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Samora NL, Wallis CJD, Huang L, Tallman JE, Zhao Z, Hoffman K, Morgans A, Cooperberg M, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan S, O'Neil B, Paddock LE, Stroup A, Wu X, Koyama T, Penson DF, Barocas DA. Association between body mass index and localized prostate cancer management and disease-specific quality of life. BJUI COMPASS 2022; 4:223-233. [PMID: 36816144 PMCID: PMC9931544 DOI: 10.1002/bco2.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 02/17/2023] Open
Abstract
Purpose The purpose of this work is to describe the association between body mass index (BMI) and (1) management option for localized prostate cancer (PCa) and (2) disease-specific quality of life (ds-QoL) after treatment or active surveillance. Subjects/patients and methods We analysed data from men with localized PCa managed with radical prostatectomy (RP), radiation therapy (RT), or active surveillance (AS) in a prospective, population-based cohort study. We evaluated the association between BMI and management option with multivariable multinomial logistic regression analysis. The association between BMI and ds-QoL was assessed using multivariable longitudinal linear regression. Regression models were adjusted for baseline domain scores, demographics, and clinicopathologic characteristics. Results A total of 2378 men were included (medians [quartiles]: age 64 [59-69] years; BMI 27 kg/m2; 77% were non-Hispanic white); 29% were obese (BMI ≥ 30). Accounting for demographic and clinicopathologic features, BMI ≥ 28 kg/m2 was inversely associated with the likelihood of receiving RP (compared with RT) and became statistically significant at BMI ≥ 33 kg/m2 (maximum adjusted relative risk ratio = 0.80, 95% CI 0.67 to 0.95, p = 0.013 for BMI ≥ 33 vs. 25). Conversely, BMI was not significantly associated with the likelihood of receiving AS compared with RT. After stratification by management option, obese men who underwent definitive treatment were not found to have clinically worse ds-QoL. Obese men initially on AS appeared to have worse urinary incontinence than nonobese men, but this was not significant on an as-treated sensitivity analysis. Conclusions Among men with localized PCa, those with BMI ≥ 33 kg/m2 were less likely to receive surgery than radiation. Obesity was not associated with ds-QoL in men undergoing definitive treatment, nor in men who remained on AS.
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Affiliation(s)
| | | | - Li‐Ching Huang
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Jacob E. Tallman
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Zhiguo Zhao
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Karen Hoffman
- Department of Radiation OncologyThe University of Texas MD Anderson CenterHoustonTexasUSA
| | - Alicia Morgans
- Dana Farber Cancer InstituteHarvard Medical SchoolBostonMassachusettsUSA
| | | | - Michael Goodman
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGeorgiaUSA
| | - Sheldon Greenfield
- Department of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Ann S. Hamilton
- Department of Population and Public Health SciencesKeck School of Medicine at the University of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mia Hashibe
- Department of Family and Preventative MedicineUniversity of Utah School of MedicineSalt Lake CityUtahUSA
| | - Sherrie Kaplan
- Department of MedicineUniversity of California IrvineIrvineCaliforniaUSA
| | - Brock O'Neil
- Department of UrologyUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Lisa E. Paddock
- Department of EpidemiologyRutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Antoinette Stroup
- Department of EpidemiologyRutgers Cancer Institute of New JerseyNew BrunswickNew JerseyUSA
| | - Xiao‐Cheng Wu
- Department of EpidemiologyLouisiana State University New Orleans School of Public HealthNew OrleansLouisianaUSA
| | - Tatsuki Koyama
- Department of BiostatisticsVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - David F. Penson
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
- Geriatric Research Education and Clinical CenterVeterans Affairs Tennessee Valley Healthcare SystemNashvilleTennesseeUSA
| | - Daniel A. Barocas
- Department of UrologyVanderbilt University Medical CenterNashvilleTennesseeUSA
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Chiang CY, Lin V, Tung MC, Wu CH, Wu R, Kuo WT, Mai HC, Chen SH. Does obesity affect the outcomes of clinically localized prostate cancer in the era of extraperitoneal robot-assisted radical prostatectomy? UROLOGICAL SCIENCE 2022. [DOI: 10.4103/uros.uros_139_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hoeh B, Preisser F, Wenzel M, Humke C, Wittler C, Hohenhorst JL, Volckmann-Wilde M, Köllermann J, Steuber T, Graefen M, Tilki D, Karakiewicz PI, Becker A, Kluth LA, Chun FKH, Mandel P. Correlation of Urine Loss after Catheter Removal and Early Continence in Men Undergoing Radical Prostatectomy. Curr Oncol 2021; 28:4738-4747. [PMID: 34898569 PMCID: PMC8628712 DOI: 10.3390/curroncol28060399] [Citation(s) in RCA: 3] [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: 10/10/2021] [Revised: 11/07/2021] [Accepted: 11/13/2021] [Indexed: 12/09/2022] Open
