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OBJECTIVE To assess the effects of robot-assisted radical prostatectomy in the Trendelenburg position on postoperative neurocognitive outcomes this study compared cognitive function between patients who underwent robot-assisted radical prostatectomy and those who underwent open retropubic radical prostatectomy. METHODS Objective evaluations of pre- and postoperative cognitive function were performed upon admission and before hospital discharge, by using a neuropsychological test battery. We collected self-reported data on cognitive failures at 3 months postoperatively. Binary logistic regression analysis was used to assess the effects of surgical technique on postoperative cognitive performance. RESULTS The pre- and postoperative neuropsychological assessments were completed by 367 patients with a median age of 64 years (range 44-76). The incidence of postoperative cognitive dysfunction was 23.9% after robot-assisted (39/165) and 22.3% after open radical prostatectomy (45/202). There was no significant difference in postoperative cognitive function during the early postoperative period (P = 0.758) and self-reported cognitive failures at 3 months (P = 0.303) between robot-assisted and open surgery. Surgical technique was not associated with early postoperative cognitive dysfunction in multivariable analysis (OR 1.012, 95%CI: 0.608-1.685, P = 0.962). CONCLUSION Compared with open surgery in supine position postoperative neurocognitive disorders do not occur more frequently after robot-assisted radical prostatectomy in the extreme Trendelenburg position. Based on these findings potential adverse effects on cognitive function do not have to be considered in the choice of surgical approach for radical prostatectomy.

To analyze the benefit of pelvic lymph node dissection (PLND) in patients with biopsy Gleason grade ≤ 6, cT ≤ 2b, and prostate-specific antigen (PSA) 10-20 ng/mL (main study cohort), as the indication for PLND during radical prostatectomy remains uncertain in patients with nonhigh-risk tumors.The main study cohort included 1383 patients with low intermediate-risk cancer undergoing radical prostatectomy with or without PLND between 1994 and 2013. Positive lymph node (LN) rates were reported and compared to patients with higher (≥20 ng/mL; n = 314) and lower (10 ng/mL; n = 6861) PSA. Oncological outcome was assessed by Cox regressions in patients with a minimum follow-up of 5years.In the main study cohort (PSA 10-20 ng/mL), PLND was performed in 867 (62.7%) patients with a median number of removed LNs of 11 (interquartile range 16-6). Positive LNs were detected in 3.3% of these patients. Compared to the main study cohort, patients with preoperatively higher PSA ≥ 20 ng/mL (or lower PSA 10 ng/ml) underwent PLND in 83.8% (32.7%) of the cases, with 8.0% (1.8%) showing positive LNs. Median follow-up in the main study cohort was 84.5 months. Biochemical recurrence (BCR) occurred in 20.6% of these men. The 5-year and 10-year BCR-free survival rates were 82.2% and 75.6% for those with PLND, and 83.4% and 75.8% for patients without PLND. PLND was not a significant factor influencing BCR-free, metastasis-free, or cancer-specific survival in the main study cohort.Positive LNs are rare in patients with Gleason grade ≤ 6, cT ≤ 2b, and PSA 10-20 ng/mL. Performing PLND had no statistical influence on oncologic outcome and therefore should be decided upon on an individual basis.

Objective To test the effect of obesity (body mass index ≥30 kg/m2) on perioperative outcomes and total hospital charges at robot-assisted vs open radical prostatectomy (RARP vs ORP). Methods Within the National Inpatient Sample database (2008-2015), we identified obese vs nonobese RARP and ORP patients. Estimated annual percent changes, multivariable logistic regression and linear regression models were used. All models were adjusted for clustering and weighted. Results Of all, 53,626 (60%) underwent RARP vs 35,757 (40%) underwent ORP. At RARP, 8.6% were obese vs 6.9% at ORP. RARP rate increased significantly over time (12.5%-81.5%). Obesity rate increased significantly over time at both, RARP (5.1%-10.5%) and ORP (5.4%-10.7%). In multivariable logistic regression models, obesity predicted 5 of 11 unfavourable perioperative complications at RARP (odds ratio: 1.6-1.8) and 9 of 11 at ORP (odds ratio: 1.3-2.8). In linear regression models, obesity significantly added to total hospital charges at RARP (740$) and ORP (312$). Conclusion Obesity may predispose to higher rates of adverse outcomes at RP. Its effect varies according to surgical approach.

