[MOL] Presurgical Staging of Prostate Cancer [01634] Medicine On Line


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[MOL] Presurgical Staging of Prostate Cancer



Presurgical Staging of Prostate Cancer CME

Christina B. Calvanese, BS, Hillel Kahane, MD, Grant D. Carlson, BS, Raymond L. Compagna, BA, DIANON Systems, Inc., Stratford, Conn.; Perinchery Narayan, MD, University of Florida, Gainesville, Fla.; Ashutosh Tewari, MD, Josephine Ford Cancer Center, Detroit, Mich.


Abstract

Men with seminal vesicle or lymph node metastases may benefit from adjuvant radiation, hormone replacement, or combination hormone and radiation therapy, but only if their metastases are detected before radical prostatectomy. We confirmed that PSA levels and sextant biopsy findings can be used, individually or in combination, to identify these cases. We also found that combining PSA, Gleason scores, base and mid involvement, and percent of biopsy involved in tumor yielded accurate probabilities and the best detection (70% sensitivity and 80% specificity). We recommend routine performance of sextant biopsies including specimens from each prostate section. [Infect Urol 12(1):22-28, 1999. © 1999 SCP Communications, Inc.]


Introduction

Between 7% and 19% of men who undergo radical prostatectomy are found to have seminal vesicle and/or lymph node metastases. Those with seminal vesicle or lymph node metastases have the highest rate of disease progression and the lowest survival rates.[1-4] Epstein and colleagues[3] reported that men with lymph node metastases had the same progression rates regardless of whether they had seminal vesicle metastases.

It is generally accepted that surgery alone will not cure men with lymph node metastases,[5] and most urologists would not recommend radical prostatectomy alone because of increased survival rates and improved quality of life with the addition of adjuvant hormone therapy.[6,7] Men with lymph node or seminal vesicle metastases may achieve better quality of life and prolonged progression-free survival with hormone replacement therapy or a combination of hormonal and radiation therapy. However, all of these treatments depend on the detection of seminal vesicle and lymph node metastases before radical prostatectomy.

Our study's goal was to determine an efficient way to interpret sextant biopsy findings with respect to seminal vesicle and lymph node metastases. With this information, men who need further diagnostic staging procedures (ie, seminal vesicle biopsies, CT scan, MRI, bone scan, or a staging lymphadenectomy[8]) can be identified and mentally and emotionally prepared for additional treatment after surgery.[9]