Abstract
BACKGROUND To determine the correlation between urine loss in PAD-test after catheter removal, and early urinary continence (UC) in RP treated patients. METHODS Urine loss was measured by using a standardized, validated PAD-test within 24 h after removal of the transurethral catheter, and was grouped as a loss of <1, 1-10, 11-50, and >50 g of urine, respectively. Early UC (median: 3 months) was defined as the usage of no or one safety-pad. Uni- and multivariable logistic regression models tested the correlation between PAD-test results and early UC. Covariates consisted of age, BMI, nerve-sparing approach, prostate volume, and extraprostatic extension of tumor. RESULTS From 01/2018 to 03/2021, 100 patients undergoing RP with data available for a PAD-test and early UC were retrospectively identified. Ultimately, 24%, 47%, 15%, and 14% of patients had a loss of urine <1 g, 1-10 g, 11-50 g, and >50 g in PAD-test, respectively. Additionally, 59% of patients reported to be continent. In multivariable logistic regression models, urine loss in PAD-test predicted early UC (OR: 0.21 vs. 0.09 vs. 0.03; for urine loss 1-10 g vs. 11-50 g vs. >50 g, Ref: <1 g; all p < 0.05). CONCLUSIONS Urine loss after catheter removal strongly correlated with early continence as well as a severity in urinary incontinence.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H3T 1C5, Canada; (J.L.H.); (P.I.K.)
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
- Correspondence: ; Tel.: +49-(0)69-6301-83147; Fax: +49-(0)69-6301-83140
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Jan L. Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H3T 1C5, Canada; (J.L.H.); (P.I.K.)
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
| | - Maja Volckmann-Wilde
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany;
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany; (T.S.); (M.G.); (D.T.)
- Department of Urology, University Hospital Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H3T 1C5, Canada; (J.L.H.); (P.I.K.)
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Luis A. Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Felix K. H. Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, 60323 Frankfurt am Main, Germany; (B.H.); (M.W.); (C.H.); (C.W.); (M.V.-W.); (A.B.); (L.A.K.); (F.K.H.C.); (P.M.)
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Health-Related Quality of Life following Cytoreductive Radical Prostatectomy in Patients with De-Novo Oligometastatic Prostate Cancer. Cancers (Basel) 2021; 13:cancers13225636. [PMID: 34830791 PMCID: PMC8616367 DOI: 10.3390/cancers13225636] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Recent retrospective data indicate a survival benefit of surgical removal of the prostate in patients with oligometastatic prostate cancer as part of a multimodal therapeutic regime. However, the impact of radical prostatectomy (RP) on patient’s health-related quality of life (HRQOL) in this scenario has not been evaluated yet. In a contemporary and well-balanced cohort, we compared the self-assessed HRQOL of patients with oligometastatic prostate cancer with patients with locally confined prostate cancer two years postoperatively. In multivariate analysis, we found no significant difference in postoperative HRQOL and urinary continence recovery in patients with de-novo oligo-metastatic compared to patients with locally confined prostate cancer. Abstract (1) Background: local treatment of the primary tumor has become a valid therapeutic option in de-novo oligo-metastatic prostate cancer (PC). However, evidence regarding radical prostatectomy (RP) in this setting is still subpar, and the effect of cytoreductive RP on postoperative health-related quality of life (HRQOL) is still unclear. (2) Methods: for the current study, patients with de-novo oligo-metastatic PC (cM1-oligo), defined as ≤5 bone lesions in the preoperative staging, were included, and matched cohorts using the variables age, body-mass index (BMI), and pT-stage were generated. Patient-reported outcome measures (PROMS) were assessed pre- and postoperatively using the validated EORTC-QLQ-C30, IIEF-5, and ICIQ-SF questionnaires. The primary endpoint for univariate and multivariable analysis was good general HRQOL defined by previously validated cut-off values. (3) Results: in total, 1268 patients (n = 84 (7%) cM1-oligo) underwent RP between 2012 and 2020 at one tertiary care center. A matched cohort of 411 patients (n = 79 with oligo-metastatic bone disease (cM1-oligo) and n = 332 patients without clinical indication of metastatic disease (cM0)) was created. The median follow-up was 25mo. There was no significant difference in good general HRQOL rates between cM1-oligo-patients and cM0-patients before RP (45.6% vs. 55.2%, p = 0.186), and at time of follow-up (44% vs. 56%, p = 0.811). Global health status (GHS) worsened significantly in cM0-patients compared to baseline (−5, p = 0.001), whereas GHS did not change significantly in cM1-oligo-patients (+3.2, p = 0.381). In multivariate analysis stratified for good erectile function (IIEF5 > 18; OR 5.722, 95% CI 1.89–17.36, p = 0.002) and continence recovery (OR 1.671, 95% CI 1.03–2.70, p = 0.036), cM1-oligo was not an independent predictive feature for general HRQOL (OR 0.821, 95% CI 0.44–1.53, p = 0.536). (4) Conclusions: in this large contemporary retrospective analysis, we observed no significant difference in HRQOL in patients with the oligometastatic bone disease after cytoreductive radical prostatectomy, when compared to patients with localized disease at time of surgery.
