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Reports from Dr. Catalona's Follow-up Studies

Each year, Dr. Catalona and his research collaborators deliver their research findings at the American Urological Association (AUA) annual meeting.

In the last issue of QUEST, we summarized findings from recent research projects of Dr. Catalona and his collaborators. The following summaries are from additional studies written with QUEST readers in mind.

Although the information is technical, we feel that Quest readers would like to be familiar with the direction of the research and the vocabulary associated with it.

Some of the information has practical application now. Some shows the beginning of research projects with exploration or new understanding as the main purpose, and hopefully, practical applications will follow.

Surely, though, this research will define how prostate cancer is diagnosed, treated and hopefully prevented in generations to come.

Adjuvant Radiation Therapy Following RRP and Non-Recurrence

Adjuvant Radiation Therapy (aRT) is a precautionary treatment.

This therapy is considered for men whose postoperative results from a RRP indicate a high probability of recurrence. The pathology report after an RRP is unfavorable but the PSA is undetectable.

We looked at the non-recurrence survival rates in matched groups of men who did or did not receive aRT.

In the 5-year follow-up study, the non-recurrence survival rate for men who had aRT was 78% and for men who did not, it was 75%.

The 10-year follow-up had more dramatic differences. The non-recurrence survival rate for men who had aRT was 64% and for men who did not, it was 50%.

Our Conclusion:
Men whose postoperative results from a RRP indicate a high probability of recurrence have a substantially greater chance of non-recurrence survival in the long term, at least through the 10-year follow-up, if they receive aRT than if they donít.

Jonathan Rubenstein, Misop Han, Sheila Hawkins, William J. Catalona

Does A TURP (Transurethral Resection of Prostate) Affect the Outcomes of a RRP(Radical Retropubic Prostatectomy)?

We wanted to look at the effects of the TURP procedure on those men who later underwent a RRP. Did the TURP have any effect on the outcomes of the RRP in terms of cancer response, potency or continence?

After excluding those patients not applicable to the study, we used the records from 3,478 men who underwent RRP by Dr. Catalona and divided them into those who underwent TURP prior to RRP and those who had never undergone TURP.

Our Conclusion:
The good news is that TURP seems to have no effect on the recurrence rate for prostate cancer after a RRP. And TURP does not affect the urinary continence outcome following RRP. However, the potency outcome following RRP is negatively affected for men who underwent TURP prior to RRP.

Misop Han, Norm D. Smith, William J. Catalona

Prostate Size Estimation by DRE or Transrectal Ultrasonography (TRUS)

The estimation of prostate size is helpful in the treatment planning for benign prostatic hyperplasia (BPH) and prostate cancer (CaP).

We compared the prostate size estimates by DRE and TRUS and compared them with true prostate weight measurement from radical prostatectomy (RRP) specimens in Dr. Catalonaís PSA Study.

The DRE estimation was poorly correlated with the actual prostate size from the RRP specimen. The TRUS estimate was moderately correlated with the actual size, but was off more in larger prostates.

Our Conclusion:
Compared to DRE, TRUS provides a better estimation of prostate size. However, TRUS tends to underestimate prostate size. Still, a DRE should be used for detection of CaP, but once something suspicious is found and diagnosed, then a patient should ask for a TRUS.

Mishop Han and William J. Catalona

Perineural Invasion and CaP recurrence with Organ Confined Disease

The presence of perineural invasion (PNI) on prostate biopsy specimens has been shown to be an independent predictor of extracapsular tumor extension and therefore may influence long-term, recurrence-free survival.

We wanted to see if PNI, by itself, tells us anything about a patientís long term, non-recurrence survival potential.

We looked at the records of 1454 men who underwent RP as a primary therapy for prostate cancer. What we found in an 8-year follow-up was that patients with PNI, after a RP, had an 88% non-recurrence rate and the patients without PNI had a 95% non-recurrence rate. The PNI was not a factor by itself, but only part of a combined set of factors including Gleason score and tumor volume.

Our Conclusion:
The study suggested that the presence of PNI in patients with organ-confined disease was associated with lower PSA recurrence-free rate. However, at this time, it was not found to be an independent factor that could be used for diagnostic predictions by itself. Further prospective studies in a larger population with longer follow-up are needed to confirm a diagnostic role for PNI.

Hui Zhu, Kimberly A Roehl, Jo Ann V Antenor, William J. Catalona

Free PSA and PSA Density to Predict Non-Recurrence Survival in CaP

Free PSA percentages have been used in the diagnosis of CaP (see previous QUEST articles at

PSA density (the total PSA divided by prostate volume) can be calculated after a PSA test and an ultrasound, but we didnít know what its diagnostic use might be.

We examined whether either of them could be useful in predicting non-recurrence survival in prostate cancer patients.

We recorded PSA readings and ultrasound-determined prostate volume measurements (in men who underwent biopsies) from the beginning of Dr. Catalonaís 35,000 men PSA study in 1989. In 1995, we began recording free PSA measurements.

Now, we are beginning to look at the men who were treated for prostate cancer in relationship to these two measurements and their non-recurrence survival rates.

Our Conclusion:
The % Free PSA and PSA density both appear to have a significant association with an intermediate (4-year) non-recurrence survival rate in men following a RP. The PSA density appears to be more useful, but longer follow-up studies will be necessary to confirm this association and indicate ways to use the information in treatment.

Kimberly A Roehl, Jo Ann V Antenor, Hui Zhu, Keegan L Maxwell, William J Catalona

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