Objective To examine the accuracy of HistoScanning (HS) in detecting seminal vesicle (SV) invasion (SVI) within prostate cancer (PCa) patients. Methods We relied on our prospective institutional database. Patients who received HS before radical prostatectomy were included in the study cohort. An experienced HS examiner retrospectively reanalyzed the HS data blinded to patient characteristics and pathologic results. The HS results for every single SV were compared with the corresponding findings from the final pathologic report after radical prostatectomy. An area under the receiver operating characteristic curve for the prediction of SVI by HS was calculated. Depending on HS signal volume cut-offs (>0, >0.2, and >0.5 mL), the sensitivity, specificity, positive predictive value, and negative predictive value for the prediction of SVI were assessed. Results Overall, 131 patients and 262 SVs were assessable. Of those, 23 (17.5%) men had SVI, and 39 (14.9%) single SVs were infiltrated by tumor overall. The area under the receiver operating characteristic curve for predicting SVI by HS was 0.54. Depending on the HS signal volume cut-offs (>0, >0.2, and >0.5 mL), the sensitivity, specificity, positive predictive value, and negative predictive value for predicting SVI were 76.9%, 10.8%, 13.1%, and 72.7%; 61.5%, 24.2%, 12.4%, and 78.3%; and 46.2%, 50.2%, 14.0%, and 84.2%, respectively. Conclusion HS results did not allow a reliable prediction of SVI within PCa patients. Despite, the application of HS signal volume cut-offs (>0.2 and >0.5 mL), the prediction of SVI within PCa patients remained insufficient.

Objective To determine the rates of lymph nodes and lymph node metastases in periprostatic fat pads yielded during exposure of the anterior surface of the dorsal vein complex, puboprostatic ligaments, and endopelvic fascia during radical prostatectomy. Methods Histopathologic examination was performed in 356 patients who underwent radical prostatectomy between July 2010 and September 2010 at a single institution. Separate histologic work-up of the periprostatic fat pads addressed the presence of lymph nodes and possible metastatic invasion of lymph nodes within this area. Descriptive analyses and multivariable analyses to predict the presence of lymph node metastases within these fat pads were performed. Results Lymph nodes within periprostatic fat pads were detected in 19 (5.5%) patients. Among these patients, tumor infiltration was found in 4 (1.2%). Three of these 4 patients harbored lymph node metastases without any other lymph node metastasis during standard lymphadenectomy. No relationship was detected between the total number of lymph nodes removed and the detection of lymph nodes within periprostatic fat pads ( P = .6). Conclusion Our analysis demonstrates that periprostatic fat pads harbor lymph nodes. No relationship between the presence of lymph node metastases in periprostatic fat pads and the presence of lymph node metastases in other areas was found. Similarly, no relationship exists between the presence of lymph nodes in this area and the total number of lymph nodes yielded in other lymphatic fields. Therefore, for guaranteeing precise lymph node staging, implementing routinely pathologic work-up of periprostatic fat pads yielded during radical prostatectomy should be considered.

Objective To test whether cancer control outcomes justify the consideration of partial nephrectomy in patients with large tumors (Stage pT2 or greater) or high-grade tumors (Fuhrman grade III-IV) or lesions extending beyond the kidney (Stage pT3a). Methods We abstracted the data for 8847, 11 547, and 5232 patients with tumors >7 cm, Fuhrman grade III-IV, and Stage T3a from the Surveillance, Epidemiology, and End Results database, respectively. All were treated with either partial nephrectomy or radical nephrectomy from 1988 to 2008. The 2- and 5-year cancer-specific mortality rates were compared between the partial nephrectomy and radical nephrectomy groups after propensity score matching. Separate multivariate analyses were conducted within each subcohort and specifically quantified the effect of partial nephrectomy on cancer-specific mortality. Results For each of the 3 examined groups, the patients treated with partial nephrectomy failed to demonstrate statistically significant cancer-specific mortality differences relative to radical nephrectomy patients. The hazard ratio for the tumors >7 cm, Fuhrman grade III-IV, and Stage pT3a was 0.67 (95% confidence interval 0.39-1.17, P = .2), 0.81 (95% confidence interval 0.58-1.12, P = .21), and 0.99 (95% confidence interval 0.61-1.61, P = 1.0). Conclusion Even in patients with adverse pathologic features, partial nephrectomy does not compromise cancer-specific mortality. This implies that when functional outcomes are considered in patients with high-risk features, the decision to perform partial nephrectomy should not depend on the stage or grade, but rather on the technical ability to remove the tumor with a negative margin and provide sufficient functional renal remnant.

