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Kano H, Kadono Y, Naito R, Makino T, Iwamoto H, Yaegashi H, Kawaguchi S, Nohara T, Shigehara K, Izumi K, Mizokami A. Salvage Androgen Deprivation Therapy as Potential Treatment for Recurrence after Robot-Assisted Radical Prostatectomy. Cancers (Basel) 2024; 16:1304. [PMID: 38610982 PMCID: PMC11011007 DOI: 10.3390/cancers16071304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND The efficacy of intermittent androgen deprivation therapy (ADT) for biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP) is unknown, and its usefulness in Japanese practice needs to be investigated. METHODS We conducted a retrospective analysis of 85 patients who underwent RARP and were selected for intermittent ADT for postoperative recurrence at Kanazawa University Hospital between 2009 and 2019. Intermittent ADT was administered for 2 years. If prostate-specific antigen levels increased post-treatment, intermittent ADT was reinitiated. The median follow-up period was 47 months. RESULTS The 73 patients had completed the initial course of ADT, and 12 were under initial ADT. The 5-year castration-resistant prostate-cancer-free survival rates, cancer-specific survival, and overall survival were 92.7%, 98.3%, and 94.7%, respectively. A subgroup analysis of 69 patients who completed intermittent ADT was conducted to evaluate the BCR rate following initial ADT. The 5-year BCR-free survival rate was 53.2%. Multivariate analysis identified testosterone ≤ 0.03 ng/mL during ADT as the sole predictor of BCR after ADT. CONCLUSIONS Salvage intermittent ADT may be an effective treatment option for BCR after RARP. In addition, it would be useful to confirm strong testosterone suppression as a criterion for transition to intermittent therapy.
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Affiliation(s)
- Hiroshi Kano
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Yoshifumi Kadono
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
- Department of Nephrology and Urology, Japanese Red Cross Fukui Hospital, Fukui 918-8501, Japan
| | - Renato Naito
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Tomoyuki Makino
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Hiroaki Iwamoto
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Hiroshi Yaegashi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Shohei Kawaguchi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Takahiro Nohara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Kazuyoshi Shigehara
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Kouji Izumi
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
| | - Atsushi Mizokami
- Department of Integrative Cancer Therapy and Urology, Kanazawa University Graduate School of Medical Science, Kanazawa 920-8640, Japan; (H.K.); (R.N.); (T.M.); (H.I.); (H.Y.); (S.K.); (T.N.); (K.S.); (K.I.); (A.M.)
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Wang J, Hu K, Wang Y, Wu Y, Bao E, Wang J, Tan C, Tang T. Robot-assisted versus open radical prostatectomy: a systematic review and meta-analysis of prospective studies. J Robot Surg 2023; 17:2617-2631. [PMID: 37721644 DOI: 10.1007/s11701-023-01714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/02/2023] [Indexed: 09/19/2023]
Abstract
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
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Affiliation(s)
- Junji Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Ke Hu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yu Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Yinyu Wu
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Erhao Bao
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Jiahao Wang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Chunlin Tan
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China
| | - Tielong Tang
- Department of Urology, Affiliated Hospital of North Sichuan Medical College, No.1, Maoyuan South Road, Nanchong City, Sichuan Province, China.
