No difference between LR and AS groups was observed for BCR. The authors concluded that PSA density and number of cores positive are important factors in AS selection. Three papers addressed the significance of positive lymph nodes. Froehehner and associates40 studied prostate cancer patients with positive lymph nodes to assess survival. A total of 193 men were evaluated with a median follow-up of 7.3 years. Immediate hormone Inhibitors,research,lifescience,medical therapy was given to 94%. Independent prognostic factors included age > 70 years, Gleason score 8 to 10, and ≥ 3 positive nodes. Comorbidity was associated with mortality in the univariate but not multivariate models.
PSA had no prognostic significance. Intriguingly, about one-third of patients without additional adverse prognostic features had survival similar to node negative men. In another study of men with positive lymph nodes, Pierorazio and colleagues41 reported the 30-year experience from Johns Hopkins. A total of 505 N+ men (2.5% of patients treated with RP between 1982 and 2011) were identified. Median total and positive Inhibitors,research,lifescience,medical nodes were 13.2 and 1.7, respectively. Of 135 men with a dominant unilateral nodule, positive nodes were ipsilateral in 59.3%, contralateral in 20.7%, and bilateral in 11.1%. Fifteen-year BCR-free,
metastases-free, and cancer-specific survival were 7.1%, 41.5%, and 57.5%, respectively. Predictors of BCR, metastases, and cancer Inhibitors,research,lifescience,medical death in multivariate analysis included Gleason sum and percent positive lymph node (LN). Of note, the selleck chemical Imatinib extent of LN dissection did not correlate Inhibitors,research,lifescience,medical with outcome. Finally Abdollah and colleagues42 studied 4938 men undergoing radical prostatectomy between 1993 and 2010. Patients were divided into four Axitinib FDA cohorts based on seminal vesicle invasion (SVI) and nodal status. Approximately Inhibitors,research,lifescience,medical 83.7% had negative SVI; 13.8% of men were N+ with a mean of 16.1 nodes removed. N+ was observed in 5.9% vs 53.8% of men with negative and positive SVI, respectively. At a mean follow-up of 62 months, there was a significant difference in cancer-specific survival in men
with versus without N+ in the −SVI. However, in men with +SVI, N− patients and N+ had similar survival. The TMPRSS2-ERG fusion has been the subject of numerous investigations. Gonzales-Roibon43 described the Johns Hopkins experience in a nested case-control trial. They had previously Cilengitide shown that ERG alone expression is a surrogate for the fusion. They examined 444 men who had RP with recurrence and matched them to 444 controls on the basis of age, Gleason score, and pathological stage. ERG protein was assessed immunohistochemically. After multivariate analysis, 48.5% of recurrent cases had ERG expression-nearly identical to the control subjects (48.3%). The extent of staining also had no prognostic impact. Cooperberg and colleagues44 provided validation of a cell-cycle progression (CCP) gene panel to improve risk stratification in a modern RP cohort.