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Ferrario F, Franzese C, Faccenda V, Vukcaj S, Belmonte M, Lucchini R, Baldaccini D, Badalamenti M, Andreoli S, Panizza D, Magli A, Scorsetti M, Arcangeli S. Toxicity profile and Patient-Reported outcomes following salvage Stereotactic Ablative Radiation Therapy to the prostate Bed: The POPART multicentric prospective study. Clin Transl Radiat Oncol 2024; 44:100704. [PMID: 38111610 PMCID: PMC10726256 DOI: 10.1016/j.ctro.2023.100704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/25/2023] [Indexed: 12/20/2023] Open
Abstract
Background While SBRT to the prostate has become a valuable option as a radical treatment, limited data support its use in the postoperative setting. Here, we report the updated results of the multicentric Post-Prostatectomy Ablative Radiation Therapy (POPART) trial, investigating possible predictors of toxicities and patient-reported outcomes. Methods Patients with PSA levels between 0.1-2.0 ng/mL after radical prostatectomy received Linac-based SBRT to the prostate bed in five fractions every other day for a total dose of 32.5 Gy (EQD21.5 = 74.3 Gy). Late toxicity was assessed using CTCAE v.5 scale, while EPIC-CP, ICIQ-SF, IIEF 5 questionnaires and PSA levels measured quality of life and biochemical control. Pre- and post-treatment scores were compared using a paired t-test, with MID established at > 0.5 pooled SD from the baseline. A logistic regression analysis was performed to evaluate potential associations between specific patient/tumor/treatment factors and outcome deterioration. Results From April 2021 to April 2023 a total of 50 pts were enrolled and treated. Median follow-up was 12.2 (3-27) months. No late ≥ G2 GI or GU toxicity was registered. Late G1 urinary and rectal toxicities occurred in 46 % and 4 % of patients, respectively. Among 47 patients completing all EPIC-CP domains, four (9 %) showed worsened QoL, and eleven (26 %) developed erectile dysfunction correlating with PTV D2% (P = 0.032). At Multivariate analysis bladder wall D10cc independently correlated with late G1 GU toxicity (P = 0.034). Median post-treatment PSA nadir was 0.04 ng/mL (0.00 - 0.84). At the last follow-up, six patients presented with biochemical failure, including two nodal relapses. Conclusions Our findings show that post-prostatectomy SBRT did not result in increased toxicity nor a significant decline in QoL measures, thus showing that it can be safely extended to the postoperative setting. Long-term follow-up and randomized comparisons with different RT schedules are needed to validate this approach.
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Affiliation(s)
- Federica Ferrario
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Department of Radiation Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Ciro Franzese
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele (MI), Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano (MI), Italy
| | - Valeria Faccenda
- Department of Medical Physics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Suela Vukcaj
- Department of Radiation Oncology, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Maria Belmonte
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Department of Radiation Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Raffaella Lucchini
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Department of Radiation Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Davide Baldaccini
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano (MI), Italy
| | - Marco Badalamenti
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano (MI), Italy
| | - Stefano Andreoli
- Department of Medical Physics, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
| | - Denis Panizza
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Department of Medical Physics, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
| | - Alessandro Magli
- Department of Radiation Oncology, AULSS 1 Dolomiti, 32100 Belluno, Italy
| | - Marta Scorsetti
- Department of Biomedical Sciences, Humanitas University, 20090 Pieve Emanuele (MI), Italy
- Radiotherapy and Radiosurgery Department, IRCCS Humanitas Research Hospital, 20089 Rozzano (MI), Italy
| | - Stefano Arcangeli
- School of Medicine and Surgery, University of Milan Bicocca, 20126 Milan, Italy
- Department of Radiation Oncology, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
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Aker MN, Brisbane WG, Kwan L, Gonzalez S, Priester AM, Kinnaird A, Delfin MK, Felker E, Sisk AE, Kuppermann D, Marks LS. Cryotherapy for partial gland ablation of prostate cancer: Oncologic and safety outcomes. Cancer Med 2023; 12:9351-9362. [PMID: 36775929 PMCID: PMC10166973 DOI: 10.1002/cam4.5692] [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: 11/30/2022] [Revised: 01/27/2023] [Accepted: 01/31/2023] [Indexed: 02/14/2023] Open
Abstract
BACKGROUND Partial gland ablation (PGA) is a new option for treatment of prostate cancer (PCa). Cryotherapy, an early method of PGA, has had favorable evaluations, but few studies have employed a strict protocol using biopsy endpoints in men with clinically significant prostate cancer (csPCa). METHODS 143 men with unilateral csPCa were enrolled in a prospective, observational trial of outpatient PGA-cryotherapy. Treatment was a 2-cycle freeze of the affected prostate part. Participants were evaluated with MRI-guided biopsy (MRGB) at baseline and at 6 months and 18 months after treatment. Absence of csPCa upon MRGB was the primary endpoint; quality-of-life at baseline and at 6 months after treatment was assessed by EPIC-CP questionnaires in the domains of urinary and sexual function. RESULTS Of the 143 participants, 136 (95%) completed MRGB at 6 months after treatment. In 103/136 (76%), the biopsy revealed no csPCa. Of the 103, 71 subsequently had an 18-month comprehensive biopsy; of the 71 with 18-month biopsies, 46 (65%) were found to have no csPCa. MRI lesions became undetectable in 96/130 (74%); declines in median serum PSA levels (6.9 to 2.5 ng/mL), PSA density (0.15 to 0.07), and prostate volume (42 to 34cc) were observed (all p < 0.01). Neither lesion disappearance on MRI nor PSA decline correlated with biopsy outcome. Urinary function was affected only slightly and sexual function moderately. CONCLUSION In the near to intermediate term, partial gland ablation with cryotherapy was found to be a safe and moderately effective treatment of intermediate-risk prostate cancer. Eradication of cancer was better determined by MRI-guided biopsy than by MRI or PSA.
