Wim Van de Voorde

Neoadjuvant Hormonal Therapy Before Radical Prostatectomy Decreases the Number of Positive Surgical Margins in Stage T2 Prostate Cancer: Interim Results of a Prospective Randomized Trial

PURPOSE We investigated the effect of neoadjuvant treatment before radical prostatectomy for clinically localized prostate cancer. MATERIALS AND METHODS A total of 130 patients with stages T2b and T3 prostate cancer was randomized in a multicenter study: 62 underwent immediate radical prostatectomy and 65 received 560 mg. estramustine phosphate daily for 6 weeks preoperatively. RESULTS For clinical stage T2b tumors the neoadjuvant treatment resulted in a significant decrease in positive surgical margins compared to the nonpretreated group. This difference was not found for clinical stage T3 tumors. The impact on progression and survival still must be analyzed. CONCLUSIONS Neoadjuvant treatment can be beneficial for clinical stage T2 prostate cancer. Optimal treatment for stage T3 tumors remains controversial.

Radical Prostatectomy Can Provide a Cure For Well–Selected Clinical Stage T3 Prostate Cancer

Objective: Radical prostatectomy is commonly believed not to achieve the eradication of locally advanced disease. This retrospective study aimed to elucidate the role of radical prostatectomy in this condition.Methods: A retrospective study of 158 patients surgically treated for clinical stage T3N0M0 prostate cancer was undertaken. Thirty patients had postoperative hormonal treatment, rendering prostate–specific antigen (PSA) follow–up unreliable, and were considered to be progressive at 1 month. Eighteen other patients received postoperative radiotherapy. One hundred and ten patients had radical prostatectomy only. PSA–relapse–free survival was analyzed. The mean follow–up time was 30 months.Results: Seventy–nine percent of the resected specimens were pathologically T3 (pT3), and about 25% were pT3c. Thirteen percent were pT2 and 8% were pT4. Ninety–five specimens (60%) had positive surgical margins. There was poor accordance between the biopsy Gleason score and that of the specimen. A multivariate analysis showed that seminal vesicle and nodal invasion, margin status and a PSA level above 10 ng/ml were independent prognostic factors. In 47 cT3a patients with PSA <10 ng/ml, the PSA–free survival rate exceeded 70% at 24 months and the 5–year estimated PSA–free survival rate was more than 60%.Conclusions: Radical prostatectomy has a place in the treatment of clinical stage T3 prostate cancer patients with a PSA value lower than 10 ng/ml. There is a need to definitively rule out nodal or seminal vesicle invasion in order to select those patients that can benefit from surgery.

Accuracy of Combined Computerized Tomography and Fine Needle Aspiration Cytology in Lymph Node Staging of Localized Prostatic Carcinoma

The sensitivity and accuracy rate of computerized tomography (CT) in lymph node staging of localized prostatic carcinoma is commonly considered to be low. Fine needle aspiration cytology of pathological lymph nodes seen on radiological staging can enhance this low accuracy rate. We prospectively investigated the accuracy of CT and fine needle aspiration cytology in lymph node evaluation of 285 patients with clinically locally confined prostatic carcinoma. The sensitivity, specificity and accuracy rates of this combined method were 77.8%, 100% and 96.5%, respectively. False-negative staging results were found in only 10 patients with minimal nodal disease. Although in contrast with previous reports, combined CT and fine needle aspiration cytology in our hands seems to be a highly efficient staging method for lymph node involvement. This method could be considered as an alternative to surgical lymphadenectomy in the preoperative evaluation of the nodal status of patients with localized prostatic carcinoma who are scheduled for radical prostatectomy or curative radiotherapy.

Improved age determination of blood and teeth samples using a selected set of DNA methylation markers

Age estimation from DNA methylation markers has seen an exponential growth of interest, not in the least from forensic scientists. The current published assays, however, can still be improved by lowering the number of markers in the assay and by providing more accurate models to predict chronological age. From the published literature we selected 4 age-associated genes (ASPA, PDE4C, ELOVL2, and EDARADD) and determined CpG methylation levels from 206 blood samples of both deceased and living individuals (age range: 0–91 years). This data was subsequently used to compare prediction accuracy with both linear and non-linear regression models. A quadratic regression model in which the methylation levels of ELOVL2 were squared showed the highest accuracy with a Mean Absolute Deviation (MAD) between chronological age and predicted age of 3.75 years and an adjusted R2 of 0.95. No difference in accuracy was observed for samples obtained either from living and deceased individuals or between the 2 genders. In addition, 29 teeth from different individuals (age range: 19–70 years) were analyzed using the same set of markers resulting in a MAD of 4.86 years and an adjusted R2 of 0.74. Cross validation of the results obtained from blood samples demonstrated the robustness and reproducibility of the assay. In conclusion, the set of 4 CpG DNA methylation markers is capable of producing highly accurate age predictions for blood samples from deceased and living individuals

