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Joyce DD, Soligo M, Morlacco A, Latuche LJR, Schulte PJ, Boorjian SA, Frank I, Gettman MT, Thompson RH, Tollefson MK, Karnes RJ. Effect of Preoperative Multiparametric Magnetic Resonance Imaging on Oncologic and Functional Outcomes Following Radical Prostatectomy. EUR UROL SUPPL 2022; 47:87-93. [PMID: 36601046 PMCID: PMC9806697 DOI: 10.1016/j.euros.2022.11.018] [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] [Accepted: 11/27/2022] [Indexed: 12/23/2022] Open
Abstract
Background Advancements in imaging technology have been associated with changes to operative planning in treatment of localized prostate cancer. The impact of these changes on postoperative outcomes is understudied. Objective To compare oncologic and functional outcomes between men who had computed tomography (CT) and those who had multiparametric magnetic resonance imaging (mpMRI) prior to undergoing radical prostatectomy. Design setting and participants In this retrospective cohort study, we identified all men who underwent radical prostatectomy (n = 1259) for localized prostate cancer at our institution between 2009 and 2016. Of these, 917 underwent preoperative CT and 342 mpMRI. Outcome measurements and statistical analysis Biochemical recurrence-free survival, positive margin status, postoperative complications, and 1-yr postprostatectomy functional scores (using the 26-item Expanded Prostate Cancer Index Composite [EPIC-26] questionnaire) were compared between those who underwent preoperative CT and those who underwent mpMRI using propensity score weighted Cox proportional hazard regression, logistic regression, and linear regression models. Results and limitations Baseline and 1-yr follow-up EPIC-26 data were available for 449 (36%) and 685 (54%) patients, respectively. After propensity score weighting, no differences in EPIC-26 functional domains were observed between the imaging groups at 1-yr follow-up. Positive surgical margin rates (odds ratio 1.03, 95% confidence interval [CI] 0.77-1.38, p = 0.8) and biochemical recurrence-free survival (hazard ratio 1.21, 95% CI 0.84-1.74, p = 0.3) were not significantly different between groups. Early and late postoperative complications occurred in 219 and 113 cases, respectively, and were not different between imaging groups. Our study is limited by a potential selection bias from the lack of functional scores for some patients. Conclusions In this single-center study of men with localized prostate cancer undergoing radical prostatectomy, preoperative mpMRI had minimal impact on functional outcomes and oncologic control compared with conventional imaging. These findings challenge the assumptions that preoperative mpMRI improves operative planning and perioperative outcomes. Patient summary In this study, we assessed whether the type of prostate imaging performed prior to surgery for localized prostate cancer impacted outcomes. We found that urinary and sexual function, cancer control, and postoperative complications were similar regardless of whether magnetic resonance imaging or computed tomography was utilized prior to surgery.
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Affiliation(s)
| | - Matteo Soligo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Alessandro Morlacco
- Department of Surgical and Oncological Sciences, Clinica Urologica, University of Padova, Padova, Italy
| | - Laureano J. Rangel Latuche
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Phillip J. Schulte
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | - R. Jeffrey Karnes
- Department of Urology, Mayo Clinic, Rochester, MN, USA,Corresponding author at: Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. Tel. +1 (507) 512-6511; Fax: +1 (507) 284-4951.
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The Changing Face of cN0M0 Prostate Cancer Being Found With pN+ After Surgery in the Contemporary Era: Results of an International European Survey on Disease Management. Clin Genitourin Cancer 2022; 21:416.e1-416.e10. [PMID: 36609130 DOI: 10.1016/j.clgc.2022.11.012] [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: 09/26/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The urological community's opinion over the management of men being found with pathologically positive nodes (pN+) following radical prostatectomy (RP) performed with curative intent after preoperative negative conventional staging (cN0M0) has never been assessed. This remains crucial, especially considering the advent of novel imaging modalities. Our aim was to investigate the current opinion on management of pN+ cN0M0 prostate cancer (PCa) in the European urological community. METHODS Following validation, a 31-item survey, complying with the Cherries checklist, was distributed using a web link from December 2021 to April 2022 to 10 urological societies mailing list. Social media (Twitter, Facebook) were also used. RESULTS We received 253 replies. The majority were Urologists (96.8%), younger than 60 (90.5%); 5.2% did not have access to PET-scans; 78.9% believed pN+ is a multifaceted category; 10-years CSS was marked as 71 to 95% by 17.5%. Gold standard management was stated not being ADT by 80.8% and being RT±ADT by 52.3%. Early sRT±ADT was considered an option vs. aRT±ADT by 72.4%. In case of BCR 71% would perform and decide management based on PSMA-PET whilst 3.7% would not perform PSMA-PET. pN+ management is still unclear for 77.1%. On multivariate analysis PSMA-PET availability related to a lower and higher likelihood of considering aRT±ADT as standard and of considering early salvage versus aRT respectively (P < .05). CONCLUSIONS The Urological community has an acceptable awareness of pN+ disease and management, although it may overestimate disease aggressiveness. The majority consider pN+ PCa as a multifaceted category and rely on a risk-adapted approach. Expectant compared to immediate upfront management and new imaging modalities are increasingly considered.
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Loughlin KR. The Inexorable March of Prostate Cancer Research. Urol Clin North Am 2022; 49:567-572. [DOI: 10.1016/j.ucl.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Stereotactic or conventional radiotherapy for macroscopic prostate bed recurrence: a propensity score analysis. Radiol Med 2022; 127:449-457. [PMID: 35247134 PMCID: PMC8897730 DOI: 10.1007/s11547-022-01465-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022]
Abstract
Purpose To assess outcomes between salvage radiation therapy (SRT) with curative intent and stereotactic radiotherapy for macroscopic prostate recurrence (SSRT) after radical prostatectomy (RP). In order to compare these two different options, we compared their outcomes with a propensity score-based matched analysis. Methods Data from 185 patients in seven Italian centres treated for macroscopic prostate bed recurrence after RP were retrospectively collected. To make a comparison between the two treatment groups, propensity matching was applied to create comparable cohorts.
Results After matching, 90 patients in the SRT and SSRT groups were selected (45 in each arm). Kaplan–Meier analysis did not show any significant differences in terms of BRFS and PFS between matched populations (p = 0.08 and p = 0.8, respectively). Multivariate models show that treatment was not associated with BRFS, neither in the whole or matched cohort, with HR of 2.15 (95%CI 0.63–7.25, p = 0.21) and 2.65 (95%CI 0.59–11.97, p = 0.21), respectively. In the matched cohort, lower rate of toxicity was confirmed for patients undergoing SSRT, with acute GI and GU adverse events reported in 4.4 versus 44.4% (p < 0.001) and 28.9 versus 46.7% (p = 0.08) of patients, and late GI and GU adverse events reported in 0 versus 13.3% (p = 0.04) and 6.7 versus 22.2% (p = 0.03) of patients, respectively.