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Affiliation(s)
- Mamdouh N Aker
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Wayne G Brisbane
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Lorna Kwan
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Samantha Gonzalez
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | | | - Adam Kinnaird
- Department of Urology, University of Alberta, Edmonton, Alberta, USA
| | - Merdie K Delfin
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Ely Felker
- Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles
| | - Anthony E Sisk
- Department of Pathology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - David Kuppermann
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
| | - Leonard S Marks
- Department of Urology, David Geffen School of Medicine at University of California, Los Angeles, California, USA
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Simhal RK, Sholklapper TN, Simhal AK, Zwart AL, Danner MT, Kumar D, Aghdam N, Suy S, Hankins RA, Kowalczyk KJ, Collins SP. Association of baseline self-reported fatigue with overall survival after stereotactic body radiation therapy for localized prostate cancer. Front Oncol 2022; 12:1015264. [PMID: 36620537 PMCID: PMC9816795 DOI: 10.3389/fonc.2022.1015264] [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] [Received: 08/09/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction Stereotactic Body Radiation Therapy (SBRT) has emerged as a definitive therapy for localized prostate cancer (PCa). However, more data is needed to predict patient prognosis to help guide which patients will benefit most from treatment. The FACIT-Fatigue (FACIT-F) is a well validated, widely used survey for assessing fatigue. However, the role of fatigue in predicting PCa survival has yet to be studied. Herein, we investigate the role of FACIT-F as a baseline predictor for overall survival (OS) in patients undergoing SBRT for localized PCa. Methods A retrospective review was conducted of 1358 patients who received SBRT monotherapy between January 2008 to April 2021 at an academic, tertiary referral center. FACIT-F scores (range 0 to 52) were summed for patients who answered all 13-items on the survey. FACIT-F total scores of ≥35 represented severe fatigue. Patients receiving androgen deprivation therapy were excluded. Differences in fatigue groups were evaluated using chi-squared tests. OS rates were determined using the Kaplan-Meier method and predictors of OS were evaluated using Cox proportional hazard method. Results Baseline full FACIT-F scores and survival data was available for 891 patients. 5-year OS was 87.6% and 95.2%, respectively, for the severely fatigued and non-fatigued groups. Chi-squared analysis of fatigue groups showed no significant difference in the following categories: D'Amico risk group, age, ethnicity, grade group, T-stage, or PSA density. Severe fatigue was associated with a significant decrease in OS (hazard ratio 2.76; 95%CI 1.55 - 4.89). The Cox proportional hazard model revealed that age and FACIT-F were both statistically significant (p <0.05). Conclusion Baseline FACIT-F scores are significantly associated with OS. Higher FACIT-F scores, representing less fatigued patients, are associated with an overall survival benefit. These results indicate that the FACIT-F survey could serve as an additional metric for clinicians in determining prognostic factors for patients undergoing SBRT.
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Affiliation(s)
- Rishabh K. Simhal
- School of Medicine, Georgetown University, Washington, DC, United States,*Correspondence: Rishabh K. Simhal,
| | | | - Anish K. Simhal
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Alan L. Zwart
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Malika T. Danner
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Deepak Kumar
- Julius L. Chambers Research Institute, North Carolina Central University, Durham, NC, United States
| | - Nima Aghdam
- Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Simeng Suy
- Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Ryan A. Hankins
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Keith J. Kowalczyk
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Urology, MedStar Georgetown University Hospital, Washington, DC, United States
| | - Sean P. Collins
- School of Medicine, Georgetown University, Washington, DC, United States,Department of Radiation Oncology, MedStar Georgetown University Hospital, Washington, DC, United States
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Acute Toxicity and Quality of Life in a Post-Prostatectomy Ablative Radiation Therapy (POPART) Multicentric Trial. Curr Oncol 2022; 29:9349-9356. [PMID: 36547147 PMCID: PMC9776836 DOI: 10.3390/curroncol29120733] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 11/23/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the feasibility of ultrahypofractionated radiotherapy to the prostate bed in patients with biochemical and/or clinical relapse following radical prostatectomy who were enrolled in the prospective, observational, multicentric POPART trial (NCT04831970). METHODS Patients with post-radical prostatectomy PSA levels of ≥0.1-2.0 ng/mL and/or local relapse at PSMA PET/CT or multiparametric MRI were treated with Linac-based SBRT on the prostate bed up to a total dose of 32.5 Gy in five fractions every other day (EQD21.5 = 74.2 Gy). Maximum acute toxicity was assessed using the Common Terminology Criteria for Adverse Events version 5 scale. International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) scores were assessed at baseline and during the follow-up. RESULTS From April 2021 to June 2022, thirty men with a median age of 72 years (range 55-82) were enrolled in three centers. The median PSA level before RT was 0.30 ng/mL (range 0.18-1.89 ng/mL). At 3 months post-treatment, no GI or ≥2 GU side effects were reported; three patients (10%) experienced Grade 1 GU toxicity. No changes in ICIQ-SF or in the urinary domains of EPIC-CP were observed, while a transient worsening was registered in the bowel domain. At the same time point, all but two patients, who progressed distantly, were found to be biochemically controlled with a median post-treatment PSA level of 0.07 ng/mL (range 0-0.48 ng/mL). CONCLUSIONS Our preliminary findings show that SBRT can be safely extended to the postoperative setting, without an increase in short-term toxicity or a significant decline in QoL. Long-term results are needed to confirm this strategy.