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Sood A, Grauer R, Diaz-Insua M, Tewari AK, Hemal AK, Shrivastava A, Peabody JO, Jeong W, Abdollah F, Rudzinski JK, Andrews JR, Gorin MA, Bhandari M, Menon M. 15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer. Prostate Cancer Prostatic Dis 2023; 26:778-786. [PMID: 37142635 DOI: 10.1038/s41391-023-00674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND An informed decision regarding a treatment option requires data on its long-term efficacy and side-effect profile. While the side-effects of robotic radical prostatectomy have been well-quantified, the data on its long-term efficacy are lacking. We here provide 15-year oncological outcomes of clinically-localized prostate cancer (CLPCa) patients treated with robot-assisted laparoscopic prostatectomy (RALP). METHODS We treated 1,807 men with CLPCa with RALP between 2001 and 2005 and prospectively collected follow-up data through 2020. We examined the rates of biochemical failure (BCF), metastatic progression, secondary therapy use, PCa-specific mortality (PCSM), and overall survival (OS) using Kaplan-Meier and competing-risk cumulative incidence methods as appropriate. RESULTS The median follow-up was 14.1 years. Six hundred eight and 312 men had D'Amico intermediate- and high-risk disease, respectively. Overall, the 15-year rates of BCF, metastasis, secondary therapy use, PCSM, and OS were 28.1%, 4.0%, 16.3%, 2.5%, and 82.1%, respectively. The rates of oncologic failure increased with increasing D'Amico (preoperative) and Diaz (postoperative) risk scores - BCF, metastasis, and PCSM rates in D'Amico low-, intermediate-, and high-risk groups at 15-years were 15.2%, 38.3%, and 44.1% [BCF], 1.1%, 4.1%, and 13.0% [metastasis], and 0.5%, 3.4%, and 6.6% [PCSM], respectively, and in Diaz risk groups 1, 2, 3, 4, and 5 were 5.5%, 20.6%, 41.8%, 66.9%, and 89.2% [BCF], 0%, 0.5%, 3.2%, 20.5%, and 60.0% [metastasis], and 0%, 0.8%, 0.6%, 13.5%, and 37.5% [PCSM], respectively. The OS rates in D'Amico low-to-high and Diaz 1-to-5 risk groups at 15-years were 85.9%, 78.6%, and 75.2%, and 89.4%, 83.2%, 80.6%, 67.2%, and 23.4%, respectively. CONCLUSIONS Men diagnosed with clinically-localized prostate cancer in the contemporaneous PSA-screening era and treated with RALP achieve durable long-term oncological control. The data reported here (in a risk-stratified manner) represent the longest follow-up after robotic radical prostatectomy, and as such, should be of value when counseling patients regarding expected oncologic outcomes from RALP.
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Affiliation(s)
- Akshay Sood
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mireya Diaz-Insua
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | | | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Abdollah
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jan K Rudzinski
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack R Andrews
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Mani Menon
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kawase M, Goto T, Ebara S, Tatenuma T, Sasaki T, Ishihara T, Ikehata Y, Nakayama A, Toide M, Yoneda T, Sakaguchi K, Teishima J, Kobayashi T, Makiyama K, Inoue T, Kitamura H, Saito K, Koga F, Urakami S, Koie T. Nomogram Predicting Locally Advanced Prostate Cancer in Patients with Clinically Organ-Confined Disease Who Underwent Robot-Assisted Radical Prostatectomy: A Retrospective Multicenter Cohort Study in Japan (The MSUG94 Group). Ann Surg Oncol 2023; 30:6925-6933. [PMID: 37338747 DOI: 10.1245/s10434-023-13747-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/28/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE We created a clinically applicable nomogram to predict locally advanced prostate cancer using preoperative parameters and performed external validation using an external independent validation cohort. PATIENTS AND METHODS From a retrospective multicenter cohort study of 3622 Japanese patients with prostate cancer who underwent robot-assisted radical prostatectomy at ten institutions, the patients were divided into two groups (MSUG cohort and validation cohort). Locally advanced prostate cancer was defined as pathological T stage ≥ 3a. A multivariable logistic regression model was used to identify factors strongly associated with locally advanced prostate cancer. Bootstrap area under the curve was calculated to assess the internal validity of the prediction model. A nomogram was created as a practical application of the prediction model, and a web application was released to predict the probability of locally advanced prostate cancer. RESULTS A total of 2530 and 427 patients in the MSUG and validation cohorts, respectively, met the criteria for this study. On multivariable analysis, initial prostate-specific antigen, prostate volume, number of cancer-positive and cancer-negative biopsy cores, biopsy grade group, and clinical T stage were independent predictors of locally advanced prostate cancer. The nomogram predicting locally advanced prostate cancer was demonstrated (area under the curve 0.72). Using a nomogram cutoff of 0.26, 464 of 1162 patients (39.9%) could be correctly diagnosed with pT3, and 2311 of 2524 patients (91.6%) could avoid underdiagnosis. CONCLUSIONS We developed a clinically applicable nomogram with external validation to predict the probability of locally advanced prostate cancer in patients undergoing robot-assisted radical prostatectomy.