OBJECTIVE To examine the effect of annual prostatectomy volume (APV) on contemporary intraoperative rectal laceration (RL) rates after radical prostatectomy. METHODS From 1999 to 2008, 36 699 radical prostatectomy procedures were performed in Florida. First, logistic regression models predicting the RL rate were fitted. Second, other logistic regression models were used to examine the association between RL and 2 other secondary outcomes: prolonged length of stay (> 3 days) and increased hospital charges (> $37 621). The covariates included APV quintiles, surgical approach (minimally invasive vs open radical prostatectomy), lymph node dissection status, age, year of surgery, race, and baseline Charlson comorbidity index. RESULTS The overall RL rate was 0.7%. The RL rate was 0.3%, 0.6%, 0.7%, 0.9%, and 1.0% for the very high, high, intermediate, low, and very low APV quintiles, respectively (P < .001). In multivariate analyses predicting RL, patients treated by intermediate (odds ratio 2.39, P = .003), low (odds ratio 2.95, P < .001), and very low (odds ratio 3.26, P < .001) APV surgeons had a greater likelihood of experiencing an RL relative to patients treated by very high APV surgeons. Second, in the multivariate analyses, patients with a RL were 9.1-fold more likely to have a prolonged length of stay (P < .001) and were 3.4-fold more likely to have increased total hospital charges (P < .001). CONCLUSION A greater APV exerts a protective effect on RL rates. Additionally, RL increases the length of stay and hospital charges. UROLOGY 79: 796-803, 2012. (C) 2012 Elsevier Inc.

OBJECTIVES To revisit whether the perioperative mortality differs between septuagenarian and octogenarian patients and younger patients in a large contemporary population-based cohort. The data from tertiary care centers have suggested that perioperative mortality after radical cystectomy is not considerably different in septuagenarian or octogenarian patients compared with younger patients. However, population-based data have stated otherwise. METHODS From 1988 to 2006, 12 722 radical cystectomies were performed for urothelial carcinoma of the urinary bladder in 17 Surveillance, Epidemiology, and End Results registries. Of those 12 722 patients, 4480 (35.2%) were aged 70-79 years and 1439 (11.3%) were aged >= 80 years. Univariate and multivariate logistic regression models tested the 90-day mortality after radical cystectomy. Covariates consisted of sex, race, year of surgery, Surveillance, Epidemiology, and End Results registry, and histologic grade and stage. RESULTS The overall 90-day mortality rate was 4% for the entire population, 2% for patients aged

OBJECTIVES To determine whether an increased body mass index (BMI) is a predictor of advanced pathologic findings in European men undergoing radical prostatectomy (RP). The relationship between obesity and prostate cancer is controversial. Studies, predominantly derived from the United States, have suggested that an increased BMI is a significant predictor of adverse pathologic findings in patients treated with open RP. METHODS From April 2005 to June 2008, 1538 consecutive patients were treated with open RP at a single tertiary referral center. We tested the effect of BMI on the rate of extracapsular extension, seminal vesicle invasion, lymph node invasion, and positive surgical margins in univariate and multivariate logistic regression models. The covariates consisted of clinical stage, prostate-specific antigen, biopsy Gleason score, age, prostate volume, and rate of nerve-sparing surgery. RESULTS On multivariate analysis, both continuously coded and categorically coded BMI was unrelated to the rate of extracapsular extension (odds ratio [OR] 1.02, P = .5), seminal vesicle invasion (OR 1.03, P = .3), lymph node invasion (OR 0.98, P = .7), or positive surgical margins (OR 1.03, P = .3). CONCLUSIONS Obese patients who are candidates for open RP should not expect to have worse pathologic findings after surgery than their nonobese counterparts. Differences in patients' weight and height between North America and Europe might explain the lack of adverse effects of an elevated BMI in this European cohort.

