51
|
Gandaglia G, Schiffmann J, Schlomm T, Fossati N, Moschini M, Suardi N, Chun FKH, Montorsi F, Graefen M, Briganti A. Identification of pathologically favorable disease in intermediate-risk prostate cancer patients: Implications for active surveillance candidates selection. Prostate 2015; 75:1484-91. [PMID: 26177942 DOI: 10.1002/pros.23040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 05/26/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Intermediate-risk prostate cancer (PCa) represents a heterogeneous disease, where a non-negligible proportion of patients harbor favorable pathologic characteristics and are potentially eligible for active surveillance (AS). We aimed at developing a model for the identification of pathologically favorable PCa at radical prostatectomy (RP) among intermediate-risk patients. METHODS Overall, 3,821 intermediate-risk patients treated with RP at two centers between 2005 and 2013 were identified. Pathologically favorable PCa was defined as low-grade organ-confined disease. Age, biopsy Gleason, PSA density (PSAD), and the percentage of positive cores were included in multivariable logistic regression analyses predicting favorable PCa and formed the basis for a logistic regression-based risk calculator. The internally validated discrimination and calibration of the risk calculator were quantified using 200 bootstrap resamples. Decision curve analysis (DCA) provided an estimate of the net benefit obtained using this model versus treating no one and treating everyone. RESULTS Overall, 10.0% of all intermediate risk patients had favorable disease. In multivariable analyses, patients with biopsy Gleason score ≤6 had higher probability of favorable disease compared to those with higher-grade disease (P < 0.001). Similarly, age, PSAD, and percentage of positive cores were associated with the probability of favorable disease (all P ≤ 0.01). The risk calculator achieved a validated accuracy of 82.5%. The DCA showed that our prediction model is better than both treating no one and treating everyone. CONCLUSIONS One out of ten intermediate-risk patients harbors favorable disease at RP. Our novel, pre-operative, validated risk calculator may help clinicians identifying patients who could be considered for conservative therapy approaches such as AS.
Collapse
Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jonas Schiffmann
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thorsten Schlomm
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nicola Fossati
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Moschini
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Felix K H Chun
- Department of Urology, University Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
52
|
Changing Trends in Surgical Management of Prostate Cancer: The End of Overtreatment? Eur Urol 2015; 68:175-8. [DOI: 10.1016/j.eururo.2015.02.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 02/13/2015] [Indexed: 01/28/2023]
|
53
|
Hansen J, Becker A, Kluth LA, Rink M, Steuber T, Zacharias M, Briganti A, Fisch M, Graefen M, Chun FKH. Assessing the clinical benefit of a nomogram to predict specimen-confined disease at radical prostatectomy in patients with high-risk prostate cancer: An external validation. Urol Oncol 2015; 33:384.e1-8. [PMID: 26122714 DOI: 10.1016/j.urolonc.2015.02.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 02/19/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The objective of the current study was to test generalizability and clinical value of a recently published nomogram to predict specimen-confined disease (SCD, pT2-pT3a+R0+pN0) at radical prostatectomy (RP) in patients with clinical high-risk prostate cancer (HRPCa). The nomogram allows improved decision making with curative intent within this heterogeneous patient cohort, which is important, as RP in patients with clinical HRPCa remains a topic of controversy. METHODS We externally validated the nomogram in 1,669 men with clinical HRPCa who underwent RP and extended pelvic lymph node dissection between 1992 and 2011. A Kaplan-Meier analysis to estimate 5- and 10-year biochemical recurrence-free survival was performed. To investigate the SCD model׳s performance, the previously reported regression coefficients of the SCD nomogram were applied. Within loess calibration plots, the extent of overestimation or underestimation was graphically explored. Finally, decision curve analysis (DCA) to assess the clinical value of the SCD nomogram was performed. RESULTS Overall, 49% of men showed SCD after RP. The 5- and 10-year biochemical recurrence rates for men with SCD were 66% and 56%, respectively, vs. 32% and 20%, respectively, for men without SCD (log-rank test P<0.001). External validation demonstrated comparable accuracy in relation to accuracy derived from internal validation (68.1% vs. 72.0%). Calibration was suboptimal, showing a tendency to underestimate SCD probability. In DCA, the nomogram׳s usage was associated with a clinical net benefit relative to both treating all and none. CONCLUSIONS Within our cohort, the nomogram׳s use was associated with a clinical net benefit according to DCA. However, one-third of men were falsely classified as having SCD or non-SCD. Nevertheless, in the absence of superior tools, the SCD nomogram represents a useful clinical decision aid.
Collapse
Affiliation(s)
- Jens Hansen
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany.
| | - Andreas Becker
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Martini Clinic, Prostate Cancer Centre at University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Luis A Kluth
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Rink
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini Clinic, Prostate Cancer Centre at University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Mario Zacharias
- Department of Urology, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | - Margit Fisch
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini Clinic, Prostate Cancer Centre at University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K-H Chun
- Department of Urology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany; Martini Clinic, Prostate Cancer Centre at University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
54
|
Fossati N, Passoni NM, Moschini M, Gandaglia G, Larcher A, Freschi M, Guazzoni G, Sjoberg DD, Vickers AJ, Montorsi F, Briganti A. Impact of stage migration and practice changes on high-risk prostate cancer: results from patients treated with radical prostatectomy over the last two decades. BJU Int 2015; 117:740-7. [PMID: 25787671 DOI: 10.1111/bju.13125] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To evaluate the impact of year of surgery on clinical, pathological and oncological outcomes of patients with high-risk prostate cancer. PATIENTS AND METHODS We evaluated 1 033 patients with clinically high-risk prostate cancer, defined as the presence of at least one of the following risk factors: preoperative prostate-specific antigen (PSA) level >20 ng/mL, and/or clinical stage ≥T3, and/or biopsy Gleason score ≥8. Patients were treated between 1990 and 2013 at a single institution. The year-by-year trends in clinical and pathological characteristics were examined. Multivariable Cox regression analysis was used to test the relationship between year of surgery and oncological outcomes. RESULTS We observed a decrease over time in the proportion of patients with high-risk disease (preoperative PSA >20 ng/mL or clinical stage cT3). A trend in the opposite direction was seen for biopsy Gleason score ≥8 tumours. We observed a considerable increase in the median number of lymph nodes removed, which was associated with an increased rate of lymph node invasion (LNI). On multivariable Cox regression analysis, year of surgery was associated with a reduced risk of biochemical recurrence (hazard ratio [HR] per 5-year interval 0.90, 95% confidence interval [CI] 0.84-0.96; P = 0.01) and distant metastasis (HR per 5-year interval 0.91, 95% CI 0.83-0.99; P = 0.039), after adjusting for age, preoperative PSA, pathological stage, LNI, surgical margin status, and pathological Gleason score. CONCLUSIONS In this single-centre study, an increased diagnosis of localized and less extensive high-grade prostate cancer was observed over the last two decades. Patients with high-risk disease who were selected for radical prostatectomy showed better cancer control over time. Better definitions of what constitutes high-risk prostate cancer among contemporary patients are needed.
