Prostatic Neoplasms: Herr HW

Montie JE, Clark PE, Eisenberger MA, El-Galley R, Greenberg RE, Herr HW, Hudes GR, Kuban DA, Kuzel TM, Lange PH, Lele SM, Michalski J, Patterson A, Pohar KS, Richie JP, Sexton WJ, Shipley WU, Small EJ, Trump DL, Walther PJ, Wilson TG, Anonymous00046. · University of Michigan Comprehensive Cancer Center. · J Natl Compr Canc Netw. · Pubmed #19176203 No free full text.

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Montie JE, Abrahams NA, Bahnson RR, Eisenberger MA, El-Galley R, Herr HW, Hudes GR, Kuzel TM, Lange PH, Patterson A, Pollack A, Richie JP, Sexton WJ, Shipley WU, Small EJ, Trump DL, Walther PJ, Wilson TG, Anonymous00097. · No affiliation provided · J Natl Compr Canc Netw. · Pubmed #17112448 No free full text.

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Konety BR, Eastham JA, Reuter VE, Scardino PT, Donat SM, Dalbagni G, Russo P, Herr HW, Schwartz L, Kantoff PW, Scher H, Kelly WK. · Department of Urology, Memorial Sloan-Kettering Cancer Center and Cornell University, New York, New York 10021, USA. · J Urol. · Pubmed #14713792 No free full text.

Abstract: PURPOSE:We determined the feasibility of radical prostatectomy after neoadjuvant chemohormonal therapy in locally advanced (stage T3 or greater) and/or high risk tumors (Gleason 8 to 10 and/or serum prostate specific antigen (PSA) greater than 20 ng/ml). MATERIALS AND METHODS: Enrollment criteria included clinical stage T1 to 2 with any Gleason grade and PSA greater than 20 ng/ml, clinical stage T3 to 4 with any serum PSA or Gleason grade, or any clinical stage with biopsy Gleason grade of 8 to 10 and any serum PSA. All patients received neoadjuvant hormonal therapy during chemotherapy (4 cycles of paclitaxel and carboplatin and estramustine) followed by radical prostatectomy. Nerve sparing was decided on an individual basis and a nerve graft was offered to those who underwent unilateral or bilateral nerve resection. Perioperative morbidity, mortality and delayed complications were assessed. RESULTS: A total of 36 patients were enrolled. After chemohormonal therapy clinical stage was less in 39% of patients and greater in 36%. Bilateral nerve sparing was performed in 3 patients and the remaining 33 underwent either unilateral or bilateral neurovascular bundle resection with nerve grafts performed in 17 (52%). Deep vein thrombosis (22%) was the most frequent complication of chemotherapy. Minor postoperative complications occurred in 6 patients. At a median followup of 29 months (range 5 to 51) after radical prostatectomy 32 (89%) were continent and 5 (15%) preoperatively potent men remained potent. The positive surgical margin rate was 22%. Of all subjects 45% remain free from biochemical recurrence. CONCLUSIONS: Neoadjuvant chemohormonal therapy followed by radical prostatectomy can be performed with low morbidity. Positive surgical margin rates are low. This approach yielded good local control of disease, however impact on tumor recurrence and survival is not known.

Herr HW, Carver B. · Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA. · Urology. · Pubmed #18804265 No free full text.

This publication has no abstract.

Sandhu JS, Vickers AJ, Bochner B, Donat SM, Herr HW, Dalbagni G. · Department of Urology, Memorial Sloan-Kettering Cancer Center and Weill Medical College of Cornell University, New York, NY, USA. · BJU Int. · Pubmed #16626308 No free full text.

Abstract: OBJECTIVE: To determine if bladder cancer diagnosed after prostatic radiation therapy (RT) differs in behaviour from bladder cancer diagnosed after prostate cancer not treated with RT, as such bladder cancer is thought to be more aggressive than de novo bladder cancer, and epidemiological studies show a higher rate of bladder cancer in patients after irradiation. PATIENTS AND METHODS: We reviewed our records to identify patients who had a diagnosis of bladder cancer with a previous diagnosis of prostate cancer. Patient age, date of diagnosis of prostate cancer, date of diagnosis of bladder cancer, symptoms, clinical stage, initial pathology, definitive therapy, definitive pathological stage, and disease status were recorded. RESULTS: In all, 100 patients were identified who had a diagnosis of bladder cancer after a diagnosis of prostate cancer between January 1992 and August 2003; 58 had had RT for prostate cancer. The mean time between a diagnosis of bladder cancer and prostate cancer was 62 months in the RT group and 34 months in the unirradiated group (P = 0.002) At diagnosis of bladder cancer, 56 (97%) of the patients who received RT had high-grade urothelial carcinoma, vs 27 (64%) of those not irradiated (P < 0.001). Thirty (52%) of the patients with RT had muscle-invasive bladder cancer, vs 17 (40%) of those not irradiated (P = 0.3). The survival rate was similar for both groups. CONCLUSIONS: Bladder cancer is diagnosed later, and is of higher grade, in patients who are irradiated for prostate cancer than in those treated with other methods. Patients with prostate cancer who are treated with RT should be monitored closely for the presence of bladder cancer.

Donat SM, Wei DC, McGuire MS, Herr HW. · Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. · J Urol. · Pubmed #11342921 No free full text.

