Search

Radical prostatectomy is the best treatment for patients with T1-2 prostate cancer and a life expectancy of over 10 years, but no pN1 patient that underwent only surgery, was progression free at 10 years (Partin 1994). In the last 10 years we performed 441 consecutive pelvic lymphadenectomy in patients with prostate cancer. We examined 32 patients pN1 (7.2%), with preoperatory PSA < 10 ng/ml. Mean age was 66.7, all these patients were clinically T1-2, mean PSA was 6.89 ng/ml and mean Gleason score 6.7 (< or = 7 in 27/32). Frozen sections and orchiectomy were performed in 8 patients who had macroscopic nodal involvement. In 24 patients with microscopic nodal involvement retropubic radical prostatectomy was performed. Pathologic stadiation (TNM 1997) was: 1 pT2a N1, 6 pT2b N1, 2 pT3a N1, 14 pT3b N1 and 1 pT4 N1. Seminal vesicle involvement was found in 14 of patients; in 13 of these positive surgical margins was found. Definitive Gleason score was > or = 7 in 22/24 patients (mean 7.7). Five patients underwent adjuvant radiotherapy, 13 radiotherapy and hormonotherapy and 6 only hormonotherapy. Mean follow up was at 66.6 months, but data are available for only 29/32 patients, with 8 (27.5%) biochemical progressions and 2 deaths (10.3%) for metastatic disease. Our experience indicates that the pelvic lymphadenectomy is very important for correct staging, also when PSA <10 ng/mI, bioptic Gleason score < or = 7 and clinical stage T1-2. In pN1 patients the adjuvant hormonotherapy allows a significant extension of disease free survival. [ABSTRACT FROM AUTHOR]

(High intensity focused ultrasound) HIFU is a minimally invasive treatment based on thermal ablation of tissues which are warmed up to 85°C in the focal area. From May 2002 to March 2008, 145 patients with prostate cancer, aged 44 to 86 years (mean 74.4) underwent 170 HIFU treatments. Mean PSA was 28. 1 ng/ml (range 0, 1-143) and mean Gleason sum 6.3 (range 3-9). The prognosis subgroups were defined as low-risk in 29 patients (clinical stage T1-T2a, PSA < or = 10 ng/mL, and Gleason score lower than 7), intermediate-risk in 21 patients (clinical stage T2b or PSA 10 - 20 ng/mL, or Gleason score of 7), and high-risk in 95 patients (clinical stage > or = T2c, or PSA > 20 ng/mL, or Gleason score higher than 7). At a mean follow-up of 47.1 months, biochemical success rate (PSA constantly <0.5 ng/ml) was obtained in 84.0% of low and intermediate risk patients and in 43. 1% of high risk patients; post-treatment biopsies (6 months after treatment) revealed no residual tumor in 92.8% of low or intermediate risk patients and in 62.3 % of high risk patients. Complication included: asymptomatic urinary tract infection (17.5%), pros tatitis (2.9%), epididymorchitis (1.7%), hemorrhoidal pain (0.5%), hematuria (3.5%), prostatic urethra structures (7.6%%), bladder neck sclerosis (12.3%) and rectourethral fistula (0.5%). Light stress incontinence occurred in 4.1% of the patients and erectile dysfunction in 77.8%. HIFU seems to be a promising alternative and less invasive treatment modality with an encouraging success rate, at least in the short-term. [ABSTRACT FROM AUTHOR]