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Medical Forum / Diseases and Disorders / Prostate Cancer / May 2006Surgery Plus Radiation Does Not Control Aggressive PCA
Surgery Plus Radiation Does Not Control Aggressive Prostate Cancer NEW YORK (Reuters Health) Apr 28 - Lymphovascular invasion (LVI) in prostate cancer remains a strong predictor of poor outcome even when radical prostatectomy is followed by radiation therapy, investigators report. In fact, their analysis shows that LVI is the only prognostic factor associated with a shorter time to the development of distant metastases. Dr. Matthew M. Poggi and colleagues defined LVI as "the unequivocal presence of tumor cells within a vascular or lymphatic, endothelial-lined space." Although LVI is recognized as a predictor of progression and mortality following radical prostatectomy, the authors note, its significance in patients who received postprostatectomy radiotherapy (P-XRT) is not known. They therefore reviewed the medical records of 160 men who underwent P-XRT between 1991 and 2001. According to their report in the April 1st issue of Cancer, 18 (11%) had LVI in their surgical specimens. The patients were followed for a median of 8.3 years after radical prostatectomy. Dr. Poggi, from the National Naval Medical Center in Bethesda, Maryland, and his team observed that LVI was significantly associated with other unfavorable pathologic features, including seminal vesicle invasion and higher Gleason score. Median time to biochemical recurrence was 2.6 years for those with LVI versus 7.8 years for those without (p < 0.001). A higher proportion of those with LVI developed distant metastases (median time 7.4 years versus > 15 years). After adjusting for all confounders, the relative risk of LVI for distant metastases was 28.8. It did not seem to matter if radiation was delivered as adjuvant treatment soon after surgery or as salvage treatment after disease progression. "In patients with LVI after radical prostatectomy, it seems that additional therapy beyond P-XRT is needed," the authors conclude. Possible candidates are androgen suppression therapy and radiation that includes the uninvolved pelvis. Cancer 2006;106:1521-1526. > Surgery Plus Radiation Does Not Control Aggressive Prostate Cancer Ouch! >> Surgery Plus Radiation Does Not Control Aggressive Prostate Cancer > > Ouch! I think you missed this: >> Although LVI is recognized as a predictor of >> progression and mortality following radical prostatectomy, the authors >> note, its significance in patients who received postprostatectomy >> radiotherapy (P-XRT) is not known.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum >Surgery Plus Radiation Does Not Control Aggressive Prostate Cancer >NEW YORK (Reuters Health) Apr 28 - Lymphovascular invasion (LVI)... >... "the unequivocal >presence of tumor cells within a vascular or lymphatic, >endothelial-lined space." QUESTION: Does LVI refer to tissue inside or outside the prostate capsule? It sounds like tissue outside, but I'm not sure. Its the lymph nodes, which go throughout the body. Definitely not within the prostate. However, there is some hope (perhaps misplaced) that when cancer is visible in the lymph nodes directly surrounding the prostate, the cancer is still fairly localized (locally advanced). The other view says that if the cancer has enough "ooph" to create a nodal tumor, regardless of how close to the prostate, the lymph system (which is a vascular system sort of like the blood's circulatory system) will have cancer cells throughout. > >Surgery Plus Radiation Does Not Control Aggressive Prostate Cancer > [quoted text clipped - 4 lines] > QUESTION: Does LVI refer to tissue inside or outside the prostate > capsule? It sounds like tissue outside, but I'm not sure. > After adjusting for all confounders, the relative risk of LVI for > distant metastases was 28.8. It did not seem to matter if radiation was Was trying to clarify the meaning of relative risk and came upon this site. http://www.numberwatch.co.uk/FAQs.htm |
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