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Affiliation(s)
- Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takayuki Goto
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shin Ebara
- Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | - Takeshi Sasaki
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, Gifu, Japan
| | | | - Akinori Nakayama
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tatsuaki Yoneda
- Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Jun Teishima
- Department of Urology, Kobe City Hospital Organization Kobe City Medical Center West Hospital, Kobe, Japan
| | - Takashi Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Japan
| | | | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan.
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Moretti TBC, Magna LA, Reis LO. Open, laparoscopic, and robot-assisted radical prostatectomy oncological results: a reverse systematic review. J Endourol 2023; 37:521-530. [PMID: 36924303 DOI: 10.1089/end.2022.0819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE to apply the Reverse Systematic Review (RSR) to compare three radical prostatectomies (RP) techniques: open (RRP), laparoscopic (LRP), and robotic (RARP) in relation to oncological outcomes: positive surgical margin (PSM) and biochemical recurrence rate (BCR). EVIDENCE ACQUISITION a search was carried out in 8 databases between 2000 and 2020 through SR studies referring to RRP, LRP, or RARP (80 SR). All references used in these SRs were captured referring to 1,724 reports. Preoperative and oncological outcomes were compared and correlated among RRP, LRP, and RARP. EVIDENCE SYNTHESIS 559 (32.4%) reports for RRP, 413 (23.9%) for LRP, and 752 (43.7%) for RARP, and a total of 1,353,485 patients were found. Regarding PSM, 284 reports were collected for RRP, 324 for LRP, and 499 for RARP, with rates of 23.6%, 20.7%, and 19.2%, respectively, and only the RRP with a statistical difference (P<0.001). Using a non-linear regression model, the BCR rate was correlated with follow-up time at 1, 2, 3, 5, 7, and 10 years: 10%, 15%, 18%, 20%, 23 %, and 38% for RRP; 6%, 9%, 13%, 20%, 23%, 10% for LRP; 8%, 12%, 16%, 23%, 27%, 19% for RARP. The absence of long-term work for RARP prevented more accurate projections of BCR. CONCLUSIONS RSR proved to be effective in generating a population and heterogeneous sample capable of demonstrating better oncological results for minimally invasive surgery (LRP and RARP) compared to RRP. It demonstrated the maturity of temporal follow-up data for RRP and LRP and the impact of lack of late follow-up from RARP studies on the long-term rate of BC.
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Affiliation(s)
- Tomás Bernardo Costa Moretti
- State University of Campinas - UNICAMP, Urology, Rua Vital Brasil, 251, Cidade Universitária, Campinas, SP, Brazil, 13083-888;
| | | | - Leonardo Oliveira Reis
- State University of Campinas - UNICAMP, Urology, R. Tessália Vieira de Camargo, 126, Cidade Universitária, 13083-887, Campinas, SP, Brazil, 13073090;
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Labban M, Dasgupta P, Song C, Becker R, Li Y, Kreaden US, Trinh QD. Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK. JAMA Netw Open 2022; 5:e225740. [PMID: 35377424 PMCID: PMC8980901 DOI: 10.1001/jamanetworkopen.2022.5740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE The cost-effectiveness of different surgical techniques for radical prostatectomy remains a subject of debate. Emergence of recent critical clinical data and changes in surgical equipment costs due to their shared use by different clinical specialties necessitate an updated cost-effectiveness analysis in a centralized, largely government-funded health care system such as the UK National Health Service (NHS). OBJECTIVE To compare robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) and laparoscopic-assisted radical prostatectomy (LRP) using contemporary data on clinical outcomes, costs, and surgical volumes in the UK. DESIGN, SETTING, AND PARTICIPANTS This economic analysis used a Markov model developed to compare the cost-effectiveness of RARP, LRP, and ORP to treat localized prostate cancer. The model was constructed from the perspective of the UK NHS. The model