Collapse
Affiliation(s)
- Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Niccolò M Passoni
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marco Moschini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Massimo Freschi
- Department of Pathology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Centre, Humanitas University, Milan, Italy
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| |
Collapse
|
55
|
Beauval JB, Roumiguié M, Ouali M, Doumerc N, Thoulouzan M, Mazerolles C, Rischmann P, Malavaud B, Soulié M. [A prospective trial comparing consecutive series of open retropubic and robot-assisted laparoscopic radical prostatectomy in a centre: Oncologic and functional outcomes]. Prog Urol 2015; 25:370-8. [PMID: 25937373 DOI: 10.1016/j.purol.2015.03.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/03/2015] [Accepted: 03/24/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Radical prostatectomy (RP) is an oncologic and functional challenge. Few series compare prospectively the two approaches, open retropubic (ORP) and laparoscopic robot-assisted RP (LRARP). The objective was to compare the oncological and functional results of ORP and LRARP. MATERIAL AND METHODS From January 2009 to March 2012, two practiced surgeons conducted 304 consecutive RP: respectively 129 ORP and 175 LRARP. Preoperative, perioperative and postoperative data (location and size of positive surgical margins [PSM]) were recorded prospectively and compared with oncological results (PSM, biochemical recurrence-free survival [BCR]) and functional outcomes (urinary and erectile) by self-validated questionnaires (USP, IIEF-15). The comparison was made by the Chi(2) test and Student t-test for qualitative and quantitative variables. RESULTS The preoperative data 2 groups were comparable. MCP rate was 13.2% for the ORP and 20% for the LRARP (ns) and was 1.4% and 29.6% (ORP) versus 9.4% and 36.7% (LRARP) for pT2 and pT3 for respectively (P=0.078). BCR was the same in both groups (95.2% at 13.1 months). At 12 months, the results of continence showed no difference (P=0.49) and about erectile function, the EF-score was significantly higher in LRARP: 22 versus 17 for the ORP (P=0.03). CONCLUSION Oncological results were comparable after ORP and LRARP. The recovery of continence was excellent regardless of the surgical technique, the recovery of erectile function a bit faster by LRARP. LEVEL OF EVIDENCE 3.
Collapse
Affiliation(s)
- J-B Beauval
- Département d'urologie, andrologie et transplantation rénale, CHU Rangueil, 1, avenue Jean-Pouilhès, 31059 Toulouse cedex, France.
| | - M Roumiguié
- Département d'urologie, andrologie et transplantation rénale, CHU Rangueil, 1, avenue Jean-Pouilhès, 31059 Toulouse cedex, France
| | - M Ouali
- Département d'études statistiques, IUC Oncopôle, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - N Doumerc
- Département d'urologie, andrologie et transplantation rénale, CHU Rangueil, 1, avenue Jean-Pouilhès, 31059 Toulouse cedex, France
| | - M Thoulouzan
- Département d'urologie, andrologie et transplantation rénale, CHU Rangueil, 1, avenue Jean-Pouilhès, 31059 Toulouse cedex, France
| | - C Mazerolles
- Département d'anatomopathologie, IUC Oncopôle, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France
| | - P Rischmann
- Département d'urologie, andrologie et transplantation rénale, CHU Rangueil, 1, avenue Jean-Pouilhès, 31059 Toulouse cedex, France
| | - B Malavaud
- Département d'urologie, andrologie et transplantation rénale, CHU Rangueil, 1, avenue Jean-Pouilhès, 31059 Toulouse cedex, France
| | - M Soulié
- Département d'urologie, andrologie et transplantation rénale, CHU Rangueil, 1, avenue Jean-Pouilhès, 31059 Toulouse cedex, France
| |
Collapse
|
56
|
Cheney MD, Zhang D, Chen MH, Loffredo MJ, Richie JP, D'Amico AV. Greatest Percentage Involved Core Length and Risk of Clinically Significant Prostate-Specific Antigen Failure After Radical Prostatectomy. Clin Genitourin Cancer 2015; 13:338-343. [PMID: 25862320 DOI: 10.1016/j.clgc.2015.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 11/13/2014] [Accepted: 02/27/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Radical prostatectomy (RP) can cure men with unfavorable intermediate- or high-risk prostate cancer (PC). However, some will experience short prostate-specific antigen (PSA) doubling time (PSADT) failure that requires additional treatment with increased toxicity. The present study investigated whether the greatest percentage of involved biopsy core length (GPC) can preoperatively identify men at risk of short PSADT failure. PATIENTS AND METHODS A total of 503 men with biopsy-proven PC underwent RP at an academic institution from January 2005 to December 2008. Men with incomplete pathologic information, those who had received neoadjuvant or adjuvant hormonal therapy or chemotherapy, and those who had undergone adjuvant radiation therapy were excluded. The median follow-up period was 4.89 years (interquartile range, 1.97-5.68 years). A competing risk regression was used to assess whether an increasing GPC value was associated with an increased PSADT at < 10-month failure risk, adjusting for age, percentage of positive biopsy results, and risk group. RESULTS Of the 402 men, 34 (8.46%) developed PSA failure, 17 (50.0%) of whom had a PSADT of < 10 months. An increasing GPC value was significantly associated with an increased PSADT of < 10-month failure risk (adjusted hazard ratio, 1.03; 95% confidence interval, 1.01-1.06; P = .015). Men with a GPC > 30% (median) versus ≤ 30% and unfavorable intermediate- or high-risk PC (P = .011), but not low or favorable intermediate-risk PC (P = .57), had a significantly greater incidence of PSADT < 10-month failure estimates (30% vs. 0% at 5 years). CONCLUSION Men planning to undergo RP for unfavorable intermediate- or high-risk PC with a GPC of > 30% should be considered for randomized trials evaluating the effect on survival of the neoadjuvant use of treatment that extends survival in those with castrate-resistant metastatic PC.
Collapse
Affiliation(s)
- Matthew D Cheney
- Harvard Radiation Oncology Program, Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA.
| | - Danjie Zhang
- Department of Statistics, University of Connecticut, Storrs, CT
| | - Ming-Hui Chen
- Department of Statistics, University of Connecticut, Storrs, CT
| | - Marian J Loffredo
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| | - Jerome P Richie
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA
| |
Collapse
|
57
|
Pretreatment Tables Predicting Pathologic Stage of Locally Advanced Prostate Cancer. Eur Urol 2015; 67:319-25. [DOI: 10.1016/j.eururo.2014.03.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 03/12/2014] [Indexed: 11/21/2022]
|
58
|
Gandaglia G, Ploussard G, Isbarn H, Suardi N, De Visschere PJL, Futterer JJ, Ghadjar P, Massard C, Ost P, Sooriakumaran P, Surcel CI, van der Bergh RCN, Montorsi F, Ficarra V, Giannarini G, Briganti A. What is the optimal definition of misclassification in patients with very low-risk prostate cancer eligible for active surveillance? Results from a multi-institutional series. Urol Oncol 2015; 33:164.e1-9. [PMID: 25620154 DOI: 10.1016/j.urolonc.2014.12.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND The risk of unfavorable prostate cancer in active surveillance (AS) candidates is nonnegligible. However, what represents an adverse pathologic outcome in this setting is unknown. We aimed at assessing the optimal definition of misclassification and its effect on recurrence in AS candidates treated with radical prostatectomy (RP). MATERIALS AND METHODS Overall, 1,710 patients eligible for AS according to Prostate Cancer Research International: Active Surveillance criteria treated with RP between 2000 and 2013 at 3 centers were evaluated. Patients were stratified according to pathology results at RP: organ-confined disease and pathologic Gleason score ≤ 6 (group 1); organ-confined disease and Gleason score 3+4 (group 2); and non-organ-confined disease, Gleason score ≥ 4+3, and nodal invasion (group 3). Biochemical recurrence (BCR) was defined as 2 consecutive prostate-specific antigen (PSA) ≥ 0.2 ng/ml. Kaplan-Meier curves assessed time to BCR. Multivariable Cox regression analyses tested the association between pathologic features and BCR. Multivariable logistic regression analyses identified the predictors of adverse pathologic characteristics. RESULTS Overall, 926 (54.2%), 653 (33.0%), and 220 (12.9%) patients were categorized in groups 1, 2, and 3, respectively. Median follow-up was 32.2 months. The 5-year BCR-free survival rate was 94.2%. Patients in group 3 had lower BCR-free survival rates compared with those in group 1 (79.1% vs. 97.0%, P<0.001). No differences were observed between patients included in group 1 vs. group 2 (97.0% vs. 94.7%, P = 0.1). These results were confirmed at multivariable analyses and after stratification according to margin status. Older age and PSA density ≥ 10 ng/ml/ml were associated with higher risk of unfavorable pathologic characteristics (i.e., inclusion in group 3; all P<0.001). CONCLUSIONS Among patients eligible for AS treated with RP, only men with Gleason score ≥ 4+3 or non-organ-confined disease at final pathology were at increased risk of BCR. These individuals represent the real misclassified AS patients, who can be predicted based on older age and higher PSA density.
