 52 resection materials (12 seminal vesicles without prostatic adenocarcinoma, 26 seminal vesicles with prostatic adenocarcinoma infiltration, and 14 cases of seminal vesicles infiltrated by urothelial carcinoma) and 11 prostatic core needle biopsies with incidentally sampled fragment of seminal vesicles. In all cases, tissues from seminal vesicles were completely negative for NKX3.1, despite using polyclonal and monoclonal NKX3.1 antibodies, and regardless of the detection system utilized (diaminobenzidine (DAB) versus alkaline phosphatase (AF)). However, prostatic adenocarcinoma was negative in several cases (n = 6), when AF detection system was used. Reaction with DAB was strong and robust in all cases. Based on our data, we can recommend NKX3.1 as a negative immunohistochemical marker of seminal vesicles.
- MeSH
- adenokarcinom diagnóza MeSH
- diferenciální diagnóza MeSH
- homeodoménové proteiny analýza metabolismus MeSH
- imunohistochemie MeSH
- jehlová biopsie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádorové biomarkery analýza metabolismus MeSH
- nádory prostaty diagnóza MeSH
- prostata metabolismus MeSH
- semenné váčky metabolismus patologie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- transkripční faktory analýza metabolismus MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
Diagnóza prostatického adenokarcinomu se opírá o kombinaci histologických znaků, z nichž žádný není pro prostatický adenokarcinom absolutně sensitivní a specifický. Pomoc imunohistochemických barvení je proto potřeba v některých komplikovaných případech k potvrzení diagnózy prostatického adenokarcinomu a jeho odlišení od lézí jej napodobujících. Druhou hlavní indikací k použití imunohistochemie v rámci prostatické patologie je metastatický proces, tedy dotypování origa metastatického nádoru právě z prostaty.
The diagnosis of prostatic adenocarcinoma is based on a combination of histological features, none of which is absolutely sensitive and specific. Immunohistochemical examination is therefore sometimes necessary in difficult cases for confirmation of the diagnosis and distinction of mimickers. The second major indication of immunohistochemical staining in prostatic pathology is metastatic prostatic adenocarcinoma.
- MeSH
- imunohistochemie * metody MeSH
- lidé MeSH
- nádory prostaty * diagnóza MeSH
- prostatický specifický antigen analýza MeSH
- semenné váčky patologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
BACKGROUND: Prostate-specific membrane antigen (PSMA), also known as glutamate carboxypeptidase II (GCPII), is an important diagnostic and therapeutic target in prostate cancer. PSMA/GCPII is also expressed in many healthy tissues, but its function has only been established in the brain and small intestine. Several research groups have attempted to produce PSMA/GCPII-deficient mice to study the physiological role of PSMA/GCPII in detail. The outcomes of these studies differ dramatically, ranging from embryonic lethality to production of viable PSMA/GCPII-deficient mice without any obvious phenotype. METHODS: We produced PSMA/GCPII-deficient mice (hereafter also referred as Folh1-/- mice) by TALEN-mediated mutagenesis on a C57BL/6NCrl background. Using Western blot and an enzyme activity assay, we confirmed the absence of PSMA/GCPII in our Folh1-/- mice. We performed anatomical and histopathological examination of selected tissues with a focus on urogenital system. We also examined the PSMA/GCPII expression profile within the mouse urogenital system using an enzyme activity assay and confirmed the presence of PSMA/GCPII in selected tissues by immunohistochemistry. RESULTS: Our Folh1-/- mice are viable, breed normally, and do not show any obvious phenotype. Nevertheless, aged Folh1-/- mice of 69-72 weeks exhibit seminal vesicle dilation, which is caused by accumulation of luminal fluid. This phenotype was also observed in Folh1+/- mice; the overall difference between our three cohorts (Folh1-/- , Folh1+/- , and Folh1+/+ ) was highly significant (P < 0.002). Of all studied tissues of the mouse urogenital system, only the epididymis appeared to have a physiologically relevant level of PSMA/GCPII expression. Additional experiments demonstrated that PSMA/GCPII is also present in the human epididymis. CONCLUSIONS: In this study, we provide the first evidence characterizing the reproductive tissue phenotype of PSMA/GCPII-deficient mice. These findings will help lay the groundwork for future studies to reveal PSMA/GCPII function in human reproduction.
- MeSH
- antigeny povrchové genetika metabolismus MeSH
- glutamátkarboxypeptidasa II nedostatek genetika metabolismus MeSH
- imunohistochemie MeSH
- lidé MeSH
- membránové glykoproteiny nedostatek genetika metabolismus MeSH
- myši inbrední C57BL MeSH
- myši MeSH
- semenné váčky enzymologie patologie MeSH
- stárnutí metabolismus patologie MeSH
- zvířata MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- myši MeSH
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
BACKGROUND: This article reviews the potential of magnetic resonance imaging (MRI) in prostate cancer diagnosis. METHODS: Systematic scan of Pubmed, Ovid, Medline, Elsevier search engines was used, additional information was found through bibliographic review of relevant articles. Results. Substantial progress has been made in the imaging of prostate cancer in MR imaging, as well as in advanced MR spectroscopy. CONCLUSIONS: MRI is a non-invasive and direct imaging modality useful for cancer staging, therapy response, detection of recurrence and guided biopsy in previous negative biopsies. MRI with 3.0T system, whole-body MRI, dynamic contrast enhanced MRI, diffusion-weighted imaging (DWI) and MR spectroscopy (MRS) have improved tumor staging, assessment of tumor volume, aggressiveness or recurrence. Implementation of endorectal/phased array superficial MRI findings on 1.5 or 3.0T systems into nomograms for prostate pretreatment prediction is warranted. Surface phasedarray coil MRI accurately defines prostate cancer with elevated risk of extraprostatic disease.
To evaluate the potential role of several clinical and pathological parameters in prediction of seminal vesicle invasion in patients with clinically localized prostate cancer undergoing radical prostatectomy. We retrospectively analyzed the medical records of patients who undergone radical prostatectomy from January 2005 until November 2010. Patients age, prostate volume, PSA, PSA density, percent of cancer in prostate biopsy material, Gleason summary, 1st Gleason pattern, 2nd Gleason pattern and the presence of high grade prostatic intraepithelial neoplasia were studied for their predictive ability. Two hundred and seventeen patients analyzed and 13.8% of them had seminal vesicle invasion in the final histopathological examination of the surgical specimen. A significant difference in PSA values, PSA density, percentage of cancer in biopsy material, biopsy Gleason score and 1st Gleason pattern was noticed between patients with and without seminal vesicle invasion. In univariate analysis, PSA, PSA density, prostate volume, percentage of cancer in biopsy material, biopsy Gleason score and 1st Gleason pattern found significant. However, in multivariate analysis, only PSA (p=0.008) and prostate volume (p=0.027) were found to be significant predictors. PSA ≥10 ng/ml and prostate volume ≤41 ml was shown to be the optimal cut-off values for seminal vesicle invasion in receiver operating curve analysis. PSA and prostate volume should be considered significant predictors for adverse pathology of the seminal vesicles in patients planned for surgical treatment of prostate cancer. This is of great concern especially in cases that a seminal vesicle sparing technique is planned.
- MeSH
- invazivní růst nádoru MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory prostaty chirurgie patologie MeSH
- prediktivní hodnota testů MeSH
- prostata patologie MeSH
- prostatektomie MeSH
- prostatický specifický antigen krev MeSH
- semenné váčky patologie MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- velikost orgánu MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