Objectives To assess the prognostic significance of a positive surgical margin in the radical prostatectomy specimen, and to test for the presence of statistically significant interactions between surgical margin status and select pathologic stage variables. Methods We combined prospectively collected data from 7816 consecutive patients treated with radical prostatectomy at eight institutions. The pretreatment serum prostate-specific antigen level, pathologic Gleason sum, surgical margin status (positive versus negative), presence of extracapsular extension, seminal vesicle involvement, and pelvic lymph node status were examined as predictors of the rate of biochemical progression in 5831 patients with complete records. Results In multivariate Cox regression models, a positive surgical margin was associated with a 3.7-fold greater risk of progression (P = 0.001). Moreover, a statistically significant interaction was found between surgical margin status and Gleason sum 7 to 10 (P = 0.008) and lymph node invasion (P Conclusions The presence of a positive surgical margin in the radical prostatectomy specimen has an adverse effect on prognosis. The greatest risk of biochemical recurrence may be expected if a positive surgical margin is present with Gleason sum 7 to 10 disease or lymph node invasion.

To examine age and pretreatment prostate-specific antigen (PSA) level as predictors of organ-confined disease in a large multinational database of men with pretreatment PSA levels less than 10 ng/mL who were treated with radical prostatectomy. The optimal PSA and age cutoffs for triggering prostate biopsy are controversial. Although a PSA level greater than 4.0 ng/mL is generally accepted, recent observations suggest that PSA values between 2.5 and 4.0 ng/mL are associated with a 20% detection rate. Furthermore, age has been shown to represent an independent predictor of outcome after radical prostatectomy.We analyzed a cohort of 3198 patients from five institutions, who underwent radical prostatectomy between 1985 and 2001 for clinically localized prostate cancer. All presented with a pretreatment PSA level of less than 10 ng/mL. Multivariate analyses addressed age, preoperative PSA, year of treatment, biopsy Gleason sum, and clinical stage as independent predictors of non-organ-confined disease (NOCD).Twenty-nine percent of patients had NOCD. All tested variables were independent, multivariate predictors of NOCD (age, P = 0.004; year of treatment, P0.0001; PSA, P0.0001; Gleason sum, P0.0001; clinical stage, P0.0001). A linear relationship between age and the risk of NOCD was noted. The likelihood of NOCD remained constant for PSA levels between 0.1 and 4.0 ng/mL and rose substantially for PSA levels greater than 4.0 ng/mL.After controlling for other covariates, the rate of NOCD increased in proportion to age and pretreatment PSA level in men initially diagnosed with a serum PSA level less than 10 ng/mL. These observations suggest that younger men with a lower PSA are more likely to have organ-confined and curable disease at diagnosis. This information has important implications for counseling and screening.

Objectives To report on five serious intraoperative damages to nonprocedure-related organs during 10 years of experience with the Bookwalter device. Self-retaining retractors are helpful devices, particularly during major transperitoneal and retroperitoneal operations. Various retractors are available and allow the use of all combinations of blades to maintain exposure during each step of an operation. Furthermore, by using these devices, most operations can be performed by two surgeons only. Methods With the help of the operation protocols, more than 4000 applications of the Bookwalter device between January 1992 and December 2001 were retrospectively reviewed. Four cases with damage to the large bowel and one of femoral neuropathy were documented. Results In one transperitoneal and three retroperitoneal approaches, serious damage to the large bowel occurred. None was recognized before postoperative days 2 and 7. One femoral neuropathy was noted. Conclusions The Bookwalter self-retaining retractor is a helpful and safe device in exposing the intraoperative situs. However, care must be taken in patients with risk factors, such as immunosuppression and diverticulitis, and particularly in retroperitoneal operations when tightening the blades. When the intra-abdominal cavity is not exposed, damage to other organs may not be directly noted, which could explain the delay of several days to the onset of symptoms.

