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The objective of this study was to determine Bcl-2 expression in localized prostate cancer and its potential role as a predictive factor for biochemical recurrence (BCR).
This study included 171 Korean patients with newly diagnosed adenocarcinoma of the prostate who underwent radical prostatectomy (RP) without neoadjuvant therapy at a single center between February 2005 and May 2009. RP specimens obtained from these patients were analyzed for the expression of Bcl-2 using tissue microarray. The values of Bcl-2 and other clinicopathologic factors were evaluated. Statistical analysis was performed with contingency table analysis, chi-square tests, and a Cox proportional hazard model.
Bcl-2 expression was immunohistologically-confirmed in 42 patients (24.6%). Bcl-2 expression was not associated with conventional clinicopathologic factors. Bcl-2 negative patients had a significantly longer mean BCR-free survival than Bcl-2-positive patients (p=0.036). Among several variables, a high Gleason score in the RP specimen (≥8), extraprostatic extension, seminal vesicle invasion (SVI), lymphovascular invasion (LVI), and Bcl-2 expression were significant predictors of BCR based on univariate analysis. Multivariate Cox proportional hazards analysis revealed that BCR was significantly associated with a high prostate specific antigen level (p=0.047), SVI (p<0.001), a positive surgical margin (p=0.004) and Bcl-2 expression (p=0.012).
Bcl-2 expression in RP specimens is associated with a significantly worse outcome, suggesting a potential clinical role for Bcl-2. Post-operative Bcl-2 could be a significant predictor of outcome after RP.
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A progressively rising level of serum prostate specific antigen (PSA) after radical prostatectomy (RP) invariably indicates the recurrence of prostate cancer. The optimal management of patients with post-RP PSA relapse has remained uncertain due to a wide variability in the natural course of post-RP PSA relapse and the inability to separate a recurrent disease confined to the prostate bed from that with occult distant metastasis. Management uncertainty is further compounded by the lack of phase III clinical studies demonstrating which therapeutic approach, if any, would prolong life with no significant morbidity. Radiotherapy has been the main therapeutic modality with a curative potential for patients with post-RP PSA relapse. This review article depicts issues and challenges in the management of patients with post-RP PSA relapse, presents the literature data for the efficacy of salvage radiotherapy, either alone or in combination of androgen ablation therapy, and discusses future directions that can optimize treatment strategies.
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To determine whether the biopsy core number and time interval between prostate biopsy and radical prostatectomy affect the operative and oncologic outcome of robot assisted laparoscopic radical prostatectomy (RALP).
From January 2008 to April 2009, a single surgeon performed 72 RALPs after an initial learning period of 30 cases. The relationship between time from biopsy to prostatectomy and biopsy core number with operative time and estimated blood loss (EBL) were initially evaluated with a linear regression model. These patients were classified into groups according to whether the interval from biopsy to RALP was within four weeks or not, and whether there were less than or greater than 10 core specimens removed.
RALP was performed in 34 patients within four weeks of biopsy, and in 38 patients more than 4 weeks after biopsy. According to the number of core specimens removed, less than 10 cores were performed in 10 patients, and more than 10 cores were performed in 62 patients. Using an interval of 4 weeks as the cutoff point, early surgery was associated with longer operating time (232.6 vs 208.8 min) and increased estimated blood loss (305.1 vs 276.9 mL). For cases with more than 10 biopsy cores, there was a slight increase in operative time (229.2 vs 210.3 min). None of these differences were statistically significant by multivariate analysis.
Our data suggests that there is no reason to delay RALP to more than 4 weeks after prostate biopsy. It also revealed that the number of biopsy cores (up to 14) did not influence operative outcome. Thus, RALP is a feasible procedure regardless of the biopsy related prostate state.
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