Collapse
Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Hendrik Isbarn
- Department of Urology, Regio Clinic Wedel, Wedel, Germany; Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Germany
| | - Nazareno Suardi
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Jurgen J Futterer
- Department of Radiology, Radboud University, Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Pirus Ghadjar
- Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Piet Ost
- Department of Radiation Oncology and Experimental Cancer Research, Ghent University Hospital, Ghent, Belgium
| | | | - Christian I Surcel
- Centre of Urological Surgery, Dialysis and Renal Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Francesco Montorsi
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Vincenzo Ficarra
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy
| | - Gianluca Giannarini
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Unit of Urology/Division of Oncology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.
| | | |
Collapse
|
59
|
Fossati N, Sjoberg DD, Capitanio U, Gandaglia G, Larcher A, Nini A, Mirone V, Vickers AJ, Montorsi F, Briganti A. Extended pelvic lymph node dissection in patients with prostate cancer previously treated with surgery for lower urinary tract symptoms. BJU Int 2015; 116:366-72. [DOI: 10.1111/bju.12912] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Nicola Fossati
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Daniel D. Sjoberg
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Umberto Capitanio
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Alessandro Larcher
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Alessandro Nini
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | | | - Andrew J Vickers
- Department of Epidemiology and Biostatistics; Memorial Sloan-Kettering Cancer Center; New York NY USA
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele; Milan Italy
| |
Collapse
|
60
|
Moul JW, Sarno MJ, McDermed JE, Triebell MT, Reynolds MA. NADiA ProsVue Prostate-specific Antigen Slope, CAPRA-S, and Prostate Cancer–specific Survival After Radical Prostatectomy. Urology 2014; 84:1427-32. [DOI: 10.1016/j.urology.2014.07.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 06/11/2014] [Accepted: 07/01/2014] [Indexed: 11/16/2022]
|
61
|
Bernie A, Ramasamy R, Ali A, Tewari AK. Changes in pathologic outcomes and operative trends with robot-assisted laparoscopic radical prostatectomy. Indian J Urol 2014; 30:378-82. [PMID: 25378817 PMCID: PMC4220375 DOI: 10.4103/0970-1591.142054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: We hypothesized that there is a reverse stage migration, or a shift toward operating on higher-risk prostate cancer, in patients undergoing robot-assisted laparoscopic prostatectomy (RALP). We therefore evaluated the stage of disease at the time of surgery for patients with prostate cancer at a large tertiary academic medical center. Materials and Methods: After institutional review board approval, we reviewed all patients that had undergone robotic prostatectomy. These patients were separated into three categories: An early era of 2005-2008, intermediate era of 2009-2010, and a current era of 2011-2012. Results: A total of 3451 patients underwent robotic prostatectomy from 2005 to 2012. The proportion men with clinical T1 tumors declined from 88.3% in the early era to 72.2% in the current era (P < 0.0001). Men with preoperative biopsy Gleason 6 disease decreased from the early to the current era (P < 0.0001), while men with preoperative biopsy Gleason ≥ 8 showed the opposite trend, increasing from the early to the current era (P = 0.0002). From the early to the current era, the proportion of patients with National Comprehensive Cancer Network (NCCN) low risk prostate cancer decreased, while those with NCCN intermediate and high-risk disease increased. The proportion of pathologic T3 disease increased from 15.5% in the early to 30.6% in the current era (P < 0.0001). On the other hand, the proportion of pathologic T2/+ SMS (surgical margin status) decreased from 6.6% in the early era to 3.1% in the current era (P = 0.0002). Conclusions: We have demonstrated a reverse stage migration in men undergoing robotic prostatectomy. Despite the increasing proportion of men with extra-capsular disease undergoing RALP, the surgical margin status has remained similar. This could reflect both the changing dynamics of the population opting for surgery as well as the learning curve of the surgeons.
Collapse
Affiliation(s)
- Aaron Bernie
- Department of Urology, Weill Cornell Medical College, NY, USA
| | | | - Adnan Ali
- Department of Urology, Weill Cornell Medical College, NY, USA
| | | |
Collapse
|
62
|
[Interdisciplinary and individualized therapy of prostate cancer : International prostate cancer symposium Bonn 2013 - challenges and targets]. Urologe A 2014; 54:1584-90. [PMID: 25297487 DOI: 10.1007/s00120-014-3580-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Multimodal treatment of prostate cancer is based on specific staging via imaging, clinical parameters, tumor markers and histopathological grading. Risk-adapted therapy encompasses wait and see, active surveillance, surgical intervention, radiotherapy and hormone therapy. Some patients also need a combination of these treatment options. Even though clinical parameters guide the treatment plan, patient wishes and preferences are incorporated. Against this background leading basic research scientists, urologists, radiotherapists, epidemiologists and members of other associated disciplines discussed state of the art treatment concepts, innovative trial designs and translational research projects at the international meeting "Challenges and Chances in Prostate Cancer Research" organized by the German Cancer Aid (Deutsche Krebshilfe).
Collapse
|
63
|
Laparoscopic radical prostatectomy with bladder neck preservation: positive surgical margin and urinary continence status. Wideochir Inne Tech Maloinwazyjne 2014; 9:362-70. [PMID: 25337159 PMCID: PMC4198659 DOI: 10.5114/wiitm.2014.45085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 05/12/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Preservation of the bladder neck (BN) has been controversial, as limited excision of the bladder neck may result in incomplete resection of the disease. Moreover, the urinary continence rate may not be improved. AIM To evaluate the effect of bladder neck sparing on urinary continence, and surgical margins status in prostate cancer (PCa) patients treated with laparoscopic radical extraperitoneal prostatectomy. MATERIAL AND METHODS A retrospective analysis of 295 consecutive patients who had undergone laparoscopic radical extraperitoneal prostatectomy for clinically localised prostate cancer in a single institution was performed. Positive surgical margin (SM(+)) and urinary continence status at 3, 6, and 12 months were evaluated. RESULTS The distribution of SM(+) for pT2, pT3, and pT4a was 15.3% (27/176), 49.1% (58/118), and 100% (1/1), respectively. Overall, there were 55.61%, 80.61%, and 84.69% of men continent at 3, 6, and 12 months, respectively. However, when limiting the analysis to those who did not receive adjuvant radiotherapy within 12 months following surgery, urinary continence rates were 59.23%, 85.86%, and 90.21% at 3, 6, and 12 months, respectively. Preoperative prostate-specific antigen (PSA) and pathological T stage were identified as significant predictors of positive surgical margins. CONCLUSIONS CONCLUSIONS Laparoscopic radical extraperitoneal prostatectomy with bladder neck preservation has been a safe procedure which has resulted in good functional outcome. We observed a relatively high incidence of positive surgical margins which could be attributed to a large number of extracapsular disease cases.