simulated 65-year-old men who underwent radical prostatectomy for localized prostate cancer and were followed up for a 10-year period. Data were analyzed from May 1, 2020, to July 31, 2021. EXPOSURES Robotic-assisted radical prostatectomy, LRP, and ORP. MAIN OUTCOMES AND MEASURES Quality-adjusted life-years (QALYs), costs (direct medical costs and costs outside the NHS), and incremental cost-effectiveness ratios (ICERs). RESULTS Compared with LRP, RARP cost £1785 (US $2350) less and had 0.24 more QALYs gained; thus, RARP was a dominant option compared with LRP. Compared with ORP, RARP had 0.12 more QALYs gained but cost £526 (US $693) more during the 10-year time frame, resulting in an ICER of £4293 (US $5653)/QALY. Because the ICER was below the £30 000 (US $39 503) willingness-to-pay threshold, RARP was more cost-effective than ORP in the UK. The most sensitive variable influencing the cost-effectiveness of RARP was the lower risk of biochemical recurrence (BCR). Scenario analysis indicated RARP would remain more cost-effective than ORP as long as the BCR hazard ratios comparing RARP vs ORP were less than 0.99. CONCLUSIONS AND RELEVANCE These findings suggest that in the UK, RARP has an ICER lower than the willingness-to-pay threshold and thus is likely a cost-effective surgical treatment option for patients with localized prostate cancer compared with ORP and LRP. The results were mainly driven by the lower risk of BCR for RARP. These findings may differ in other health care settings where different thresholds and costs may apply.
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Affiliation(s)
- Muhieddine Labban
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Prokar Dasgupta
- MRC (Medical Research Council) Centre for Transplantation, Guy’s Hospital Campus, King’s College London, King’s Health Partners, London, United Kingdom
| | - Chao Song
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Atlanta, Georgia
| | | | - Yanli Li
- Global Health Economics and Outcome Research, Intuitive Surgical Inc, Sunnyvale, California
| | - Usha Seshadri Kreaden
- Biostatistics & Global Evidence Management, Intuitive Surgical Inc, Sunnyvale, California
| | - Quoc-Dien Trinh
- Division of Urological Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
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7
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Gülkesen KH, Bora F, Ilhanli N, Avsar E, Zayim N. Cohen's d and physicians' opinion on effect size: a questionnaire on anemia treatment. J Investig Med 2021; 70:814-819. [PMID: 34740945 DOI: 10.1136/jim-2021-002031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 11/03/2022]
Abstract
A well-known effect size (ES) indicator is Cohen's d. Cohen defined d measures of small, medium, and large ES as 0.2, 0.5, and 0.8, respectively. This approach has been criticized because practical and clinical importance depends on the context of research. The aim of the study was to examine physicians' perception of ES using iron deficiency anemia treatment as an example and observing the effects of pretreatment level and duration of treatment on the magnitude of ES. We prepared a questionnaire describing four different clinical studies: (1) 1 month of treatment of anemia in a group of patients with a mean hemoglobin (Hb) of 10 g/dL; (2) 3 months of treatment at an Hb level of 10 g/dL; (3) 1 month of treatment at an Hb level of 8 g/dL; and (4) 3 months of treatment at an Hb level of 8 g/dL. In each scenario, respondents were required to evaluate six various levels of Hb improvement as being very small, small, medium, large, or very large effect: 0.1 g/dL, 0.3 g/dL, 0.7 g/dL, 1.1 g/dL, 1.7 g/dL, and 2.8 g/dL. The responses of 35 physicians were evaluated. For 10 mg/dL, the Cohen's d for small, medium, and large ES was 0.5, 0.8, and 1.2 respectively, for 1 month of treatment. In terms of 3 months of treatment, the Cohen's d was 0.8, 1.2, and 2, respectively. Two separate pretreatment Hb levels (8 g/dL and 10 g/dL) demonstrated a minor difference. Determination of ES during the planning phase of studies requires thorough evaluation of specific clinical cases. Our results are divergent from the classic Cohen's d values. Additionally, duration of treatment affects ES perception.
