John W. Colberg

a Prospective Randomized Comparison of Three Blood Conservation Strategies for Radical Prostatectomy

BACKGROUND Preoperative autologous blood donation is a standard of care for elective surgical procedures requiring transfusion. The authors evaluated the efficacy of alternative blood-conservation strategies including preoperative recombinant human erythropoietin (rHuEPO) therapy and acute normovolemic hemodilution (ANH) in radical retropubic prostatectomy patients. METHODS Seventy-nine patients were prospectively randomized to preoperative autologous donation (3 U autologous blood); rHuEPO plus ANH (preoperative subcutaneous administration of 600 U/kg rHuEPO at 21 and 14 days before surgery and 300 U/kg on day of surgery followed by ANH in the operating room); or ANH (blinded, placebo injections per the rHuEPO regimen listed previously). Transfusion outcomes, perioperative hematocrit levels, postoperative outcomes, and blood-conservation costs were compared among the three groups. RESULTS Baseline hematocrit levels were similar in all groups (43%+/-2%). On the day of surgery hematocrit decreased to 34% +/-4% in the preoperative autologous donation group (P < 0.001), increased to 47%+/-2% in the rHuEPO plus ANH group (P < 0.001), and remained unchanged at 43%+/-2% in the ANH group. Allogeneic blood exposure was similar in all groups. The rHuEPO plus ANH group had significantly higher hematocrit levels compared with the other groups throughout the hospitalization (P < 0.001). Average transfusion costs were significantly lower for ANH (

Surgery, brachytherapy, and external-beam radiotherapy for early prostate cancer

194+/-

Whole Pelvic Radiotherapy Versus Prostate Only Radiotherapy in the Management of Locally Advanced or Aggressive Prostate Adenocarcinoma

192) compared with preoperative autologous donation (

Radical prostatectomy vs. intensity-modulated radiation therapy in the management of localized prostate adenocarcinoma

690+/-

CURRENT FOLLOWUP STRATEGIES AFTER RADICAL PROSTATECTOMY: A SURVEY OF AMERICAN UROLOGICAL ASSOCIATION UROLOGISTS

128; P < 0.001) or rHuEPO plus ANH (

Iodine 125 Versus Palladium 103 Implants for Prostate Cancer: Clinical Outcomes and Complications

1,393+/-

Surgery versus implant for early prostate cancer: results from a single institution, 1992-2005.

204, P < 0.001). CONCLUSIONS All three blood-conservation strategies resulted in similar allogeneic blood exposure rates, but ANH was the least costly technique. Preoperative rHuEPO plus ANH prevented postoperative anemia but resulted in the highest transfusion costs.

Vascularity of primary and metastatic renal cell carcinoma specimens.

Patients diagnosed with early prostate cancer after 2000 can expect better outcomes from treatment than patients who were diagnosed in the 1980s and early 1990s. These improved outcomes are the result of stage migration, new technologies such as three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated external-beam radiotherapy (IMRT), better implant techniques, and optimum use of hormone therapy. We review the outcomes for radical prostatectomy, permanent seed implant, 3DCRT, and IMRT. For patients with clinical stage T1c or T2 disease and a Gleason score of less than 8, 5-year biochemical disease-free survival is remarkably similar for all the above treatments. Furthermore, complication rates are acceptable for all these modalities. For patients with bulky T2-3 disease or a Gleason score of 8-10, hormone therapy plus 3DCRT or IMRT is an excellent treatment choice. Studies of radical prostatectomy show the most reliable long-term results, and the studies of external-beam radiotherapy have used the best scientific methods to assess efficacy. On the basis of current data, we recommend specific treatment options.

Ewing sarcoma/primitive neuroectodermal tumor arising in the adrenal gland

PURPOSE To determine whether whole pelvic radiotherapy (WPRT) or prostate-only radiotherapy (PORT) yields improved biochemical disease-free survival (BDFS) in patients with advanced or aggressive prostate adenocarcinoma. METHODS AND MATERIALS Between 2000 and 2007, a consecutive sample of 277 patients with prostate adenocarcinoma and at least a 15% likelihood of lymph node involvement who had undergone WPRT (n = 68) or PORT (n = 209) at two referral centers was analyzed. The median radiation dose in both arms was 75.6 Gy. The outcome measure was BDFS, as determined using the prostate-specific antigen nadir + 2 ng/mL definition of failure. BDFS was calculated using the Kaplan-Meier method and compared with the log-rank test. A multivariate analysis was performed to assess for confounding. Treatment-related toxicity was assessed using the National Cancer Institutes Common Terminology Criteria for Adverse Events guidelines. The median follow-up was 30 months. RESULTS WPRT patients had more advanced and aggressive disease at baseline (p < .001). The 4-year BDFS rate was 69.4% in the PORT cohort and 86.3% in the WPRT cohort (p = .02). Within the entire cohort, after adjustment for confounding variables, the pretreatment prostate-specific antigen (p < .001), Gleason score (p < .001), use of hormonal therapy (p = .002), and use of WPRT (vs. PORT, p = .006) predicted for BDFS. Patients undergoing WPRT had increased acute gastrointestinal toxicity (p = .048), but no significant difference in acute genitourinary toxicity was seen (p = .09). No difference in late toxicity was found. CONCLUSION WPRT may yield improved BDFS in patients with advanced or aggressive prostate adenocarcinoma, but results in a greater incidence of acute toxicity.

The effect of age on prostate implantation results.

BACKGROUND AND PURPOSE To determine whether radical prostatectomy (RP) or intensity-modulated radiation therapy (IMRT) to > or =72 Gy, plus hormonal therapy if indicated, results in improved biochemical disease-free survival (BDFS) in localized prostate adenocarcinoma. MATERIALS AND METHODS Between 1997 and 2005, a consecutive sample of 556 patients who underwent RP (n=204) or IMRT (n=352) at two referral centers was analyzed. The patients were stratified into prognostic groups based on clinical stage, Gleason score, and pretreatment prostate-specific antigen (PSA). The outcome measure was BDFS. RESULTS IMRT patients had more advanced disease at baseline (p<.001). There was no difference in five-year BDFS rates between RP and IMRT in the favorable (92.8% vs. 85.3%, p=.20) or intermediate prognosis (86.7% vs. 82.2%, p=.46) subsets. A difference favoring IMRT plus hormonal therapy was seen in the poor prognosis (38.4% vs. 62.2%, p<.001) subset. Within the entire cohort, after adjustment for confounding variables, Gleason score (p<.001) and clinical stage (p<.001) predicted BDFS, but treatment modality (p=.06) did not. Within the poor prognosis subset, treatment modality (p=.006) predicted BDFS. CONCLUSIONS BDFS is similar between RP and IMRT for patients with a favorable or intermediate prognosis. Patients with a poor prognosis display higher BDFS when treated with IMRT to > or =72 Gy plus hormonal therapy.