Conclusion Considering the favourable therapeutic ratio of this approach and the lower number of fractions needed, SSRT should be considered as an attractive alternative to conventional SRT in this setting.
Supplementary Information The online version contains supplementary material available at 10.1007/s11547-022-01465-w.
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Francolini G, Bellini C, Di Cataldo V, Detti B, Bruni A, Alicino G, Triggiani L, La Mattina S, D'Angelillo RM, Demofonti C, Mazzola R, Cuccia F, Alongi F, Aquilano M, Allegra AG, Ciccone LP, Burchini L, Salvestrini V, Morelli I, Frosini G, Desideri I, Livi L. Pattern of Recurrence After Stereotactic Radiotherapy in Prostate Cancer Patients With Nodal Pelvic Relapse. A Multi-Institutional Retrospective Analysis. Clin Oncol (R Coll Radiol) 2021; 34:57-62. [PMID: 34598843 DOI: 10.1016/j.clon.2021.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 09/20/2021] [Indexed: 01/22/2023]
Abstract
AIMS Currently, when nodal pelvic oligorecurrent disease is detected, no standard treatment option is recommended. One possible salvage option is nodal stereotactic body radiotherapy (SBRT). Here we analysed recurrence patterns after nodal SBRT in patients affected by pelvic oligometastatic relapse after radical prostatectomy, and androgen deprivation therapy (ADT)-free survival in this population. MATERIALS AND METHODS Data on 93 patients consecutively treated in five different institutions for pelvic oligorecurrent disease were reviewed. Inclusion criteria were biochemical recurrence after radical prostatectomy and imaging showing three or fewer metachronous lymphoadenopathies under aortic bifurcation. Patients underwent SBRT on all sites of disease. Concomitant ADT was allowed. RESULTS After a median follow-up of 20 months (interquartile range 11-41), 57 patients had post-SBRT radiological evidence of relapse, for a median disease-free survival (DFS) of 15 months (95% confidence interval 9-24). Concomitant ADT was administered in 20 patients (21.5%). Overall, eight (8.6%), 21 (22.6%) and 28 (30.1%) patients had prostate bed only, pelvic nodal or distant relapse, respectively. The median ADT-free survival was not reached. Concomitant ADT, International Society for Urologic Pathology pattern at diagnosis < or ≥3, time to relapse ≤ or >12 months, prostate-specific antigen at recurrence < or ≥1.10 ng/ml and prostate-specific membrane antigen staging were not significantly associated with DFS. After relapse, 42 patients (45.2%) received a second SBRT course. CONCLUSION Nodal SBRT yielded encouraging DFS and ADT-free survival in this population. Only a minority of patients developed prostate bed recurrence, suggesting that local treatment may be safely avoided. A consistent percentage of patients could be managed with a second SBRT course.
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Affiliation(s)
- G Francolini
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - C Bellini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | | | - B Detti
- Radiotherapy Unit, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy.
| | - A Bruni
- Radiation Oncology Unit, Modena Hospital, Modena, Italy
| | - G Alicino
- Radiation Oncology Unit, Modena Hospital, Modena, Italy
| | - L Triggiani
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - S La Mattina
- Department of Radiation Oncology, University and Spedali Civili Hospital, Brescia, Italy
| | - R M D'Angelillo
- Department of Radiation Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - C Demofonti
- Department of Radiation Oncology, Policlinico Tor Vergata University, Rome, Italy
| | - R Mazzola
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - F Cuccia
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - F Alongi
- Radiation Oncology Department, IRCCS, Sacro Cuore Don Calabria Hospital, Negrar-Verona, Italy
| | - M Aquilano
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - A G Allegra
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L P Ciccone
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L Burchini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - V Salvestrini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - I Morelli
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - G Frosini
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - I Desideri
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
| | - L Livi
- Department of Biomedical, Experimental and Clinical Sciences, "Mario Serio", University of Florence, Florence, Italy
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Francolini G, Timon G, Matrone F, Marvaso G, Nicosia L, Ognibene L, Vinciguerra A, Trodella LE, Franzese C, Borghetti P, Jereczek-Fossa BA, Arcangeli S. Postoperative radiotherapy after upfront radical prostatectomy: debated issues at a turning point-a survey exploring management trends on behalf of AIRO (Italian Association of Radiotherapy and Clinical Oncology). Clin Transl Oncol 2021; 23:2568-2578. [PMID: 34286475 DOI: 10.1007/s12094-021-02665-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/07/2021] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Postoperative prostate cancer patients are a heterogeneous population, and many prognostic factors (e.g., local staging, PSA kinetics, margin status, histopathological features) may influence their clinical management. In this complex scenario, univocal recommendations are often lacking. For these reasons, the present survey was developed by the Italian Association of Radiotherapy and Clinical Oncology (AIRO) to collect the opinion of Italian radiation oncologists and delineate a representation of current clinical practice in our country. METHODS A questionnaire was administered online to AIRO (Italian Association of Radiotherapy and Clinical Oncology) members registered in 2020 with a clinical interest in uro-oncological disease. RESULTS Sixty-one per cent of AIRO members answered the proposed survey. Explored topics included career and expertise, indications to adjuvant RT, additional imaging in biochemical recurrence setting, use of salvage radiotherapy (SRT), management of clinically evident locoregional recurrence and future considerations. CONCLUSIONS Overall, good level of agreement was found between participants for most of the topics. Most debated issues regarded, as expected, implementation of new imaging methods in this setting. Notably, trend in favour of early SRT vs. immediate adjuvant RT was underlined, and preference for global evaluation rather than isolated risk factors for RT indications was noticed.
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Affiliation(s)
- G Francolini
- Radiotherapy Department, University of Florence, Florence, Italy.