Objectives. The selection criteria for a nerve-sparing radical prostatectomy (NSRP) are not thoroughly investigated and are based mainly on preoperative digital rectal examinations and intraoperative findings. At our institution NSRP is performed only on patients whose preoperative systematic sextant biopsy of the prostate showed only unilateral cancer. To prove the safety of these criteria, we analyzed the incidence of positive surgical margins and tumor progression rate in patients who were selected for an NSRP only by the result of the biopsy. Methods. Preoperative systematic sextant biopsies revealed unilateral cancer in 69 preoperatively potent men of 289 consecutive prostatic cancer patients (23.9%); contralateral NSRP was performed on these 69 patients. The prostate specimens were investigated by using a 3-mm step-section technique to identify positive surgical margins. Tumor progression was defined as a prostate-specific antigen (PSA) level greater than 0.4 ng/mL in the native and greater than 0.025 ng/mL in the suprasensitive postoperative blood test. Mean follow-up was 15 months (range 6 to 24). Results. In 69 patients who underwent NSRP, 11 positive margins (15.9%) were found. Only 3 patients (4.3%) had a positive margin on the nerve-sparing side. In 220 patients who underwent non-NSRP 59 positive margins (26.8%) were detected. PSA recurrence rate after 12 months was similar in patients with NSRP and non-NSRP. Analysis of systematic sextant biopsies gives safe selection criteria because in approximately 95% the surgical margin on the nerve-sparing side will be negative. Conclusions. Basing the indication for an NSRP on the results of preoperative systematic biopsies was safe according to margin status and postoperative PSA, when all patients with tumor in one of the three biopsy cores of each side of the prostate were excluded from an NS technique on that side. Such a strict approach will exclude approximately 30% of patients from NSRP unnecessarily because of tumor findings on a prostate side where the cancer is still organ-confined. Less strict criteria, including patients with only well-differentiated cancer and a maximum of one positive biopsy on the evaluated side, seem to be as safe as the described selection. However, data on these patients need further evaluation.

To examine the homologous blood transfusion (HBT), autologous blood transfusion (ABT) and intraoperative blood conservation technique (IOBCT) rates and trends at open (ORP) and minimally invasive radical prostatectomy (MIRP).The Nationwide Inpatient Sample was queried. Multivariable logistic regression models focused on all three transfusion types. Covariables consisted of procedure specific annual hospital caseload (AHC), year of surgery, age, Charlson Comorbidity Index, and region.Overall, 119,966 patients underwent radical prostatectomy between 1998 and 2007. The HBT, ABT, and IOBCT rates were 6.2%, 6.0%, and 1.2%, respectively. HBT rates ranged from 5.1-5.1% between 1998 and 2007 (P=.49) vs 9.4-2.7% (P.001) for ABT vs 1.9-0.9% (P=.003) for IOBCT in the same time period, respectively. In multivariable analyses, ORP patients treated at intermediate (odds ratio [OR] 1.48, P=.003) and low (OR 2.73, P.001) AHC institutions were more likely to receive an HBT than ORP patients treated at high AHC institutions. Conversely, MIRP patients treated at high (OR 0.46, P=.040), intermediate (OR 0.27, P=.001), and low (OR 0.59, P=.015) AHC institutions were less likely to receive an HBT than ORP patients treated at high AHC institutions.Our results indicate that the overall transfusion rate at radical prostatectomy decreased within the last decade because of a substantial decline in ABT use. Moreover, MIRP protects from HBT, even when performed at low AHC Centers.

