1
|
Wakamiya T, Kohjimoto Y, Yamashita S, Hara I. Local extension findings on MRI compensate for the ability of pathological staging to predict oncological outcome. Int J Clin Oncol 2024:10.1007/s10147-024-02621-0. [PMID: 39251476 DOI: 10.1007/s10147-024-02621-0] [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: 02/27/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND We investigated whether local extension findings on preoperative MRI and excisional pathology are associated with positive surgical margin and biochemical recurrence after robot-assisted radical prostatectomy. METHODS We identified 704 of our patients that underwent robot-assisted radical prostatectomy between 2012 and 2020, and extracted the 326 patients who had preoperative MRI scans and a radiologist reading. These patients were classified into groups according to the presence of local extension on MRI and pathological findings: ≤ cT2pT2 (195 cases), ≤ cT2pT3 (55 cases), cT3pT2 (31 cases), and cT3pT3 (45 cases). We compared positive surgical margin and biochemical recurrence between them. RESULTS Median age was 69 years, positive surgical margin rate was 20.2%, and five-year biochemical recurrence rate was 20.3%. Of the 226 patients without local invasion on excisional pathology, those with local extension on MRI (cT3pT2) had relatively higher positive surgical margin rate (29.0% vs. 14.4%, p = 0.05) and significantly higher five-year biochemical recurrence rate (25.8% vs. 9.3%, p = 0.01) than those without local extension on MRI (≤ cT2pT2). Similarly, among the 100 patients with local extension on excisional pathology, those with cT3pT3 had relatively higher positive surgical margin (37.8% vs. 21.8%, p = 0.08) and significantly higher five-year biochemical recurrence (53.3% vs. 29.3%, p = 0.01) than those with ≤ cT2pT3. In multivariate analysis, local extension on MRI was an independent predictor of biochemical recurrence (OR 2.1, 95%CI 1.1-3.9, p = 0.01). CONCLUSIONS Local extension on MRI is a prognostic factor independent of pathological stage. The use of MRI may complement the prognostic value of excisional pathology of prostate cancer.
Collapse
Affiliation(s)
- Takahito Wakamiya
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan.
| | - Yasuo Kohjimoto
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Shimpei Yamashita
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| | - Isao Hara
- Department of Urology, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan
| |
Collapse
|
2
|
Ishikawa Y, Suzuki M, Seto I, Takagawa Y, Murakami M. Long-Term Control With Proton Beam Therapy for Recurrent Prostate Cancer in the Right Perineum Following Intensity-Modulated Radiation Therapy: A Case Report. Cureus 2024; 16:e58386. [PMID: 38633140 PMCID: PMC11022003 DOI: 10.7759/cureus.58386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/19/2024] Open
Abstract
Radiation therapy (RT) is commonly used for the treatment of prostate cancer, with intensity-modulated radiation therapy (IMRT) and proton beam therapy (PBT) being the utilized modalities. This case report outlines the treatment course of a recurrent prostate cancer lesion in the right perineal musculature managed with proton therapy following IMRT. A 64-year-old Japanese man, diagnosed with prostate cancer and categorized as high risk according to the National Comprehensive Cancer Network guidelines, underwent six months of androgen deprivation therapy, which included bicalutamide and degarelix acetate. Six months after completing 78 Gy in 39 fractions of IMRT, the patient reported perineal to anal pain. Laboratory tests showed an elevated serum prostate-specific antigen (PSA) level, and pelvic MRI showed a mass lesion in the right perineal musculature. Consequently, the patient was diagnosed with recurrent prostate cancer. Thereafter, the patient underwent eight cycles of systemic chemotherapy with docetaxel; however, his pain progressively worsened. Subsequently, the treatment was switched to 12 cycles of cabazitaxel, which led to gradual pain relief. The patient received PBT at 60 Gy relative biological effectiveness in 30 fractions for the recurrent lesion. Five years after PBT, pelvic MRI showed no mass lesions in the prostate or surrounding tissues. The PSA levels remained low, less than 0.008 ng/ml, and there were no apparent late complications.
Collapse
Affiliation(s)
- Yojiro Ishikawa
- Department of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Ichiro Seto
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Koriyama, JPN
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| |
Collapse
|
3
|
Fulcoli V, Bianco M, Sartor G, Agostini A, Costa G, Laurini L. Safety of robot-assisted radical prostatectomy in an Italian spoke hospital: Long-term oncologic and functional outcomes with median 11.3 years follow-up. Urologia 2022; 89:248-256. [PMID: 35139712 DOI: 10.1177/03915603221077595] [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: 11/16/2022]
Abstract
INTRODUCTION Robot-assisted radical prostatectomy (RARP) long-term oncologic outcomes were published in few studies. This paper provides a complete overview of RARP long-term oncologic and functional results produced in an Italian spoke hospital. METHODS From December 2004 to December 2010, 300 consecutive patients with prostate cancer were treated with extraperitoneal RARP. Biochemical recurrence-free survival (BCRFS), salvage therapy-free survival (STFS), prostate cancer specific survival (PCa-SS), and overall survival (OS) were estimated using the Kaplan-Meier analysis and log-rank test. Cox proportional hazard regression analysis was performed to identify predictors of BCR and ST. Crude rates of continence and potency recovery after surgery were reported. RESULTS Median follow-up was 135.6 months (IQR 20-184). At 15 years, BCR-FS, ST-FS, PCa-SS, and OS rates were 78% (95% CI 0.73-0.83), 85% (95% CI 0.81 -0.89), 98% (95% CI 0.97-100), and 89% (95% CI 0.84-0.94), respectively. On multivariate analysis, biopsy ISUP grade ⩾2, clinical stage ⩾pT3a, D'Amico high-risk patients subgroup, pathologic ISUP grade ⩾2, and multifocal/extensive positive margins were independent predictors of BCR. The same risk factors plus D'Amico intermediate risk patients subgroup were independent predictors of ST. After surgery, 280 (93.3%) and 93 (35.2%) patients experienced continence and potency recovery, respectively. The retrospective nature of the analysis and some selection biases represent the principal limitations of the study. CONCLUSION The results showed in the present study match those obtained in referral centers and this is an evidence against the general belief that best prostate cancer care in provided in high volume hospitals and against centralization. Adverse characteristics of the tumor remain the best predictors of BCR and ST.
Collapse
Affiliation(s)
- Vittorio Fulcoli
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy
| | - Marta Bianco
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy
| | | | - Andrea Agostini
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy
| | - Giuseppe Costa
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy.,Chief of Urologic Unit, Camposampiero Civil Hospital, Padua, Italy
| | - Lucio Laurini
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy.,Past Chief of Urologic Unit (Retired), Camposampiero Civil Hospital, Padua, Italy
| |
Collapse
|
4
|
Wei Y, Tang J, Yuan L, Su J, Zhang Y, Deng Z, Zhu C, Shen L, Wang N, Xu G, Yang Y, Zhu Q. Laparoendoscopic radical prostatectomy (LRP): stepwise transition from multi-site to single-site with the aid of the transurethral port. Int Urol Nephrol 2020; 53:249-255. [PMID: 32902797 DOI: 10.1007/s11255-020-02638-0] [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: 06/12/2020] [Accepted: 09/04/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To describe our initial experience with laparoendoscopic radical prostatectomy (LRP) and a stepwise transition towards transurethral assisted laparoendoscopic single-site RP (TU-LESS RP). PATIENTS AND METHODS From Jan. 2007 to Dec. 2016, 195 patients underwent RP, of which 89 patients were performed by LRP (Group A), 106 by TU-LESS RP (Group B). The peri-operative data were collected and analyzed. All data referring to patient demographics, surgery, pathology, and peri-operative outcomes were recorded. The cosmetic result was investigated by the Patient Scar Assessment Questionnaire (PSAQ). Analysis of variance or Chi squared test were adopted to analyze the data. RESULTS 195 procedures were completed successfully. The operation time (109.6 ± 31.9 vs. 151.5 ± 87.3, P = 0.025) and anastomosis time (10.1 ± 4.8 vs. 21.8 ± 9.9, P < 0.001) of Group B was significantly reduced compared with Group A. Estimated blood loss in Group B was significantly lower than that in Group A (95.9 ± 11.1 vs. 180.2 ± 99.7, P = 0.006). About perioperative complications, Group B was also less compared with Group A (1.9% vs. 7.9%, P = 0.047). As to the usage of postoperative analgesics, Group B apparently used less than that in Group A (6.6% vs. 62.9%, P < 0.001), which is consistent with the visual analogue scale (VAS) of the two groups (1.7 ± 1.3 vs. 7.8 ± 1.1, P < 0.001). Patients in Group B were significantly more satisfied with incision healing than in group A (74.9 ± 9.3 vs. 49.7 ± 5.8, P < 0.001). There was no significant difference both in BCR rate and time between Group B and Group A. In urination control, more patients in Group B did not have urinary incontinence 3 month after RP compared with Group A (81.1% vs. 67.4%, P = 0.028). CONCLUSIONS LESS RP is proved to be feasible for the proper patients, but it is difficult to popularized due to inconvenient operation. While by means of TU-LESS, operating difficulty can be significantly decreased. TU-LESS RP will be wildly accepted by surgeons and patients because of cosmetic satisfaction and quicker recovery.