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Awad MA, Hallgarth L, Barayan GA, Shahait M, Abu-Hijlih R, Farkouh A, Azhar RA, Alghamdi MM, Bugis A, Yaiesh S, Aldousari S, Barham A, Saed M, Moussa A, Hassen W, Naud S, Plante MK, Grunert R. Creation and validation of the harmonized Arabic version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Arab J Urol 2021; 20:88-93. [PMID: 35530568 PMCID: PMC9067989 DOI: 10.1080/2090598x.2021.2002636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objectives Tocreate and validate a translated Arabic version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), a validated patient-reported outcome (PRO) widely used for assessing the quality of life in patients with prostate cancer (PCa). Patients and Methods Using the established protocol as defined by the Professional Society for the Health Economics and Outcomes Research (ISPOR) for translating patient care questionnaires, a harmonised translated Arabic version of EPIC-CP was created. The questionnaire was tested in native Arabic speakers from four different Arabic countries (Saudi Arabia, United Arab Emirates, Jordan, and Kuwait). Cronbach’s alpha and interclass coefficient correlation (ICC) analyses were used to test the internal consistency and test–retest reliability, respectively. In addition, PCa characteristics were collected for participants. Results In total, 168 patients with PCa participated in the study (39 from Saudi Arabia, 23 from United Arab Emirates, 65 from Jordan, and 41 from Kuwait). In all, 52 (31%) participants repeated the questionnaire for test–retest reliability analysis. The median (interquartile range [IQR]) age of patients included in the study was 66 (61–71) years. The median (IQR) PSA level was 9.8 (6–19) ng/mL. Most patients had Grade Group 2 PCa at diagnosis (31%), clinical stage cT1 (42%), managed primarily by urology (79%), and the primary treatment was radical prostatectomy (71%). The total Cronbach’s alpha coefficient was 0.84 demonstrating an acceptable internal consistency. The total ICC was also acceptable at 0.64. Conclusion The Arabic version of the EPIC-CP is a reliable and valid tool for assessing health-related quality of life for Arabic patients with PCa.
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Affiliation(s)
- Mohannad A. Awad
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Luke Hallgarth
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
| | - Ghassan A. Barayan
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammed Shahait
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ramiz Abu-Hijlih
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ala’a Farkouh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Raed A. Azhar
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Musab M. Alghamdi
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Bugis
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Said Yaiesh
- Urology Unit, Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait, Kuwait
| | - Saad Aldousari
- Department of Surgery (Urology Division), Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Alaeddin Barham
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Mohamed Saed
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Ayman Moussa
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Waleed Hassen
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | - Shelly Naud
- Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mark K. Plante
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
| | - Richard Grunert
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
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Lourenço DB, Amaral BS, Alfer-Junior W, Vasconcellos A, Russo F, Sanchez-Salas R, Bianco B, Wagner AA, Chang P, Moschovas MC, Lemos GC, Carneiro A. Portuguese version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP): psychometric validation and prospective application for early functional outcomes at a single institution. BMC Urol 2020; 20:163. [PMID: 33081748 PMCID: PMC7574474 DOI: 10.1186/s12894-020-00734-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 10/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background The Expanded Prostate Index Composite for Clinical Practice (EPIC-CP) is a short version of the original EPIC, developed to facilitate the instrument’s use in routine care. This study aimed to validate the EPIC-CP Portuguese version, and evaluate its role in presenting early functional outcomes of surgically treated prostate cancer patients at a Latin American referral center.
Methods The EPIC-CP was self-administered prospectively and individually by all localized prostate cancer patients, before and after robotic-assisted radical prostatectomy, from March 2017 to June 2018 at a single institution. For validation, we used the Cronbach’s alpha coefficient to evaluate internal consistency. The EPIC-CP domains were compared before surgery, and 6 months and 12 months after surgery. Statistical analyses were performed using the student’s t test, and Wilcoxon and Friedman tests, with p values < 0.05 considered significant. Results One hundred and fifty two patients answered the EPIC-CP. The patients had a median age of 62.7 (± 8.5) years and prostate specific antigen level of 6.3 (± 4.6) ng/ml. The Cronbach’s alpha varied from 0.75 to 0.77 for all domains with good internal consistency, except for the “vitality/hormonal” domain, which had a score of 0.35. The domain evolution for the preoperative and 6-month postoperative groups revealed that the domains related to urinary continence and bowel worsened, and were increased during the first 6 months; however, this variation had no obvious clinical implications, and the irritative symptoms improved. Regarding the sexual domain, the scores worsened, and also increased over the first 6 months. The results of the confirmatory factor analysis were robust, with an explained variance of 0.951 and covariance of 0.929. Conclusions The Portuguese version of the EPIC-CP is a reliable and valid questionnaire for postoperative patients, and very useful to improve the knowledge of the early functional outcomes of men treated for prostate cancer.
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Affiliation(s)
- Danilo B Lourenço
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Breno Santos Amaral
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Wladimir Alfer-Junior
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Ana Vasconcellos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Fernanda Russo
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | | | - Bianca Bianco
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil.
