Salvage treatments for prostate-specific antigen relapse of cT3N0M0 prostatic adenocarcinoma after radical prostatectomy combined with neoadjuvant androgen deprivation

Objective The aim of the study was to evaluate the efficiency of salvage treatments for prostate specific antigen(PSA)relapse of cT3N0M0 prostatic adenocarcinoma(PCa)after radical prostatectomy(RP)combined with neoadjuvant androgen deprivation(ADT).Methods A total of 332 patients with cT3N0M0 PCa were enrolled in the prospective study and received RP and pelvic lymph node dissection with neoadjuvant ADT for 3 months.All patients with PSA relapse were treated with salvage external beam radiation therapy(RT)and ADT for 6 months.Results The 5-year postoperative PSA relapse rate was 40.96%(136/332).The patients have been divided into the PSA relapse and PSA relapse-free groups in order to compare patient characteristics.The ratio of patients with Gleason score≥8 and positive surgical margin in the PSA relapse group were significantly higher than those of in the PSA relapse-free group(P=0.01).The mean duration between the start of operative treatment and PSA relapse was 31 months.Salvage treatment to all 136 PSA relapse patients led to favorable outcomes.PSA relapse was not observed after salvage treatment by the end of follow-up.The 5-year overall survival rates of the PSA relapse and PSA relapse-free groups were 94.9%and 93.9%,respectively.Conclusion In pursuit of curative treatment,our study showed that RP combined with neoadjuvant ADT is an aggressive multimodality strategy associated with lower PSA relapse and better survival outcomes for stage cT3N0M0 PCa patients.Patients with PSA relapse after RP may benefit from early aggressive salvage RT combined with short-term ADT.

Thyroid Metastasis Revealing Prostatic Adenocarcinoma

Introduction: Metastasis to the thyroid gland is rarely encountered and usually detected after the diagnosis of the primary tumor. The most common sites of primary are breast, kidney, and lung. Prostate has been rarely reported as primary site. Here is reported a case of thyroid metastasis revealing prostate adenocarcinoma. Case summary: A 59-year-old man was admitted for pulmonary embolism. CT scan showed a hypertrophy of left thyroid lobe, and ultrasonography of the neck revealed cervical nodes. Thyroid function tests were within normal limits. Total thyroidectomy associated to cervical nodes dissection was done. There was no postoperative complication. Histopathological examination of the surgical specimen concluded to a papillary carcinoma. Then, immunohistochemistry examination revealed prostatic metastatic adenocarcinoma to lymph node and thyroid gland. The patient was treated by androgen deprivation therapy. After thirty three months of follow-up, he is still in good condition with stable disease. Conclusion: This case suggests thyroid cancer might be metastasis, and more frequent than known. Surgical specimen of thyroidectomy requires further histological examination such as immunohistochemistry to document primary tumor. Prostate is one of the primary, despite not the most common.

Prostatic Foamy Adenocarcinoma:A Case Report.

A 58-year-old male patient, complaining of dysuresia, which increased over a period of 2 months, had a history of urine retention that did not respond to treatment administered in an outpatient clinic. Upon admission to the hospital on August 2, 2005, examination showed that his prostate was midrange size by rectal palpation, and without pain or prostate nodus. An ultrasound examination indicated the prostate size was 6.1 cm×4.7 cm×3.6 cm, without an occupying lesion in the prostate.

The benign mimickers of prostatic acinar adenocarcinoma

As the most frequent malignant histological subtype in prostatic cancer, prostatic acinar adenocarcinoma （PAA） has a series of benign mimickers including prostatic or non-prostatic lesions and normal structures, which may lead to an erroneous diagnosis and inappropriate treatment. It is very important to be aware of the existence of these mimickers and to recognize their histological features. The differential diagnosis should be based on a comprehensive evaluation of clinical history, histological structure, cytological morphology and the results of immunohistochemistry （IHC） straining, rather than on single criteria （e.g., the presence of prominent nueleoli or basal cell layer）.

Clinical value of intravesical prostatic protrusion in the evaluation and management of prostatic and other lower urinary tract diseases

Intravesical prostatic protrusion(IPP)has emerged as a new prostatic morphometric parameter of significance to aid the clinicians in various aspects of managing the patients with some diseases of the lower urinary tract and the prostate.These include but may not be limited to its role in such conditions as:bladder outlet obstruction,trial without catheter,medical treatment effect,progression of lower urinary tract symptoms related to benign prostatic hypertrophy(LUTS/BPH),risk factor for bladder stone in BPH,overactive bladder,prostate carcinoma,and early urinary continence recovery after laparoscopic radical prostatectomy.In this review,I will try to summarize the different researchers’efforts on the potential practical application of this clinical tool.Technology is ever evolving to help us in the diagnosis and management of our patients.However,we as clinicians should contemplate their cost and possible suffering for the patient by wise and judicious utilization based on our clinical experience and tools.IPP seems to be one such promising clinical tool.

Complementary comments on metastatic liver lesions with exceptional and rare cases

Liver metastases can appear in different forms in magnetic resonance imaging.Contrary to popular belief,while radiologists report hypovascular or hypervascular metastatic lesions,exceptional examples may be detected in various tumors.The aim of this article is to improve this review by presenting rare and atypical examples of liver metastasis,as well as cases that might potentially be misdiagnosed as metastases during the process of differential diagnosis.