Collapse
Affiliation(s)
- Yunfei Wei
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Jingyuan Tang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Lin Yuan
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Jian Su
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Yang Zhang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Zhonglei Deng
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Chen Zhu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Luming Shen
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Ninghong Wang
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Guojiang Xu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China
| | - Yong Yang
- Department of Pharmaceutical Analysis, China Pharmaceutical University, Nanjing, China
| | - Qingyi Zhu
- Department of Urology, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, No.155 Han Zhong Road, Nanjing, 210029, China.
| |
Collapse
|
5
|
Suh J, Jung JH, Jeong CW, Lee SE, Lee E, Ku JH, Kim HH, Kwak C. Long-term oncologic outcomes after radical prostatectomy in clinically localized prostate cancer: 10-year follow-up in Korea. Investig Clin Urol 2020; 61:269-276. [PMID: 32377602 PMCID: PMC7189112 DOI: 10.4111/icu.2020.61.3.269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/22/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose The clinical behavior of prostate cancer differs by race and ethnicity; however, data on the Korean population are scarce. We assessed the long-term oncologic outcomes of clinically localized prostate cancer after radical prostatectomy in Korean men. Materials and Methods We analyzed 786 clinically localized prostate cancer patients who underwent radical prostatectomy, from June 1993 to June 2008. Kaplan-Meier survival curve analysis and log-rank test were used to assess the oncologic outcomes. Results The mean age of the patients was 64.9±6.6 years. Pelvic lymph node dissection was performed in 373 patients. Pathologic T and N stage cancer with local advancement and invasion were detected by radical prostatectomy in 307 and 22 patients, respectively. In total, 38 patients who underwent adjuvant therapy were excluded from the analysis of progression after biochemical recurrence (BCR), which occurred in 261 men. In total, 219 patients underwent salvage treatment. Local recurrence and distant metastasis occurred in 109 and 42 patients, respectively; 36 patients experienced metastasis with local recurrence. Castration-resistant prostate cancer developed in 22 patients, and overall and disease-specific mortality was noted in 148 and 23 patients, respectively. The median duration from operation to BCR, BCR to metastasis, and metastasis to disease-specific death was 25, 40, and 22 months, respectively. Conclusions We demonstrated the long-term prognosis of localized prostate cancer after radical prostatectomy among Koreans. Our results differ from those reported in the Western literature, with a lower prevalence of distant metastasis and shorter time to metastasis after BCR.
Collapse
Affiliation(s)
- Jungyo Suh
- Hospital Medicine Center, Division of Urology, Seoul National University Hospital, Seoul, Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae Hyun Jung
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Seoul Leaders Urology Clinic, Seoul, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eunsik Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea.,Department of Urology, Seoul National University Hospital, Seoul, Korea
| |
Collapse
|
6
|
Kanehira M, Takata R, Ishii S, Ito A, Ikarashi D, Matsuura T, Kato Y, Obara W. Predictive factors for short-term biochemical recurrence-free survival after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients. Int J Clin Oncol 2019; 24:1099-1104. [PMID: 30972506 DOI: 10.1007/s10147-019-01445-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/04/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND We aimed to assess the short-term oncological outcomes of robot-assisted laparoscopic radical prostatectomy to determine the predictive factors associated with biochemical recurrence in high-risk prostate cancer patients. METHODS A total of 331 patients with localized prostate cancer underwent robot-assisted laparoscopic radical prostatectomy. Of them, 113 patients were diagnosed with high-risk prostate cancer according to the D'Amico risk group classification. We evaluated the association between pre- or postoperative predictive factors and biochemical recurrence using Cox regression analysis. RESULTS The 2-year biochemical recurrence-free survival rate was 65.0% in the high-risk group. On univariate analyses, PSA level > 20 ng/mL, Gleason pattern 5 component on biopsy, pathological stage T3 or higher, perineural invasion, and positive surgical margin were predictive factors for biochemical recurrence. On multivariate analysis, PSA level > 20 ng/mL, Gleason pattern 5 component on biopsy, perineural invasion, and positive surgical margin were identified as independent predictive factors. The 2-year biochemical recurrence-free survival rate was 36.5% for patients with PSA level > 20 ng/mL and/or Gleason pattern 5 component on biopsy. CONCLUSIONS PSA level > 20 ng/mL and/or presence of the Gleason pattern 5 component on biopsy are predictive factors for early biochemical recurrence after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients. We considered that these patients require a combined modality therapy to improve their prognosis.
Collapse
Affiliation(s)
- Mitsugu Kanehira
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | - Ryo Takata
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shuhei Ishii
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Akito Ito
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Daiki Ikarashi
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Tomohiko Matsuura
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yoichiro Kato
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Wataru Obara
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| |
Collapse
|
7
|
Bianchi L, Gandaglia G, Fossati N, Larcher A, Pultrone C, Turri F, Selli C, de Groote R, de Naeyer G, Borghesi M, Schiavina R, Brunocilla E, Briganti A, Montorsi F, Mottrie A. Oncologic outcomes in prostate cancer patients treated with robot-assisted radical prostatectomy: results from a single institution series with more than 10 years follow up. MINERVA UROL NEFROL 2018; 71:38-46. [PMID: 30547906 DOI: 10.23736/s0393-2249.18.03285-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) has gained increasing diffusion as standard of care in the surgical treatment of prostate cancer (PCa) patients, even in the absence of robust long-term oncologic comparative data. This article is a report of oncologic outcomes of RARP at more than 10 years follow-up. METHODS We retrospectively evaluated 173 consecutive PCa patients underwent RARP between 2002 and 2005 at a single European center with complete clinic and pathologic data and potential follow-up of at least 10 years. Kaplan-Meier analyses assessed biochemical recurrence free survival (BCR-FS), clinical recurrence free survival (CR-FS), cancer specific mortality free survival (CSM-FS), other causes mortality free survival (OCM-FS) in the overall population and CR-FS after stratification according to pathologic stage and Gleason score. Multi-variable Cox regression analyses were performed to assess the predictors of BCR and CR. RESULTS Median follow-up (Interquatile Range [IQR]) was 133 (123-145) months. The BCR-FS, CR-FS, CSM-FS and OCM-FS rates at median follow-up were 73.4%, 81.1%, 95.7%, and 68.6%, respectively. Patients staged as pT3b-T4 and men with Gleason score 8-10 experienced significantly lower CR-FS rates as compared to those with less aggressive pathologic features (all P≤0.001). At multivariable analysis, pathologic Gleason score 8-10 (Hazard Ratio [HR]: 2.85), pathologic stage pT3b-pT4 (HR: 2.76) and adjuvant therapy (HR: 2.09 for radiotherapy [RT] and HR: 13.66 for androgen deprivation therapy [ADT]) were independent predictors of BCR (all p≤0.02). While, pathologic Gleason score 8-10 (HR: 4.05) and pathologic stage pT3b-pT4 (HR: 6.78) were found to be independently related to higher risk of CR (all P≤0.03). Retrospective data and limited number of patients included could have affected our analyses. CONCLUSIONS In experienced centers, RARP allows optimal oncologic outcomes at long term follow-up. Adverse pathologic characteristics are independent predictors of BCR and CR.
