Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

Fig. 3.59 Preoperative PSA levels (ng/ml) and prostatic cancer recurrence.
clinically. There are conflicting studies as
to the prognostic significance of quantifying
microvessel density counts, Ki-67
(proliferation), and chromogranin (neuroendocrine
differentiation), p27 kip1 , Her-
2/neu, E-cadherin, and CD44. Numerous
studies have correlated various nuclear
measurements with progression following
radical prostatectomy. These techniques
have not become clinically
accepted in the evaluation of prostate
cancer since the majority of studies have
come from only a few institutions, some
of these nuclear morphometry measurements
are patented and under control of
private companies, and these techniques
are time consuming to perform.
Preoperative and postoperative
nomograms
Although there are nomograms to predict
for stage prior to therapy {1284,2023},
this and other prognostic factors are best
assessed, following pathologic examination
of the radical prostatectomy specimen,
many of which have been incorporated
in a new postoperative nomogram
{1284}. The prognostic factors have
appreciable limitations when they are
used as stand-alone. However, validation
of the several nomograms proposed in
the recent times is sometimes lacking
whereas comparison for superiority
amongst the proposed nomograms has
not always been tested. A limitation of
these nomograms is that they do not provide
predictive information for the individual
patient.
Stages T3 and T4
In general, patients with clinical stage T3
prostate cancer are not candidates for
radical prostatectomy and are usually
treated with radiotherapy. Between 50%
and 60% of clinical stage T3 prostate
cancers have lymph node metastases at
the time of diagnosis. More than 50% of
patients with clinical stage T3 disease
develop metastases in 5 years, and 75%
of these patients die of prostate carcinoma
within 10 years.
Distant metastases appear within 5 years
in more than 85% of patients with lymph
node metastases who receive no further
treatment. In patients with distant metastases,
the mortality is approximately 15%
at 3 years, 80% at 5 years, and 90% at 10
years. Of the patients who relapse after
hormone therapy, most die within several
years.
192 Tumours of the prostate