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Overweight and obesity as risk factors for biochemical recurrence of prostate cancer after radical prostatectomy. Int J Clin Oncol 2021; 27:403-410. [PMID: 34714459 DOI: 10.1007/s10147-021-02058-9] [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: 06/05/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Previous studies have shown a relationship between the occurrence and recurrence of prostate cancer; however, this relationship remains controversial. We investigated the relationship between obesity and biochemical recurrence in patients with prostate cancer. METHODS Clinicopathological factors were analyzed after dividing the patient population according to the Asian population-specific body mass index (BMI) criteria for "normal" (< 23 kg/m2), "overweight" (23-27.5 kg/m2), and "obese" (≥ 27.5 kg/m2). Among the 389 patients included in this study, 108 were classified as normal, while 227 and 54 patients were classified as overweight and obese, respectively. The relationships between clinicopathological factors and biochemical recurrence were analyzed by univariate and multivariate Cox ≤ proportional hazard models. Biochemical recurrence was defined as two consecutive prostate-specific antigen (PSA) measurements ≥ 0.2 ng/mL. RESULTS In univariate analysis, the categorical variables of "overweight" and "obese" were significant prognostic factors for biochemical recurrence. In multivariate analysis models including PSA density [hazard ratio (HR) 1.8, p = 0.01], extraprostatic extension (HR 2.0, p < 0.001), Gleason score (HR 1.7, p = 0.01), surgical margin positivity (HR 2.46, p < 0.001), and lymphovascular invasion (HR 2.53, p < 0.001), the categorical variables of "overweight" (HR 1.6, p = 0.03) and "obese" (HR 1.76, p = 0.035) were prognostic factors for biochemical recurrence. CONCLUSION The obesity status of patients with prostate cancer as "overweight" and "obese" was a risk factor for biochemical recurrence after adjusting for other clinicopathological factors.
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6
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Westhofen T, Buchner A, Schlenker B, Becker A, Chaloupka M, Bischoff R, Stief CG, Kretschmer A. A matter of size? Health-related quality of life after radical prostatectomy for patients with giant prostates. Prostate 2021; 81:443-451. [PMID: 33878204 DOI: 10.1002/pros.24124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Evidence regarding the impact of giant prostate volume (PV) on outcome after radical prostatectomy (RP) is controversial with a lack of evidence on the impact of PV on health-related quality of life (HRQOL). We aimed to assess the impact of giant PV on HRQOL and functional outcomes for men with prostate cancer (PC) undergoing RP. METHODS Giant PV was defined based on the 95th percentile of PV measured by specimen weight of 3929 patients that underwent RP between 2013 and 2018 in a large tertiary care center. A propensity score-matched analysis of 929 men treated with RP for PC (n = 184 with PV ≥ 100 cm3 , n = 745 with PV < 100 cm3 ) was conducted. Primary endpoint was the impact of giant PV on HRQOL (based on EORTC QLQ-C30) assessed with binary logistic regression and Cox proportional hazard model. Secondary endpoint was the impact of PV on oncological- and functional outcome. RESULTS Median follow-up was 24 months. Median PV, measured by specimen-weight, was 58 cm3 . We found no significant differences in median general HRQOL (p = .183), giant PV was not associated with better HRQOL (odds ratio [OR], 1.54; 95% confidence interval [CI], 0.96-2.47; p = .075). No significant differences were found regarding continence recovery (hazard ratio [HR], 0.956; 95% CI, 0.771-1.185; p = .682), median International Consultation of Incontinence Questionnaire-Short-Form (ICIQ-SF) scores (p = .062) or potency rates (p = .151). Giant PV did not significantly impair biochemical recurrence-free survival (HR, 0.968; 95% CI, 0.651-1.439; p = .871). CONCLUSIONS For patients undergoing RP, giant PV was not associated with adverse HRQOL outcomes. We found no significant impact of PV on continence rates, potency rates, and biochemical recurrence-free survival. Hence, RP is an efficient cancer treatment for men even with giant PV.