| | - Andrew A Wagner
- Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Peter Chang
- Beth Israel Medical Center, Harvard Medical School, Boston, MA, USA
| | - Marcio Covas Moschovas
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Gustavo Caserta Lemos
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, Av. Albert Einstein, 627, Sala 303, Bloco A1, São Paulo, SP, Brazil
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Egan J, Marhamati S, Carvalho FLF, Davis M, O'Neill J, Lee H, Lynch JH, Hankins RA, Hu JC, Kowalczyk KJ. Retzius-sparing Robot-assisted Radical Prostatectomy Leads to Durable Improvement in Urinary Function and Quality of Life Versus Standard Robot-assisted Radical Prostatectomy Without Compromise on Oncologic Efficacy: Single-surgeon Series and Step-by-step Guide. Eur Urol 2020; 79:839-857. [PMID: 32536488 DOI: 10.1016/j.eururo.2020.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retzius-sparing robot-assisted radical prostatectomy (RS-RARP) has been shown to improve continence. However, questions remain regarding feasibility and generalizability of technique and outcomes. OBJECTIVE To compare the outcomes of 140 consecutive standard robot-assisted radical prostatectomy (S-RARP) versus RS-RARP. DESIGN, SETTING, AND PARTICIPANTS A total of 70 S-RARPs were performed followed by 70 RS-RARPs. Demographic, pathologic, and functional outcomes were compared preoperatively and through 12 mo. Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) was used to compare functional outcomes. Logistic and linear regression analyses were utilized to analyze variables associated with EPIC-CP urinary incontinence and overall quality of life (QOL) scores, and oncologic outcomes. Cox regression analysis was used to analyze incontinence at 12 mo. SURGICAL PROCEDURE RS-RARP versus S-RARP. MEASUREMENTS Patient and tumor characteristics (age, body mass index, prostate-specific antigen, Charlson Comorbidity Index, Gleason group, clinical stage, and Prostate Imaging Reporting and Data System score), perioperative outcomes (console time, estimated blood loss, postoperative complications, and length of stay), oncologic outcomes (positive surgical margin [PSM], and biochemical recurrence), overall and 12-mo continence rates (zero pads and zero to one safety pad), time to continence, potency (erection sufficient for sexual activity), EPIC-CP urinary incontinence, sexual function, and overall QOL scores. RESULTS AND LIMITATIONS Median follow-up for S-RARP versus RS-RARP was 46.3 versus 12.3 mo. RS-RARP versus S-RARP had improved overall continence rates at total follow-up (95.7% vs 85.7%, p = 0.042) and 12-mo follow-up (97.6% vs 81.4%, p = 0.002), and faster return to continence (zero to one safety pad, 44 vs 131 d, p < 0.001). RS-RARP EPIC-CP urinary incontinence and overall QOL scores remained significantly better at 12 mo. There were no differences in overall PSM rates, although RS-RARP had lower rates of nonfocal PSMs. There were no differences in sexual function. In multivariate analysis, RS-RARP was significantly associated with improved 12-mo EPIC-CP urinary incontinence and improved QOL scores, but was not associated with PSM or biochemical recurrence. Limitations include retrospective study design and unequal follow-up; however, significantly better RS-RARP continence at 12 mo is striking despite fewer patients attaining 12-mo follow-up. CONCLUSIONS RS-RARP significantly improves early and long-term continence without compromising oncologic outcomes and leads to overall improved QOL. PATIENT SUMMARY Retzius-sparing robot-assisted radical prostatectomy is an emerging technique for robotic radical prostatectomy that improves urinary function and quality of life without compromising cancer control.
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Affiliation(s)
- Jillian Egan
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shawn Marhamati
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Filipe L F Carvalho
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Meghan Davis
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John O'Neill
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Harry Lee
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - John H Lynch
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Ryan A Hankins
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Jim C Hu
- Department of Urology, Weill Cornell Medicine, New York, NY, USA
| | - Keith J Kowalczyk
- Department of Urology, MedStar Georgetown University Hospital, Washington, DC, USA.
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8
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Amornratananont N, Sirisopana K, Worawichawong S, Chalermsanyakorn P, Sangkum P, Pacharatakul S, Leenanupunth C, Kongchareonsombat W. Perioperative outcomes of robot-assisted laparoscopic radical prostatectomy (RALRP) and LRP in patients with prostate cancer based on risk groups. Arab J Urol 2020; 18:187-193. [PMID: 33029430 PMCID: PMC7473109 DOI: 10.1080/2090598x.2020.1750865] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective To compare the perioperative and pathological outcomes between robot-assisted laparoscopic radical prostatectomy (RALRP) and LRP based on the patient's risk. Patients and methods The medical records of 588 patients with prostate cancer who underwent RP, using minimally invasive surgery (MIS) techniques (240 LRP and 348 RALRP) by a single surgeon during January 2008 to June 2018 at the Ramathibodi Hospital, were retrospectively reviewed. The patient's risk was classified according to the National Comprehensive Cancer Network (NCCN) Guideline, 2018. The demographic, perioperative, and pathological data of patients were collected. The differences in perioperative and pathological outcomes between LRP and RALRP in each risk classification were assessed using chi-square, Fisher's exact tests and logistic regression, as appropriate. Results In terms of positive margins, RALRP had significant advantages in high-risk patients when compared to LRP (adjusted odds ratio 0.46, 95% confidence interval 0.26-0.84), while there were no differences in the low- and intermediate-risk patients. Overall, the patients who underwent RALRP had significant advantages over those who underwent LRP in terms of operative time, estimate blood loss, and blood transfusion rate. While, adjacent organ injury rate and length of hospital stay were similar for both techniques in all subgroup analyses. Conclusion MIS techniques appear to be safe, especially RALRP, which has significantly better perioperative outcomes in all subgroups of patient risk classification, and in the high-risk patient group it seems to have better pathological outcomes when compared to LRP. Abbreviations EBL: estimated blood loss; LOS: length of hospital stay; PSM: positive surgical margin; (L)(O)(RAL)RP: (laparoscopic) (open) (robot-assisted laparoscopic) radical prostatectomy; MIS: minimally invasive surgery.