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Affiliation(s)
- Kemal Hakan Gülkesen
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
| | - Feyza Bora
- Division of Nephrology, Akdeniz University, Antalya, Turkey
| | - Nevruz Ilhanli
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
| | - Esin Avsar
- Division of Internal Medicine, Akdeniz University, Antalya, Turkey
| | - Nese Zayim
- Department of Biostatistics and Medical Informatics, Akdeniz University, Antalya, Turkey
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Tian JH, Mu LJ, Wang MY, Zeng J, Long QZ, Guan B, Wang W, Jiang YM, Bai XJ, Du YF. BUB1B Promotes Proliferation of Prostate Cancer via Transcriptional Regulation of MELK. Anticancer Agents Med Chem 2021; 20:1140-1146. [PMID: 31893996 DOI: 10.2174/1871520620666200101141934] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Prostate cancer remains one of the most common and deadliest forms of cancer, generally respond well to radical prostatectomy and associated interventions, up to 30% of individuals will suffer disease relapse. Although BUB1B was found to be essential for cell growth and proliferation, even in several kinds of tumor cells, the specific importance and mechanistic role of BUB1B in prostate cancer remain unclear. METHODS Quantitative Real-Time PCR and Western-blot were used in the detection of mRNA and protein expression. Lentivirus infection was used to overexpression or knock down the target gene. Flow cytometry analysis was performed to test protein expression and apoptosis level. Immunohistochemistry was used to identify protein expression in tissue. Statistical differences between the two groups are evaluated by two-tailed t-tests. The comparison among multiple groups is performed by one-way Analysis of Variance (ANOVA) followed by Dunnett's posttest. The statistical significance of the Kaplan-Meier survival plot is determined by log-rank analysis. RESULTS In the present report, we found BUB1B expression to be highly increased in prostate cancer tissues relative to normal controls. We further found BUB1B to be essential for efficient tumor cell proliferation, and to correlate with poorer prostate cancer patient outcomes. From a mechanistic perspective, the ability of BUB1B to regulate MELK was found to be essential for its ability to promote prostate cancer cell proliferation. CONCLUSION Altogether, our data suggest that BUB1B is up-regulated in prostate cancer, suggesting that the growth of cancer cells may depend on BUB1B-dependent regulation of MELK transcription. BUB1B may serve as a clinical prognostic factor and a druggable target for prostate cancer.
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Affiliation(s)
- Juan-Hua Tian
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Li-Jun Mu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Mei-Yu Wang
- Department of Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Jin Zeng
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Qing-Zhi Long
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Bin Guan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Wen Wang
- Department of Outpatient, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Yu-Mei Jiang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Xiao-Jing Bai
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
| | - Yue-Feng Du
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China
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9
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Faria EF, Maciel CVM, Berger A, Mitre A, Dauster B, Freitas CH, Fraga C, Chade D, Dall'Oglio M, Carvalho F, Campos F, Carvalhal GF, Lemos GC, Guimarães G, Zampolli H, Alves JR, Manzano JP, Fortes MA, Rocha MFH, Rubinstein M, Luz M, Romanelli P, Coelho R, Rocha R, Machado RD, Dos Reis RB, Zequi S, Guida R, Muglia V, Tobias-Machado M. Recommendations on robotic-assisted radical prostatectomy: a Brazilian experts' consensus. J Robot Surg 2021; 15:829-839. [PMID: 33426578 DOI: 10.1007/s11701-020-01186-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
Radical prostatectomy is a commonly adopted treatment for localized/locally advanced prostate cancer in men with a life expectancy of ten years or more. Robotic-assisted radical prostatectomy (RARP) is comparable to open radical prostatectomy on cancer control and complication rates; however, new evidence suggests that RARP may have better functional outcomes, especially with respect to urinary incontinence and erectile dysfunction. Some of the surgical steps of RARP are not adequately described in published literature and, as such, may have an impact on the final outcomes of the procedure. We organized a Brazilian experts' panel to evaluate best practices in RARP. The confection of the recommendations broadly involved: selection of the experts; establishment of working groups; systematic review of the literature and elaboration of a questionnaire; and construction of the final text with the approval of all participants. The participants reviewed the publications in English from December 2019 to February 2020. A one-round Delphi technique was employed in 188 questions. Five reviewers worked on the final recommendations using consensual and non-consensual questions. We found 59.9% of questions with greater than 70% agreement that were considered consensual. Non-consensual questions were reported according to the responses. The recommendations were based on evidence-based literature and individual perceptions adapted to the Brazilian reality, although some issues remain controversial. We believe that these recommendations may help urologists involved in RARP and hope that future discussions on this surgical procedure may evolve over the ensuing years.
