Best of AUA 2005 Edition

July 1, 2005

The most important factor in predicting a successful prostatectomy appears to be the overall experience of the surgeon, not the frequency of using a specific approach.

Beginning here and continuing inside, Urology Times presents the "Best of AUA," our report of the annual meeting's popular take-home messages. A total of 21 categories of clinical urology are covered. The editors have highlighted items of particular interest to practicing urologists.

Localized Prostate Cancer Localized Prostate Cancer Presented by William C. DeWolf, MD, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston.

The capromab pendetide (ProstaScint) scan could not predict the site of metastases in recurrent prostate cancer after radical prostatectomy.

Only one-third of men with PIN at baseline will have PIN on subsequent biopsy, but they will continue to be at risk for prostate cancer.

Patients who have multiple negative biopsies but who have persistently rising PSA may have anterior tumors, which can be large and associated with higher positive margin rates.

Mucinous carcinoma, once thought to be aggressive, behaves in a manner similar to common adenocarcinoma.

Stage for stage, transition zone and peripheral zone tumors behave similarly in terms of biochemical recurrence and other pathologic parameters.

Time from biopsy to RP does not alter results, even in high-grade disease.

Positive tumor margins are not an independent predictor of recurrence, whereas extracapsular extension is an independent predictor of recurrence.

Careful intraoperative palpation with appropriate wide excision significantly decreases positive margins, although it is unclear whether this really makes a difference.

Men whose biopsy core shows a tumor length of 7 mm and a positive basal core of any length or grade have a 33% chance of ipsilateral extracapsular extension near the neurovascular bundle.

Anastomotic strictures are associated with post-RP bleeding but not with urinary extravasation or duration of catheter use.

Surgeons need about 25 cases of experience to learn robotic or minimally invasive RP.

With laparoscopic prostatectomy, the extraperitoneal approach is as effective as the intraperitoneal approach, except when the patient has had minimally invasive hernioplasty. In that case, the extraperitoneal approach is more effective.

As with open surgery, urinary extravasation at the urethrovesical anastomosis does not predict long-term urinary control in laparoscopic prostatectomy.

Transfusion rates are not significantly different between minimally invasive and open RP.

Early outcomes, such as positive margins and discharge data, are comparable between minimally invasive and open RP, but there is a tendency for higher early postoperative complications to occur following robotic surgery.

Patients with prostate volumes greater than 50 mL appear to have significant risk of retention after brachytherapy.

Results of combined brachytherapy and external beam radiation for patients with PSA greater than 20.0 ng/mL and no apparent metastatic disease are fairly good. The probability of these patients being biochemically free of disease at 10 years is 23%.

Body mass index does not adversely affect outcomes following external beam radiation therapy as it does for RP.

Symptomatic local recurrence after radiation therapy is uncommon, but when it does occur, it's an ominous sign: 70% of those men die within 2 years.

Cryotherapy for primary prostate cancer is associated with a 10-year biochemical disease-free rate of 64%, but there is still concern about complications with this technique.