| | - G Timon
- Radioterapia Oncologica, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - F Matrone
- Department of Radiation Oncology, Centro di Riferimento, Oncologico di Aviano CRO-IRCCS, Aviano, PN, Italy
| | - G Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - L Nicosia
- Advanced Radiation Oncology Department, Cancer Care Center, IRCCS Sacro Cuore Don Calabria Hospital, via Don Sempreboni 5, 37034, Verona, Negrar, Italy
| | - L Ognibene
- Radiotheray Unit, San Gaetano Radiotherapy and Nuclear Medicine Center, Palermo, Italy
| | - A Vinciguerra
- Department of Radiation Oncology, "SS Annunziata" Hospital, "G. D'Annunzio" University, Via dei Vestini, 66100, Chieti, Italy
| | - L E Trodella
- Radiation Oncology, Campus Bio-Medico University, Via A. del Portillo, 21, 00128, Rome, Italy
| | - C Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Clinical and Research Hospital-IRCCS, Via Manzoni 56, Rozzano, Milan, Italy
| | - P Borghetti
- Radiation Oncology Department, University and Spedali Civili of Brescia, Brescia, Italy
| | - B A Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Division of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - S Arcangeli
- Department of Radiation Oncology, School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
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Pang HYM, Chalmers K, Landon B, Elshaug AG, Matelski J, Ling V, Krzyzanowska MK, Kulkarni G, Erickson BA, Cram P. Utilization Rates of Pancreatectomy, Radical Prostatectomy, and Nephrectomy in New York, Ontario, and New South Wales, 2011 to 2018. JAMA Netw Open 2021; 4:e215477. [PMID: 33871618 PMCID: PMC8056282 DOI: 10.1001/jamanetworkopen.2021.5477] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/20/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Few studies have compared surgical utilization between countries or how rates may differ according to patients' socioeconomic status. Objective To compare population-level utilization of 3 common nonemergent surgical procedures in New York State (US), Ontario (Canada), and New South Wales (Australia) and how utilization differs for residents of lower- and higher-income neighborhoods. Design, Setting, and Participants This cohort study included all adults aged 18 years and older who were hospitalized for pancreatectomy, radical prostatectomy, or nephrectomy between 2011 and 2016 in New York, between 2011 and 2018 in Ontario, and between 2013 and 2018 in New South Wales. Each patient's address of residence was linked to 2016 census data to ascertain neighborhood income. Data were analyzed from August 2019 to November 2020. Main Outcomes and Measures Primary outcomes were (1) each jurisdiction's per capita age- and sex-standardized utilization rates (procedures per 100 000 residents per year) for each surgery and (2) utilization rates among residents of lower- and higher-income neighborhoods. Results This study included 115 428 surgical patients (25 780 [22.3%] women); 5717, 21 752, and 24 617 patients in New York were hospitalized for pancreatectomy, radical prostatectomy, and nephrectomy, respectively; 4929, 19 125, and 16 916 patients in Ontario, respectively; and 2069, 13 499, and 6804 patients in New South Wales, respectively. Patients in New South Wales were older for all procedures (eg, radical prostatectomy, mean [SD] age in New South Wales, 64.8 [7.3] years; in New York, 62.7 [8.4] years; in Ontario, 62.8 [6.7] years; P < .001); patients in New York were more likely than those in other locations to be women for pancreatectomy (New York: 2926 [51.2%]; Ontario: 2372 [48.1%]; New South Wales, 1003 [48.5%]; P = .004) and nephrectomy (New York: 10 645 [43.2%]; Ontario: 6529 [38.6%]; 2605 [38.3%]; P < .001). With the exception of nephrectomy in Ontario, there was a higher annual utilization rate for all procedures in all jurisdictions among patients residing in affluent neighborhoods (quintile 5) compared with poorer neighborhoods (quintile 1). This difference was largest in New South Wales for pancreatectomy (4.65 additional procedures per 100 000 residents [SE, 0.28]; P < .001) and radical prostatectomy (73.46 additional procedures per 100 000 residents [SE, 1.20]; P < .001); largest in New York for nephrectomy (8.43 additional procedures per 100 000 residents [SE, 0.85]; P < .001) and smallest in New York for radical prostatectomy (19.70 additional procedures per 100 000 residents [SE, 2.63]; P < .001); and smallest in Ontario for pancreatectomy (1.15 additional procedures per 100 000 residents [SE, 0.28]; P < .001) and nephrectomy (-1.10 additional procedures per 100 000 residents [SE, 0.52]; P < .001). New York had the highest utilization of nephrectomy (28.93 procedures per 100 000 residents per year [SE, 0.18]) and New South Wales for had the highest utilization of pancreatectomy and radical prostatectomy (6.94 procedures per 100 000 residents per year [SE, 0.15] and 94.37 procedures per 100 000 residents per year [SE, 0.81], respectively; all P < .001). Utilization was lowest in Ontario for all procedures (pancreatectomy, 6.18 procedures per 100 000 residents per year [SE, 0.09]; radical prostatectomy, 49.24 procedures per 100 000 residents per year [SE, 0.36]; nephrectomy, 21.40 procedures per 100 000 residents per year [SE, 0.16]; all P < .001). Conclusions and Relevance In this study, New York and New South Wales had higher per capita surgical utilization and larger neighborhood income-utilization gradients than Ontario. These findings suggest that income-based disparities are larger in the United States and Australia and smaller in Canada and highlight trade-offs inherent in the health care systems of different countries.
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Affiliation(s)
- Hilary Y. M. Pang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kelsey Chalmers
- Menzies Centre for Health Policy, School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- Lown Institute, Brookline, Massachusetts
| | - Bruce Landon
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Adam G. Elshaug
- Centre for Health Policy, Melbourne School of Population and Global Health and the Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia
- USC–Brookings Schaeffer Initiative for Health Policy, The Brookings Institution, Washington, DC
| | - John Matelski
- Biostatistics Research Unit, Toronto General Hospital, Toronto, Ontario, Canada
| | | | - Monika K. Krzyzanowska
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Girish Kulkarni
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES Sciences, Toronto, Ontario, Canada
- Department of Surgical Oncology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | | | - Peter Cram
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- ICES Sciences, Toronto, Ontario, Canada
- Department of General Internal Medicine, University Health Network and Sinai Health Systems, Toronto, Ontario, Canada
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Contemporary National Trends and Variations of Pelvic Lymph Node Dissection in Patients Undergoing Robot-Assisted Radical Prostatectomy. Clin Genitourin Cancer 2021; 19:309-315. [PMID: 33663952 DOI: 10.1016/j.clgc.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/10/2021] [Accepted: 01/17/2021] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Previous studies showed suboptimal adherence to clinical practice guidelines for pelvic lymph node dissection (PLND) during radical prostatectomy (RP). Robot-assisted RP (RARP) has become the predominant surgical management for localized prostate cancer in the United States but contemporary national data on PLND adherence during RARP are still lacking. METHODS RARPs for clinically localized (cT1-2N0M0) intermediate-risk and high-risk prostate cancer diagnosed between 2010 and 2016 in National Cancer Database were identified. Outcome of interest was PLND and multivariable logistic regressions were used to identify whether patient demographics and facility characteristics were associated with the outcome. RESULTS We included 115,355 patients in the final cohort (intermediate-risk = 86,314, high-risk = 29,041). From 2010 to 2016, there was an increasing trend of PLND in the overall, intermediate-risk, and high-risk cohorts. In 2016, PLND was performed in 79.7% of the intermediate-risk and 93.5% of the high-risk patients. Multivariable logistic regressions showed Hispanic race/ethnicity (vs. white) (odds ratio [OR] = 0.90, P = .010), lowest socioeconomic status (vs. highest) (OR = 0.85, P < .001), rural area (vs. metro area) (OR=0.61, P < .001), and community facility (vs. academic) (OR = 0.56, P < .001) were some of the factors associated with lower PLND rate. Variations of PLND rate among reporting facility's locations were also identified. CONCLUSION Contemporary national data showed significantly increased PLND rate in patients who underwent RARP for intermediate-risk and high-risk prostate cancer in recent years. However, there were still some variations in PLND rate among different patient populations and facilities. Continued efforts need to be made to further increase PLND rate and narrow or eliminate disparities we identified.