Collapse
Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy - .,Department of Urology, OLV, Aalst, Belgium - .,ORSI Academy, Melle, Belgium -
| | - Giorgio Gandaglia
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristian Pultrone
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Filippo Turri
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Department of Urology, University of Pisa, Pisa, Italy
| | - Cesare Selli
- Department of Urology, University of Pisa, Pisa, Italy
| | | | | | - Marco Borghesi
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium
| |
Collapse
|
8
|
Wang YJ, Huang CY, Hou WH, Wang CC, Lan KH, Yu HJ, Lai MK, Liu SP, Pu YS, Cheng JCH. Dual-timing PSA as a biomarker for patients with salvage intensity modulated radiation therapy for biochemical failure after radical prostatectomy. Oncotarget 2018; 7:44224-44235. [PMID: 27317764 PMCID: PMC5190091 DOI: 10.18632/oncotarget.10000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/04/2016] [Indexed: 11/25/2022] Open
Abstract
We investigated the outcomes and the associated clinical-pathological factors in patients with prostate cancer (PCa) undergoing salvage intensity modulated radiation therapy (IMRT) for post-radical-prostatectomy (RP) biochemical failure. We report clinical outcomes of post-RP salvage IMRT, and describe chronic toxicity in these patients.Fifty patients with PCa underwent post-RP salvage IMRT. The median dose of IMRT was 70 Gy to the prostatic and seminal vesicle bed. Clinical-pathological and toxicity information were collected. The prostate cancer-specific survival (PCSS), disease-free survival (DFS), and biochemical-failure-free survival (BFFS) were calculated. Prognostic factors were analyzed for their association with disease control.The median follow-up time was 74 months. The 5-year PCSS, DFS, and BFFS after salvage IMRT were 95%, 88%, and 60%, respectively. Two patients (4%) experienced late gastrointestinal toxicity ≥ grade 3, and 5 patients (10%) had late genitourinary toxicity ≥ grade 3. On multivariate analysis, post-RP prostate-specific antigen (PSA) nadir ≤0.1 ng/ml (P=0.018) and PSA ≤0.5 ng/ml at salvage IMRT (P=0.016) were independent factors predicting better BFFS. Patients with both post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT had a 5-year BFFS of 83% as compared with 43% in other patients (P=0.001).In conclusion, with hormonal therapy in most PCa patients, the addition of salvage IMRT for post-RP biochemical failure can achieve a good outcome with low toxicity. Patients with a post-RP PSA nadir ≤0.1 ng/ml and PSA ≤0.5 ng/ml at salvage IMRT could benefit the most from salvage IMRT.
Collapse
Affiliation(s)
- Yu-Jen Wang
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chao-Yuan Huang
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Wei-Hsien Hou
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Chia-Chun Wang
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Keng-Hsueh Lan
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Hong-Jen Yu
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Ming-Kuen Lai
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Shihh-Ping Liu
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yeong-Shau Pu
- Department of Urology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Jason Chia-Hsien Cheng
- Division of Radiation Oncology, Department of Oncology, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
9
|
Sachdeva A, Veeratterapillay R, Voysey A, Kelly K, Johnson MI, Aning J, Soomro NA. Positive surgical margins and biochemical recurrence following minimally-invasive radical prostatectomy - An analysis of outcomes from a UK tertiary referral centre. BMC Urol 2017; 17:91. [PMID: 28969608 PMCID: PMC5625596 DOI: 10.1186/s12894-017-0262-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 08/24/2017] [Indexed: 12/05/2022] Open
Abstract
Background Positive surgical margins are a strong prognostic marker of disease outcome following radical prostatectomy, though prior evidence is largely from a PSA-screened population. We therefore aim to evaluate the biochemical recurrence in men with positive surgical margins (PSM) after minimally-invasive radical prostatectomy (MIRP) in a UK tertiary centre. Methods Retrospective study of men undergoing laparoscopic or robotic-assisted radical prostatectomy between 2002 and 2014. Men with positive surgical margins (PSM) were identified and their biochemical recurrence (BCR) rate compared with men without PSM. The primary outcome measures were BCR rates and time to BCR. Cox regression was used to estimate adjusted hazard ratios for biochemical recurrence rate (BCR), accounting for potential confounders. Results Five hundred ninety-two men were included for analysis. Pre-operative D’Amico risk stratification showed 37.5%, 53.3% and 9.3% of patients in the low, intermediate and high-risk groups, respectively. On final pathological analysis, the proportion of patients with local staging pT2, pT3a and pT3b was 68.8%, 25.2% and 6.1% respectively. Overall positive margin rate was 30.6%. On multivariate analysis, the only pre-operative factor associated with PSM was age >65years. Patients with PSM were more likely to have higher tumour volume and more advanced pathological local stage. The BCR rate was 10.7% in margin-positive patients and 5.1% in margin-negative patients, at median 4.4-year follow-up. Upon multivariate analysis, high pre-operative PSA and high Gleason group were the only significant predictors of BCR (P<0.05). Conclusions In comparison to patients with negative surgical margins, those with PSM do not translate into worse medium-term oncological outcomes in the majority of cases amongst our cohort. We found that high pre-operative PSA and high Gleason group were the only significant predictors of BCR. Electronic supplementary material The online version of this article (10.1186/s12894-017-0262-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Ashwin Sachdeva
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK.,Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK
| | - Rajan Veeratterapillay
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Antonia Voysey
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Katherine Kelly
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Mark I Johnson
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Jonathan Aning
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Naeem A Soomro
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK. .,Northern Institute for Cancer Research, Newcastle University, Newcastle-upon-Tyne, UK.
| |
Collapse
|
10
|
Moon A, Vasdev N, Veeratterapillay R, O'riordan A, Durkan G, Johnson M, Soomro NA. Oncological outcomes in low-, intermediate- and high D'Amico-risk patients undergoing laparoscopic radical prostatectomy at a single UK centre. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415813489553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background and purpose Laparoscopic radical prostatectomy (LRP) is an established treatment option for patients with prostate cancer in selected centres with appropriate expertise. The goal of LRP is to achieve excellent cancer control whilst attempting to preserve normal urinary continence and erectile function. We studied our single-centre experience evaluating the oncological outcomes in patients undergoing LRP. Patients and methods Three hundred and six patients underwent LRP between 2005 and 2011. Patients were divided into D'Amico low-, intermediate- and high-risk groups. Results The mean age was 61.9 years (range 46-74 years). The two most important factors predictive of positive surgical margins (PSMs) at LRP were the initial prostate-specific antigen (PSA) level and tumour stage at diagnosis. The overall PSM rate was 26.7%. For low D'Amico-risk patients, the PSM was 24.5%, intermediate-risk patients had a PSM of 32.4%, while high-risk patients had a PSM of 13.6%; 6.4% (nine of 139) of patients sampled had evidence of lymph node-positive disease. Five-year PSA progression-free survival rates were 83% in low-risk patients, 57% in intermediate-risk and 41% in high-risk patients. Conclusion LRP offers good oncological outcomes in the low- and intermediate-risk groups with low incidence of biochemical recurrence for patients with localised disease. Our high-risk group has a low incidence of PSM and a five-year PSA progression-free survival rate of 41%. Patients with high-risk, but non-metastatic, prostate cancer can be offered a minimally invasive prostatectomy in an experienced centre.
Collapse
|
11
|
Abdel Raheem A, Kim DK, Santok GD, Alabdulaali I, Chung BH, Choi YD, Rha KH. Stratified analysis of 800 Asian patients after robot-assisted radical prostatectomy with a median 64 months of follow up. Int J Urol 2016; 23:765-74. [DOI: 10.1111/iju.13151] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/22/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Ali Abdel Raheem
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
- Department of Urology; Tanta University Medical School; Tanta Egypt
| | - Dae Keun Kim
- Department of Urology; CHA Seoul Station Medical Center; CHA University Medical School; Seoul Korea
| | - Glen Denmer Santok
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Ibrahim Alabdulaali
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Byung Ha Chung
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Koon Ho Rha
- Department of Urology and Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| |
Collapse
|
12
|
Tyson MD, Penson DF, Resnick MJ. The comparative oncologic effectiveness of available management strategies for clinically localized prostate cancer. Urol Oncol 2016; 35:51-58. [PMID: 27133953 DOI: 10.1016/j.urolonc.2016.03.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 03/22/2016] [Accepted: 03/28/2016] [Indexed: 11/19/2022]
Abstract
The primary goal of modern prostate cancer treatment paradigms is to optimize the balance of predicted benefits associated with prostate cancer treatment against the predicted harms of therapy. However, given the limitations in the existing evidence as well as the significant tradeoffs posed by each treatment, there remain myriad challenges associated with individualized prostate cancer treatment decision-making. In this review, we summarize the existing comparative effectiveness evidence of treatments for localized prostate cancer with an emphasis on oncologic control. While we focus on the major treatment categories of radical prostatectomy, radiation therapy, and observation, we also provide a review of emerging therapies such as cryotherapy and high-intensity frequency ultrasound (HIFU).