Collapse
|
64
|
Baco E, Rud E, Vlatkovic L, Svindland A, Eggesbø HB, Hung AJ, Matsugasumi T, Bernhard JC, Gill IS, Ukimura O. Predictive value of magnetic resonance imaging determined tumor contact length for extracapsular extension of prostate cancer. J Urol 2014; 193:466-72. [PMID: 25150643 DOI: 10.1016/j.juro.2014.08.084] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE Tumor contact length is defined as the amount of prostate cancer in contact with the prostatic capsule. We evaluated the ability of magnetic resonance imaging determined tumor contact length to predict microscopic extracapsular extension compared to existing predictors of extracapsular extension. MATERIALS AND METHODS We retrospectively analyzed the records of 111 consecutive patients with magnetic resonance imaging/ultrasound fusion targeted, biopsy proven prostate cancer who underwent radical prostatectomy from January 2010 to July 2013. Median patient age was 64 years and median prostate specific antigen was 8.9 ng/ml. Clinical stage was cT1 in 93 cases (84%) and cT2 in 18 (16%). Postoperative pathological analysis confirmed pT2 in 71 patients (64%) and pT3 in 40 (36%). We evaluated 1) in the radical prostatectomy specimen the correlation of microscopic extracapsular extension with pathological cancer volume, pathological tumor contact length and Gleason score, 2) the correlation between microscopic extracapsular extension and magnetic resonance imaging tumor contact length, and 3) the ability of preoperative variables to predict microscopic extracapsular extension. RESULTS Logistic regression analysis revealed that pathological tumor contact length correlated better with microscopic extracapsular extension than the predictive power of pathological cancer volume (0.821 vs 0.685). The Spearman correlation between pathological and magnetic resonance imaging tumor contact length was r = 0.839 (p <0.0001). ROC AUC analysis revealed that magnetic resonance imaging tumor contact length outperformed cancer core involvement on targeted biopsy and the Partin tables to predict microscopic extracapsular extension (0.88 vs 0.70 and 0.63, respectively). At a magnetic resonance imaging tumor contact length threshold of 20 mm the accuracy for diagnosing microscopic extracapsular extension was superior to that of conventional magnetic resonance imaging criteria (82% vs 67%, p = 0.015). We developed a predicted probability plot curve of extracapsular extension according to magnetic resonance imaging tumor contact length. CONCLUSIONS Magnetic resonance imaging determined tumor contact length could be a promising quantitative predictor of microscopic extracapsular extension.
Collapse
Affiliation(s)
- Eduard Baco
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California.
| | - Erik Rud
- Department of Radiology, Oslo University Hospital Aker, Oslo University Hospital, Oslo, Norway
| | - Ljiljana Vlatkovic
- Department of Pathology, Oslo University Hospital, The Norwegian Radiumhospital, Oslo University Hospital, Oslo, Norway
| | - Aud Svindland
- Department of Pathology, Oslo University Hospital, The Norwegian Radiumhospital, Oslo University Hospital, Oslo, Norway
| | - Heidi B Eggesbø
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Andrew J Hung
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Toru Matsugasumi
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jean-Christophe Bernhard
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Inderbir S Gill
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Osamu Ukimura
- University of Southern California Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
65
|
Impact of NADiA ProsVue PSA slope on secondary treatment decisions after radical prostatectomy. Prostate Cancer Prostatic Dis 2014; 17:280-5. [DOI: 10.1038/pcan.2014.25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 05/01/2014] [Accepted: 05/15/2014] [Indexed: 11/08/2022]
|
66
|
Bach C, Pisipati S, Daneshwar D, Wright M, Rowe E, Gillatt D, Persad R, Koupparis A. The status of surgery in the management of high-risk prostate cancer. Nat Rev Urol 2014; 11:342-51. [DOI: 10.1038/nrurol.2014.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
67
|
|
68
|
Røder MA, Brasso K, Christensen IJ, Johansen J, Langkilde NC, Hvarness H, Carlsson S, Jakobsen H, Borre M, Iversen P. Changes in preoperative characteristics in patients undergoing radical prostatectomy--a 16-year nationwide analysis. Acta Oncol 2014; 53:361-7. [PMID: 23957596 DOI: 10.3109/0284186x.2013.819998] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The Danish attitude for diagnosis and treatment of early localized prostate cancer (PCa) has historically been conservative. Denmark introduced radical prostatectomy (RP) as the last of the Nordic countries in 1995. However, a rapid increment in the Danish incidence of PCa is indicative of a shift in attitude with increasing opportunistic PSA testing. This had led to an increasing number of RPs being performed in Denmark. The objective of this study was to analyze changes in preoperative characteristics over time for the complete cohort of 6489 men who underwent RP between 1995 and 2011. Our hypothesis was that an increasing amount of men undergo RP for lower risk PCa. MATERIAL AND METHODS All patients operated from 1995 to 2011 were identified via patient files and registries. Changes over time in age at surgery, preoperative PSA, clinical T-category, biopsy Gleason score (GS), and D'Amico classification are described. Tests for statistically significant changes were performed. RESULTS Median age increased from 61.4 to 64.8 years (p < 0.0001) during the 16-year period. Median PSA declined from 11.5 to 7.9 ng/ml (p < 0.0001). Distribution of biopsy GS changed significantly, especially after 2005. Biopsy GS = 7 was found in 20.2% of the patients in 2005 compared to 57.1% in 2011. The proportion of T1 disease increased from 32% to 56%. Significant changes in percentage of patients according to the D'Amico classification were found. After 2005 the proportion of intermediate-risk patients increased significantly. The proportion of patients age 70 or above increased from 2% to 13% in the period studies. CONCLUSION Significant preoperative stage- and Gleason grade migration was found in this complete Danish nationwide cohort of patients undergoing RP during the past 16 years. This effect is most likely attributed to an increasing use of PSA as marker for early prostate cancer diagnosis in Denmark and new international guidelines for Gleason grading and scoring.