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Affiliation(s)
| | | | - André Berger
- Hospital Moinhos de Vento, Porto Alegre , RS, Brazil
| | - Anuar Mitre
- University of São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Daher Chade
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
| | | | | | - Franz Campos
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, Brazil
| | | | | | | | | | | | | | | | | | | | - Murilo Luz
- Hospital Albert Einstein, São Paulo, SP, Brazil
| | | | - Rafael Coelho
- Instituto Cancer de São Paulo, São Paulo, SP, Brazil
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10
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Feng LF, Yan PJ, Chu XJ, Zhang N, Li JY, Li JW, Guo KL, Lu CC, Li MX, Guo TK, Liu XR, Yang KH. A scientometric study of the top 100 most-cited publications based on Web-of-Science regarding robotic versus laparoscopic surgery. Asian J Surg 2020; 44:440-451. [PMID: 33288372 DOI: 10.1016/j.asjsur.2020.10.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/17/2020] [Accepted: 10/25/2020] [Indexed: 12/18/2022] Open
Abstract
Minimally invasive surgery includes traditional laparoscopic and robot-assisted surgery. Although many studies related to robotic surgery and laparoscopic surgery have been published, when doing our search, scientometric studies that focus on related robotic surgery versus laparoscopic surgery were limited. In this study, we aimed to analyze and review the research hots and research status of robotic surgery versus laparoscopic surgery. We searched publications that involved robotic surgery versus laparoscopic surgery in the Web of Science database from 1980 to May 23, 2020. The top 100 publications were published in 2012 with the number of 17 and citations ranged from 618 to 64. Published across 34 different journals, namely European urology (n = 17) and others, the greatest contribution among 36 institutes was made by the Cleveland Clinic (n = 11). Of the top 100 publications, a total of 429 unique words were identified and the most frequently occurring keyword was laparoscopy (n = 33). The co-occurrence of keywords in the top 100 publications indicated that the study of diseases mainly focused on prostatectomy, complications, prostate cancer, retropubic prostatectomy, nephron-sparing surgery, lymph-node dissection, total mesenteric excision, sexual function, rectal cancer, and assisted distal gastrectomy. In recent years, comparative research on robot and laparoscopic surgery has decreased and most studies focus on cancer.
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Affiliation(s)
- Lu-Fang Feng
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Pei-Jing Yan
- Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610044, China
| | - Xia-Jing Chu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Na Zhang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Jie-Yun Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Jing-Wen Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Kang-Le Guo
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Cun-Cun Lu
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Mei-Xuan Li
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China
| | - Tian-Kang Guo
- General Surgery Clinical Medical Center, Gansu Provincial Hospital, Lanzhou, 730000, China.
| | - Xing-Rong Liu
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China.
| | - Ke-Hu Yang
- Evidence Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, 730000, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, 730000, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, 730000, China.
