BACKGROUND: Early detection of small volume prostate cancer (PCa) has led to the concept of focal therapy to treat in an organ-sparing manner. We evaluated trends in pathologic staging among patients with localized PCa undergoing radical prostatectomy (RP), defining the frequency of unilateral cancers during 1988-1995, 1996-2000 and 2001-2006. METHODS: Data were abstracted from the Duke Prostate Cancer Outcome database selecting 3,676 men with available pathology treated with RP. Based on surgical pathology, trends in as pathological T (pT) stage, pathological Gleason Score (pGS), and percent tumor involvement (PTI) were evaluated. RESULTS: pT2a increased from 2.8% of men undergoing RP in 1988-1995 to 13.0% during 2001-2006 (P < 0.0005). PTI analysis shifted towards low volume disease, e.g. PTI <or= 5% increased from 10% during 1988-1995, to 37% in 2001-2006 (P < 0.005). Of all pT2a disease throughout 1988-2006, an increase in proportion of pT2a tumors from 10% during 1988-1995 to 69.4% during 2001-2006 was identified. Over three eras, pT2a had minimal (65% had PTI <or= 5%) or small volume (14% had PTI 5.01-10.00) disease, and 59% were low grade (pGS <or= 6). Using a Cox Hazard model, pT2a versus pT2b disease, surgical margins, PTI, and PSA statistically contributed to PSA disease-free survival in the contemporary era 2001-2006. CONCLUSIONS: The increasing prevalence of unilateral pT2a/T2b PCa characterizes a growing proportion of men recently electing RP. These tumors are associated with lower PTI, pGS <or= 7, and demonstrated better PSA-free survival in the 2001-2006 era. These low risk pathologic characteristics may allow for unilateral focal therapy in carefully selected patients. (c) 2008 Wiley-Liss, Inc.
BACKGROUND: Early detection of small volume prostate cancer (PCa) has led to the concept of focal therapy to treat in an organ-sparing manner. We evaluated trends in pathologic staging among patients with localized PCa undergoing radical prostatectomy (RP), defining the frequency of unilateral cancers during 1988-1995, 1996-2000 and 2001-2006. METHODS: Data were abstracted from the Duke Prostate Cancer Outcome database selecting 3,676 men with available pathology treated with RP. Based on surgical pathology, trends in as pathological T (pT) stage, pathological Gleason Score (pGS), and percent tumor involvement (PTI) were evaluated. RESULTS: pT2a increased from 2.8% of men undergoing RP in 1988-1995 to 13.0% during 2001-2006 (P < 0.0005). PTI analysis shifted towards low volume disease, e.g. PTI <or= 5% increased from 10% during 1988-1995, to 37% in 2001-2006 (P < 0.005). Of all pT2a disease throughout 1988-2006, an increase in proportion of pT2a tumors from 10% during 1988-1995 to 69.4% during 2001-2006 was identified. Over three eras, pT2a had minimal (65% had PTI <or= 5%) or small volume (14% had PTI 5.01-10.00) disease, and 59% were low grade (pGS <or= 6). Using a Cox Hazard model, pT2a versus pT2b disease, surgical margins, PTI, and PSA statistically contributed to PSA disease-free survival in the contemporary era 2001-2006. CONCLUSIONS: The increasing prevalence of unilateral pT2a/T2b PCa characterizes a growing proportion of men recently electing RP. These tumors are associated with lower PTI, pGS <or= 7, and demonstrated better PSA-free survival in the 2001-2006 era. These low risk pathologic characteristics may allow for unilateral focal therapy in carefully selected patients. (c) 2008 Wiley-Liss, Inc.
Authors: Phillip M Pierorazio; Ashley E Ross; Misop Han; Jonathan I Epstein; Alan W Partin; Edward M Schaeffer Journal: BJU Int Date: 2011-08-22 Impact factor: 5.588
Authors: Markos Karavitakis; Hashim U Ahmed; Paul D Abel; Steven Hazell; Mathias H Winkler Journal: Nat Rev Clin Oncol Date: 2010-11-23 Impact factor: 66.675