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Affiliation(s)
- Thilo Westhofen
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexander Buchner
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Boris Schlenker
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Armin Becker
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Michael Chaloupka
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Robert Bischoff
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Christian G Stief
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Alexander Kretschmer
- Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Munich, Germany
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Wenzel M, Preisser F, Theissen LH, Humke C, Welte MN, Wittler C, Kluth LA, Karakiewicz PI, Chun FKH, Mandel P, Becker A. The Effect of Adverse Patient Characteristics on Perioperative Outcomes in Open and Robot-Assisted Radical Prostatectomy. Front Surg 2020; 7:584897. [PMID: 33240927 PMCID: PMC7683519 DOI: 10.3389/fsurg.2020.584897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/16/2020] [Indexed: 02/03/2023] Open
Abstract
Objective: To analyze the effect of adverse preoperative patient and tumor characteristics on perioperative outcomes of open (ORP) and robot-assisted radical prostatectomy (RARP). Material and Methods: We retrospectively analyzed 656 patients who underwent ORP or RARP according to intraoperative blood loss (BL), operation time (OR time), neurovascular bundle preservation (NVBP) and positive surgical margins (PSM). Univariable and multivariable logistic regression models were used to identify risk factors for impaired perioperative outcomes. Results: Of all included 619 patients, median age was 66 years. BMI (<25 vs. 25-30 vs. ≥30) had no influence on blood loss. Prostate size >40cc recorded increased BL compared to prostate size ≤ 40cc in patients undergoing ORP (800 vs. 1200 ml, p < 0.001), but not in patients undergoing RARP (300 vs. 300 ml, p = 0.2). Similarly, longer OR time was observed for ORP in prostates >40cc, but not for RARP. Overweight (BMI 25-30) and obese ORP patients (BMI ≥30) showed longer OR time compared to normal weight (BMI <25). Only obese patients, who underwent RARP showed longer OR time compared to normal weight. NVBP was less frequent in obese patients, who underwent ORP, relative to normal weight (25.8% vs. 14.0%, p < 0.01). BMI did not affect NVPB at RARP. No differences in PSM were recorded according to prostate volume or BMI in ORP or RARP. In multivariable analyses, patient characteristics such as prostate volume and BMI was an independent predictor for prolonged OR time. Moreover, tumor characteristics (stage and grade) predicted worse perioperative outcome. Conclusion: Patients with larger prostates and obese patients undergoing ORP are at risk of higher BL, OR time or non-nervesparing procedure. Conversely, in patients undergoing RARP only obesity is associated with increased OR time. Patients with larger prostates or increased BMI might benefit most from RARP compared to ORP.