Collapse
Affiliation(s)
- Mark D Tyson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
| | - David F Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Geriatric, Research, and Educational Center, Veterans Affairs Tennessee Valley Health Care System, Nashville, TN
| | - Matthew J Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN; Geriatric, Research, and Educational Center, Veterans Affairs Tennessee Valley Health Care System, Nashville, TN
| |
Collapse
|
13
|
Intermediate-term cancer control outcomes in prostate cancer patients treated with robotic-assisted laparoscopic radical prostatectomy: a multi-institutional analysis. World J Urol 2016; 34:1357-66. [PMID: 26873596 DOI: 10.1007/s00345-016-1781-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 02/02/2016] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Cancer control outcomes following robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) remain inadequately addressed over intermediate-term (≥5-year) follow-up. We examined biochemical recurrence-free survival (BCRFS), clinical recurrence-free survival (CRFS), and cancer-specific survival (CSS) in a multi-institutional cohort of men undergoing RARP for localized PCa. MATERIALS AND METHODS A total of 5670 PCa patients undergoing RARP ± pelvic lymph node dissection as primary treatment modality at three tertiary care centers between 2001 and 2010 were analyzed. BCRFS, CRFS, and CSS were estimated using the Kaplan-Meier method. Cox proportional hazards model tested their association with available preoperative and postoperative parameters. RESULTS 43.6 and 15.1 % of patients had D'Amico intermediate- and high-risk disease, respectively. Over a mean (median) follow-up of 56 (50.4) months, 797 men had a BCR, 78 men had CR, and 32 men died of PCa. Actuarial BCRFS, CRFS, and CSS, respectively, were 83.3, 98.6, and 99.5 % at 5-year; 76.5, 97.5, and 98.7 % at 8-year; and 73.3, 96.7, and 98.4 % at 10-year follow-ups. Only 1.7 % of patients received any adjuvant treatment. Preoperative prostate-specific antigen (PSA) and biopsy Gleason score (GS) were independent clinical predictors of BCRFS, CRFS, and CSS, while postoperatively positive surgical margin, pathological GS, pathological stage, and lymph node invasion were significantly associated with BCR and CR (all p < 0.05). CONCLUSIONS Cancer control outcomes of RARP appear comparable to those reported for open and laparoscopic RP in previous literature, despite low overall rate of adjuvant treatment. Disease severity and preoperative PSA may aid in risk prognostication and defining postoperative follow-up protocols.
Collapse
|
14
|
Long-Term Oncologic Outcome of an Initial Series of Laparoscopic Radical Prostatectomy for Clinically Localized Prostate Cancer After a Median Follow-up of 10 Years. Clin Genitourin Cancer 2015; 14:290-7. [PMID: 26710661 DOI: 10.1016/j.clgc.2015.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/22/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION When laparoscopic radical prostatectomy (LRP) was introduced as a novel treatment option for prostate cancer, it had to compete with the established open techniques. The short- and intermediate-term oncologic and functional outcomes were encouraging and comparable to those with retropubic radical prostatectomy. However, the long-term oncologic safety for LRP has yet to be fully elucidated. We evaluated the long-term oncologic outcomes of an initial series of patients who had undergone LRP. PATIENTS AND METHODS An initial unselected and consecutive series of 100 patients who had undergone LRP for clinically localized prostate cancer from 1999 to 2001 was identified. The pre-, intra-, and postoperative data were collected. Biochemical recurrence (BCR) was defined as a prostate-specific antigen (PSA) value of ≥ 0.2 ng/mL. The outcome measures were cancer control (CC), BCR-free survival (BCRFS), cancer-specific survival (CSS), and overall survival (OS). RESULTS The mean patient age was 64 ± 7 years, and the mean preoperative PSA level was 9.6 ± 8.3 ng/mL. Of the 100 patients, 79 (79%) had stage pT2 and 15 (15%) had stage pT3 disease. Positive surgical margins were found in 25 patients (25%; 16.4% for pT2 and 40% for pT3). The median follow-up time was 126 months (range, 60-176 months). The 5-year CC rate was 82%. The estimated 10-year BCRFS was 83% and 80% for patients with stage pT2 and pT3 tumors, respectively. The median time to BCR was 52 months (range, 6-144 months). The estimated 10-year CSS and OS was 98% and 93%, respectively. CONCLUSION Our long-term follow-up data from an initial unselected patient cohort have indicated that LRP offers excellent long-term oncologic control for patients with localized prostate cancer.
Collapse
|
15
|
Hu XH, Cammann H, Meyer HA, Jung K, Lu HB, Leva N, Magheli A, Stephan C, Busch J. Risk prediction models for biochemical recurrence after radical prostatectomy using prostate-specific antigen and Gleason score. Asian J Androl 2015; 16:897-901. [PMID: 25130472 PMCID: PMC4236336 DOI: 10.4103/1008-682x.129940] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Many computer models for predicting the risk of prostate cancer have been developed including for prediction of biochemical recurrence (BCR). However, models for individual BCR free probability at individual time-points after a BCR free period are rare. Follow-up data from 1656 patients who underwent laparoscopic radical prostatectomy (LRP) were used to develop an artificial neural network (ANN) to predict BCR and to compare it with a logistic regression (LR) model using clinical and pathologic parameters, prostate-specific antigen (PSA), margin status (R0/1), pathological stage (pT), and Gleason Score (GS). For individual BCR prediction at any given time after operation, additional ANN, and LR models were calculated every 6 months for up to 7.5 years of follow-up. The areas under the receiver operating characteristic (ROC) curve (AUC) for the ANN (0.754) and LR models (0.755) calculated immediately following LRP, were larger than that for GS (AUC: 0.715; P = 0.0015 and 0.001), pT or PSA (AUC: 0.619; P always <0.0001) alone. The GS predicted the BCR better than PSA (P = 0.0001), but there was no difference between the ANN and LR models (P = 0.39). Our ANN and LR models predicted individual BCR risk from radical prostatectomy for up to 10 years postoperative. ANN and LR models equally and significantly improved the prediction of BCR compared with PSA and GS alone. When the GS and ANN output values are combined, a more accurate BCR prediction is possible, especially in high-risk patients with GS ≥7.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Jonas Busch
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany,
| |
Collapse
|
16
|
Soares R, Di Benedetto A, Dovey Z, Bott S, McGregor RG, Eden CG. Minimum 5-year follow-up of 1138 consecutive laparoscopic radical prostatectomies. BJU Int 2015; 115:546-53. [PMID: 25098710 DOI: 10.1111/bju.12887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the long-term outcomes of laparoscopic radical prostatectomy (LRP). PATIENTS AND METHODS In all, 1138 patients underwent LRP during a 163-month period from 2000 to 2008, of which 51.5%, 30.3% and 18.2% were categorised into D'Amico risk groups of low-, intermediate- and high-risk, respectively. All intermediate- and high-risk patients were staged by preoperative magnetic resonance imaging or computed tomography and isotope bone scanning, and had a pelvic lymph node dissection (PLND), which was extended after April 2008. The median (range) patient age was 62 (40-78) years; body mass index was 26 (19-44) kg/m(2) ; prostate-specific antigen level was 7.0 (1-50) ng/mL and Gleason score was 6 (6-10). Neurovascular bundle was preservation carried out in 55.3% (bilateral 45.5%; unilateral 9.8%) of patients. RESULTS The median (range) gland weight was 52 (14-214) g. The median (range) operating time was 177 (78-600) min and PLND was performed in 299 patients (26.3%), of which 54 (18.0%) were extended. The median (range) blood loss was 200 (10-1300) mL, postoperative hospital stay was 3 (2-14) nights and catheterisation time was 14 (1-35) days. The complication rate was 5.2%. The median (range) LN count was 12 (4-26), LN positivity was 0.8% and the median (range) LN involvement was 2 (1-2). There was margin positivity in 13.9% of patients and up-grading in 29.3% and down-grading in 5.3%. While 11.4% of patients had up-staging from T1/2 to T3 and 37.1% had down-staging from T3 to T2. One case (0.09%) was converted to open surgery and six patients were transfused (0.5%). At a mean (range) follow-up of 88.6 (60-120) months, 85.4% of patients were free of biochemical recurrence, 93.8% were continent and 76.6% of previously potent non-diabetic men aged <70 years were potent after bilateral nerve preservation. CONCLUSIONS The long-term results obtainable from LRP match or exceed those previously published in large contemporary open and robot-assisted surgical series.