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Loughlin KR. Robotic Urology: Remember the Future. Urol Clin North Am 2020; 48:xiii-xiv. [PMID: 33218598 DOI: 10.1016/j.ucl.2020.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Kevin R Loughlin
- Vascular Biology Research Program at Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
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10
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Omil-Lima DO, Gupta K, Calaway AC, Zell MA. Historical Considerations and Surgical Quality Improvement in Robotic Prostatectomy. Urol Clin North Am 2020; 48:35-44. [PMID: 33218592 DOI: 10.1016/j.ucl.2020.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Laparoscopic prostatectomy was technically challenging and not widely adopted. Robotics led to the widespread adoption of minimally invasive prostatectomy, which has been used heavily, supplanting the open and traditional laparoscopic approach. The benefits of robotic prostatectomy are disputed. Data suggest that robotic prostatectomy outcomes have improved over time.
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Affiliation(s)
- Danly O Omil-Lima
- Urology Institute, University Hospitals-Cleveland Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Karishma Gupta
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam C Calaway
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael A Zell
- Urology Institute-University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Li HK, Thibodeau R, Nsouli T, Jacob J, Lawrence G, Hahn SS. Peritoneal and port site seeding of an undiagnosed urothelial carcinoma of the bladder after robot-assisted laparoscopic prostatectomy. Radiol Case Rep 2020; 15:2550-2553. [PMID: 33082896 PMCID: PMC7553891 DOI: 10.1016/j.radcr.2020.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 11/29/2022] Open
Abstract
Laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy are common procedure performed for the treatment of localized prostate cancer. Port site and peritoneal seeding is an exceedingly rare but known complications associated with this procedure. We present a case of a 71-year old male with low-intermediate risk prostate adenocarcinoma who underwent a robot-assisted laparoscopic prostatectomy. Pathology at that time was negative for extraprostatic extension, seminal vesicle invasion, or margins. Seven months later, the patient presented with gross hematuria and was found to have multiple superficial tumors of the bladder urothelium consistent with high-grade papillary urothelial carcinoma. He then began to experience increasing lower abdominal pain and a palpable, right anterior abdominal mass. Computed tomography-guided biopsy revealed high-grade papillary urothelial carcinoma which strongly suggests peritoneal seeding from his recent robot-assisted laparoscopic prostatectomy. Despite its rarity, the morbidity associated with this phenomenon could help justify a recommendation of careful pathologic examination of each prostate specimen for a second urothelial primary with subsequent cystoscopy if one is found.
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Affiliation(s)
- Hsin Kwung Li
- Department of Radiation Oncology, Upstate Medical University, Syracuse, NY
| | - Ryan Thibodeau
- Department of Radiation Oncology, Upstate Medical University, Syracuse, NY
| | - Tamara Nsouli
- Department of Radiation Oncology, Upstate Medical University, Syracuse, NY
| | - Joseph Jacob
- Department of Urology, Upstate Medical University, Syracuse, NY
| | - Gilbert Lawrence
- Department of Radiation Oncology, Upstate Medical University, Syracuse, NY.,Department of Radiation Oncology, Mohawk Valley Health Systems, Utica, NY
| | - Seung Shin Hahn
- Department of Radiation Oncology, Upstate Medical University, Syracuse, NY
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12
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Loughlin KR. Relentlessly make yourself obsolete: Robot-assisted radical cystectomy, the emerging standard of care. Urol Oncol 2020; 39:13-14. [PMID: 32900622 DOI: 10.1016/j.urolonc.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Kevin R Loughlin
- Harvard Medical School, Vascular Biology Research Program, Boston Children's Hospital, Karp Family Research Laboratories, Boston, MA.
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13
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Cacciamani GE, Bassi S, Sebben M, Marcer A, Russo GI, Cocci A, Dell'Oglio P, Medina LG, Nassiri N, Tafuri A, Abreu A, Porcaro AB, Briganti A, Montorsi F, Gill IS, Artibani W. Consulting "Dr. Google" for Prostate Cancer Treatment Options: A Contemporary Worldwide Trend Analysis. Eur Urol Oncol 2020; 3:481-488. [PMID: 31375427 PMCID: PMC9235534 DOI: 10.1016/j.euo.2019.07.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/14/2019] [Accepted: 07/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In the era of digital data, the Internet has become the primary source from which individuals draw healthcare information. OBJECTIVE The aim of the present study is to determine worldwide public interest in prostate cancer (PCa) treatments, their penetrance and variation, and how they compare over time. DESIGN, SETTING, AND PARTICIPANTS An analysis of worldwide search-engine trends included electronic Google queries from people who searched PCa treatment options from January 2004 to August 2018, worldwide. Join-point regression was performed. Comparisons of annual relative search volume (ARSV), average annual percentage change (AAPC), and temporal patterns were analysed to assess loss or gain of interest. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Evaluations were made regarding (1) interest in PCa treatments, (2) comparison of people's interest, and (3) impact of the US Preventive Service Task Force (USPSTF) screening recommendation and National Comprehensive Cancer Network (NCCN) guideline endorsements on Internet searching for PCa treatments. RESULTS AND LIMITATIONS The mean ARSV for "prostatectomy" was 73% in 2004 and decreased thereafter, reaching a nadir of 36% in 2014 (APC: -7.2%; 95% confidence interval [CI] -7.8, -6.7; p < 0.01). Similarly, decreased interest was recorded for radiation therapy (AAPC: -3.2%; p = 0.1), high-intensity focused ultrasound (AAPC: -2.3%; p = 0.1), hormonal therapy (AAPC: -11.6%; p < 0.01), ablation therapy (AAPC: -4.1%; p < 0.01), cryotherapy (AAPC: -9.9%; p < 0.01), and brachytherapy (AAPC: -8.3%; p < 0.01). A steep interest was found in active surveillance (AS) (AAPC: +14.2%; p < 0.01) and focal therapy (AAPC: +27.5%; p < 0.01). When trends were compared before and after NCCN and USPSTF recommendations, a consistent decrease of all the treatment options was found, while interest in focal therapy and AS showed an augmented mean ARSV (+19.6 and +31.6, respectively). CONCLUSIONS People are increasingly searching the Internet for PCa treatment options. A parallel decrease of interest was found for the nonmonitoring treatments, except for focal therapy, while an important growth of appeal has been recorded for AS. Understanding people inquisitiveness together with their degree of knowledge could be supportive to guiding counselling in the decision-making process and putting effort in certifying patient information. PATIENT SUMMARY In the era of digital data, patients are increasingly searching the Internet for prostate cancer (PCa) treatment options. To safeguard patients' knowledge, it is mandatory to understand how people seek healthcare information, guaranteeing certified and evidence-based information pertaining to PCa treatments options.
