Dan Lewinshtein

Incidence of second malignancies after external beam radiotherapy for clinical stage I testicular seminoma.

Study Type – Harm (case series)

The association between pre-operative PSA and prostate cancer-specific mortality in patients with long-term follow-up after radical prostatectomy.

The clinical and pathologic predictors of prostate cancer‐specific mortality (PCSM) many years after radical prostatectomy (RP) remain to be fully elucidated. We explored the association between pre‐operative prostate‐specific antigen (PSA) and other pathologic predictors and PCSM in men who have undergone (RP).

The Long-Term Outcomes after Radical Prostatectomy of Patients with Pathologic Gleason 8–10 Disease

Background. We explored the long-term clinical outcomes including metastases-free survival and prostate cancer-specific survival (PCSS) in patients with pathologic Gleason 8–10 disease after radical prostatectomy (RP). Methods. We report on 91 patients with PCSS data with a median followup of 8.2 years after RP performed between 1988 and 1997. Cox regression and Kaplan-Meier analysis were used to evaluate year of surgery, pathologic stage, and surgical margin status as predictors of PCSM. Results. Median age was 65 years (IQR: 61–9), and median PSA was 9.7 ng/ml (IQR: 6.1–13.4). Of all patients, 62 (68.9%) had stage T3 disease or higher, and 48 (52.7%) had a positive surgical margin. On multivariate analysis, none of the predictors were statistically significant. Of all patients, the predicted 10-year BCR-free survival, mets-free survival, and PCSS were 59% (CI: 53%–65%), 88% (CI: 84%–92%), and 94% (CI: 91%–97%), respectively. Conclusions. We have demonstrated that cancer control is durable even 10 years after RP in those with pathologic Gleason 8–10 disease. Although 40% will succumb to BCR, only 6% of patients died of their disease. These results support the use of RP for patients with high-risk localized prostate cancer.

The Impact of Multiple Prostate Needle Biopsies on Long-Term Erectile Dysfunction

Introduction: The impact of transrectal ultrasound guided prostate needle biopsy on erectile dysfunction remains uncertain. We examined whether transrectal ultrasound guided prostate needle biopsy contributes to the development or worsening of erectile dysfunction as assessed by IIEF‐5 scores in patients who underwent multiple prostate needle biopsies. Methods: The study population consisted of 826 men who underwent transrectal ultrasound guided 10 to 12‐core prostate needle biopsy for suspicion or surveillance of prostate cancer. Men were evaluated for erectile dysfunction using the IIEF‐5 questionnaire. Erectile dysfunction was modeled as a categorical variable, defined as any (0 to 20), mild (16 to 20), mild to moderate (11 to 15), moderate (6 to 10) or severe (0 to 5). The impact of multiple prostate needle biopsies was also evaluated. Results: Of 826 men who underwent prostate needle biopsy 240 (29%) had undergone 1 or more and 168 (20%) had undergone 2 or more biopsies. Mean patient age was 63 years and mean IIEF‐5 score was 16. On univariate analysis age (OR 1.11, 95% CI 1.09–1.14, p <0.001), and 1 (OR 1.79, 95% CI 1.06–3.03, p=0.03) or 2 (OR 1.80, 95% CI 1.02–3.17, p=0.04) prior prostate needle biopsies were associated with erectile dysfunction. On multivariate analysis age alone was predictive of severe erectile dysfunction (OR 1.09, 95% CI 1.05–1.12, p=0.002). A repeat prostate needle biopsy within 12 months was associated with worse erectile dysfunction (OR 1.55, 95% CI 1.08–2.93, p=0.02). When long‐term erectile function was evaluated, prostate needle biopsy was not significant after adjustment for covariates. Conclusions: In the short term prostate needle biopsy may be important in predicting transient (less than 1 year) erectile dysfunction. However, in the long term prostate needle biopsy does not predict erectile dysfunction in aging men.