Evolution of the Clinical Presentation and Outcomes after Radical Prostatectomy for Patients with Clinically Localized Prostate Cancer – Changing Trends over a Ten Year Period

We demonstrate the evolution of the clinical presentation and outcomes for patients with clinically localized prostate cancer (PC) treated with radical retropubic prostatectomy (RRP) at our department, emphasizing epidemiologic significance of changes during the 10-year period.We assessed the annual trends for changes in patients age, preoperative prostate specific antigen (PSA), preoperative versus postoperative stages and Gleason grades, organ confined status and surgical margin status. A total of 488 RRPs were performed from January 1996 to December 2005 with the annual frequency increased from 8 to 129 (1512.5%). Mean patient age increased from 61.5 to 66.12 years in 2005, with the percentage of men aged more than 70 years increased from 12.5 to 26.5%, respectively. The detection of PC based solely on pathological PSA levels (as indication for prostate biopsy) rose impressively from 25.5 to 70% and the rates of postoperative organ- confined disease also increased significantly from 25 to 74.7%. Mean preoperative PSA decreased from 16.7 to 9.89 ng/mL. On the contrary, there was an increase in percentage of patients with preoperative PSA values ranging from 4 to 10 ng/mL (from 20 to 65.4%). Positive surgical margin rate decreased from 49.4 to 25% and percent of patients receiving neoadjuvant therapy decreased from 78.5 to 5.4%. Proportion of patients who were undergraded decreased from 75.1 to 31.7%. The rates of understaging have remained relatively stable over the years. During the study period, PC was increasingly detected by prostate biopsy on the basis of a pathological PSA level only and shifted significantly to more organ- confined stages with more favourable outcomes for pathological variables due to a more accurate assessment of clinical stage prior to surgery, reduced use of neoadjuvant therapy and improved surgical technique. Our data also argue strongly that routine PSA testing should be expanded and not restricted

CLINICAL GUIDELINES FOR DIAGNOSING, TREATMENT AND MONITORING PATIENTS WITH PROSTATE CANCER – CROATIAN ONCOLOGY SOCIETY AND CROATIAN UROLOGY SOCIETY, CROATIAN MEDICAL ASSOCIATION

Adenokarcinom prostate druga je po učestalosti zloćudna neoplazija u muškaraca u Republici Hrvatskoj. Klinički je često asimptomatski, a najčešće se otkriva na osnovi povišenih vrijednosti PSA u serumu. Odluka o liječenju donosi se na osnovi TNM-klasifikacije, Gleasonova gradusa (stupnja diferenciranosti) i vrijednosti PSA. Klinički lokalizirana bolest liječi se vrlo uspješno radikalnom prostatektomijom ili radikalnom radioterapijom s hormonskom terapijom ili bez nje. Klinički lokalno uznapredovala bolest najčešće se liječi združenom primjenom radikalne radioterapije i hormonske terapije. Metastatska bolest može se godinama kontrolirati androgenom deprivacijom, a nakon razvoja bolesti rezistentne na kastraciju opravdana je kemoterapija ili dodatni oblici hormonske terapije. U tekstu koji slijedi predstavljene su kliničke upute s ciljem standardizacije postupaka i kriterija postavljanja dijagnoze, liječenja te praćenja bolesnika s rakom prostate u Republici Hrvatskoj.Prostate adenocarcinoma is the second most common solid neoplasm in male population in Croatia. It rarely causes symptoms unless it is advanced. The finding of PSA rise is the most common reason for diagnostic workout. Treatment plan is based on TNM classification, Gleason score and PSA. Clinically localized disease is successfully treated by radical prostatectomy or radiotherapy with or without hormonal therapy. Locally advanced disease is treated with radiotherapy and hormonal therapy. Metastatic disease can be controlled for many years by androgen deprivation. For castration resistant disease appropriate treatment is chemotherapy or secondary hormonal therapy. The following paper presents the clinical guidelines in order to standardize procedures and criteria for the diagnosis, management, management, treatment and monitoring of patients with prostate cancer in the Republic of Croatia

SAC-C Orbit Reconstruction Using the Experimental GPS/GLONASS Receiver LAGRANGE

The Argentinian satellite SAC-C was launched in November 2000. It carries onboard an experimental prototype of the first Italian-built, combined GPS/GLONASS space receiver LAGRANGE, developed for the Italian Space Agency (ASI) by LABEN S.p.a. It also carries a second GPS receiver provided by JPL known as Blackjack. The SAC-C prototype of the LAGRANGE receiver is based on the first-version of the Advanced GPS/GLONASS ASIC (AGGA) developed by the European Space Agency (ESA). The dual-frequency LAGRANGE receiver is provided with 12 channels that can be dynamically allocated to GPS and GLONASS frequencies. The receiver was operating during a period of 56 days until 23 January 2001, when it suffered a radiation-induced failure and ceased operations before the end of the commissioning phase. However, data were collected during the entire period and were made available for analysis. This paper will address the results from the LAGRANGE data processing. It is of interest to evaluate the performance of this receiver based on the availability of the well-known, long-heritage BlackJack receiver onboard the same spacecraft. The two receiver antennas were placed very to each other, thus allowing a very similar satellite tracking scenario. In this experimental setup the LAGRANGE receiver suffered from important limitations such as channel-dependent pseudorange biases, very low availability of measurements at the L2 frequency and a clock with a very high drift. A new strategy to cope with the biased pseudorange measurements (\u201crealignment\u201d) was implemented, which allowed to obtain a navigation solution otherwise impossible. This strategy, based on the availability of another GPS receiver (BlackJack), did not allow the recovery of the absolute LAGRANGE clock error. This important quantity was inferred through reference to a precise orbit of the SAC-C satellite obtained using BlackJack carrier phase data. An along-track orbit difference was the key to calibrate the LAGRANGE clock. The two receivers were later compared in their performance in terms of an L1-only, doubly differenced carrier phase-based Precise Orbit Determination analysis. When the orbits obtained from single frequency data from each of the two receivers are compared in an RTN reference frame with the same precise reference orbit\u2014 obtained from dual-frequency BlackJack data\u2014the residuals show very similar behavior in terms of both mean and standard deviation. This can be interpreted as an indication that the two receivers performances are quite similar. Studies are ongoing to assess wether use of combined iono-free pseudoranges and carrier phase LAGRANGE measurements provide indications of a better performance of the receiver when the comparisons are made with the precise SAC-C orbit