OBJECTIVES To complement existing data with population-based cancer control outcomes that account for the effect of other-cause mortality (OCM). Cancer control rates are virtually equivalent between partial (PN) and radical nephrectomy (RN) for patients with T1aN0M0 renal cell carcinoma (RCC). To date, only 6 studies from centers of excellence examined cancer control rates after PN vs RN for T1aN0M0 RCC. OCM was unaccounted for in those studies, which may introduce a bias. We relied on the surveillance, epidemiology, and end results (SEER) database and assessed cancer-specific mortality (CSM) after either PN or RN for T1aN0M0 RCC, in competing-risks models. METHODS Between 1988 and 2004, the SEER-9 database identified 1622 PN (22.3%) and 5658 RN (77.7%) T1aN0M0 RCC. Competing-risks regression models, controlling for OCM and matched for age, year of surgery, tumor size, and Fuhrman grade, addressed the effect of nephrectomy type (PN vs RN) on CSM. RESULTS At 5 years, in a PN and RN matched-population controlling for OCM, CSM after PN and RN was respectively 1.8% vs 2.5% (P = .5). The CSM rates in this cohort for patients aged >= 70 years were respectively 1.0% and 3.4% (P = .7). CONCLUSIONS This competing-risks population-based analysis confirmed the CSM equivalence between PN and RN for T1aN0M0 RCC and showed virtually perfect CSM-free rates (97.5% or better) even in older patients. UROLOGY 76: 883-888, 2010. Crown Copyright (C) 2010 Published by Elsevier Inc.

OBJECTIVES To perform a population-based analysis of the potential staging or prognostic value (or both) of lymph node dissection (LND) in patients without nodal metastases vs no LND. In several previous reports, LND in patients with upper tract urothelial carcinoma (UTUC) treated with nephroureterectomy (NU) was associated with better survival relative to no LND (pN(x)), even in the absence of pathologically confirmed nodal metastases (pN(0)). METHODS Within the surveillance, epidemiology, and end results database, we identified 2824 patients treated with NU for UTUC between 1988 and 2004. CSM rates after NU were graphically explored using Kaplan-Meier plots. Univariable and multivariable Cox regression models tested the effect of N(0) vs N(x) stage on CSM, after adjusting for T stage, tumor grade, age, gender, primary tumor location, type, and year of surgery. RESULTS The CSM-free survival rate at 5 years after NU was 81.2% and 77.8% respectively for pN(0) and pN(x) patients. In univariable analyses pN(x) vs pN(0) status was not associated with worse survival (HR: 1.19; P = .09). After adjustment for all covariates, pN(x) vs pN(0) status still failed to achieve independent predictor status (HR: 0.99; P = .9). CONCLUSIONS We found no survival benefit related to the performance of LND in pN(0) patients, relative to pN(x) patients. Lack of standardized criteria for patients' selection for LND and for pathological lymph node specimen evaluation represents some of the explanation for the observed discrepancy between the current finding and previous findings. UROLOGY 75: 118-125, 2010. Crown Copyright (C) 2010 Published by Elsevier Inc.

Cancer control outcomes after partial cystectomy (PC) are not well studied. We compared the population-based rates of overall (OS) and cause-specific survival (CSS) in patients with urothelial carcinoma of the urinary bladder (UCB) treated with PC or radical cystectomy (RC).Within the Surveillance Epidemiology and End Results-9 database, we identified 7243 patients treated with PC (n = 1573) or RC (n = 5670), who had pathologic T(1-4)N(1-2)M(0) UCB. Matched Kaplan-Meier survival analyses compared the effect of PC vs RC on OS and CSS.In the entire cohort, the OS and CSS estimates at 5 years were 57.2% and 76.4%, respectively, for PC patients and 50.2% and 65.8%, respectively, for RC patients (P.001). In the cohort matched for age, race, pT stage, pN stage, tumor grade, and year of surgery, at 5 years the OS and CSS estimates were 56.0% and 73.5%, respectively, for PC patients, and 50.9% and 67.5%, respectively, for RC patients (OS, P = .03 and CSS, P.001). When the number of removed lymph nodes was added to the matching criteria, the 5-year OS and CSS estimates were 57.2% and 70.3%, respectively, for PC patients, and 54.6% and 69.2%, respectively, for RC patients (HR 1.1, P = .3 and HR 1.1, P = .5).Partial cystectomy does not undermine cancer control in appropriately selected patients with UCB.