Collapse
Affiliation(s)
- Martin Andreas Røder
- Copenhagen Prostate Cancer Center and Department of Urology, Rigshospitalet. Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University Hospital , Copenhagen N , Denmark
| | | | | | | | | | | | | | | | | | | |
Collapse
|
69
|
Roiss M, Schiffmann J, Tennstedt P, Kessler T, Blanc I, Goetz A, Schlomm T, Graefen M, Reuter DA. Oncological long-term outcome of 4772 patients with prostate cancer undergoing radical prostatectomy: does the anaesthetic technique matter? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2014; 40:1686-92. [PMID: 24613743 DOI: 10.1016/j.ejso.2014.02.223] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 01/31/2014] [Accepted: 02/07/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Recent data suggest that using additional neuroaxial anaesthesia during oncological surgery is associated with favourable recurrence-free survival, when compared with general anaesthesia alone. We assessed the impact of adjunctive perioperative spinal anaesthesia and dose of opioids on the oncological long-term outcome of patients following radical prostatectomy. METHODS We selected patients from our institutional review board-approved database who consecutively underwent radical prostatectomy between 2002 and 2007. Patients were stratified by type of anaesthesia, administered as general anaesthesia alone, or spinal anaesthesia in addition to general anaesthesia. Biochemical recurrence-free survival, metastasis-free survival and overall survival were analysed by a multivariate Cox regression model and by Kaplan-Meier analysis in propensity-score based matched cohorts, adjusted for standard clinico-pathological variables and year of surgery. RESULTS Overall, 4772 patients were analysed. Regarding the type of anaesthesia no significant difference for biochemical recurrence-free survival, metastasis-free survival and overall survival was analysed by a multivariate Cox regression model (p = 0.5, 0.8 and 0.7). The Kaplan-Meier analyses after propensity-score matched based comparisons revealed no significant difference depending on type of anaesthesia for biochemical recurrence-free survival, metastasis-free survival and overall survival (p = 0.6, 0.1 and 0.4). The same accounted for a propensity-score matched model adjusted for the year of surgery on biochemical recurrence-free survival (p = 0.7). CONCLUSIONS The oncological outcome after radical prostatectomy was not affected by the adjunctive use of spinal anaesthesia.
Collapse
Affiliation(s)
- M Roiss
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - J Schiffmann
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany
| | - P Tennstedt
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany
| | - T Kessler
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - I Blanc
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - A Goetz
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany
| | - T Schlomm
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany; Department of Urology, Section for Translational Prostate Cancer Research, University Medical Center Hamburg-Eppendorf, Germany
| | - M Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Germany
| | - D A Reuter
- Department of Anaesthesiology, Center of Anaesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Germany.
| |
Collapse
|
70
|
Røder MA, Kawa S, Scheike T, Toft BG, Hansen JB, Brasso K, Vainer B, Iversen P. Non-apical positive surgical margins after radical prostatectomy for pT2 prostate cancer is associated with the highest risk of recurrence. J Surg Oncol 2014; 109:818-22. [PMID: 24522971 DOI: 10.1002/jso.23573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/15/2014] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE To investigate how location of positive surgical margins (PSM) in pT2 tumors affect the risk of biochemical recurrence (BR). METHODS The study includes 1,133 consecutive patients from 1995 until end of 2011, who had organ-confined disease (pT2) following RP. The location of PSM was stratified into apical and non-apical. BR was defined as the first PSA ≥ 0.2 ng/ml after RP. Risk of BR was analyzed with Kaplan-Meier and Cox regression analysis. RESULTS Median follow-up was 3.6 years (range: 0.5-15.5 years). The overall pT2 PSM rate was 26.3%. Overall, a pT2 with PSM had a 3.1-fold increased risk of BR compared to margin negative patients. Patients with pT2 apical and non-apical PSM had a 5-year biochemical recurrence-free survival of 84.9% (95% CI: 77.6-92.2%) and 78.6% (95% CI: 71.3-85.9%), respectively. In multivariate analysis, pT2 apical and non-apical PSM was individually associated with a 2.2- and 3.8-fold increased risk of BR compared to margin negative patients. CONCLUSION In our cohort the location of pT2 PSM was associated with time to BR, that is, patients with non-apical pT2 PSM endured the highest risk of BR compared to apical PSM. This may indicate that not all patients with pT2 PSM should be offered adjuvant therapy.
Collapse
Affiliation(s)
- Martin Andreas Røder
- Copenhagen Prostate Cancer Center, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | | |
Collapse
|
71
|
Hansen J, Bianchi M, Sun M, Rink M, Castiglione F, Abdollah F, Steuber T, Ahyai SA, Steurer S, Göbel C, Freschi M, Montorsi F, Shariat SF, Fisch M, Graefen M, Karakiewicz PI, Briganti A, Chun FKH. Percentage of high-grade tumour volume does not meaningfully improve prediction of early biochemical recurrence after radical prostatectomy compared with Gleason score. BJU Int 2013; 113:399-407. [PMID: 24053339 DOI: 10.1111/bju.12424] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To examine whether percentage of tumour volume (%TV) and percentage of high-grade tumour volume (%HGTV) help to better identify men at higher risk of early biochemical recurrence (BCR) after radical prostatectomy (RP) for non-metastatic high-risk prostate cancer, as early BCR after RP might be associated with higher risk of metastases and cancer-specific mortality. PATIENTS AND METHODS We examined the data of 595 men treated with RP for non-metastatic high-risk prostate cancer between 1992 and 2011 at two European tertiary care centres. Kaplan-Meier analyses were used to graphically depict 2-year BCR-free survival. Multivariable Cox regression models addressed early BCR. We tested whether addition of %TV and %HGTV to a multivariable Cox regression model helps to increase a model's predictive accuracy (PA) for prediction of early BCR. RESULTS In all, 32 men (10%) with specimen-confined prostate cancer (pT2-pT3a, negative surgical margin, pN0) and 67 men (24%) with non-specimen-confined prostate cancer had early BCR. After stratification according to %HGTV (%HGTV threshold: ≤33.33 vs >33.33%), the 2-year BCR-free survival rates were respectively 93 vs 60% (log-rank P < 0.001). In multivariable Cox regression models %HGTV emerged as an independent predictor of early BCR (P < 0.001), whereas %TV did not (P > 0.05). However, adding %HGTV (regardless of its coding) to other covariates in multivariable Cox regression analysis did not increase the model's PA in a meaningful fashion compared with the use of the detailed Gleason grading system (6 vs 7a vs 7b vs 8 vs 9-10). CONCLUSIONS In a large cohort of patients with high-risk prostate cancer, %HGTV and %TV did not improve prediction of early BCR after RP substantially, although %HGTV was an independent predictor of early BCR. Therefore, sophisticated TV/HGTV measurements do not seem to have additional benefit for early BCR prediction relative to the use of Gleason grading. However, these results need to be confirmed in larger, prospective studies.
Collapse
Affiliation(s)
- Jens Hansen
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Martini Clinic, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
72
|
Louis AS, Kalnin R, Maganti M, Pintilie M, Matthew AG, Finelli A, Zlotta AR, Fleshner N, Kulkarni G, Hamilton R, Jewett M, Robinette M, Alibhai SMH, Trachtenberg J. Oncologic outcomes following radical prostatectomy in the active surveillance era. Can Urol Assoc J 2013; 7:E475-80. [PMID: 23914263 DOI: 10.5489/cuaj.1404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In this study, we examine the oncologic outcomes of men with low, intermediate and high preoperative risk for prostate cancer treated with radical prostatectomy prior to and during the active surveillance era. METHODS We analyzed records from patients who underwent radical prostatectomy at our Canadian tertiary care facility from 2000 to 2012. Patients were stratified by D'Amico preoperative risk category and by year of treatment. Biochemical recurrence-free survival was estimated using the Kaplan-Meier method. RESULTS We included 2643 consecutive patients in our analysis. The proportion of men with low-risk disease undergoing radical prostatectomy decreased from 2007 onwards coincident with the implementation of an active surveillance strategy in our institution. Men with low-risk and high-risk disease showed significantly worse biochemical outcomes from 2007 to 2012 compared to 2000 to 2006 (p < 0.05), while men with intermediate-risk prostate cancer showed no significant differences (p = 0.27). Within the low-risk cohort, the later treatment group displayed significantly lower age, pre-treatment prostate specific antigen and tumour volume and significantly higher testosterone and body mass index. CONCLUSIONS The time period corresponding with the implementation of active surveillance at our institution corresponded with significant deterioration of biochemical outcomes in the low- and high-risk groups. This suggests that the men with most favourable disease deferred treatment, whereas men with worse preoperative disease characteristics were increasingly treated with radical prostatectomy in the past 6 years perhaps to their benefit.