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Affiliation(s)
- Napat Amornratananont
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kun Sirisopana
- Division of Urology, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Suchin Worawichawong
- Division of Clinical Pathology, Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panas Chalermsanyakorn
- Division of Clinical Pathology, Department of Pathology, 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
| | - Suthep Pacharatakul
- Division of Urology, Department of Surgery, Police Hospital, Bangkok, Thailand
| | - Charoen Leenanupunth
- 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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9
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Alexidis P, Dragoumis D, Karatzoglou S, Drevelegas K, Tzitzikas I, Hatzimouratidis K, Chrisogonidis I, Giannakidis D, Koulouris C, Katsaounis A, Michalopoulos N, Huang H, Li Q, Aidoini Z, Fyntanidou V, Amaniti A, Hohenforst-Schmidt W, Maragouli E, Petanidis S, Zarogoulidis P, Sapalidis K, Kosmidis C, Romanidis K, Oinkonomou P, Vagionas A, Nikolaos-Katsios I, Ioannidis A, Boniou K, Kesisoglou I. The role of hypofractionated radiotherapy for the definitive treatment of localized prostate cancer: early results of a randomized trial. J Cancer 2019; 10:6217-6224. [PMID: 31772654 PMCID: PMC6856757 DOI: 10.7150/jca.35510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 08/25/2019] [Indexed: 02/07/2023] Open
Abstract
Background: Prostate cancer is considered to have a special biology which could affect the radiation therapy result based on the selected fractionation scheme. We present the preliminary results of a randomized trial comparing conventionally and hypofractionated radiation therapy for prostate cancer. Methods: Patients included in the study had localized prostate cancer (cT1c-T3bN0M0) and were randomly assigned to mild hypofractionated (72 Gy in 32 fractions, arm1) or conventionally fractionated (74 Gy in 37 fractions, arm2) radiation therapy treatment with Volumetric Arc Therapy technique. The treatment was delivered only to the prostate with or without the seminal vesicles according to physician's discretion and hormone therapy was optional according to the disease stage and comorbidities. Here we present the preliminary results of acute toxicity from the gastrointestinal (GI) and genitourinary (GU) system. Results: Between 2015 and 2016, 139 patients were enrolled. 67 patients were treated with conventional fractionation and 72 were treated with hypofractionation. Grade≥ 2 toxicity from GU and GI was observed in 23 and 21 patients (31,9% vs 31,3%, p=0,79) and 15 and 12 (20,8% vs 17,9%, p=0,6) for arm1 and arm2 respectively. No statistically significant differences were observed between arms in the incidence of early toxicity. There was no correlation observed between patient characteristics and toxicity from either GU or GI. Conclusions: Hypofractionated radiotherapy appears to be equally tolerated compared to conventional fractionation in the early setting. Longer follow up is needed to assess the late toxicity profile of the patients and any potential differences between the control and experimental arm.
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Affiliation(s)
- Petros Alexidis
- Department of Radiation Oncology, Interbalkan European Medical Center; Thessaloniki, Greece
| | - Dimitris Dragoumis
- Neurosurgical Department, ``G. Papanikolaou`` General Hospital, Thessaloniki, Greece
| | - Sotirios Karatzoglou
- Neurosurgical Department, ``G. Papanikolaou`` General Hospital, Thessaloniki, Greece
| | | | - Ioannis Tzitzikas
- Department of Radiation Oncology, AHEPA University Hospital of Thessaloniki, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Konstantinos Hatzimouratidis
- Department of Urology, Papageorgiou hospital of Thessaloniki, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Greece
| | - Ioannis Chrisogonidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Dimitris Giannakidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Charilaos Koulouris
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Athanasios Katsaounis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Nikolaos Michalopoulos
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Haidong Huang
- The Diagnostic and Therapeutic Center of Respiratory Diseases, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Qiang Li
- The Diagnostic and Therapeutic Center of Respiratory Diseases, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Zoi Aidoini
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Varbara Fyntanidou
- Anesthisiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School; Thessaloniki, Greece
| | - Aikaterini Amaniti
- Anesthisiology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School; Thessaloniki, Greece
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology/Pulmonology/Intensive Care/Nephrology, "Hof" Clinics, University of Erlangen, Hof, Germany
| | - Elena Maragouli
- Oncology Department, University of Thessali, Larissa, Greece
| | - Savvas Petanidis
- Department of Pulmonology, I.M. Sechenov First Moscow State Medical University; Moscow, 119992, Russian Federation
| | - Paul Zarogoulidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos Sapalidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Christoforos Kosmidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantinos Romanidis
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Panagoula Oinkonomou
- Second Department of Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | | | - Iason Nikolaos-Katsios
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Aris Ioannidis
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
| | - Konstantina Boniou
- Radiology Department, ``Theageneio`` Cancer Hospital, Thessaloniki, Greece
| | - Isaak Kesisoglou
- 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece
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Prospective multicentre study using high intensity focused ultrasound (HIFU) for the focal treatment of prostate cancer: Safety outcomes and complications. Urol Oncol 2019; 38:225-230. [PMID: 31628038 DOI: 10.1016/j.urolonc.2019.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/15/2019] [Accepted: 09/04/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE To investigate focal therapy using High Intensity Focused Ultrasound (HIFU) for the treatment of localized prostate cancer (CaP), we analyzed the safety and complications of this procedure. METHODS Patients (pts) eligible for this multicenter prospective cohort study suffered from low to intermediate risk localized CaP with no prior treatment. After tumor identification on multiparametric MRI and in prostate biopsy, the lesions were treated with HIFU observing a safety margin of 8 to 10 mm. Adverse events (AE) after 30 and 90 days, as well as the required interventions were assessed and stratified for treatment localizations. RESULTS Of the 98 men included in the study in two European centers, 35 (35.7%) experienced AEs in the first 30 days after HIFU intervention with Clavien-Dindo grade ≤ II: 15 pts (15.3%) had a postoperative urinary tract infection and 26 pts (26.5%) a urinary retention. Four pts (4.1%) underwent subsequent intervention (Clavien-Dindo grade IIIa/b). The number of late postoperative complications occurring between 30 and 90 days after intervention was low (2.0%). The highest complication rate was associated with tumors located at the anterior base (50.0%). The inclusion of the urethra in the ablation zone led to AEs in 20 out of 41 cases (48.8%) and represented a significant risk factor for complications within 30 days (odds ratio = 2.53; 95% confidence interval: 1.08-5.96; P = 0.033). CONCLUSIONS Focal therapy of CaP lesions with a robotic HIFU-probe is safe and renders an acceptable rate of minor early AEs. The inclusion of the urethra in the ablation zone leads to an increase in early complications and should be avoided whenever possible.