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Affiliation(s)
- Giovanni E Cacciamani
- Department of Urology, University of Verona, Verona, Italy; Urology Institute, University of Southern California, Los Angeles, CA, USA.
| | - Silvia Bassi
- Department of Urology, University of Verona, Verona, Italy
| | - Marco Sebben
- Department of Urology, University of Verona, Verona, Italy
| | - Anna Marcer
- Department of Urology, University of Verona, Verona, Italy
| | - Giorgio I Russo
- Department of Urology, University of Catania, Catania, Italy
| | - Andrea Cocci
- Department of Urology, University of Florence, Florence, Italy
| | | | - Luis G Medina
- Urology Institute, University of Southern California, Los Angeles, CA, USA
| | - Nima Nassiri
- Urology Institute, University of Southern California, Los Angeles, CA, USA
| | | | - Andre Abreu
- Urology Institute, University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Inderbir S Gill
- Urology Institute, University of Southern California, Los Angeles, CA, USA
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14
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Swaan A, Muller BG, Wilk LS, Almasian M, Zwartkruis ECH, Rozendaal LR, de Bruin DM, Faber DJ, van Leeuwen TG, van Herk MB. En-face optical coherence tomography for the detection of cancer in prostatectomy specimens: Quantitative analysis in 20 patients. JOURNAL OF BIOPHOTONICS 2020; 13:e201960105. [PMID: 32049426 DOI: 10.1002/jbio.201960105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/10/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
The increase histopathological evaluation of prostatectomy specimens rises the workload on pathologists. Automated histopathology systems, preferably directly on unstained specimens, would accelerate the pathology workflow. In this study, we investigate the potential of quantitative analysis of optical coherence tomography (OCT) to separate benign from malignant prostate tissue automatically. Twenty fixated prostates were cut, from which 54 slices were scanned by OCT. Quantitative OCT metrics (attenuation coefficient, residue, goodness-of-fit) were compared for different tissue types, annotated on the histology slides. To avoid misclassification, the poor-quality slides, and edges of annotations were excluded. Accurate registration of OCT data with histology was achieved in 31 slices. After removing outliers, 56% of the OCT data was compared with histopathology. The quantitative data could not separate malignant from benign tissue. Logistic regression resulted in malignant detection with a sensitivity of 0.80 and a specificity of 0.34. Quantitative OCT analysis should be improved before clinical use.
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Affiliation(s)
- Abel Swaan
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Berrend G Muller
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Leah S Wilk
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Mitra Almasian
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Evita C H Zwartkruis
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - L Rence Rozendaal
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Daniel M de Bruin
- Department of Urology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Dirk J Faber
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ton G van Leeuwen
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel B van Herk
- Department of Biomedical Engineering and Physics, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Institute of Cancer Sciences, University of Manchester, Manchester, UK
- Department of Radiotherapy Related Research, The Christie NHS Foundation Trust, Manchester, UK
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15
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Beaulieu E, Laurence A, Birlea M, Sheehy G, Angulo-Rodriguez L, Latour M, Albadine R, Saad F, Trudel D, Leblond F. Wide-field optical spectroscopy system integrating reflectance and spatial frequency domain imaging to measure attenuation-corrected intrinsic tissue fluorescence in radical prostatectomy specimens. BIOMEDICAL OPTICS EXPRESS 2020; 11:2052-2072. [PMID: 32341866 PMCID: PMC7173915 DOI: 10.1364/boe.388482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/13/2020] [Accepted: 03/08/2020] [Indexed: 06/11/2023]
Abstract
The development of a multimodal optical imaging system is presented that integrates endogenous fluorescence and diffuse reflectance spectroscopy with single-wavelength spatial frequency domain imaging (SFDI) and surface profilometry. The system images specimens at visible wavelengths with a spatial resolution of 70 µm, a field of view of 25 cm2 and a depth of field of ∼1.5 cm. The results of phantom experiments are presented demonstrating the system retrieves absorption and reduced scattering coefficient maps using SFDI with <6% reconstruction errors. A phase-shifting profilometry technique is implemented and the resulting 3-D surface used to compute a geometric correction ensuring optical properties reconstruction errors are maintained to <6% in curved media with height variations <20 mm. Combining SFDI-computed optical properties with data from diffuse reflectance spectra is shown to correct fluorescence using a model based on light transport in tissue theory. The system is used to image a human prostate, demonstrating its ability to distinguish prostatic tissue (anterior stroma, hyperplasia, peripheral zone) from extra-prostatic tissue (urethra, ejaculatory ducts, peri-prostatic tissue). These techniques could be integrated in robotic-assisted surgical systems to enhance information provided to surgeons and improve procedural accuracy by minimizing the risk of damage to extra-prostatic tissue during radical prostatectomy procedures and eventually detect residual cancer.