Collapse
Affiliation(s)
- Alyssa S Louis
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
73
|
Sperm banking is of key importance in patients with prostate cancer. Fertil Steril 2013; 100:367-72.e1. [DOI: 10.1016/j.fertnstert.2013.03.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/10/2013] [Accepted: 03/29/2013] [Indexed: 01/01/2023]
|
74
|
Glass AS, Cowan JE, Fuldeore MJ, Cooperberg MR, Carroll PR, Kenfield SA, Greene KL. Patient Demographics, Quality of Life, and Disease Features of Men With Newly Diagnosed Prostate Cancer: Trends in the PSA Era. Urology 2013; 82:60-5. [DOI: 10.1016/j.urology.2013.01.072] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 01/03/2013] [Accepted: 01/22/2013] [Indexed: 10/26/2022]
|
75
|
Abdollah F, Suardi N, Gallina A, Bianchi M, Tutolo M, Passoni N, Fossati N, Sun M, dell'Oglio P, Salonia A, Karakiewicz P, Rigatti P, Montorsi F, Briganti A. Extended pelvic lymph node dissection in prostate cancer: a 20-year audit in a single center. Ann Oncol 2013; 24:1459-66. [DOI: 10.1093/annonc/mdt120] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
76
|
Mitsuzuka K, Koie T, Narita S, Kaiho Y, Yoneyama T, Tsuchiya N, Kakoi N, Kawamura S, Tochigi T, Ohyama C, Habuchi T, Yamaguchi T, Arai Y. Changes in Indications and Oncological Outcomes of Radical Prostatectomy After 2000—Data From 1268 Japanese Patients Treated with Radical Prostatectomy Between 2000 and 2009. Jpn J Clin Oncol 2013; 43:821-6. [DOI: 10.1093/jjco/hyt072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
77
|
Hansen J, Rink M, Bianchi M, Kluth LA, Tian Z, Ahyai SA, Shariat SF, Briganti A, Steuber T, Fisch M, Graefen M, Karakiewicz PI, Chun FKH. External validation of the updated Briganti nomogram to predict lymph node invasion in prostate cancer patients undergoing extended lymph node dissection. Prostate 2013; 73:211-8. [PMID: 22821742 DOI: 10.1002/pros.22559] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 06/13/2012] [Indexed: 01/19/2023]
Abstract
PURPOSE We aimed to test accuracy and generalizability of a recently updated nomogram to assess the probability of lymph node invasion (LNI), when applied to a different European cohort of men undergoing radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). MATERIALS AND METHODS The study cohort consisted of 1,282 men with clinically localized PCa who underwent RP and ePLND, including removal of obturator, external iliac, and hypogastric lymph nodes, between 01/2007 and 08/2011. Descriptive measurements included preoperative clinical and biopsy variables, such as prostate-specific antigen (PSA), clinical stage (CS), primary and secondary biopsy Gleason pattern, and percentage of positive cores. We used the area under curve (AUC) of the receiver operator characteristic analysis to quantify accuracy of the model to predict LNI. The extent of over- or under-estimation was explored graphically within loess calibration plots. RESULTS The median number of removed lymph nodes was 15 with an interquartile range of 12-20. Twelve percent (n = 155) of men had LNI. Preoperative clinical and biopsy characteristics differed significantly (all P ≤ 0.002) between men with LNI and those without. External validation of the previously reported updated LNI nomogram showed very good accuracy (AUC: 0.829). A nomogram-derived cut-off of 4% could lead to a reduction of 48% of lymph node dissection, while missing 10% of patients with LNI. CONCLUSIONS We report the external validation of an updated LNI nomogram, demonstrating accuracy and applicability in a different European cohort. A nomogram-derived cut-off of 4% confirmed good performance characteristics within a different external validation cohort.
Collapse
Affiliation(s)
- Jens Hansen
- Martini Clinic, Prostate Cancer Centre at University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
78
|
Hyams ES, Mullins JK, Pierorazio PM, Partin AW, Allaf ME, Matlaga BR. Impact of robotic technique and surgical volume on the cost of radical prostatectomy. J Endourol 2012; 27:298-303. [PMID: 22967039 DOI: 10.1089/end.2012.0147] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND PURPOSE Our present understanding of the effect of robotic surgery and surgical volume on the cost of radical prostatectomy (RP) is limited. Given the increasing pressures placed on healthcare resource utilization, such determinations of healthcare value are becoming increasingly important. Therefore, we performed a study to define the effect of robotic technology and surgical volume on the cost of RP. METHODS The state of Maryland mandates that all acute-care hospitals report encounter-level and hospital discharge data to the Health Service Cost Review Commission (HSCRC). The HSCRC was queried for men undergoing RP between 2008 and 2011 (the period during which robot-assisted laparoscopic radical prostatectomy [RALRP] was coded separately). High-volume hospitals were defined as >60 cases per year, and high-volume surgeons were defined as >40 cases per year. Multivariate regression analysis was performed to evaluate whether robotic technique and high surgical volume impacted the cost of RP. RESULTS There were 1499 patients who underwent RALRP and 2565 who underwent radical retropubic prostatectomy (RRP) during the study period. The total cost for RALRP was higher than for RRP ($14,000 vs 10,100; P<0.001) based primarily on operating room charges and supply charges. Multivariate regression demonstrated that RALRP was associated with a significantly higher cost (β coeff 4.1; P<0.001), even within high-volume hospitals (β coeff 3.3; P<0.001). High-volume surgeons and high-volume hospitals, however, were associated with a significantly lower cost for RP overall. High surgeon volume was associated with lower cost for RALRP and RRP, while high institutional volume was associated with lower cost for RALRP only. CONCLUSIONS High surgical volume was associated with lower cost of RP. Even at high surgical volume, however, the cost of RALRP still exceeded that of RRP. As robotic surgery has come to dominate the healthcare marketplace, strategies to increase the role of high-volume providers may be needed to improve the cost-effectiveness of prostate cancer surgical therapy.
