Stage T1c prostate cancer: defining the appropriate staging evaluation and the role for pelvic lymphadenectomy

A good staging system should be able to accurately reflect the natural history of a malignant disease, to express the extent of the disease at the time of diagnosis, and stratify patients in prognostically distinctive groups. The staging system for prostate cancer, as it is today, fails to fulfill these requirements. Approximately one third of the patients who undergo surgery for complete excision of prostate cancer in fact do not have a localize disease. The incidence of tumor at the inked margin may reach 30% for T1 stage and up to 60% for clinical T2b prostate cancer according to comparision with pathologic examination of resected specimen. Several concepts have been recently proposed as a means of improving the accuracy of the available staging system. In this paper, we review current aspects of clinical and pathological staging of prostate cancer, and the importance of these new concepts on the early stages of prostate cancer.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47057/1/345_2005_Article_BF01300182.pd

Cost-effectiveness of MR lymphography for the detection of lymph node metastases in patients with prostate cancer.

Contains fulltext : 79657.pdf (publisher's version ) (Closed access)PURPOSE: To apply a decision analytic model to determine whether the addition of magnetic resonance (MR) lymphography to the diagnostic workup of patients with intermediate or high probability of lymph node metastases is cost effective from a health care perspective. MATERIALS AND METHODS: The data that were used for the decision analytic model were obtained from an empiric study population of 375 patients. As the input of the decision analytic model was made given prospective patient data from several hospitals, the ethics review board of each hospital approved the study. Written consent was obtained from all patients. To investigate possible differences between strategies that utilize MR lymphography and those that do not (pelvic lymph node dissection [PLND]), two outcome measures were examined and combined in an incremental cost-effectiveness ratio (ICER) of health care resources consumed and quality-adjusted life-years (QALYs). Probabilistic and one-way sensitivity analyses were performed. RESULTS: The PLND strategy is dominated by the MR lymphography strategy. Probabilistic sensitivity analysis showed that in 63% of simulations, MR lymphography was cost saving and resulted in better patient outcome for patients with prostate cancer and intermediate or high probability of lymph node metastases. The probability of MR lymphography being inferior (more expensive and worse patient outcome) is less than 3%. CONCLUSION: MR lymphography is an efficient strategy in the detection of lymph node metastases of prostate cancer when compared with the PLND strategy

Case selection and outcome of radical perineal prostatectomy in localized prostate cancer

Radical prostatectomy continues to play a central role in the management of localized prostate cancer. The majority of patients diagnosed with prostate cancer will undergo radical prostatectomy. A decrease in the morbidity of this surgical procedure has been accomplished through an improved understanding of pelvic anatomy and a greater understanding of the natural history of prostate cancer. Recently, minimally invasive techniques have been applied to radical prostatectomy (laparoscopic prostatectomy) in order to further decrease the morbidity of this operation. What remains to be determined is whether this approach confers the same long term surgical outcomes as the open approach. One method which offers known long term outcomes coupled with decreased morbidity is the radical perineal prostatectomy. The purpose of this paper is to review the criteria for patient selection as well as outcomes of the radical perineal prostatectomy