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Affiliation(s)
- Emile Beaulieu
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Audrey Laurence
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Mirela Birlea
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Guillaume Sheehy
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Leticia Angulo-Rodriguez
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
| | - Mathieu Latour
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Roula Albadine
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Fred Saad
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
| | - Dominique Trudel
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
- University of Montreal, Dept. of Pathology
and Cellular Biology, C.P. 6128, Succ. Centre-ville, Montreal, QC
H3 T 1J4, Canada
| | - Frédéric Leblond
- Polytechnique Montreal, Dept. of
Engineering Physics, C.P. 6079, Succ. Centre-ville, Montreal, QC H3C
3A7, Canada
- Centre Hospitalier Universitaire de
Montreal Research Center (CRCHUM), 900 Rue Saint-Denis, Montreal, QC
H2X 0A9, Canada
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16
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Murphy C, Laine C, Macaulay M, Fader M. Development and randomised controlled trial of a Continence Product Patient Decision Aid for men postradical prostatectomy. J Clin Nurs 2020; 29:2251-2259. [DOI: 10.1111/jocn.15223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 01/24/2023]
Affiliation(s)
- Catherine Murphy
- School of Health Sciences University of Southampton Southampton UK
| | - Christine Laine
- School of Health Sciences University of Southampton Southampton UK
| | | | - Mandy Fader
- School of Health Sciences University of Southampton Southampton UK
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17
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Climacturia (Uroclimax) in Men After Radical Prostatectomy: A Comprehensive Review of the Current Literature and Treatment Strategies. CURRENT SEXUAL HEALTH REPORTS 2019. [DOI: 10.1007/s11930-019-00217-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Francolini G, Jereczek-Fossa BA, Di Cataldo V, Simontacchi G, Marvaso G, Zerella MA, Gentile P, Bianciardi F, Allegretta S, Detti B, Masi L, Lo Russo M, Livi L. Stereotactic radiotherapy for prostate bed recurrence after prostatectomy, a multicentric series. BJU Int 2019; 125:417-425. [PMID: 31608534 DOI: 10.1111/bju.14924] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the safety and effectiveness of stereotactic salvage radiotherapy (SSRT) in RT-naïve patients affected by macroscopic prostate bed recurrence. PATIENTS AND METHODS Consecutive patients treated for prostate bed macroscopic recurrence in three different Italian institutes were reviewed. Patients were treated with SSRT, with a total dose of 30-40 Gy in five fractions, the mean pre-SSRT PSA level was 2.3 ng/mL. Two different PSA thresholds were defined and biochemical recurrence-free survival (BCRFS) was reported, in order to better express outcome: BCRFS1 (a PSA level increase of >10% compared to the pre-SSRT value) and BCRFS2 (a PSA level increase of >0.2 ng/mL for patients with a PSA nadir of <0.2 ng/mL or two consecutive PSA level increases of >25% compared to nadir in patients with a PSA nadir of <0.2 ng/mL). RESULTS In all, 90 patients were treated, with a mean (range) follow-up of 21.2 (2-64) months, and 17 of these patients (19%) had concomitant androgen-deprivation therapy (ADT) during SSRT. Complete biochemical response, defined as a PSA nadir of <0.2 ng/mL, was obtained in 39 of the 90 patients (43.3%). Considering BCRFS1, 25 patients (27.8%) had BCR, with an actuarial median BCRFS1 time of 36.4 months. For BCRFS2, BCR was reported in 32 patients (35.5%), with an actuarial median BCRFS2 time of 24.3 months. There was no Grade >2 toxicity. CONCLUSIONS SSRT was found to yield significant biochemical control and allowed ADT delay despite adverse features.
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Affiliation(s)
- Giulio Francolini
- Radiation Oncology Unit, University of Florence, Florence, Italy.,CyberKnife Center, L'Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Barbara Alicja Jereczek-Fossa
- Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.,Division of Radiotherapy, European Institute of Oncology (IEO), L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Vanessa Di Cataldo
- Radiation Oncology Unit, University of Florence, Florence, Italy.,CyberKnife Center, L'Istituto Fiorentino di Cura e Assistenza (IFCA), Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Giulia Marvaso
- Division of Radiotherapy, European Institute of Oncology (IEO), L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Maria Alessia Zerella
- Division of Radiotherapy, European Institute of Oncology (IEO), L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan, Italy
| | - Piercarlo Gentile
- University of Pittsburgh Medical Center (UPMC) San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Federico Bianciardi
- University of Pittsburgh Medical Center (UPMC) San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Sara Allegretta
- University of Pittsburgh Medical Center (UPMC) San Pietro Fatebenefratelli (FBF), Rome, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Laura Masi
- Department of Medical Physics and Radiation Oncology, IFCA, Florence, Italy
| | - Monica Lo Russo
- Radiation Oncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Biomedical, Experimental, and Clinical Sciences 'Mario Serio', University of Florence, Florence, Italy
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19
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Huang W, Zhang Y, Shen BH, Wang S, Meng HZ, Jin XD. Outcomes of health-related quality of life after open, laparoscopic, or robot-assisted radical prostatectomy in China. Cancer Manag Res 2019; 11:899-907. [PMID: 30697080 PMCID: PMC6342140 DOI: 10.2147/cmar.s189893] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose To compare the outcomes of health-related quality of life (HRQOL) in patients undergoing open (ORP), laparoscopic (LRP), or robot-assisted (RARP) radical prostatectomy. Patients and methods We retrospectively analyzed 347 men with clinically localized prostate cancer treated with ORP (n=97), LRP (n=71), or RARP (n=179) by high-volume surgeons in our institution between January 2014 and December 2016. The primary endpoint was HRQOL including urinary incontinence and erectile dysfunction. Results One year after surgery, 15.9% of men reported moderate to severe urinary incontinence (ORP 16.5%, LRP 15.4%, and RARP 15.7%), with only 4.6% using pads. There were no statistically significant differences in the ratios of no pad usage and urinary incontinence bother after 12 months postoperatively among the three groups. However, 67.7% of the men reported moderate to severe erectile dysfunction (ORP 66%, LRP 66.1%, and RARP 69.3%) 12 months after surgery. There was no statistically significant difference in the international index of erectile function-5 (IIEF-5) postoperatively among the different surgical groups. In the univariate and multivariate analyses, age at surgery, preoperative IIEF-5, and neurovascular bundle preservation were the risk factors for moderate to severe sexual bother. Interestingly, 16.1% of men with an erection hardness score of grade 3-4 were hesitant to become sexually active postoperatively. Conclusion ORP, LRP, and RARP have similar early HRQOL outcomes with respect to urinary incontinence and erectile dysfunction. In contrast to urinary continence, erectile dysfunction is still a serious concern for patients who undergo radical prostatectomy.
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Affiliation(s)
- Wei Huang
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,
| | - Yan Zhang
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,
| | - Bai-Hua Shen
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,
| | - Shuo Wang
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,
| | - Hong-Zhou Meng
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,
| | - Xiao-Dong Jin
- Department of Urology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China,
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20
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Mukherjee K, Kamal KM. Variation in prostate surgery costs and outcomes in the USA: robot-assisted versus open radical prostatectomy. J Comp Eff Res 2019; 8:143-155. [PMID: 30620207 DOI: 10.2217/cer-2018-0109] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM To compare perioperative complications, inpatient cost and length of stay between robot-assisted radical prostatectomy (RARP) and open radical prostatectomy (ORP) using National Inpatient Sample data from 2010 to 2015. PATIENTS & METHODS A total of 69,009 records with RARP or ORP were analyzed using multivariate logistic regression and generalized linear models. RESULTS The RARP had superior perioperative outcomes at a higher cost (adjusted mean difference = 2956; 95% CI: $2822-$3090) and shorter length of stay (mean difference = 0.85; 95% CI: 0.81-0.89) compared with ORP. Mean cost of RARP was lowest in urban teaching, private invest-own, high volume and northeast region hospitals and highest for black men. CONCLUSION Compared with ORP, RARP had significantly better perioperative outcomes at a higher cost.