Collapse
Affiliation(s)
- Ricardo Soares
- Department of Urology, Royal Surrey County Hospital, Guildford, Surrey, UK
| | | | | | | | | | | |
Collapse
|
17
|
Udwadia TE. Robotic surgery is ready for prime time in India: Against the motion. J Minim Access Surg 2015; 11:5-9. [PMID: 25598592 PMCID: PMC4290119 DOI: 10.4103/0972-9941.147655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 09/26/2014] [Indexed: 11/15/2022] Open
Abstract
The use of Robotic Surgery as a purported adjunct and aid to Minimal Access Surgery (MAS) is growing in several areas. The acknowledged advantages as also the obvious and hidden disadvantages of Robotic Surgery are highlighted. Survey of literature shows that while Robotic Surgery is “feasible” and the results are “comparable” there is no convincing evidence that it is any better than MAS or even open surgery in most areas. To move “Robotic Surgery is ready for prime time in India” with no less than two dozen robots, many sub-optimally utilized for a population of 1.2 billion seems untenable.
Collapse
Affiliation(s)
- Tehemton E Udwadia
- Department of Minimal Access Surgery, Hinduja Hospital, Veer Savarkar Road, Mumbai, Maharashtra, India
| |
Collapse
|
18
|
|
19
|
Sukumar S, Rogers CG, Trinh QD, Sammon J, Sood A, Stricker H, Peabody JO, Menon M, Diaz-Insua M. Oncological outcomes after robot-assisted radical prostatectomy: long-term follow-up in 4803 patients. BJU Int 2014; 114:824-31. [DOI: 10.1111/bju.12404] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Shyam Sukumar
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Craig G. Rogers
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Quoc Dien Trinh
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Jesse Sammon
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Akshay Sood
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Hans Stricker
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - James O. Peabody
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Mani Menon
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| | - Mireya Diaz-Insua
- Vattikuti Urology Institute; Henry Ford Health System; Detroit MI USA
| |
Collapse
|
20
|
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
|
21
|
Phase I/II trial of definitive carbon ion radiotherapy for prostate cancer: evaluation of shortening of treatment period to 3 weeks. Br J Cancer 2014; 110:2389-95. [PMID: 24722181 PMCID: PMC4021525 DOI: 10.1038/bjc.2014.191] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 03/04/2014] [Accepted: 03/15/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the feasibility of a new shortened 3-week treatment schedule of carbon ion radiotherapy (CIRT) for prostate cancer. METHODS Beginning in May 2010, patients with T1b-T3bN0M0, histologically proven prostate adenocarcinoma were enrolled in the phase II trial of CIRT. Patients received 51.6 GyE in 12 fractions over 3 weeks (protocol 1002). The primary end point was defined as the incidence of late adverse events that were evaluated based on the Common Terminology Criteria for Adverse Events version 4.0. Biochemical failure was determined using the Phoenix definition (nadir +2.0 ng ml(-1)). RESULTS Forty-six patients were enrolled, and all patients were included in the analysis. The number of low-, intermediate-, and high-risk patients was 12 (26%), 9 (20%), and 25 (54%), respectively. The median follow-up period of surviving patients was 32.3 months. Two patients had intercurrent death without recurrence, and the remaining 44 patients were alive at the time of this analysis. In the analysis of late toxicities, grade 1 (G1) rectal haemorrhage was observed in 3 (7%) patients. The incidence of G1 haematuria was observed in 6 (13%) patients, and G1 urinary frequency was observed in 17 (37%) patients. No ⩾G2 late toxicities were observed. In the analysis of acute toxicities, 2 (4%) patients showed G2 urinary frequency, and no other G2 acute toxicities were observed. CONCLUSIONS The new shortened CIRT schedule over 3 weeks was considered as feasible. The analysis of long-term outcome is warranted.
Collapse
|
22
|
Fortin I, Carrier JF, Beauchemin MC, Béliveau-Nadeau D, Delouya G, Taussky D. Using fiducial markers in the prostate bed in postprostatectomy external beam radiation therapy improves accuracy over surgical clips. Strahlenther Onkol 2014; 190:467-71. [PMID: 24557058 DOI: 10.1007/s00066-014-0631-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 12/09/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE The purpose of this work was to assess the stability of fiducial markers in the prostate bed and compared their use to surgical clips. PATIENTS AND METHODS In this study, 3-4 gold fiducial markers were transrectally implanted in the prostate bed of 14 patients. The stability of the fiducial markers position (fiducial markers fixity) over an EBRT course was assessed. Furthermore, the advantages of the fiducial markers compared to the surgical clips were assessed and the interobserver variation between the two technologies was compared. RESULTS The mean fiducial marker migration during a course of EBRT was small with 1.2 mm (SD ± 0.8 mm). Compared to fiducial markers, the matches with surgical clips were mismatched ≥ 2 mm in 68% of treatments. This discrepancy of > 2 mm was on average 3.7 ± 1.3 mm. There was less interobserver variability for matching of fiducial markers (0.8 ± 0.7 mm) than for surgical clips (2.0 ± 1.6 mm). CONCLUSION Fiducial markers showed less interobserver variability in matching and less variation in position than surgical clips. Fiducial markers could ultimately help in reducing treatment margins.
Collapse
Affiliation(s)
- I Fortin
- Département de Radio-Oncologie, Centre Hospitalier de l'Université de Montréal, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Hôpital Notre-Dame, Sherbrooke St. E., 1560, Montréal, Québec, Canada
| | | | | | | | | | | |
Collapse
|
23
|
Gao L, Yang L, Lv X, Bu S, Wan F, Qian S, Wei Q, Han P, Fan T. A systematic review and meta-analysis of comparative studies on the efficacy of extended pelvic lymph node dissection in patients with clinically localized prostatic carcinoma. J Cancer Res Clin Oncol 2013; 140:243-56. [DOI: 10.1007/s00432-013-1574-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Accepted: 12/16/2013] [Indexed: 10/25/2022]
|
24
|
Dickinson PD, Malik J, Mandall P, Swindell R, Bottomley D, Hoskin P, Logue JP, Wylie JP. Five-year outcomes after iodine-125 seed brachytherapy for low-risk prostate cancer at three cancer centres in the UK. BJU Int 2013; 113:748-53. [PMID: 24053230 DOI: 10.1111/bju.12358] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the outcomes of >1000 men with low-risk prostate cancer treated with low-dose-rate (LDR) brachytherapy at three large UK cancer centres. PATIENTS AND METHODS A total of 1038 patients with low-risk prostate cancer (prostate-specific antigen [PSA] ≤10 ng/mL, Gleason score 6, ≤T2b disease) were treated with LDR iodine 125 (I-125) brachytherapy between 2002 and 2007. Patients were treated at three UK centres. PSA and clinical follow-up was performed at each centre. Biochemical recurrence-free survival was reported for the cohort. RESULTS The median (range) PSA follow-up for the whole group was 5 years (4 months to 9 years). A total of 79 patients had biochemical failure, defined by a rise in PSA level: 16 patients fulfilled the ASTRO definition of biochemical failure, 25 patients fulfilled the Phoenix definition and 38 patients fulfilled both definitions. The 5-year biochemical relapse-free survival (bRFS) rate was 94.1% by the ASTRO definition and 94.2% by the Phoenix definition. The absence of neoadjuvant hormone therapy was predictive of inferior biochemical control as defined by the Phoenix definition (P = 0.033). CONCLUSIONS Our prospective multicentre series showed excellent bRFS with LDR I-125 brachytherapy for patients with low-risk prostate cancer. Further work is necessary to define the role of neoadjuvant androgen deprivation therapy in combination with brachytherapy.
