Alexandre Crippa

Inguinal hernia repair with polypropylene mesh during radical retropubic prostatectomy: an easy and practical approach

To report the results of the simultaneous inguinal hernia repair during radical retropubic prostatectomy (RRP) with the preperitoneal tension‐free Stoppa technique, using a polypropylene mesh.

The percentage of positive biopsy cores as a predictor of disease recurrence in patients with prostate cancer treated with radical prostatectomy.

To analyse the prognostic value of the percentage of positive biopsy cores (PPBC) in determining the pathological features and biochemical outcome of patients with prostate cancer treated by radical prostatectomy, as published data evaluating the prognostic value of PPBC in such patients have limitations.

A new nomogram to predict pathologic outcome following radical prostatectomy

OBJECTIVE To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical prostatectomy for clinical localized prostate cancer. MATERIALS AND METHODS Nine hundred and sixty patients with clinical stage T1 and T2 prostate cancer were evaluated following radical prostatectomy, and 898 were included in the study. Following a multivariate analysis, nomograms were developed incorporating serum PSA, biopsy Gleason score, and percentage of positive biopsy cores in order to predict the risks of extraprostatic tumor extension, and seminal vesicle involvement. RESULTS In univariate analysis there was a significant association between percentage of positive biopsy cores (p < 0.001), serum PSA (p = 0.001) and biopsy Gleason score (p < 0.001) with extraprostatic tumor extension. A similar pathologic outcome was seen among tumors with Gleason score 7, and Gleason score 8 to 10. In multivariate analysis, the 3 preoperative variables showed independent significance to predict tumor extension. This allowed the development of nomogram-1 (using Gleason scores in 3 categories - 2 to 6, 7 and 8 to 10) and nomogram-2 (using Gleason scores in 2 categories - 2 to 6 and 7 to 10) to predict disease extension based on these 3 parameters. In the validation analysis, 87% and 91.1% of the time the nomograms-1 and 2, correctly predicted the probability of a pathological stage to within 10% respectively. CONCLUSION Incorporating percent of positive biopsy cores to a nomogram that includes preoperative serum PSA and biopsy Gleason score, can accurately predict the presence of extraprostatic disease extension in patients with clinical localized prostate cancer.

Survival of patients with prostate cancer and normal PSA levels treated by radical prostatectomy

INTRODUCTION The unpredictability of prostate cancer has become a daily challenge for the urologist, with different strategies being required to manage these cases. In this study, we report on the perspectives for curing prostate cancer in males undergoing radical prostatectomy with Gleason score of 2-6 on prostate biopsy in relation to pre-operative PSA levels. MATERIALS AND METHODS From 1991-- 2000, we selected 440 individuals whose pathological diagnosis revealed a Gleason score of 2-6 upon prostate biopsy and who subsequently underwent retro-pubic radical prostatectomy due to localized prostate cancer. The clinical stage identified in the group under study was T1c: 206 (46.8%); T2a: 122 (27.7%); T2b: 93 (21.1%); T2c: 17 (3.9%); T3a: 2 (0.5%). Following surgery, we constructed a biochemical recurrence-free survival curve according to pre-operative PSA levels between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL, with a median follow-up of 5 years. RESULTS Following radical prostatectomy, the pathological stage was confirmed as pT2a: 137 (31.1%); T2b: 118 (26.8%); T2c: 85 (19.3%); T3a: 67 (15.2%); T3b: 6 (1.4%); T3c: 22 (5%). The biochemical recurrence-free survival, according to PSA values between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL, was 86.6%, 62.7%, 39.8% and 24.8% respectively. CONCLUSION Better chances for curing low-grade prostate cancer occur in individuals with normal PSA for whom a biopsy is not usually recommended.

Prostate biopsy: is age important for determining the pathological features in prostate cancer?

INTRODUCTION The influence of age on the aggressiveness of prostate cancer (PCa) is controversial. This study aims to assess the influence of age in determining the pathological features of biopsies from patients diagnosed with PCa. PATIENTS AND METHODS We selected 1422 patients with clinical suspicion of PCa; among them, 547 (38.5%) had received a diagnosis of adenocarcinoma. Patients were categorized into the following age groups: up to 50 years old, 51 to 60 years, 61 to 70 years, 71 to 80 years, and over 80 years. The evaluated variables were histological grade, presence of perineural invasion and estimate of tumor volume through measurement of the maximum percentage of tissue with cancer in one fragment and total percentage of tissue with cancer in the sample. RESULTS The mean age of patients was 66.4 years, with age range from 32 to 94 years. The estimate of tumor volume by maximum percentage of tissue with cancer in one fragment (p = 0.064), total percentage of tissue with cancer in the sample (p = 0.443), and Gleason score (p = 0.485) were not statistically different in relation to the age groups under study. The presence of perineural invasion occurred more frequently among the 50 years and 81 years age groups when compared with patients aged from 51 to 60 and from 61 to 80 years (p = 0.005). CONCLUSIONS Age did not represent a determining factor for pathological findings concerning Gleason score and estimate of tumor volume by the variables in use.