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11
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Sanchez-Salas R, de la Rosette J, Polascik TJ, Carneiro A, Sivaraman A, Cathelineau X, Walz J. Focal Therapy for Prostate Cancer: A More Vehement View of the Approach Could Translate into Real Benefits for Our Patients. Eur Urol 2018; 74:537-539. [DOI: 10.1016/j.eururo.2018.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/16/2018] [Indexed: 01/20/2023]
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12
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Albisinni S, Mélot C, Aoun F, Limani K, Peltier A, Rischmann P, van Velthoven R. Focal Treatment for Unilateral Prostate Cancer Using High-Intensity Focal Ultrasound: A Comprehensive Study of Pooled Data. J Endourol 2018; 32:797-804. [PMID: 29790383 DOI: 10.1089/end.2018.0130] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Focal therapy for prostate cancer (PCa) remains experimental. Aim of the current study is to review available evidence and perform a pooled analysis exploring oncologic and functional results of high intensity focus ultrasound (HIFU) focal therapy for the treatment of unilateral PCa. METHODS The National Library of Medicine Database was searched for relevant articles. A wide search was performed, including the combination of following words: "HIFU," "prostate," "cancer," and "focal." Overall, 167 articles were reviewed. Of these, seven articles were identified and eligible for the pooled analysis. Data on HIFU hemiablation or focal prostate ablation, oncologic and functional results were pooled from these seven studies that included 366 men with unilateral PCa. RESULTS In the 366 analyzed cases, mean age was 67 years (95% confidence interval 66-69), and mean preoperative prostate-specific antigen was 6.4 ng/cc (5.5-7.4). Three studies included PCa up to Gleason 7 (3 + 4), three studies did include also Gleason 7 (4 + 3), whereas one study had no limitation in terms of Gleason score. Regarding early complications, low-grade Clavien-Dindo I-II were reported in 26% (16-37), whereas high-grade Clavien-Dindo ≥III were found in 3.8% (0-8.6). Analyzing oncologic outcomes mean follow-up was 26 months (23-31): at one year after HIFU, negative biopsy rate for clinically significant PCa was 87% (79-96), whereas salvage treatment-free survival rate was 92% (85-98). Regarding functional outcomes, reported potency rates were 74% (64-84), and continence 96% (91-100), although definitions of potency and continence were not homogenous across studies. CONCLUSIONS This pooled analysis of the results of focal HIFU treatment of PCa shows promising oncologic and functional outcomes. Well-selected patients may be candidates for such a conservative partial treatment of the gland. Well-designed trials are awaited to compare HIFU focal treatment with current standard of care.
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Affiliation(s)
- Simone Albisinni
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium .,2 Department of Urology, Erasme Hospital, Urology Clinics, Free University of Brussels , Brussels, Belgium
| | - Christian Mélot
- 3 Department of Emergency Medicine, Erasme Hospital, Urology Clinics, Free University of Brussels , Brussels, Belgium
| | - Fouad Aoun
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
| | - Ksenija Limani
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
| | - Alexandre Peltier
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
| | | | - Roland van Velthoven
- 1 Department of Urology, Jules Bordet Institute , Urology Clinics, Free University of Brussels, Brussels, Belgium
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13
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Pak S, Kim M, Ahn H. Changes in health-related quality of life after radical prostatectomy for prostate cancer: A longitudinal cohort study in Korea. Investig Clin Urol 2018; 59:313-320. [PMID: 30182076 PMCID: PMC6121025 DOI: 10.4111/icu.2018.59.5.313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/05/2018] [Indexed: 01/09/2023] Open
Abstract
Purpose To evaluate longitudinal changes in health-related quality of life and satisfaction after radical prostatectomy for the treatment of prostate cancer in Korean men. Materials and Methods Data from patients with localized prostate cancer who underwent radical prostatectomy between January 2012 and December 2013 were analyzed. Patients completed the Expanded Prostate Cancer Index Composite questionnaire at scheduled clinic visits (baseline and 1, 3, 6, and 12 months post-surgery). Results Data from 211 men were evaluated. Urinary domain summary scores decreased postoperatively but improved over the 12-month follow-up period. Urinary function and incontinence had not recovered to baseline values at 12 months, whereas urinary bother and irritation/obstruction scores showed no differences from baseline at 12 months. Sexual function improved at each timepoint to 12 months but did not recover to baseline values; sexual bother was approximately 50% of baseline values at 12 months. Recovery of sexual function was significantly greater in patients who underwent robotic surgery versus those who underwent open surgery. At the end of the study period, 66.3% of patients were satisfied with the treatment they had received; multivariate analysis showed that only urinary function recovery was significantly associated with overall satisfaction. Conclusions Urinary outcomes and sexual outcomes had not returned to baseline at 12 months. Recovery of sexual function was significantly greater in patients who underwent robotic surgery. Only recovery of urinary function was significantly associated with overall satisfaction 12 months after radical prostatectomy in this cohort of Korean men.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Myong Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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14
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Romanzini AE, Pereira MDG, Guilherme C, Cologna AJ, de Carvalho EC. Predictors of well-being and quality of life in men who underwent radical prostatectomy: longitudinal study1. Rev Lat Am Enfermagem 2018; 26:e3031. [PMID: 30183870 PMCID: PMC6136529 DOI: 10.1590/1518-8345.2601.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/06/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE to identify socio-demographic, clinical and psychological predictors of well-being and quality of life in men who underwent radical prostatectomy, in a 360-day follow-up. METHOD longitudinal study with 120 men who underwent radical prostatectomy. Questionnaires were used for characterization and clinical evaluation of the participant, as well as the instruments Visual Analog Scale for Pain, The Ways of Coping Questionnaire, Hospital Depression and Anxiety Scale, Satisfaction with Social Support Scale, Marital Satisfaction Scale, Subjective Well-Being Scale and Expanded Prostate Cancer Index. For data analysis, the linear mixed-effects model was used. RESULTS the socio-demographic factors age and race were not predictors of the dependent variables; time of surgery, problem-focused coping, and anxiety were predictors of subjective well-being; pain, anxiety and depression were negative predictors of quality of life; emotion-focused coping was a positive predictor. Marital dissatisfaction was a predictor of both variables. CONCLUSION predictor variables found were different from the literature: desire for changes in marital relationship presented a positive association with quality of life and well-being; emotion-focused coping was a predictor of quality of life; and anxiety was a predictor of subjective well-being.