Collapse
Affiliation(s)
- Peter D Dickinson
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | | | | | | | | | | | | | | |
Collapse
|
25
|
Tai HC, Lai MK, Huang CY, Wang SM, Huang KH, Chen CH, Chung SD, Chueh SCJ, Yu HJ, Pu YS. Laparoscopic radical prostatectomy monotherapy, a more aggressive yet less invasive option, is oncologically effective in selected men with high-risk prostate cancer having only one D'Amico risk factor: experience from an Asian tertiary referral center. J Endourol 2013; 28:165-71. [PMID: 23987245 DOI: 10.1089/end.2013.0118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To present oncologic results of laparoscopic radical prostatectomy (LRP) monotherapy for men with high-risk, localized prostate cancer, and to find factors associated with a good prognosis via surgery alone. PATIENTS AND METHODS Between 2002 and 2009, 241 men underwent LRP at an Asian tertiary referral center. Among them, we retrospectively identified 85 (35.3%) men who met the D'Amico's high-risk criteria: Prostate-specific antigen level >20 ng/mL, Gleason score of 8 to 10, or clinical stage ≥T2c. Perioperative parameters were analyzed against biochemical recurrence (BCR)-free survival. RESULTS At a median follow-up of 54 months, BCR developed in 28 (34.1%), with an actuarial BCR-free survival rate of 63.3% at 5 years. Pathologically, 37.6% of the men had organ-confined (OC) disease. Positive surgical margins (PSM) were identified in 49.4% of the patients. A favorable pathologic outcome, defined as OC(+)PSM(-), was observed in 24 patients and associated with a 5-year BCR-free survival rate of 87.0%, compared with 100%, 54.0%, and 46.4% in men with OC(+)PSM(+), OC(-)PSM(-) and OC(-)PSM(+) disease (log-rank, P=0.008). The overall positive lymph node rate was 14.1%. Men (65.9%) with only one D'Amico risk factor had a 5-year BCR-free survival rate of 76.9%, compared with 34.6% in men (34.1%) with ≥2 risk factors (log-rank, P<0.001). CONCLUSIONS Radical prostatectomy monotherapy performed laparoscopically or robotically appears to be an option for high-risk prostate cancer, especially in men with a single D'Amico risk factor. Men with ≥2 risk factors are more prone for BCR to develop after surgery and may need second-line therapy.
Collapse
Affiliation(s)
- Huai-Ching Tai
- 1 Department of Urology, National Taiwan University Hospital , Taipei, Taiwan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
26
|
McNeill SA, Good DW, Stewart GD, Stolzenburg JU. Five-year oncological outcomes of endoscopic extraperitoneal radical prostatectomy (EERPE) for prostate cancer: results from a medium-volume UK centre. BJU Int 2013; 113:449-57. [PMID: 23980640 DOI: 10.1111/bju.12260] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the 5-year oncological outcomes of endoscopic extraperitoneal radical prostatectomy (EERPE) from a medium-volume centre, thereby providing much needed data on outcomes from the UK. PATIENTS AND METHODS From January 2006 to January 2012, 575 patients underwent EERPE for localized prostate cancer, performed by a single surgeon who had completed a modular training programme. Follow-up was as per local hospital policy and data were collected in our prospective database. A retrospective review of patient demographics, prostate-specific antigen (PSA) levels, pathological T stages, Gleason scores, surgical margin status and biochemical recurrence (BCR) data was performed. BCR was defined as PSA >0.2 μg/L. RESULTS The mean (range) patient age was 62 (40.3-76.5) years and the mean (range) follow-up was 30 (12-72) months. The median (interquartile range [IQR]) operating time was 135 (120-170) min and the median (IQR) blood loss was 200 (100-250) mL. Of the 575 patients, 135 (23.5%) had positive surgical margins (PSMs). The PSM rate for pT2 disease was 66/406 patients (16.3%) and for pT3 disease it was 68/168 patients (40.5%). Overall BCR-free survival at 5-years was 81.5%. Multivariate Cox analysis showed that PSMs, Gleason score, D'Amico risk category and pT stage were independent predictors of BCR-free survival. CONCLUSIONS This assessment of the oncological results of EERPE, which included the surgical learning curve, shows that the adoption of EERPE after mentored fellowship training translates into mid-term oncological outcomes in line with those of retropubic/transperitoneal laparoscopic approaches and with large-volume centres worldwide which have pioneered laparoscopic radical prostatectomy. The study shows that EERPE in a medium-volume second generation laparoscopic centre (that introduced EERPE after adequate training in pioneering centres) produces results with good 5-year oncological outcomes, similar to those of other major series, for patients in the UK.
Collapse
Affiliation(s)
- S Alan McNeill
- Department of Urology, Western General Hospital, Edinburgh, UK
| | | | | | | |
Collapse
|
27
|
Good DW, Stewart GD, Zakikhani P, Yuen H, Riddick ACP, Bollina PR, O’Donnell M, Stolzenburg JU, McNeill SA. Midterm oncological outcome and clinicopathological characteristics of anterior prostate cancers treated by endoscopic extraperitoneal radical prostatectomy. World J Urol 2013; 32:393-8. [DOI: 10.1007/s00345-013-1114-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/04/2013] [Indexed: 11/29/2022] Open
|
28
|
The role of postoperative radiotherapy in prostate cancer patients. Contemp Oncol (Pozn) 2013; 17:413-20. [PMID: 24596529 PMCID: PMC3934022 DOI: 10.5114/wo.2013.37215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2012] [Revised: 03/20/2013] [Accepted: 05/08/2013] [Indexed: 11/17/2022] Open
Abstract
AIM OF THE STUDY The aim of the study was to evaluate the effectiveness of postoperative radiotherapy in prostate cancer patients with unfavorable prognostic factors. MATERIAL AND METHODS In the years 2002-2008, 121 consecutive prostate cancer patients underwent radical prostatectomy and postoperative radiotherapy. The median dose was 64 Gy (range: 60-72 Gy). Biochemical and clinical progression-free survival were estimated. Univariate and multivariate analyses were used to analyze clinicopathological variables associated with treatment failure. RESULTS The median follow-up was 27 months. Three-year bPFS was 72%. On univariate analysis it was influenced by: extracapsular tumor extension (60% vs. 75%, p = 0.0232), seminal vesicles invasion (52% vs. 85%, p = 0.00041), Gleason score ≥ 7 (65% vs. 86%, p = 0.044) and the use of hormonal therapy (50% vs. 80%, p = 0.0058). On multivariate analysis bPFS was associated with: TNM stage (HR = 3.19), postoperative hormonal therapy (HR = 2.6), total irradiation dose (HR = 0.82) and the maximum pretreatment level of prostate-specific antigen (PSA) (HR = 0.95). Three-year cPFS was 84%. On univariate analysis it was influenced by: preoperative PSA level > 10 ng/ml (75% vs. 90%, p = 0.04), vascular-nerve bundles involvement (63% vs. 88%, p = 0.0031), adjacent organs infiltration (50% vs. 85%, p = 0.018) and the use of postoperative hormonal therapy (62% vs. 90%, p = 0.02). On multivariate analysis cPFS was associated with: TNM stage (HR = 2.68), postoperative hormonal therapy (HR = 3.61) and total irradiation dose (HR = 0.78). CONCLUSIONS Postoperative radiotherapy in patients with unfavorable prognostic factors provides good biochemical and local control. Total irradiation dose and postoperative hormonal therapy are important treatment factors influencing prognosis.
Collapse
|
29
|
Hruza M, Bermejo JL, Flinspach B, Schulze M, Teber D, Rumpelt HJ, Rassweiler JJ. Long-term oncological outcomes after laparoscopic radical prostatectomy. BJU Int 2012; 111:271-80. [DOI: 10.1111/j.1464-410x.2012.11317.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Marcel Hruza
- Department of Urology; SLK-Kliniken; Heilbronn; Germany
| | | | | | | | - Dogu Teber
- Department of Urology; University of Heidelberg; Heidelberg
| | | | | |
Collapse
|
30
|
Vasdev N, Kass-Iliyya A, Patel A, Bedford G, O'Riordon A, Johnson MI, Durkan GC, Soomro NA. Developing a Laparoscopic Radical Prostatectomy Service: Defining the Learning Curve. J Endourol 2012; 26:903-10. [DOI: 10.1089/end.2011.0635] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nikhil Vasdev
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Antoine Kass-Iliyya
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Ameet Patel
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Geoff Bedford
- Department of Anaesthetics, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Anna O'Riordon
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Mark I. Johnson
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Garrett C. Durkan
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| | - Naeem A. Soomro
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
31
|
Gaztañaga M, Crook JM. Permanent seed brachytherapy for locally recurrent prostate cancer after radical prostatectomy: a case report and review of the literature. Brachytherapy 2012; 12:338-42. [PMID: 22748289 DOI: 10.1016/j.brachy.2012.04.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/19/2012] [Accepted: 04/20/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the management of a patient with locally recurrent prostate cancer in the prostate bed, 10 years after a radical prostatectomy. METHODS AND MATERIALS A 71-year-old man had a radical prostatectomy for a Gleason 7 clinical T2a carcinoma of the prostate in 2000. Final pathologic stage was pT3a pN0. Postoperatively his prostate-specific antigen was undetectable, but by 2008 it was 1.0ng/mL and in 2011 it reached to 1.43ng/mL. He was referred for consideration of salvage radiotherapy. Staging workup was negative but transrectal ultrasound revealed a 15cc recurrence in the prostate bed. A combination of external beam radiation therapy (4600/23/4.5 weeks to the pelvis) and a brachytherapy boost (115Gy) was selected for definitive management. Androgen ablation was not used. RESULTS The treatment was well tolerated. The brachytherapy boost was planned in a similar fashion to a de novo implant for an intact prostate. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. Acute toxicity was minimal. Six months after brachytherapy, the prostate-specific antigen had fallen from 1.43 to 0.05ng/mL. CONCLUSIONS Dose escalation with combined external beam and brachytherapy may be feasible if recurrent disease can be visualized using transrectal ultrasound and encompassed in an implanted volume. Although longer followup and a larger series of patients are required to demonstrate safety and efficacy, consideration should be given this approach.