Immunohistochemical localization ofprostate-specific markers within the accessory male sex glands of Cowper, Littre, and morgagni

OBJECTIVES The aim of the study was to explore possible production of prostate-specific markers by the embryologically and physiologically related accessory male sex glands, other than the prostate. METHODS The accessory male sex glands of Cowper, Littre, and Morgagni were studied systematically in 10 whole-mount autopsy and 5 surgical cystoprostatourethrectomy specimens. Immunohistochemistry was applied with the avidin-biotin-peroxidase method and commercially available monoclonal antibodies raised against prostate-specific antigen (PSA) and prostate-specific acid phosphatase (PSAP). RESULTS All specimens showed clear microscopic identification of these glands except for Cowpers glands, which were not found in most of the surgical cystoprostatourethrectomy specimens but were found coincidentally in one. Localization of the prostate-specific markers PSA and PSAP was demonstrated for the first time in three Cowpers glands, but they were a consistent finding in Littres and Morgagnis glands when immunohistochemical identification was performed in a systematic fashion. CONCLUSIONS PSA and PSAP are mostly produced by prostatic tissue, but not exclusively. These findings may have an impact on the specificity and sensitivity of PSA serum levels after radical prostatectomy because they support the hypothesis of extraprostatic sources of PSA.

The impact of shallow burial on differential decomposition to the body: a temperate case study.

Extant literature contains a number of specific case studies on differential decomposition involving adipocere formation or desiccation, but few describe the co-occurrence of these features within a temperate climate. The case of a 65-year-old male, partially buried in a shallow grave for 7 months, is presented in which the soft tissues of the body were outwardly well preserved. The right leg was desiccated, some parts of the body were covered with adipocere (head, neck, right shoulder, upper torso and left leg) and other parts could be classified as in the early stages of decomposition. In this study the taphonomic variables resulting in differential decomposition with desiccation and adipocere formation are discussed.

Mucin-secreting adenocarcinoma of the prostate with neuroendocrine differentiation and Paneth-like cells.

We present an unusual variant of prostatic adenocarcinoma with obvious mucinous and neuroendocrine features, arising in the transition zone. The neuroendocrine component is largely represented by Paneth-like cells (PLCs). These cells correspond to previously described eosinophilic cells and are amphicrine. We could demonstrate immunohistochemically the presence of calcitonin in some of these PLCs. The prognostic significance of these special characteristics is not well known, but it is most likely that this type of prostate cancer will not respond well to hormonal therapy.

HemoVision: An automated and virtual approach to bloodstain pattern analysis

Bloodstain pattern analysis (BPA) is a subspecialty of forensic sciences, dealing with the analysis and interpretation of bloodstain patterns in crime scenes. The aim of BPA is uncovering new information about the actions that took place in a crime scene, potentially leading to a confirmation or refutation of a suspects statement. A typical goal of BPA is to estimate the flight paths for a set of stains, followed by a directional analysis in order to estimate the area of origin for the stains. The traditional approach, referred to as stringing, consists of attaching a piece of string to each stain, and letting the string represent an approximation of the stains flight path. Even though stringing has been used extensively, many (practical) downsides exist. We propose an automated and virtual approach, employing fiducial markers and digital images. By automatically reconstructing a single coordinate frame from several images, limited user input is required. Synthetic crime scenes were created and analysed in order to evaluate the approach. Results demonstrate the correct operation and practical advantages, suggesting that the proposed approach may become a valuable asset for practically analysing bloodstain spatter patterns. Accompanying software called HemoVision is currently provided as a demonstrator and will be further developed for practical use in forensic investigations.

del(1)(q12) in adenocarcinomas of the prostate

A structural change of chromosome 1 in q12 may be a new, possibly consistent, chromosome change in adenocarcinoma of the prostate.

Recurrent aneurysms of the upper arteries of the lower limb: an atypical manifestation of fibromuscular dysplasia--a case report

Fibromuscular dysplasia (syn. arterial dysplasia, fibromuscular hyperplasia, medial fibroplasia) is an arteriopathy of unknown etiology, most frequently involving the renal arteries. The string-of-beads appearance of these lesions seems to be a characteristic angiographic finding. We report atypical angiographic findings at an unusual site, which proved to correspond to fibromuscular dysplasia at histological examination.