Somatostatin receptor subtypes in hormone-refractory （castration-resistant） prostatic carcinoma

The aim of this study was to examine the tissue expression and Iocalisation of the somatostatin receptors （SSTRs） in hormone-refractory （HR） prostate cancer （PCa）. Five SSTRs were evaluated immunohistochemically in 20 radical prostatectomies （RPs） with Gleason score （GS） 3＋3=6 PCa, in 20 RPs with GS 4＋4=8 and 4＋5=9 PCa, and 20 transurethral resection of the prostate specimens with HR PCa. The mean values in the cytoplasm （all five SSTRs were expressed）, membrane （only SSTR3 and SSTR4 were expressed） and nuclei （only SSTR4 and SSTR5 were expressed） of the glands in HR PCa were 20-70% lower than in the other two groups, the differences being statistically significant. All five SSTRs were expressed in the smooth muscle and endothelial cells of HR PCa, the mean values being lower than in the other two groups. In conclusion, this study expands our knowledge on the expression and Iocalisation of five SSTRs in the various tissue components in the HR PCa compared with hormone-sensitive PCa.

Prostate adenocarcinoma with unusual first presentation – A case report

Prostate adenocarcinoma most often metastasis to the bones of spine and pelvis.Metastasis to the supradiaphragmatic lymph nodes as uncommon presentation of this disease has been increasingly reported.Here we reported a 61years old man with prostatic adenocarcinoma who presented with generalized lymphadenopathy.

Oncological outcomes of patients with ductal adenocarcinoma of the prostate receiving radical prostatectomy or radiotherapy

Objective:To evaluate the oncological outcomes of ductal adenocarcinoma of the prostate(DAC)managed with radical prostatectomy(RP)or radiotherapy(RT)and optimize the proper treatment modality to DAC comprehensively.Methods:The cohorts included a total of 528 patients from the Surveillance,Epidemiology and End Results(SEER)database,354 receiving RP and 174 receiving RT.Cox proportional hazards regressions were performed to assess cancer specific mortality(CSM)and overall mortality(OM)between treatment groups.A competing risk analysis was further conducted.Subgroup analyses by age and level of prostate-specific antigen(PSA)were performed.Propensity score matching was implemented.Results:Patients managed with RP had lower risks of CSM and OM compared with RT(before matching:Hazard ratio[HR]=0.24,95%confidence interval[CI]0.13-0.47 and HR=0.26,95%CI 0.17-0.40,respectively;after matching:HR=0.18,95%CI 0.04-0.82 and HR=0.28,95%CI 0.11-0.70,accordingly).Subgroup analyses demonstrated that patients in the middle tertile of the age or with lower tertile PSA level managed with RP took lower risks of OM significantly(HR=0.18,95%CI 0.06-0.57,p<0.01 and HR=0.17,95%CI 0.06-0.54,p<0.01).Conclusion:Among patients with DAC,treatment with RP was associated with better survival outcomes in comparison with RT.Patients with DAC in the middle tertile of the age and with lower tertile PSA level benefited the most from RP.

Sarcomatoid carcinoma of the prostate with bladder invasion shortly after androgen deprivation:Two case reports

BACKGROUND To summarize the imaging,morphological and biological characteristics of sarcomatoid carcinoma(SC)of the prostate with bladder invasion not long after castration.CASE SUMMARY Our two cases were initially diagnosed with adenocarcinoma of the prostate due to dysuria.However,prostate SC was diagnosed after transurethral resection of the prostate(TURP)and castration after only 5 and 10 mo,respectively.Distinctive liver-like tissues appeared in the second TURP procedure in case 1,while a white,fish flesh-like,narrow pedicled soft globe protruded from the prostate to the bladder in case 2.CONCLUSION The sarcomatoid component of SC may arise from one of the specific groups of cancer cells that are resistant to hormonal therapy.Morphological characteristics of SCs can present as“red hepatization”and“fish flesh”.SCs grow rapidly and have a poor prognosis,and thus,extensive TURP plus radiation may be the treatment of choice.

Augmenting prostate magnetic resonance imaging reporting to incorporate diagnostic recommendations based upon clinical risk calculators

Risk calculators have offered a viable tool for clinicians to stratify patients at risk of prostate cancer(PCa)and to mitigate the low sensitivity and specificity of screening prostate specific antigen(PSA).While initially based on clinical and demographic data,incorporation of multiparametric magnetic resonance imaging(MRI)and the validated prostate imaging reporting and data system suspicion scoring system has standardized and improved risk stratification beyond the use of PSA and patient parameters alone.Biopsy-naïve patients with lower risk profiles for harboring clinically significant PCa are often subjected to uncomfortable,invasive,and potentially unnecessary prostate biopsy procedures.Incorporating risk calculator data into prostate MRI reports can broaden the role of radiologists,improve communication with clinicians primarily managing these patients,and help guide clinical care in directing the screening,detection,and risk stratification of PCa.

The evolving Gleason grading system

The Gleason grading system for prostate adenocarcinoma has evolved from its original scheme established in the 1960s-1970s, to a significantly modified system after two major consensus meetings conducted by the International Society of Urologic Pathology （ISUP） in 2005 and 2014, respectively. The Gleason grading system has been incorporated into the WHO classification of prostate cancer, the AJCC/ UICC staging system, and the NCCN guidelines as one of the key factors in treatment decision. Both pathologists and clinicians need to fully understand the principles and practice of this grading system. We here briefly review the historical aspects of the original scheme and the recent developments of Gleason grading system, focusing on major changes over the years that resulted in the modern Gleason grading system, which has led to a new ＂Grade Group＂ system proposed by the 2014 ISUP consensus, and adopted by the 2016 WHO classification of tumours of the prostate.