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Affiliation(s)
- Kumar Mukherjee
- Department of Pharmacy Practice, Philadelphia College of Osteopathic Medicine, School of Pharmacy, Suwanee, GA, 30024, USA
| | - Khalid M Kamal
- Duquesne University School of Pharmacy, Division of Pharmaceutical, Administrative & Social Sciences, Pittsburgh, PA, 15282, USA
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21
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La Regina D, Gaffuri P, Ceppi M, Saporito A, Ferrari M, Di Giuseppe M, Mongelli F. Safety, feasibility and clinical outcome of minimally invasive inguinal hernia repair in patients with previous radical prostatectomy: A systematic review of the literature. J Minim Access Surg 2019; 15:281-286. [PMID: 30416142 PMCID: PMC6839359 DOI: 10.4103/jmas.jmas_218_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Radical prostatectomy (RP) represents an important acquired risk factor for the development of primary inguinal hernias (IH) with an estimated incidence rates of 15.9% within the first 2 years after surgery. The prostatectomy-related preperitoneal fibrotic reaction can make the laparoendoscopic repair of the IH technically difficult, even if safety and feasibility have not been extensively evaluated yet. We conducted a systematic review of the available literature. Methods: A comprehensive computer literature search of PubMed and MEDLINE databases was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Terms used to search were (‘laparoscopic’ OR ‘laparoscopy’) AND (‘inguinal’ OR ‘groin’ OR ‘hernia’) AND ‘prostatectomy’. Results: The literature search from PubMed and MEDLINE databases revealed 156 articles. Five articles were considered eligible for the analysis, including 229 patients who underwent 277 hernia repairs. The pooled analysis indicates no statistically significant difference of post-operative complications (Risk Ratios [RR] 2.06; 95% confidence interval [CI] 0.85–4.97), conversion to open surgery (RR 3.91; 95% CI 0.85–18.04) and recurrence of hernia (RR 1.39; 95% CI 0.39–4.93) between the post-prostatectomy group and the control group. There was a statistically significant difference of minor intraoperative complications (RR 4.42; CI 1.05–18.64), due to an injury of the inferior epigastric vessels. Conclusions: Our systematic review suggests that, in experienced hands, safety, feasibility and clinical outcomes of minimally invasive repair of IH in patients previously treated with prostatectomy, are comparable to those patients without previous RP.
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Affiliation(s)
- Davide La Regina
- Department of Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Paolo Gaffuri
- Department of Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Marcello Ceppi
- Department of Clinical Epidemiology, Ospedale Policlinico San Martino, Genova, Italy
| | - Andrea Saporito
- Department of Anaesthesiology, San Giovanni Hospital, Bellinzona, Switzerland
| | - Matteo Ferrari
- Department of Urology, San Giovanni Hospital, Bellinzona, Switzerland
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22
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Barashi NS, Pearce SM, Cohen AJ, Pariser JJ, Packiam VT, Eggener SE. Incidence, Risk Factors, and Outcomes for Rectal Injury During Radical Prostatectomy: A Population-based Study. Eur Urol Oncol 2018; 1:501-506. [PMID: 31158094 DOI: 10.1016/j.euo.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/18/2018] [Accepted: 06/06/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Rectal injury (RI) is a rare but potentially serious complication of radical prostatectomy (RP). Current evidence is limited owing to relatively small cohorts from select, tertiary referral centers. OBJECTIVE To evaluate the incidence of and potential risk factors for RI during radical RP at a population level in the USA. DESIGN, SETTINGS, AND PARTICIPANTS Using the National Inpatient Sample database (2003-2012), we identified patients with prostate cancer who underwent RP. Survey-weighted cohorts were created based on the diagnosis and repair of RI during initial hospitalization. Data included demographics, hospital characteristics, surgical details, complications, and perioperative outcomes. Multivariable logistic regression was used to identify risk factors for RI. RESULTS AND LIMITATIONS Of 614 294 men who underwent RP, there were 2900 (0.5%) RIs, with a 26% decline from 2003-2006 to 2009-2012 (p<0.01). Patients with RI were slightly older (62.0 vs 61.2 yr; p<0.01) and more commonly of African ancestry (0.8% vs 0.4% Caucasians; p<0.01). RI was more common among patients with benign prostatic hyperplasia (BPH), metastatic disease, and low body mass index (BMI; p<0.05). The RI incidence was higher for open (0.6%) compared to laparoscopic (0.4%) and robotic RP (0.2%; p<0.01). RI was more common at rural (0.8% vs 0.5% urban), nonteaching (0.6% vs 0.4% teaching), and low-volume hospitals (0.6% vs 0.3% high-volume; p<0.01). Complication rates (28% vs 11%; p<0.01) and length of stay (4.8 vs 2.3 d; p<0.01) were greater in the RI group. Multivariable analysis identified African ancestry, BPH, and metastatic cancer as predictors of RI, while robotic approach, high-volume hospital, and obesity reduced the risk (p<0.05). CONCLUSIONS RI during RP is a rare complication, but is more common among men with African ancestry and for procedures carried out using an open surgical technique or in low-volume hospitals, and among those with low BMI, BPH, or metastatic disease. PATIENT SUMMARY In a large US population, we found that rectal injury (RI) is a rare complication of radical prostatectomy, and that the risk of RI can increase according to patient- and hospital-specific characteristics.
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Affiliation(s)
- Nimrod S Barashi
- Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL, USA.
