A correlation between preoperative serum prostate-specific antigen (PSA) value, biopsy Gleason score, percentage of positive biopsy results, and the presence of lymph node metastases was calculated. The investigators
concluded that (1) the frequency of lymph node metastases is low in low-risk prostate cancer; (2) if more than 50% of biopsy cores are involved with prostate cancer, the risk of lymph node metastases increases significantly; and (3) if performed, pelvic lymphadenectomy has to be done in an extended variant. Preoperative serum PSA value, biopsy Gleason score, and PSA density are the best prognostic factors for patients with clinically locally advanced Inhibitors,research,lifescience,medical prostate cancer (cT3a). The combination of preoperative PSA value and biopsy Gleason score provides accurate prediction of Inhibitors,research,lifescience,medical final histopathology. The aim of the study by Joniau and colleagues4 was to determine whether PSA density is a stronger predictive factor than preoperative PSA value for adverse final histopathology
(positive section margins, seminal vesical invasion, and positive lymph nodes). The study also analyzed whether PSA density can be used as a prognostic factor for biochemical Calcitriol vit d3 progression-free survival in patients with cT3a prostate cancer. The study consisted of a cohort of 200 patients with unilateral cT3a prostate cancer, assessed by digital rectal examination. Inhibitors,research,lifescience,medical All patients underwent radical Inhibitors,research,lifescience,medical 17-DMAG prostatectomy and bilateral lymphadenectomy. Multivariate analysis showed that PSA density is an independent prognostic factor and is stronger than PSA value in the prediction of adverse histopathology and biochemical progression-free survival in cT3a prostate cancer. Therefore, PSA density can be used for patient counseling before treatment selection in cases of locally advanced prostate cancer. Therapeutic Modalities
A very interesting new approach to dealing with prostate cancer is dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) after vascular Inhibitors,research,lifescience,medical targeted photodynamic therapy (VTP) with padoporfin (Tookad®; Steba Biotech, The Hague, Netherlands).5 Tookad is a new photosensitizing drug being evaluated in phase I/II clinical trials. Each patient in the trial had an MRI scan upon enrollment. Drug_discovery Tookad was administered intravenously, and light was delivered by cylindrical diffusers in the prostate. Tookad provokes tissue ablation by causing occlusion of the blood vessels in a target tissue. Seven days later MRI was performed again, and subsequent MRI examinations followed at 1 month, 3 months, and 6 months after treatment. Tookad VTP produced lesions that were clearly delineated by DCE-MRI. On the basis of the MRI data it seems likely that the Tookad VTP treatment leads to ablation of target tissue with minimal effects on surrounding tissues (ie, it respects the anatomic and tissue boundaries within the target lesion).