Abstract: PURPOSE: Involvement of the prostate by bladder cancer directly impacts survival, the risk of urethral recurrence, and treatment decisions concerning the timing of cystectomy and type of urinary diversion. Transurethral lateromontanal loop biopsies are proposed as the most accurate method for evaluating the prostatic urethra. Due to the potential clinical impact on individuals we assessed its accuracy in a large cohort. MATERIALS AND METHODS: Transurethral lateromontanal loop biopsies were performed in 246 of 416 male patients at our institution between 1989 and 1997. The predictive value and sensitivity of transurethral biopsy, patterns of recurrence, survival and clinical impact were assessed in a cohort with 10 years of followup. RESULTS: The sensitivity of transurethral biopsy for prostatic stromal invasion was 53%, specificity was 77%, positive predictive value was 45% and negative predictive value was 82%. At the 10-year followup 129 patients (52.4%) were dead, 85 (32%) had no evidence of disease, 16 (6.5%) had disease and 16 (6.5%) were lost to followup. Mean followup in patients at risk for urethral recurrence was 61.7 months (range 0.56 to 134.1, median 56.8). Delayed urethrectomy was performed in 15 of 235 cases (6.4%) at a mean of 15.2 months. Of the 246 patients 99 had prostatic disease at transurethral biopsy and/or cystectomy, including 11 (11%) with urethral recurrence. No patient required continent diversion takedown or died of urethral recurrence. CONCLUSIONS: Transurethral biopsy did not accurately determine prostatic involvement. Prostatic involvement at biopsy or cystectomy translated into a higher risk of urethral recurrence. However, it did not have significant clinical impact or affect survival and should not be an absolute contraindication to urethral diversion.

Donat SM, Genega EM, Herr HW, Reuter VE. · Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. · J Urol. · Pubmed #11257650 No free full text.

Abstract: PURPOSE: We assess the pathological mechanisms of silent prostatic stromal invasion in patients with bladder cancer for early detection and treatment. MATERIALS AND METHODS: Between August 1998 and January 1999, 10 patients with clinically organ confined transitional cell carcinoma of the bladder and known prostatic stromal invasion on transurethral biopsy or who were high risk for prostatic involvement due to tumor location near the bladder neck were studied for histological patterns of prostatic invasion. There were 5 cystectomy specimens distended for 24 hours with formalin via a Foley catheter, then step sectioned longitudinally at 3 mm. intervals through the bladder neck and prostate. Standard hematoxylin and eosin staining methods were used and sections were analyzed by 2 pathologists. RESULTS: There were 3 separate patterns of prostatic stromal invasion elucidated, including 2 previously described methods of extravesical or intraurethral invasion into the prostatic stroma and a third one through the bladder neck directly into the prostatic stroma. The third pattern was not grossly evident on endoscopy or urethral biopsy before cystectomy. CONCLUSIONS: Longitudinal sectioning of the bladder neck and prostate of cystectomy specimens suggests tumors at the bladder neck may directly invade the prostatic stroma without histological evidence of extravesical or intraurethral spread. Such direct silent tumor invasion of the prostate by superficial or endoscopically inapparent tumor is difficult to detect clinically by current biopsy methods. New methods of detection are necessary.

Herr HW, O'Sullivan M. · Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. · J Urol. · Pubmed #10799173 No free full text.

Abstract: PURPOSE: We evaluate the quality of life of asymptomatic men with nonmetastatic prostate cancer who receive androgen deprivation therapy. MATERIALS AND METHODS: Quality of life was longitudinally evaluated in a cohort of 144 men with locally advanced prostate cancer or prostate specific antigen relapse after local therapy who chose to receive (79 patients) or not to receive (65 patients) androgen deprivation therapy. Androgen deprivation therapy consisted of orchiectomy, leuprolide alone or leuprolide plus flutamide. Multivariate analysis of variance was used to test the effect of different treatment regimens on patient quality of life. RESULTS: Men who received androgen suppression had more fatigue, loss of energy, emotional distress and a lower overall quality of life than men who deferred hormone therapy. Combined androgen blockade had a greater adverse effect on quality of life than monotherapy. CONCLUSIONS: Androgen deprivation therapy may significantly impair the physical and emotional health of asymptomatic patients with nonmetastatic prostate cancer.

Herr HW, Donat SM. · Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. · J Urol. · Pubmed #10332452 No free full text.

Abstract: PURPOSE: We assessed the outcome of patients with superficial bladder tumors with relapse in the prostate and defined prognostic variables of survival. MATERIALS AND METHODS: A cohort of 186 men with superficial bladder tumors was followed for 15 years. Tumor relapse in the prostate was classified as noninvasive (prostatic urethra and ducts) or invasive (stroma) with intraurethral or direct prostatic invasion. Bladder tumor stage at the time of prostatic relapse was defined as confined or not confined to the bladder. The end point of the study was disease specific survival. The effects of covariates on survival were estimated on multivariate analysis. RESULTS: Of the 186 patients 72 (39%) had relapse in the prostate after a median followup of 28 months (range 3 to 216), including 45 (62%) with noninvasive prostatic tumor and 27 (38%) with stromal invasion. The survival rate was 82% in patients with prostatic urethra or duct involvement compared to 48% with stromal invasion. Intraurethral stromal invasion was associated with a 75% 15-year survival rate versus 9% for extravesical prostatic stromal invasion. Bladder tumor stage and prostatic stromal invasion were independent prognostic variables of survival. CONCLUSIONS: The prostate is a frequent site of tumor relapse in patients with superficial bladder tumors followed for 15 years. Prostatic relapse may portend tumor invasion in the bladder and stromal invasion in the prostate, which significantly reduce survival.