Prediction of pathological stage in prostate cancer through the percentage of involved fragments upon biopsy

INTRODUCTION The need for defining the extension of disease in patients undergoing radical prostatectomy due to prostate adenocarcinoma is a relevant factor cure in such individuals. In order to identify a new independent preoperative factor for predicting the extension of prostate cancer, we assessed the role of the percentage of positive fragments upon biopsy. MATERIALS AND METHODS A retrospective study compared the percentage of positive fragments on biopsy with the extension of disease as defined by the pathological examination of the surgical specimen from 898 patients undergoing radical prostatectomy due to clinically localized prostate cancer. RESULTS On the univariate analysis, the percentage of positive fragments on biopsy showed a statistical significance for predicting confined disease (p < 0.001), which was found in 66.7% of the cases under study. Additionally, we observed that the total number of removed fragments exerts no influence on the extension of the disease (p = 0.567). CONCLUSION the percentage of positive fragments is an independent factor for predicting the pathological stage of prostate adenocarcinoma, and the number of removed fragments is not related to the extension of the disease.

Pathological extension of prostate cancer as defined by gleason score on biopsy

INTRODUCTION Based on the importance of the Gleason score on the behavior of prostate adenocarcinoma, this study attempts to predict the extension of prostate adenocarcinoma pre-operatively, as defined by the Gleason score on biopsy, in individuals who will undergo radical prostatectomy. MATERIALS AND METHODS We selected 899 individuals who underwent retropubic radical prostatectomy from 1988 to 2004. Clinical and pathological data obtained in the preoperative period were retrospectively analyzed through digital rectal examinations of the prostate, initial serum PSA levels and pathological data provided by biopsy. The Gleason score on biopsy was assessed and divided into 3 groups: 2 to 6, 7, and 8 to 10, and correlated with the possibility of the disease being confined to the prostate. RESULTS From the 899 selected patients, 654 (74%) showed Gleason scores of 2 to 6, 165 (18%) had a score of 7 and 80 (9%) had scores of 8 to 10 on biopsy. The likelihood of confined diseases, extraprostatic extensions, invasion of seminal vesicles and lymph nodal involvement were respectively: 74%, 18%, 8% and 0.8% for a Gleason score of 2 to 6, 47%, 30%, 19% and 4% for a Gleason score of 7, and 49%, 29%, 18% and 4% for a Gleason score of 8 to 10. CONCLUSION In patients who will undergo radical prostatectomy due to prostate adenocarcinoma, a Gleason score of 7 on biopsy shows the same behavior as a Gleason score of 8 to 10 in relation to extension of disease.

Serum PSA and cure perspective for prostate cancer in males with nonpalpable tumor

INTRODUCTION Many studies have shown the association between PSA levels and the subsequent detection of prostate cancer. In the present trial, we have studied the relationship between preoperative PSA levels and clinical outcome following radical prostatectomy in men with clinical stage T1c. MATERIALS AND METHODS 257 individuals with clinical stage T1c undergoing retropubic radical prostatectomy were selected in the period from 1991 to 2000. Following surgery, biochemical recurrence-free survival curves were constructed according to PSA levels between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL. RESULTS Of the total of 257 selected patients, 206 (80%) had Gleason scores from 2 to 6 and 51 (20%), presented Gleason scores 7 and 8, as defined by the pathological report from prostate biopsy. There was no biochemical recurrence of disease when the PSA was lower than 4, regardless of Gleason score. Biochemical recurrence-free survival according to PSA between 0-4; 4.1-10; 10.1-20 and > 20 was 100%, 87.6%, 79% and 68.8% for Gleason scores 2-6 and 100%; 79.4%; 40% and 100% for Gleason scores 7-8 respectively. When all individuals were grouped, regardless of their Gleason scores, the probability of biochemical recurrence-free survival was 100%, 65.1%, 53.4% and 72.2% according to PSA between 0-4; 4.1-10; 10.1-20 and > 20 ng/mL respectively. CONCLUSION Non-palpable prostate cancer presents higher chances of cure when the PSA is inferior to 4 ng/mL.