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11
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Vuolukka K, Auvinen P, Tiainen E, Palmgren JE, Heikkilä J, Seppälä J, Aaltomaa S, Kataja V. Stereotactic body radiotherapy for localized prostate cancer - 5-year efficacy results. Radiat Oncol 2020; 15:173. [PMID: 32664981 PMCID: PMC7362647 DOI: 10.1186/s13014-020-01608-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/30/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The use of stereotactic body radiotherapy (SBRT) as the primary treatment modality in clinically localized prostate cancer (PCa) is emerging. The aim of the study was to analyze the long-term results of PCa patients treated with SBRT. METHODS This non-selected, real-life patient cohort included 213 patients with localized PCa treated with a robotic SBRT device during 2012-2015. RESULTS The median follow-up was 64 months (range, 10-85 months), and all risk-groups were represented as 47 (22.1%), 56 (26.3%) and 110 (51.6%) patients were classified into D'Amico risk stratification of low, intermediate and high-risk groups, respectively. Androgen deprivation therapy (ADT) was administered to 64.3% of the patients. At cut-off, the biochemical relapse-free survival (bRFS) was 100, 87.5 and 80.0% for patients at low, intermediate and high-risk (p = 0.004), and 92.5, 84.2 and 66.7% for patients with Gleason score ≤ 6, 7 and ≥ 8, respectively (p = 0.001). The actuarial 5-year overall survival (OS) rates were 97.9, 96.4 and 88.6% in the low, intermediate and high-risk groups, respectively, and at the cut-off, the disease-specific survival (DSS) rate of the whole cohort was high (99.1%), as only two high-risk patients died due to PCa. CONCLUSION Our present results of SBRT delivered with CyberKnife produced excellent long-term bRFS, OS and DSS outcomes among patients with localized PCa. We conclude that SBRT provides an efficient and convenient treatment option for patients with localized PCa, irrespective of the risk-group.
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Affiliation(s)
- Kristiina Vuolukka
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland.
| | - Päivi Auvinen
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland.,University of Eastern Finland, Kuopio, Finland
| | | | - Jan-Erik Palmgren
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Janne Heikkilä
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Jan Seppälä
- Cancer Center, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Sirpa Aaltomaa
- Department of Urology, Kuopio University Hospital, PO Box 100, FI-70029, Kuopio, Finland
| | - Vesa Kataja
- University of Eastern Finland, Kuopio, Finland.,Central Finland Health Care District, Adm Bldg 6/2, FI-40620, Jyväskylä, Finland
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12
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İnkaya A, Tahra A, Sobay R, Kumcu A, Küçük EV, Boylu U. Comparison of surgical, oncological, and functional outcomes of robot-assisted and laparoscopic radical prostatectomy in patients with prostate cancer. Turk J Urol 2019; 45:410-417. [PMID: 31603415 DOI: 10.5152/tud.2019.48457] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/07/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To compare the oncological and functional outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP). MATERIAL AND METHODS We compared patients who underwent the RARP (n=778) and LRP (n=48) techniques for prostate cancer between January 2008 and July 2017 in our clinic. Patient demographics, preoperative and postoperative data, pathologic evaluation, continence, and potency rates were collected and analyzed retrospectively. RESULTS The preoperative and demographic data of the patients we included in our study were similar. The mean operation time estimated blood loss, length of hospitalization, and catheterization time were significantly shorter in the RARP group. The statistical analysis was in favor of robotic prostatectomy in the terms of the mean length of hospitalization, catheterization time, and early (<30 days) and intermediate (31-90 days) complications. Positive surgical margins and biochemical recurrence rates, and recovery of continence and erectile function, were similar in both groups. CONCLUSION RARP and LRP in organ-confined prostate cancer are safe and effective methods. Robotic prostatectomy has a shorter operative time, length of hospitalization, catheterization time, and lower early and late complication rates.