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Affiliation(s)
- Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Lena H Theissen
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Maria N Welte
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Clarissa Wittler
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, QC, Canada
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
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Suh J, Yoo S, Park J, Cho MC, Jeong CW, Ku JH, Kwak C, Kim HH, Jeong H. Differences in risk factors for biochemical recurrence after radical prostatectomy stratified by the degree of obesity: Focused on surgical methods. Sci Rep 2020; 10:10157. [PMID: 32576921 PMCID: PMC7311457 DOI: 10.1038/s41598-020-67237-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022] Open
Abstract
This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used. All 3099 patients who underwent radical prostatectomy in two medical centres from January 2008 to March 2018 were retrospectively reviewed. Patients were divided into three groups based on body mass index: ‘normal’, ‘overweight’, and ‘obese’. Risk factors associated with biochemical recurrence were compared between different degrees of obesity. We analysed the contributing risk factors of BCR-free survival using univariate and multivariable Cox hazard models. There were 378 (12.2%) and 1815 (58.6%) patients in the ‘obese’ and ‘overweight’ groups, respectively. Accordingly, 1324 patients underwent retropubic radical prostatectomy (RRP), and 1775 underwent robotic-assisted laparoscopic prostatectomy (RALP). Multivariable analysis showed that patients who underwent RALP had significantly lower BCR free survival in the ‘overweight’ and ‘obese’ groups than those who underwent RRP, with adjusted hazard ratios of 0.75 (95% CI 0.59–0.95, p-value = 0.01) and 0.55 (95% CI 0.33–0.90, p-value = 0.02), respectively. The degree of obesity was not directly associated with BCR-free survival. Robotic prostatectomy showed greater benefits in BCR-free survival than open prostatectomy in the ‘overweight’ and ‘obese’ groups.
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Affiliation(s)
- Jungyo Suh
- Hospital Medicine Center, Department of Urology, Seoul National University Hospital, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sangjun Yoo
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Juhyun Park
- Department of Urology, Asan Medical Center, Seoul, South Korea
| | - Min Chul Cho
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
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Theissen L, Preisser F, Wenzel M, Humke C, Roos FC, Kluth LA, Becker A, Banek S, Bodelle B, Köllermann J, Chun FKH, Mandel P. Very Early Continence After Radical Prostatectomy and Its Influencing Factors. Front Surg 2019; 6:60. [PMID: 31709260 PMCID: PMC6823177 DOI: 10.3389/fsurg.2019.00060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/07/2019] [Indexed: 12/20/2022] Open
Abstract
Introduction and Objectives: Surgical techniques such as preservation of the full functional-length of the urethral sphincter (FFLU) have a positive impact on postoperative continence rates. Thereby, data on very early continence rates after radical prostatectomy (RP) are scarce. The aim of the present study was to analyze very early continence rates in patients undergoing FFLU during RP. Materials and Methods: Very early-continence was assessed by using the PAD-test within 24 h after removal of the transurethral catheter. The PAD-test is a validated test that measures the amount of involuntary urine loss while performing predefined physical activities within 1 h (e.g., coughing, walking, climbing stairs). Full continence was defined as a urine loss below 1 g. Mild, moderate, and severe incontinence was defined as urine loss of 1–10 g, 11–50 g, and >50 g, respectively. Results: 90 patients were prospectively analyzed. Removal of the catheter was performed on the 6th postoperative day. Proportions for no, mild, moderate and severe incontinence were 18.9, 45.5, 20.0, and 15.6%, respectively. In logistic regression younger age was associated with significant better continence (HR 2.52, p = 0.04), while bilateral nerve-sparing (HR 2.56, p = 0.057) and organ-confined tumor (HR 2.22, p = 0.078) showed lower urine loss, although the effect was statistically not significant. In MVA, similar results were recorded. Conclusion: Overall, 64.4% of patients were continent or suffered only from mild incontinence at 24 h after catheter removal. In general, reduced urine loss was recorded in younger patients, patients with organ-confined tumor and in patients with bilateral nerve sparing. Severe incontinence rates were remarkably low with 15.6%.