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Affiliation(s)
| | | | - Caroline Guilherme
- PhD, Adjunct Professor, Curso de Enfermagem e Obstetrícia,
Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
| | - Adauto José Cologna
- PhD, Senior Professor, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Emilia Campos de Carvalho
- PhD, Senior Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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15
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Carneiro A, Sanchez-Salas R. Re: Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018; 74:234. [DOI: 10.1016/j.eururo.2018.03.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/21/2018] [Indexed: 10/17/2022]
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16
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A Prospective Analysis of the Effects of Nerve-Sparing Radical Prostatectomy on Urinary Continence Based on Expanded Prostate Cancer Index Composite and International Index of Erectile Function Scoring Systems. Int Neurourol J 2018; 22:123-132. [PMID: 29991234 PMCID: PMC6059911 DOI: 10.5213/inj.1836052.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 04/30/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE This study aims to objectively characterize the effect of successful nerve sparing (NS) during radical prostatectomy (RP) on postoperative urinary continence (UC) using International Index of Erectile Function (IIEF)-scores and a previously described Expanded Prostate Cancer Index Composite (EPIC) score cutoff value (COV) for UC. Several notable studies on this topic present conflicting outcomes. This is largely due to a lack of clear definitions and consensus regarding preserved erectile function (EF) and UC. METHODS This study is comprised of all patients who underwent RP at the Kantonsspital Baden, Switzerland, between 2004 and 2013. Patients completed self-assessment questionnaires for UC (EPIC) and EF (IIEF) pre- and postoperatively (3, 6, 9, 12, 18, and 24 months; yearly thereafter). We used a previously described EPIC subscore COV, with "satisfactory continence" signified by a score >85. Statistical analysis was performed using Kaplan-Meier and Cox regression analyses for "surgeon-" and "IIEF-defined" NS definitions. RESULTS Of 236 men with a median age of 63 years (interquartile range [IQR], 59-66 years) and median follow-up time of 48 months (IQR, 30-78 months), 176 underwent unilateral (n=33) or bilateral (n=143) NS RP. Fifty-four underwent non-NS (NNS) RP. Kaplan-Meier analyses identified the following risk factors for UC: age, prostate volume, cancer risk group, and NS status. In surgeon-defined NS RP cases, multivariate analysis for regaining continence demonstrated no significant difference (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.48-1.25; P=0.3). With successful IIEF-defined NS RPs, regression analysis demonstrated no significant difference (HR, 0.89; 95% CI, 0.59-1.35; P=0.58). Conclusions In our population, analysis and comparison of surgeon- and IIEF-defined NS and NNS cohorts revealed that NS RP did not improve postoperative UC. The conservation of UC alone should not motivate surgeons or patients to pursue NS RP.
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Kitamura K, China T, Kanayama M, Nagata M, Isotani S, Wakumoto Y, Muto S, Ide H, Horie S. Significant association between urethral length measured by magnetic resonance imaging and urinary continence recovery after robot-assisted radical prostatectomy. Prostate Int 2018; 7:54-59. [PMID: 31384606 PMCID: PMC6664308 DOI: 10.1016/j.prnil.2018.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/18/2018] [Accepted: 06/18/2018] [Indexed: 12/01/2022] Open
Abstract
Introduction To determine the clinical predictive factors affecting the recovery from postoperative urinary incontinence after robot-assisted radical prostatectomy (RARP). Materials and methods We consecutively analyzed 320 patients who underwent RARP between January 2012 and March 2015. The restoration of urinary continence was defined as follows: the use of no pads/no leakage of urine or the use of a safety pad. Preoperative covariates were statistically assessed by multivariate logistic regression analysis to investigate their predict factor to recovery of urinary incontinence. Therefore, in this study, we sought to identify predictors of early urinary continence status in a single-center retrospective study of consecutive patients who underwent RARP. Results Continence rates at 1, 3, 6, and 12 months after the catheter was removed were 44%, 71%, 83%, and 93%, respectively. Age, body mass index, and prostate volume had no significant association with urinary continence recovery. In contrast to this, longer preoperative membranous urethral length (MUL) was significantly associated with earlier postoperative continence recovery. Multivariate analysis demonstrated that longer preoperative MUL is significantly associated with continence recovery at 1 month (P = 0.0235). Conclusion Approximately 70% of patients achieved urinary continence within 3 months after RARP. Multivariate analysis showed that age, body mass index, and prostate volume had no significant association with urinary continence recovery. Preoperative MUL assessed by magnetic resonance imaging was an independent predictor of early recovery from urinary incontinence after RARP.