Collapse
Affiliation(s)
- Elias S Hyams
- Brady Urological Institute, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | | | | | | | | | | |
Collapse
|
79
|
Migration des stades pathologiques après prostatectomie totale vers des tumeurs à plus haut risque de récidive : étude bicentrique comparative entre 2005 et 2010. Prog Urol 2012. [DOI: 10.1016/j.purol.2012.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
80
|
Briganti A, Bianchi M, Sun M, Suardi N, Gallina A, Abdollah F, Bertini R, Colombo R, Girolamo VD, Salonia A, Scattoni V, Karakiewicz PI, Guazzoni G, Rigatti P, Montorsi F. Impact of the introduction of a robotic training programme on prostate cancer stage migration at a single tertiary referral centre. BJU Int 2012; 111:1222-30. [DOI: 10.1111/j.1464-410x.2012.11464.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alberto Briganti
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | | | - Maxine Sun
- Cancer Prognostics and Health Outcomes Unit; University of Montreal; Montreal; QC; Canada
| | - Nazareno Suardi
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Andrea Gallina
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Firas Abdollah
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Roberto Bertini
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Renzo Colombo
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Valerio Di Girolamo
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Andrea Salonia
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Vincenzo Scattoni
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; University of Montreal; Montreal; QC; Canada
| | - Giorgio Guazzoni
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Patrizio Rigatti
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| | - Francesco Montorsi
- Department of Urology; Vita-Salute University; San Raffaele Scientific Institute; Milan; Italy
| |
Collapse
|
81
|
Karavitakis M, Ahmed HU, Abel PD, Livni N, Hazell S, Winkler MH. Trends in pathologic outcomes after introduction of active surveillance in the UK: implication for focal therapy. Prostate 2012; 72:1464-8. [PMID: 22328187 DOI: 10.1002/pros.22498] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 01/11/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND We aimed to evaluate the trends in pathologic outcomes of clinically localized prostate cancer treated with radical prostatectomy prior to and after national guidelines placing active surveillance as the primary management in men with low-risk prostate cancer. Further, we examined whether there was a coincident change in the proportion of men potentially suitable for focal therapy. METHODS All cancer foci in 195 whole mount radical prostatectomy samples during two periods (Period 1: 07/2001-10/2003, n = 100 and Period 2: 01/2007-11/2009, n = 95) were examined. Individual tumor volumes, Gleason grade, and extracapsular extension/positive surgical margins were evaluated. The index lesion was defined as the largest by volume. RESULTS There was a statistically significant increase in the proportion of Gleason score ≥7 tumors (31-69%; P < 0.001) and pathologically non-organ confined disease (21-37%; P = 0.008), between period 1 and 2, respectively. The proportion of patients with unifocal prostate cancer potentially suitable for focal ablation was stable (14-13.7%; P = 0.9). Although there was a decrease in the proportion of patients potentially suitable for index lesion ablation (51-43%; P = 0.4) and unilateral prostate cancer potentially suitable for hemi-ablation (11-6.3%; P = 0.3), these differences were not statistically significant. CONCLUSION The increasing use of active surveillance in the UK may be responsible for a trend towards higher grade and stage prostate cancer in whole mount specimens. Despite this, there remain a significant proportion of men who currently undergo radical surgery who may be suitable for focal therapy, if that included index lesion ablation.
Collapse
Affiliation(s)
- Markos Karavitakis
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | | | | | | | | | | |
Collapse
|
82
|
Hansen J, Budäus L, Spethmann J, Schlomm T, Salomon G, Rink M, Haese A, Steuber T, Heinzer H, Huland H, Graefen M, Michl U. Assessment of rates of lymph nodes and lymph node metastases in periprostatic fat pads in a consecutive cohort treated with retropubic radical prostatectomy. Urology 2012; 80:877-82. [PMID: 22950996 DOI: 10.1016/j.urology.2012.06.052] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/27/2012] [Accepted: 06/30/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the rates of lymph nodes and lymph node metastases in periprostatic fat pads yielded during exposure of the anterior surface of the dorsal vein complex, puboprostatic ligaments, and endopelvic fascia during radical prostatectomy. METHODS Histopathologic examination was performed in 356 patients who underwent radical prostatectomy between July 2010 and September 2010 at a single institution. Separate histologic work-up of the periprostatic fat pads addressed the presence of lymph nodes and possible metastatic invasion of lymph nodes within this area. Descriptive analyses and multivariable analyses to predict the presence of lymph node metastases within these fat pads were performed. RESULTS Lymph nodes within periprostatic fat pads were detected in 19 (5.5%) patients. Among these patients, tumor infiltration was found in 4 (1.2%). Three of these 4 patients harbored lymph node metastases without any other lymph node metastasis during standard lymphadenectomy. No relationship was detected between the total number of lymph nodes removed and the detection of lymph nodes within periprostatic fat pads (P = .6). CONCLUSION Our analysis demonstrates that periprostatic fat pads harbor lymph nodes. No relationship between the presence of lymph node metastases in periprostatic fat pads and the presence of lymph node metastases in other areas was found. Similarly, no relationship exists between the presence of lymph nodes in this area and the total number of lymph nodes yielded in other lymphatic fields. Therefore, for guaranteeing precise lymph node staging, implementing routinely pathologic work-up of periprostatic fat pads yielded during radical prostatectomy should be considered.
Collapse
Affiliation(s)
- Jens Hansen
- Martini Clinic, Prostate Cancer Center at University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
83
|
Eifler JB, Feng Z, Lin BM, Partin MT, Humphreys EB, Han M, Epstein JI, Walsh PC, Trock BJ, Partin AW. An updated prostate cancer staging nomogram (Partin tables) based on cases from 2006 to 2011. BJU Int 2012; 111:22-9. [PMID: 22834909 DOI: 10.1111/j.1464-410x.2012.11324.x] [Citation(s) in RCA: 279] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To update the 2007 Partin tables in a contemporary patient population. PATIENTS AND METHODS The study population consisted of 5,629 consecutive men who underwent RP and staging lymphadenectomy at the Johns Hopkins Hospital between January 1, 2006 and July 30, 2011 and met inclusion criteria. Polychotomous logistic regression analysis was used to predict the probability of each pathologic stage category: organ-confined disease (OC), extraprostatic extension (EPE), seminal vesicle involvement (SV+), or lymph node involvement (LN+) based on preoperative criteria. Preoperative variables included biopsy Gleason score (6, 3+4, 4+3, 8, and 9-10), serum PSA (0-2.5, 2.6-4.0, 4.1-6.0, 6.1-10.0, greater than 10.0 ng/mL), and clinical stage (T1c, T2c, and T2b/T2c). Bootstrap re-sampling with 1000 replications was performed to estimate 95% confidence intervals for predicted probabilities of each pathologic state. RESULTS The median PSA was 4.9 ng/mL, 63% had Gleason 6 disease, and 78% of men had T1c disease. 73% of patients had OC disease, 23% had EPE, 3% had SV+ but not LN+, and 1% had LN+ disease. Compared to the previous Partin nomogram, there was no change in the distribution of pathologic state. The risk of LN+ disease was significantly higher for tumours with biopsy Gleason 9-10 than Gleason 8 (O.R. 3.2, 95% CI 1.3-7.6). The c-indexes for EPE vs. OC, SV+ vs. OC, and LN+ vs. OC were 0.702, 0.853, and 0.917, respectively. Men with biopsy Gleason 4+3 and Gleason 8 had similar predicted probabilities for all pathologic stages. Most men presenting with Gleason 6 disease or Gleason 3+4 disease have <2% risk of harboring LN+ disease and may have lymphadenectomy omitted at RP. CONCLUSIONS The distribution of pathologic stages did not change at our institution between 2000-2005 and 2006-2011. The updated Partin nomogram takes into account the updated Gleason scoring system and may be more accurate for contemporary patients diagnosed with prostate cancer.