Collapse
Affiliation(s)
- Miren Gaztañaga
- Department of Radiation Oncology, British Columbia Cancer Agency, Center for the Southern Interior, University of British Columbia, Kelowna, British Columbia, Canada
| | | |
Collapse
|
32
|
Busch J, Stephan C, Herold A, Erber B, Kempkensteffen C, Hinz S, Lein M, Weikert S, Miller K, Magheli A. Long-term oncological and continence outcomes after laparoscopic radical prostatectomy: a single-centre experience. BJU Int 2012; 110:E985-90. [DOI: 10.1111/j.1464-410x.2012.11279.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
33
|
Busch J, Stephan C, Klutzny A, Hinz S, Kempkensteffen C, Kilic E, Lein M, Weikert S, Miller K, Magheli A. Impact of positive surgical margins on oncological outcome following laparoscopic radical prostatectomy (LRP): long-term results. World J Urol 2012; 31:395-401. [DOI: 10.1007/s00345-012-0866-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Accepted: 03/28/2012] [Indexed: 11/30/2022] Open
|
34
|
Abstract
Anatomical radical prostatectomy was introduced in the early 1980s by Walsh and Donker. Elucidation of key anatomical structures led to a significant reduction in the morbidity of this procedure. The strive to achieve similar oncological and functional results to this gold standard open procedure but with further reduction of morbidity through a minimally invasive access led to the establishment of laparoscopic prostatectomy. However, this procedure is complex and difficult and is associated with a long learning curve. The technical advantages of robotically assisted surgery coupled with the intuitive handling of the device led to increased precision and shortening of the learning curve. These main advantages, together with a massive internet presence and aggressive marketing, have resulted in a rapid dissemination of robotic radical prostatectomy and an increasing patient demand. However, superiority of robotic radical prostatectomy in comparison to the other surgical therapeutic options has not yet been proven on a scientific basis. Currently robotic-assisted surgery is an established technique and future technical improvements will certainly further define its role in urological surgery. In the end this technical innovation will have to be balanced against the very high purchase and running costs, which remain the main limitation of this technology.
Collapse
Affiliation(s)
- R Gillitzer
- Urologische Klinik, Klinikum Darmstadt GmbH und Urologische Universitätsklinik, Johannes Gutenberg-Universität Mainz, Grafenstraße 9, 64283 Darmstadt, Deutschland.
| |
Collapse
|
35
|
Long-term Biochemical Recurrence Rates After Robot-assisted Radical Prostatectomy: Analysis of a Single-center Series of Patients With a Minimum Follow-up of 5 Years. Urology 2012; 79:133-8. [DOI: 10.1016/j.urology.2011.08.045] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Revised: 08/17/2011] [Accepted: 08/20/2011] [Indexed: 11/20/2022]
|
36
|
Boorjian SA, Eastham JA, Graefen M, Guillonneau B, Karnes RJ, Moul JW, Schaeffer EM, Stief C, Zorn KC. A critical analysis of the long-term impact of radical prostatectomy on cancer control and function outcomes. Eur Urol 2011; 61:664-75. [PMID: 22169079 DOI: 10.1016/j.eururo.2011.11.053] [Citation(s) in RCA: 167] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 11/28/2011] [Indexed: 01/24/2023]
Abstract
CONTEXT The optimal management strategy for men with newly diagnosed clinically localized prostate cancer remains a matter of debate. Numerous series have reported cancer control and quality-of-life (QoL) outcomes following treatment with radical prostatectomy (RP). OBJECTIVE Critically review published oncologic and functional outcomes after RP, and evaluate factors associated with these outcome measures. EVIDENCE ACQUISITION A review of the literature was performed using the Medline and Web of Sciences databases. Relevant reports published between 1980 and 2011 identified using the keywords prostate cancer, radical prostatectomy, prostate-specific antigen, biochemical recurrence, incontinence, and erectile dysfunction were reviewed and summarized. EVIDENCE SYNTHESIS Cancer control rates following RP largely depend on the definition of treatment efficacy. While up to 40% of men have been reported to experience postoperative biochemical recurrence on long-term follow-up, death from prostate cancer has been noted in <10% of men at 15 yr after surgery in contemporary series. For men with high-risk disease, surgery affords pathologic staging, thereby facilitating the selective application of secondary therapies, and has been associated with decreased mortality risk versus radiation in retrospective series. Reported functional outcomes after surgery, particularly urinary continence and erectile dysfunction, have varied greatly to date. These assessments have been limited by nonstandardized reporting methodology. The use of robot-assisted radical prostatectomy has increased in recent years, and while follow-up is thus far short, available data do not suggest the superiority of either approach in terms of functional or oncologic outcomes. CONCLUSIONS RP is associated with excellent long-term cancer control. Continued efforts to conduct prospective assessments of postoperative functional outcomes are necessary using validated QoL instruments. The importance of surgical approach will also require further study, incorporating comparative oncologic, functional, and economic data.
Collapse
Affiliation(s)
- Stephen A Boorjian
- Department of Urology, Mayo Medical School and Mayo Clinic, Rochester, MN 55905, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Oncologic outcomes of asian men with clinically localized prostate cancer after extraperitoneal laparoscopic radical prostatectomy: a single-institution experience. Prostate Cancer 2011; 2011:748616. [PMID: 22110998 PMCID: PMC3216056 DOI: 10.1155/2011/748616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 11/11/2010] [Indexed: 11/23/2022] Open
Abstract
Purpose. To evaluate the midterm oncologic results of extraperitoneal laparoscopic radical prostatectomy (EPLRP) for Asian men with localized prostate cancer. Methods. Between 2004 and 2009, 218 men underwent EPLRP at an Asian tertiary hospital. The mean preoperative prostate-specific antigen (PSA) was 15.5 ng/ml and mean Gleason score was 6.6. Stage distributions were cT1a-b in 21 cases, cT1c in 139, cT2 in 48 and cT3 in 10. Disease recurrence was defined as PSA ≥ 0.2 ng/mL in 2 consecutive measurements or initiation of secondary therapy.
Results. Postoperative pathological stage was pT2a-b in 33 patients, pT2cN0 in 10, pT3a in 27, pT3b in 36, pT4 in 9 and pN1 in 10. Positive surgical margins occurred in 14.6% and 48.6% for pT2 and pT3 diseases, respectively (P < .001). The overall PSA recurrence-free survival at 3 and 5 years was 82.1% and 74.5%. By the pathological stages, 3-year recurrence-free survival was 92.4% (pT2), 81.1% (pT3a), 62.6% (pT3b-4) and 55.6% (pN1), respectively (P < .001).
Conclusions. EPLRP is curative even for some locally advanced prostate cancers in a midterm follow-up. Even at an Asian center of low volume of radical prostatectomy EPLRP still provides oncologic outcomes similar to that of high volume centers.