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Affiliation(s)
- Kosuke Kitamura
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki China
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Mayuko Kanayama
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Masayosi Nagata
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Shuji Isotani
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Yoshiaki Wakumoto
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Satoru Muto
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan.,Department of Advanced Informatics for Genetic Disease, Juntendo University, Graduate School of Medicine, Tokyo, Japan
| | - Hisamitsu Ide
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Shigeo Horie
- Department of Urology, Juntendo University, Graduate School of Medicine, Tokyo, Japan
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Ávila M, Patel L, López S, Cortés-Sanabria L, Garin O, Pont À, Ferrer F, Boladeras A, Zamora V, Fosså S, Storås AH, Sanda M, Serra-Sutton V, Ferrer M. Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:23-44. [PMID: 29673922 DOI: 10.1016/j.ctrv.2018.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments. METHODS We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747. RESULTS Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I2 = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening. CONCLUSIONS No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
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Affiliation(s)
- Mónica Ávila
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Silvia López
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | | | - Victor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona University UB, Barcelona, Spain
| | - Sophie Fosså
- Oslo University Hospital, University of Oslo, Norway
| | - Anne H Storås
- Oslo University Hospital, University of Oslo, Norway
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, United States
| | - Vicky Serra-Sutton
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
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Carneiro A, Baccaglini W, Glina FPA, Kayano PP, Nunes VM, Smaletz O, Bernardo WM, Carvalho ITD, Lemos GC. Impact of local treatment on overall survival of patients with metastatic prostate cancer: systematic review and meta-analysis. Int Braz J Urol 2017; 43:588-599. [PMID: 27802009 PMCID: PMC5557433 DOI: 10.1590/s1677-5538.ibju.2016.0483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 11/02/2016] [Indexed: 11/22/2022] Open
Abstract
Context Currently, standard treatment of metastatic prostatic cancer (MPCa) is androgen-deprivation therapy (ADT). Recent studies suggested that local treatment of MPCa is related to increase of survival of those patients, as observed in other tumors. Objective To evaluate the impact of local treatment on overall survival and cancer specific survival in 3 and 5 years in patients with MPCa. Materials and Methods Systematic review and meta-analysis of population studies published at PubMed, Scielo, Lilacs, Cochrane and EMBASE databases until June 2016. Several large cohorts and Post-Roc studies were included, that evaluated patients with MPCa submitted to local treatment (LT) using radiotherapy (RDT), surgery (RP) or brachytherapy (BCT) or not submitted to local treatment (NLT). Results 34.338 patients were analyzed in six included papers, 31.653 submitted to NLT and 2.685 to LT. Overall survival in three years was significantly higher in patients submitted to LT versus NLT (64.2% vs. 44.5%; RD 0.19, 95% CI, 0.17-0.21; p<0.00001; I2=0%), as well as in five years (51.9% vs. 23.6%; RD 0.30, 95% CI, 0.11-0.49; p<0.00001; I2=97%). Sensitive analysis according to type of local treatment showed that surgery (78.2% and 45.0%; RD 0.31, 95% CI, 0.26-0.35; p<0.00001; I2=50%) and radiotherapy (60.4% and 44.5%; RD 0.17, 95% CI, 0.12-0.22; p<0.00001; I2=67%) presented better outcomes. Conclusion LT using RDT, RP or BCT seems to significantly improve overall survival and cancer-specific survival of patients with metastatic prostatic cancer. Prospective and randomized studies must be performed in order to confirm our results.
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Affiliation(s)
- Arie Carneiro
- Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil.,Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil
| | - Willy Baccaglini
- Departamento de Urologia, Faculdade de Medicina do ABC, SP, Brasil
| | - Felipe P A Glina
- Faculdade de Ciências Médicas, Universidade Metropolitana de Santos, SP, Brasil
| | - Paulo P Kayano
- Departamento de Urologia, Hospital Israelita Albert Einstein, SP, Brasil
| | - Victor M Nunes
- Centro Universitário Lusiada, Faculdade de Ciências Médicas de Santos, SP, Brasil
| | - Oren Smaletz
- Departamento de Oncologia, Hospital Israelita Albert Einstein, São Paulo, Brasil
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Dun YJ, Liu HX, Yu LP, Li Q, Zhang XW, Tang X, Qin CP, Xu T. Development and Initial Validation of the Novel Scale for Assessing Quality of Life of Prostate Cancer Patients Receiving Androgen Deprivation Therapy. Chin Med J (Engl) 2017; 130:2082-2087. [PMID: 28836552 PMCID: PMC5586177 DOI: 10.4103/0366-6999.213416] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: There has been no a specific scale to measure quality of life (QOL) for prostate cancer patients receiving androgen deprivation therapy (ADT) to date. This study aimed to develop and initially validate the scale to evaluate QOL for prostate cancer patients receiving ADT. Methods: The scale was developed following international recommendations. Moreover, the items were all generated through literature review and referenced questionnaires. After being reviewed by expert panelists, the revised scale was formed and then completed by a convenience sample of 200 prostate cancer patients from our hospital. Explore factor analysis (EFA) was applied to test the construct validity, then split-half reliability, Cronbach's alpha, and test-retest reliability were applied to assess the reliability and stability of the scale. Results: The revised scale contained 22 items and a total of 200 participants had completed the scale. One hundred participants were randomly selected from the total 200 participants to perform EFA with varimax rotation on the revised scale, and “hot flashes” item was deleted for low factor loading. We selected only 3 items from each factor, then, the final scale was formed with 18-items. We selected another 100 participants to perform the EFA again on the final scale. It was demonstrated that the structure with 6 factors explained 72.5% of total variance and factor loading value was above 0.40 in all items of the factors. Moreover, the split-half reliability coefficient, Cronbach's alpha, and test-retest reliability coefficient were calculated to be 0.74, 0.63, and 0.89, respectively, exhibiting good reliability on the whole. Conclusions: The scale was identified to be a valid and reliable instrument to measure QOL for prostate cancer patients receiving ADT. Moreover, further research is needed to overcome the potential drawbacks.
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Affiliation(s)
- Yao-Jun Dun
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Hui-Xin Liu
- Department of Clinical Epidemiology, Peking University People's Hospital, Beijing 100044, China
| | - Lu-Ping Yu
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Qing Li
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Xiao-Wei Zhang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Xu Tang
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
| | - Cai-Peng Qin
- Department of Urology, Peking University International Hospital, Beijing 102206, China
| | - Tao Xu
- Department of Urology, Peking University People's Hospital, Beijing 100044, China
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21
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Albisinni S, Aoun F, Bellucci S, Biaou I, Limani K, Hawaux E, Peltier A, van Velthoven R. Comparing High-Intensity Focal Ultrasound Hemiablation to Robotic Radical Prostatectomy in the Management of Unilateral Prostate Cancer: A Matched-Pair Analysis. J Endourol 2017; 31:14-19. [DOI: 10.1089/end.2016.0702] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Simone Albisinni
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Fouad Aoun
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Simon Bellucci
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Ibrahim Biaou
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Ksenija Limani
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Eric Hawaux
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
| | - Roland van Velthoven
- Urology Department, Jules Bordet Institute, Université libre de Bruxelles, Brussels, Belgium
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