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Affiliation(s)
- Abdurrahman İnkaya
- Department of Urology, Health Sciences University, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Ahmet Tahra
- Department of Urology, Health Sciences University, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Resul Sobay
- Department of Urology, Health Sciences University, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Ali Kumcu
- Department of Urology, Health Sciences University, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Eyüp Veli Küçük
- Department of Urology, Health Sciences University, Ümraniye Teaching Hospital, İstanbul, Turkey
| | - Uğur Boylu
- Department of Urology, Health Sciences University, Ümraniye Teaching Hospital, İstanbul, Turkey
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13
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Sirisopana K, Jenjitranant P, Sangkum P, Kijvikai K, Pacharatakul S, Leenanupun C, Kochakarn W, Kongchareonsombat W. Perioperative outcomes of robotic-assisted laparoscopic radical prostatectomy, laparoscopic radical prostatectomy and open radical prostatectomy: 10 years of cases at Ramathibodi Hospital. Transl Androl Urol 2019; 8:467-475. [PMID: 31807424 DOI: 10.21037/tau.2019.09.03] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background This study aims to compare the perioperative and pathological outcomes of open radical prostatectomy (ORP), laparoscopic radical prostatectomy (LRP), and robotic-assisted laparoscopic radical prostatectomy (RALRP) at Ramathibodi Hospital within Mahidol University in Thailand. Methods From January 2008 to July 2017, 679 RPs were performed. Patients' data were collected retrospectively to evaluate their perioperative and pathological outcomes. This data included the age, body mass index (BMI), serum prostate specific antigen (PSA) level, clinical stage, Gleason score (GS) from biopsy, operative time, estimated blood loss (EBL), perioperative complications, blood transfusion rate, adjacent organ injury rate, length of hospital stay, pathological stage, GS of the biopsy specimen, specimen weight (g), and marginal status of the patients. Results Of the 679 RPs performed, 128 (19.28%) were ORPs, 241 (36.30%) were LRPs, and 295 (44.43%) were RALRPs. Patients who underwent a RALRP had a significant advantage in EBL (1,600, 500, and 300 mL for ORPs, LRPs, and RALRPs, respectively), overall complications, and blood transfusion rate. As they are minimally invasive techniques, LRP and RALRP presented an advantage in terms of the length of hospital stay (an average of 9, 6, and 6 days for ORPs, LRPs, and RALRPs, respectively) and adjacent organ injury rate. ORPs also had the shortest operative time (160, 210, and 200 min for ORPs, LRPs, and RALRPs, respectively). However, the specimen weight and marginal status were similar in all of the techniques. Conclusions Minimally invasive RP techniques, such as LRPs and RALRPs, appear to be safe, have significantly better perioperative outcomes than ORPs, and have comparable pathological outcomes to those of ORPs.
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Affiliation(s)
- Kun Sirisopana
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pocharapong Jenjitranant
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Premsant Sangkum
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kittinut Kijvikai
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suthep Pacharatakul
- Division of Urology, Department of Surgery, Police Hospital, Bangkok, Thailand
| | - Charoen Leenanupun
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wachira Kochakarn
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wisoot Kongchareonsombat
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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14
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Long-term costs and survival of prostate cancer: a population-based study. Int Urol Nephrol 2017; 49:1707-1714. [PMID: 28762117 DOI: 10.1007/s11255-017-1669-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 07/24/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE There is a rising interest in measuring the societal burden of malignancies including prostate cancer. However, population-based studies reporting incidence costs of prostate cancer in the long term are lacking in Europe. The objectives of the study are to analyse the long-term costs and survival of prostate cancer patients treated by radical prostatectomy (RP) or conservative management (nRP). METHODS A retrospective claims data analysis of the National Health Insurance Found Administration of Hungary between 01.01.2002 and 31.10.2013 was carried out. Annual incidence costs related to prostate cancer and overall survival were calculated for a cohort of patients diagnosed between 2002 and 2005. RESULTS Altogether 17,642 patients were selected; 2185 (12%) of them have undergone RP. The annual incidence rate ranged between 4177 and 4736 cases. Mean age of RP and nRP patients was 59.4 (SD 5.9) and 71.0 (8.4) years, respectively. The mean survival time of the RP patients was significantly longer compared to nRP patients both in the total sample (11.2 vs. 7.4 years; p < 0.001) and in the subgroup <70 years (11.3 vs. 8.8 years; p < 0.001). At the end of the 12-year follow-up, RP patients had a higher (0.83 vs. 0.68), while nRP patients had a slightly lower (0.35 vs. 38) probability of being alive compared with the age-matched general male population. The long-term cumulative costs of the RP and nRP patients amounted to €4448 and €8616. The main driver of the cost difference was the high drug costs in the nRP group. CONCLUSIONS To our knowledge, this study applied the longest time-window in reporting population-based incidence costs in Europe. We found that not only RP patients lived longer but they had significantly lower total long-term costs than nRP patients. Therefore, radical prostatectomy is a cost-effective strategy in prostate cancer.
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