Collapse
Affiliation(s)
- John B Eifler
- James Buchanan Brady Urological Institute and the Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
84
|
Schlomm T, Tennstedt P, Huxhold C, Steuber T, Salomon G, Michl U, Heinzer H, Hansen J, Budäus L, Steurer S, Wittmer C, Minner S, Haese A, Sauter G, Graefen M, Huland H. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) increases nerve-sparing frequency and reduces positive surgical margins in open and robot-assisted laparoscopic radical prostatectomy: experience after 11,069 consecutive patients. Eur Urol 2012; 62:333-40. [PMID: 22591631 DOI: 10.1016/j.eururo.2012.04.057] [Citation(s) in RCA: 176] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 04/29/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Intraoperative frozen-section analysis allows real-time histologic assessment of surgical margins (SMs) and identification of candidates for nerve-sparing (NS) procedures. OBJECTIVE To examine the efficacy and oncologic safety of a systematic neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during NS radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS From January 2002 to June 2011, 11 069 consecutive RPs were performed at the University Medical Center Hamburg-Eppendorf. Of these, 5392 (49%) were conducted with NeuroSAFE. SURGICAL PROCEDURE Our NeuroSAFE approach included the whole laterorectal circumference of the prostate to determine the SM status of the complete neurovascular tissue-corresponding prostatic surface. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The impact of NeuroSAFE on NS frequency, SM status, and biochemical recurrence (BCR) was analyzed by chi-square test, and by Kaplan-Meier analyses in propensity score-based matched cohorts. RESULTS AND LIMITATIONS Positive SMs (PSMs) were detected in 1368 (25%) NeuroSAFE RPs, leading to a secondary resection of the ipsilateral neurovascular tissue. Secondary wide resection resulted in conversion to a definitive negative SM (NSM) status in 1180 (86%) patients. In NeuroSAFE RPs, frequency of NS was significantly higher (all stages: 97% vs 81%; pT2: 99% vs 92%; pT3a: 94% vs 72%; pT3b: 88% vs 40%; p<0.0001) and PSM rates were significantly lower (all stages: 15% vs 22%; pT2: 7% vs 12%; pT3a: 21% vs 32%; p<0.0001) than in the matched non-NeuroSAFE RPs. In propensity score-based comparisons, NeuroSAFE had no negative impact on BCR (pT2, p=0.06; pT3a, p=0.17, pT3b, p=0.99), and BCR-free survival of patients with conversion to NSM did not differ significantly from patients with primarily NSM (pT2, p=0.16; pT3, p=0.26). The accuracy of our NeuroSAFE approach was 97% with a false-negative rate of 2.5%. The major limitations of this study are its retrospective nature and relatively short follow-up. CONCLUSIONS NeuroSAFE enables real-time histologic monitoring of the oncologic safety of a NS procedure. Systematic NeuroSAFE significantly increases NS frequencies and reduces PSMs. Patients with a NeuroSAFE-detected PSM could be converted to a prognostically more favorable NSM status by secondary wide resection.
Collapse
Affiliation(s)
- Thorsten Schlomm
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
85
|
Budäus L, Isbarn H, Tennstedt P, Salomon G, Schlomm T, Steuber T, Haese A, Chun F, Fisch M, Michl U, Heinzer H, Huland H, Graefen M. Risk assessment of metastatic recurrence in patients with prostate cancer by using the Cancer of the Prostate Risk Assessment score: results from 2937 European patients. BJU Int 2012; 110:1714-20. [DOI: 10.1111/j.1464-410x.2012.11147.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
86
|
Karavitakis M, Ahmed HU, Abel PD, Hazell S, Winkler MH. Margin status after laparoscopic radical prostatectomy and the index lesion: implications for preoperative evaluation of tumor focality in prostate cancer. J Endourol 2012; 26:503-8. [PMID: 22142404 DOI: 10.1089/end.2011.0345] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate the impact of tumor focality on positive surgical margins (PSM) after laparoscopic radical prostatectomy. PATIENTS AND METHODS Ninety-five consecutive whole-mount laparoscopic radical prostatectomy samples (January 2007 to November 2009) were evaluated for tumor focality, laterality, Gleason score, and volume of individual foci, total tumor volume, pathologic stage, and surgical margin status. RESULTS Thirty-nine percent, 36%, and 25% were in low, intermediate, and high D'Amico risk categories. Thirty-three percent (31/95) had PSM. Overall, 269 tumor foci were identified. The incidence of PSM within lesions ≤ 0.5 cc and ≤ 0.2 cc was 1.2% (2/160) and 0% (0/132), respectively. Among the 71 multifocal cases, 19 (27%) exhibited PSM. In 13 of these, the index lesion appeared at the inked surface (mean volume 5.4 cc, range 0.63-26.9 cc) compared with 6 in which both index and satellite foci appeared at the inked margins. Mean volume of these satellite foci was 1.06 cc (range 0.22-2 cc); three had Gleason score 6 and three had Gleason score 7 (3+4). CONCLUSIONS PSM is usually attributed to the index lesion and lesions larger than commonly used thresholds for clinically significant lesion volumes. Because such lesions might be detected by multiparametric magnetic resonance imaging (MRI) or template mapping biopsies, the information from these staging modalities could be used intraoperatively to reduce PSM.
Collapse
Affiliation(s)
- Markos Karavitakis
- Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, United Kingdom.
| | | | | | | | | |
Collapse
|
87
|
Briganti A, Larcher A, Abdollah F, Capitanio U, Gallina A, Suardi N, Bianchi M, Sun M, Freschi M, Salonia A, Karakiewicz PI, Rigatti P, Montorsi F. Updated nomogram predicting lymph node invasion in patients with prostate cancer undergoing extended pelvic lymph node dissection: the essential importance of percentage of positive cores. Eur Urol 2011; 61:480-7. [PMID: 22078338 DOI: 10.1016/j.eururo.2011.10.044] [Citation(s) in RCA: 508] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 10/27/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few predictive models aimed at predicting the presence of lymph node invasion (LNI) in patients with prostate cancer (PCa) treated with extended pelvic lymph node dissection (ePLND) are available to date. OBJECTIVE Update a nomogram predicting the presence of LNI in patients treated with ePLND at the time of radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS The study included 588 patients with clinically localised PCa treated between September 2006 and October 2010 at a single tertiary referral centre. INTERVENTION All patients underwent RP and ePLND invariably including removal of obturator, external iliac, and hypogastric nodes. MEASUREMENTS Prostate-specific antigen, clinical stage, and primary and secondary biopsy Gleason grade as well as percentage of positive cores were included in univariable (UVA) and multivariable (MVA) logistic regression models predicting LNI and formed the basis for the regression coefficient-based nomogram. The area under the curve (AUC) method was used to quantify the predictive accuracy (PA) of the model. RESULTS AND LIMITATIONS The mean number of lymph nodes removed and examined was 20.8 (median: 19; range: 10-52). LNI was found in 49 of 588 patients (8.3%). All preoperative PCa characteristics differed significantly between LNI-positive and LNI-negative patients (all p<0.001). In UVA predictive accuracy analyses, percentage of positive cores was the most accurate predictor of LNI (AUC: 79.5%). At MVA, clinical stage, primary biopsy Gleason grade, and percentage of positive cores were independent predictors of LNI (all p≤0.006). The updated nomogram demonstrated a bootstrap-corrected PA of 87.6%. Using a 5% nomogram cut-off, 385 of 588 patients (65.5%) would be spared ePLND. and LNI would be missed in only 6 patients (1.5%). The sensitivity, specificity, and negative predictive value associated with the 5% cut-off were 87.8%, 70.3%, and 98.4%, respectively. The relatively low number of patients included as well as the lack of an external validation represent the main limitations of our study. CONCLUSIONS We report the first update of a nomogram predicting the presence of LNI in patients treated with ePLND. The nomogram maintained high accuracy, even in more contemporary patients (87.6%). Because percentage of positive cores represents the foremost predictor of LNI, its inclusion should be mandatory in any LNI prediction model. Based on our model, those patients with a LNI risk<5% might be safely spared ePLND.
Collapse
Affiliation(s)
- Alberto Briganti
- Department of Urology, Vita-Salute University, San Raffaele Scientific Institute, Milan, Italy.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|