OBJECTIVES: To examine the rate of biochemical recurrence (BCR) in patients with pathologically confirmed insignificant prostate cancer (PIPCa). METHODS: A total of 1358 patients underwent open retropubic radical prostatectomy at the University Medical Center Eppendorf in Hamburg, Germany, and their specimens were whole-mounted, step-sectioned, and subjected to computer-based three-dimensional reconstruction. We identified patients who fulfilled the Epstein criteria for definition of PIPCa (tumor volume

Objectives Up to 20% of men may harbor a transition zone (TZ) prostate cancer (PCa) at radical prostatectomy (RP). TZ PCa may be associated with more favorable RP pathologic findings than peripheral zone (PZ) PCa. To identify these men, we developed a model capable of predicting the probability of TZ PCa at RP. Methods The study cohort consisted of 945 consecutive men treated with RP, with clinical stage, prostate-specific antigen (PSA) level, and detailed biopsy and RP pathology data available. The preoperative variables were used as predictors in the multivariate logistic regression models to predict the rate of TZ PCa at RP. PCa was defined as a TZ tumor when more than 50% of the planimetrically measured tumor volume was situated within the TZ. Regression coefficients were used to develop nomograms, which were subjected to 200 bootstrap resamples to reduce overfit bias. Results TZ PCa at the final pathologic examination was recorded in 110 patients (11.6%). After 200 bootstraps, the most parsimonious and most accurate nomogram was 77.3% accurate in predicting the probability of TZ PCa. Conclusions This nomogram is ideally suited to identify patients with markedly elevated, nearly metastatic serum PSA levels who harbor a TZ tumor that is highly treatable by RP.

Objectives To analyze the zonal location of prostate cancer as a possible predictive feature of progression-free survival after radical prostatectomy. Methods Prostate cancers were divided into three groups according to the percentage of cancer volume (70% or more, 31% to 69%, and 30% or less) located in the transition zone (TZ). In a total of 307 patients, 5-year progression-free probabilities were estimated for different clinical and pathologic tumor characteristics using the Kaplan-Meier method. With emphasis on the percentage of cancer volume located in the TZ, univariate and multivariate analyses were performed to calculate their prognostic significance in predicting progression-free probability. Results Prostate cancer with 70% or more, 31% to 69%, and 30% or less of the cancer volume in the TZ was found in 17.3%, 6.8%, and 75.9% of the patients, respectively. Patients with tumors with 70% or more of the cancer volume in the TZ had a significantly (log-rank P = 0.0402) greater rate of biochemical cure than those with 30% or less (82.1% versus 66.2%). The increasing percentage of cancer volume located in the TZ was significantly (P = 0.0258) associated with a greater progression-free probability in univariate analysis, but did not retain independent significance (P = 0.5748) in multivariate analysis. Instead, pathologic stage (P

Objectives. To examine the significance of high-grade prostatic intraepithelial neoplasia (HGPIN) in biopsy specimens. Methods. We performed sextant biopsies on a series of 83 cystoprostatectomy specimens removed for bladder cancer. For each case the number of foci and volume of both HGPIN and prostate cancer were assessed in the prostatectomy specimens and compared with the number of biopsy specimens involved by HGPIN. Results. We identified HGPIN in 82 (99%) of 83 prostatic glands, whereas prostate cancer was found in 41 cases (49%). Corresponding sextant biopsies harbored both HGPIN and prostate cancer in 6 cases (7%), whereas only HGPIN was diagnosed in 29 sextant biopsies (35%). There was a positive correlation between the number of biopsy specimens containing HGPIN and the volume and multifocality of HGPIN in the corresponding prostatic glands. Prostates with HGPIN on sextant biopsy contained prostate cancer significantly more often when compared to cases with no HGPIN on sextant biopsy. Frequency of concurrent prostate cancer was higher in cases with two or more biopsy specimens containing HGPIN than in cases with only one such biopsy specimen, but case numbers of these categories were too small to render this difference statistically significant. Conclusions. The presence of HGPIN in sextant biopsies is a significant predictor of concurrent prostate cancer. Multifocality of HGPIN is a useful parameter in assessing the extent of HGPIN in the corresponding prostates. Its value in predicting a significantly increased risk of concurrent prostate cancer needs to be further investigated in larger case studies.