| | - Shane M Pearce
- Department of Urology, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Andrew J Cohen
- Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL, USA
| | - Joseph J Pariser
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Vignesh T Packiam
- Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL, USA
| | - Scott E Eggener
- Department of Surgery, Section of Urology, The University of Chicago Medicine, Chicago, IL, USA
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Sharma V, Nehra A, Colicchia M, Westerman ME, Kawashima A, Froemming AT, Kwon ED, Mynderse LA, Karnes RJ. Multiparametric Magnetic Resonance Imaging Is an Independent Predictor of Salvage Radiotherapy Outcomes After Radical Prostatectomy. Eur Urol 2018; 73:879-887. [DOI: 10.1016/j.eururo.2017.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 11/14/2017] [Indexed: 01/09/2023]
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Handmer M, Chabert C, Cohen R, Gianduzzo T, Kearns P, Moon D, Ooi J, Shannon T, Sofield D, Tan A, Louie-Johnsun M. The Australian laparoscopic radical prostatectomy learning curve. ANZ J Surg 2017; 88:100-103. [DOI: 10.1111/ans.14025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/06/2017] [Accepted: 03/14/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Marcus Handmer
- Department of Urology; The University of Newcastle, Gosford Hospital; Gosford New South Wales Australia
| | - Charles Chabert
- Department of Urology; Pindara Gold Coast Private Hospital; Gold Coast Queensland Australia
| | - Ronald Cohen
- Department of Pathology; Uropath Pty Ltd; Perth Western Australia Australia
- School of Pathology and Laboratory Medicine; The University of Western Australia; Perth Western Australia Australia
| | - Troy Gianduzzo
- School of Medicine; University of Queensland; Brisbane Queensland Australia
- Department of Urology; The Wesley Hospital; Brisbane Queensland Australia
| | - Paul Kearns
- Department of Urology; Geelong Hospital; Geelong Victoria Australia
- Department of Urology; St John of God Hospital; Melbourne Victoria Australia
- Department of Urology; Barwon Health University Hospital; Geelong Victoria Australia
| | - Daniel Moon
- Department of Urology; Epworth HealthCare; Melbourne Victoria Australia
| | - Jason Ooi
- Department of Surgery; The University of Melbourne; Melbourne Victoria Australia
- Urology Unit; Western Hospital; Melbourne Victoria Australia
- Department of Urology; St Vincent's Private Hospital; Melbourne Victoria Australia
| | - Tom Shannon
- Department of Urology; Hollywood Private Hospital; Nedlands Western Australia Australia
| | - David Sofield
- Department of Urology; Bethesda Hospital; Perth Western Australia Australia
| | - Andrew Tan
- Department of Urology; Royal Perth Hospital; Perth Western Australia Australia
| | - Mark Louie-Johnsun
- Department of Urology; The University of Newcastle, Gosford Hospital; Gosford New South Wales Australia
- Department of Urology; Gosford Private Hospital; Gosford New South Wales Australia
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Herlemann A, Cowan JE, Carroll PR, Cooperberg MR. Community-based Outcomes of Open versus Robot-assisted Radical Prostatectomy. Eur Urol 2017; 73:215-223. [PMID: 28499617 DOI: 10.1016/j.eururo.2017.04.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 04/19/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Identifying the optimal surgical approach for patients with localized prostate cancer (PCa) managed in the community setting remains controversial due to the lack of robust, prospective data. OBJECTIVE To assess surgical outcomes and changes in urinary and sexual quality of life (QOL) over time in patients undergoing radical prostatectomy (RP). DESIGN, SETTING, AND PARTICIPANTS Our study included patients enrolled in Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE), a large, prospective, mostly community-based, nationwide PCa registry, who underwent RP between 2004 and 2016. INTERVENTION Open (ORP) versus robot-assisted radical prostatectomy (RARP) for localized PCa. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Demographic and clinicopathologic data and surgical outcomes were compared between ORP and RARP. Self-reported, validated questionnaires (scaled 0-100 with higher numbers indicating better function) were used to evaluate urinary and sexual QOL at different time points. Repeated measures mixed-models assessed changes in function and bother over time in each domain. RESULTS AND LIMITATIONS Among 1892 men (n = 1137 ORP; n = 755 RARP), Cancer of the Prostate Risk Assessment score, Gleason grade at biopsy and RP, and pT-stage were lower in ORP patients (all p < 0.01). Men undergoing RARP had comparable surgical margin rates, lymph node yields, and biochemical recurrence rates. In a subset analysis with 1451 men reporting baseline and follow-up QOL data, ORP patients reported superior scores in urinary incontinence (ORP mean ± standard deviation 69 ± 26 vs RARP 62 ± 27) and bother (ORP 75±29 vs RARP 68±28, both p < 0.01) only in the 1st yr after RP. Differences in sexual outcomes did not differ between groups, nor did any QOL scores beyond 1 yr. Limitations include a decrease in the rate of questionnaire response during follow-up, potential selection biases in terms of patient assignment to ORP versus RARP and survey completion rates, and the fact that RARP cases likely included the initial learning curve for the CaPSURE surgeons. CONCLUSIONS Most patients experienced changes in urinary and sexual QOL in the 1st 3 yr following RP. The pattern of recovery over time was similar between ORP and RARP groups. Patients should not expect different oncologic or QOL outcomes based on surgical approach. PATIENT SUMMARY Aside from a small, early, and temporary advantage in terms of urinary incontinence and bother favoring open surgery, minimal differences in outcomes are observed when comparing men who undergo open versus robot-assisted prostatectomy in the community setting.
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Affiliation(s)
- Annika Herlemann
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Urology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Janet E Cowan
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Peter R Carroll
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA.
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26
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Lee G, Veltri RW, Zhu G, Ali S, Epstein JI, Madabhushi A. Nuclear Shape and Architecture in Benign Fields Predict Biochemical Recurrence in Prostate Cancer Patients Following Radical Prostatectomy: Preliminary Findings. Eur Urol Focus 2016; 3:457-466. [PMID: 28753763 DOI: 10.1016/j.euf.2016.05.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/21/2016] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gleason scoring represents the standard for diagnosis of prostate cancer (PCa) and assessment of prognosis following radical prostatectomy (RP), but it does not account for patterns in neighboring normal-appearing benign fields that may be predictive of disease recurrence. OBJECTIVE To investigate (1) whether computer-extracted image features within tumor-adjacent benign regions on digital pathology images could predict recurrence in PCa patients after surgery and (2) whether a tumor plus adjacent benign signature (TABS) could better predict recurrence compared with Gleason score or features from benign or cancerous regions alone. DESIGN, SETTING, AND PARTICIPANTS We studied 140 tissue microarray cores (0.6mm each) from 70 PCa patients following surgery between 2000 and 2004 with up to 14 yr of follow-up. Overall, 22 patients experienced recurrence (biochemical [prostate-specific antigen], local, or distant recurrence and cancer death) and 48 did not. INTERVENTION RP was performed in all patients. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The top 10 features identified as most predictive of recurrence within both the benign and cancerous regions were combined into a 10-feature signature (TABS). Computer-extracted nuclear shape and architectural features from cancerous regions, adjacent benign fields, and TABS were evaluated via random forest classification accuracy and Kaplan-Meier survival analysis. RESULTS AND LIMITATIONS Tumor-adjacent benign field features were predictive of recurrence (area under the receiver operating characteristic curve [AUC]: 0.72). Tumor-field nuclear shape descriptors and benign-field local nuclear arrangement were the predominant features found for TABS (AUC: 0.77). Combining TABS with Gleason sum further improved identification of recurrence (AUC: 0.81). All experiments were performed using threefold cross-validation without independent test set validation. CONCLUSIONS Computer-extracted nuclear features within cancerous and benign regions predict recurrence following RP. Furthermore, TABS was shown to provide added value to common predictors including Gleason sum and Kattan and Stephenson nomograms. PATIENT SUMMARY Future studies may benefit from evaluation of benign regions proximal to the tumor on surgically excised prostate cancer tissue for assessing risk of disease recurrence.
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Affiliation(s)
- George Lee
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
| | - Robert W Veltri
- Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Guangjing Zhu
- Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sahirzeeshan Ali
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Jonathan I Epstein
- Department of Urology, James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anant Madabhushi
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, USA.
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Dalela D, Menon M. Contemporary Trends in Radical Prostatectomy in the United States: Open vs Minimally Invasive Surgery. Mayo Clin Proc 2016; 91:1-2. [PMID: 26763508 DOI: 10.1016/j.mayocp.2015.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 11/16/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Deepansh Dalela
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI.
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI
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