Collapse
|
38
|
Prada PJ, González H, Fernández J, Jiménez I, Iglesias A, Romo I. Biochemical outcome after high-dose-rate intensity modulated brachytherapy with external beam radiotherapy: 12 years of experience. BJU Int 2011; 109:1787-93. [PMID: 21981583 DOI: 10.1111/j.1464-410x.2011.10632.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
UNLABELLED Study Type - Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Biochemical control from series in which radical prostatectomy is performed for patients with unfavorable prostate cancer and/or low dose external beam radiation therapy are given remains suboptimal. The treatment regimen of HDR brachytherapy and external beam radiotherapy is a safe and very effective treatment for patients with high risk localized prostate cancer with excellent biochemical control and low toxicity. OBJECTIVE • To investigate the long-term oncological outcome, during the PSA era, of patients with prostate cancer who were treated using high-dose-rate (HDR) brachy therapy (BT) combined with external beam radiation therapy (EBRT). PATIENTS AND METHODS • From June 1998 to April 2007, 313 patients with localized prostate cancer were treated with 46 Gy of EBRT to the pelvis with a HDR-BT boost. • The mean (median) follow-up was 71 (68) months. • Toxicity was reported according to the Common Toxicity Criteria for Adverse Event, V.4. RESULTS • The 10-year actuarial biochemical control was 100% for patients with no high-risk criteria, 88% for patients with two intermediate-risk criteria, 91% with one high-risk criterion and 79% for patients with two to three high-risk criteria (P= 0.004). • The 10-year cancer-specific survival was 97% (standard deviation ± 1%). • The multivariate Cox regression analyses identified, Gleason score and T stage as independent prognostic factors for biochemical failure. • Gleason score was the only factor to significantly affect distant metastases. • Grade ≥ 3 late toxicity was not detected. CONCLUSION • The 10-year results confirm the feasibility and effectiveness of EBRT with conformal HDR-BT boost for patients with localised prostate cancer.
Collapse
Affiliation(s)
- Pedro J Prada
- Department of Radiation Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain.
| | | | | | | | | | | |
Collapse
|
39
|
Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients. Asian J Androl 2011; 13:806-11. [PMID: 21909121 DOI: 10.1038/aja.2011.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Several techniques have been introduced to improve early postoperative continence. In this study, we evaluated the impact of bladder neck (vesicourethral anastomosis) suspension on the outcome of extraperitoneal endoscopic radical prostatectomy (EERPE). In this research, a total of 180 patients underwent EERPE. Group 1 included patients who underwent nerve-sparing EERPE (nsEERPE) (n=45), and Group 2 included patients who underwent nsEERPE with bladder neck suspension (BNS, n=45). Groups 3 (n=45) and 4 (n=45) included patients who received EERPE and EERPE with BNS, respectively. Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure. Perioperative parameters were recorded, and continence was evaluated by determining the number and weight of absorbent pads (pad weighing test) on the second day after catheter removal and by a questionnaire 3 months postoperatively. Two days after catheter removal, 11.1% of Group 1, 11.1% of Group 2, 4.4% of Group 3 and 8.9% of Group 4 were continent. The average urine loss was 80.4, 70.1, 325.0 and 291.3 g for the each of these groups, respectively. At 3 months, 76.5% of Group 1 and 81.3% of Group 2 were continent. The continence figures for Group 3 and 4 were 48.5% and 43.8%, respectively. Similar overall rates were observed in all groups. In conclusion, although there are controversial reports in the literature, early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups, regardless of the EERPE technique performed.
Collapse
|
40
|
Berge V, Berg RE, Hoff JR, Wessel N, Svindland A, Karlsen SJ, Eri LM. Five-year progression-free survival in 577 patients operated on with laparoscopic radical prostatectomy for localized prostate cancer. ACTA ACUST UNITED AC 2011; 46:8-13. [PMID: 21843041 DOI: 10.3109/00365599.2011.604790] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Laparoscopic radical prostatectomy (LRP) was introduced in the Department of Urology, Oslo University Hospital, in 2002. The aim of this study was to report mid-term oncology results and survival data. MATERIAL AND METHODS From February 2002 to November 2007, 582 consecutive patients with localized prostate cancer underwent LRP. Data were collected prospectively into a database. RESULTS Mean and median follow-up after LRP was 30.3 months (± 15.5) and 36.0 months (range 3-72). Five patients (1%) were lost during follow-up. Two patients died of prostate cancer during the study period and 10 patients died of other causes. The overall positive surgical margin (PSM) rate was 29% and decreased to 13% for the last 100 patients. The overall PSA progression-free survival (PFS) was 85% at 3 years and 73% at 5 years. Gleason score in the tumour specimen, pT stage and surgical margins were statistical significant independent predictors of biochemical PFS. CONCLUSION These oncology results and 5-year PFS data after LRP are in line with other reports.
Collapse
Affiliation(s)
- Viktor Berge
- Department of Urology, Oslo University Hospital, Aker, Oslo, Norway.
| | | | | | | | | | | | | |
Collapse
|
41
|
Finkelstein J, Eckersberger E, Sadri H, Taneja SS, Lepor H, Djavan B. Open Versus Laparoscopic Versus Robot-Assisted Laparoscopic Prostatectomy: The European and US Experience. Rev Urol 2011. [PMID: 20428292 DOI: 10.3909/riu0470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Open radical prostatectomy (ORP) is the reference standard for the surgical management of localized prostate cancer. With wider availability of minimally invasive radical prostatectomy techniques, there is a debate regarding the standard treatment of the management of localized prostate cancer. Therefore, we reviewed the current status of laparoscopic radical prostatectomy (LRP) and robotic-assisted laparoscopic radical prostatectomy (RALRP) as compared with ORP. Because no prospective, randomized trials comparing the different techniques have been performed, outcomes must be assessed from published series by centers that focus on ORP, LRP, and RALRP. Aside from reducing the amount of blood loss, current data suggest that the most significant outcomes (cure, continence, and potency) are no better with LRP or RALRP than with conventional ORP. Therefore, in experienced hands, ORP remains the gold standard procedure. However, there is a trend toward consistently better outcomes following RALRP in comparison with LRP. In the end, individual patient outcomes can be maximized by choosing the best modality based on the patient's comorbid medical conditions, cancer characteristics, and surgeon experience. Future studies are needed to further investigate long-term cancer control as well as functional outcomes for RALRP series.
Collapse
Affiliation(s)
- Julia Finkelstein
- Department of Urology, New York University School of Medicine New York, NY
| | | | | | | | | | | |
Collapse
|
42
|
Single Focus Prostate Cancer: Pathological Features and ERG Fusion Status. J Urol 2011; 185:489-94. [DOI: 10.1016/j.juro.2010.09.093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Indexed: 02/07/2023]
|
43
|
Ploussard G, de la Taille A, Xylinas E, Allory Y, Vordos D, Hoznek A, Abbou CC, Salomon L. Prospective evaluation of combined oncological and functional outcomes after laparoscopic radical prostatectomy: trifecta rate of achieving continence, potency and cancer control at 2 years. BJU Int 2011; 107:274-9. [DOI: 10.1111/j.1464-410x.2010.09462.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
44
|
Résultats carcinologiques après prostatectomie totale pour cancer : validation française de la classification de D’Amico. Prog Urol 2010; 20:1206-12. [DOI: 10.1016/j.purol.2010.05.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 04/15/2010] [Accepted: 05/31/2010] [Indexed: 11/23/2022]
|
45
|
Falzarano SM, Magi-Galluzzi C. Staging prostate cancer and its relationship to prognosis. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/j.mpdhp.2010.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
46
|
Bastide C, Savage C, Cronin A, Zelefsky MJ, Eastham JA, Touijer K, Scardino PT, Guillonneau BD. Location and number of positive surgical margins as prognostic factors of biochemical recurrence after salvage radiation therapy after radical prostatectomy. BJU Int 2010; 106:1454-7. [DOI: 10.1111/j.1464-410x.2010.09406.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
|
48
|
McNeill AS, Nabi G, McLornan L, Cook J, Bollina P, Stolzenberg JU. Endoscopic extraperitoneal radical prostatectomy: critical analysis of outcomes and learning curve. BJU Int 2010; 106:1537-43. [DOI: 10.1111/j.1464-410x.2010.09322.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
49
|
Oncologic Outcome after Extraperitoneal Laparoscopic Radical Prostatectomy: Midterm Follow-up of 1115 Procedures. Eur Urol 2010; 57:267-72. [DOI: 10.1016/j.eururo.2009.09.029] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 09/09/2009] [Indexed: 11/17/2022]
|
50
|
Ost P, Fonteyne V, Villeirs G, Lumen N, Oosterlinck W, De Meerleer G. Adjuvant High-Dose Intensity-Modulated Radiotherapy after Radical Prostatectomy for Prostate Cancer: Clinical Results in 104 Patients. Eur Urol 2009; 56:669-75. [DOI: 10.1016/j.eururo.2009.05.041] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 05/19/2009] [Indexed: 11/29/2022]
|