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Affiliation(s)
- Lena Theissen
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Felix Preisser
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Clara Humke
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Frederik C Roos
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Andreas Becker
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Severine Banek
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Boris Bodelle
- Department of Radiology, University Hospital, Goethe University, Frankfurt, Germany
| | - Jens Köllermann
- Senckenberg Institute of Pathology, University Hospital, Goethe University, Frankfurt, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital, Goethe University, Frankfurt, Germany
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Free testosterone value before radical prostatectomy is related to oncologic outcomes and post-operative erectile function. BMC Cancer 2019; 19:87. [PMID: 30658612 PMCID: PMC6339281 DOI: 10.1186/s12885-018-5148-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/28/2018] [Indexed: 01/27/2023] Open
Abstract
Purpose To investigate whether free testosterone (FT) prior to radical prostatectomy was related to post-operative oncologic outcomes, erectile function and continence. Methods The data of 586 patients with available information underwent treatment in our center was retrospectively reviewed. Total testosterone (TT) was tested by chemiluminescence immunoassay, and FT value was calculated using Vermeulen’s formula. Post-operative continence and erectile function were evaluated by the requirement of pad and the IIEF-5 score at 12 months. Results The median TT and FT value was 344 ng/dL (interquartile, IQR 314–374) and 6.9 ng/dL (IQR 6.4–7.3), and 106 patients (18.1%) and 152 patients (25.9%) were evaluated as having low TT and low FT based on current guidelines. Low TT and FT value were both related to older age (both p < 0.001), concomitant diabetes (p = 0.018 & 0.049), higher possibility of pre-operative erectile dysfunction (ED, both p < 0.001), higher pre-operative PSA value (both p < 0.001), higher clinical stage (both p < 0.001) and higher Gleason score in biopsy (both p < 0.001). Low FT was related to higher risk for pT3 (p = 0.020) and high Gleason score (p = 0.011) in logistic regression. The median follow-up duration was 52 moths (IQR 29–67) and FT was found to be an independent risk factor for biochemical recurrence (p = 0.005). In logistic regression TT was related to pre-operative ED (p = 0.010) and FT was related to post-operative ED (p = 0.001). Conclusion Low FT value before radical prostatectomy was related to adverse pathological outcomes, biochemical recurrence and post-operative ED.
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Rapoport L, Yossepowitch O, Shpot E, Chinenov D, Chernov Y, Yurova M, Enikeev D. Radical prostatectomy performed via robotic, transperitoneal and extraperitoneoscopic approaches: functional and early oncological outcomes. Cent European J Urol 2018; 71:378-385. [PMID: 30680229 PMCID: PMC6338822 DOI: 10.5173/ceju.2018.1739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 07/24/2018] [Accepted: 10/28/2018] [Indexed: 01/02/2023] Open
Abstract
Introduction Oncological remission along with high postoperative functionality [continence and erectile function (EF)] are the main aspects of prostate cancer (PCa) treatment. The aim of this study was to compare functional and oncological treatment results achieved after a nerve-sparing radical prostatectomy (RP) via transperitoneal (TPRP), extraperitoneal (EPRP) and robot-assisted (RARP) approach. Material and methods From March 2015 to March 2016, 507 RP were performed at the Institute for Urology and Reproductive Health (Moscow, Russia). A total of 264 patients with localized (cТ1а–2с) prostate cancer [prostate-specific antigen (PSA) <20 ng/ml, Gleason score ≤7], intact prostate capsule (according to MRI), International Index of Erectile Function (IIEF-5) ≥19 and a life expectancy >10 years were included into the retrospective study. All the surgeries were performed by a single surgeon. The outcomes were evaluated after urethral catheter removal and 3–6–12 months after RP. Results Nerve preservation (NP) was performed for 153 patients without significant distinctions in time (р = 0.064) and blood loss (р = 0.073). The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) score was lower for NP: 9.23 ±6.59 and 3.86 ±5.38 after 3 and 12 months respectively compared with continence after RP without nerve preservation (NP): 14.27 ±5.1 vs. 6.15 ±4.76 (р <0.001). Continent was 52.2% vs. 83.3% vs. 81.8% in TPRP, RARP and EPRP groups; р <0.001. IIEF-5 scores were 14.67 ±9.4, 4.2 ±4.26 and 4.0 ±2.07 after RARP, TPRP and EPRP respectively (р = 0.002). After 12 months the PSA: TPRP = 0.11 ±0.19, RARP = 0.03 ±0.05 and EPRP = 0.53 ±1.87 ng/ml (р <0.001). Outcomes depend on surgical approach and was better in the RARP-group (AUC = 0.768 ±0.034 (CI 95% 0,701–0.834; р <0.001). Conclusions We suggest RARP with NP as a method of choice for treatment of prostate cancer in patients interested in preservation of EF and quality of life in general.
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Affiliation(s)
- Leonid Rapoport
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Evgeniy Shpot
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Denis Chinenov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Yaroslav Chernov
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | | | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
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Abstract
PURPOSE OF REVIEW To investigate the association between obesity and prostate cancer (PCa). RECENT FINDINGS Obesity has been proposed to be involved in the pathogenesis of PCa through different biological mechanisms that include deregulation of the insulin axis, sex hormone secretion, adipokines signaling, and oxidative stress. Hypertrophic peritumoral adipocytes may also facilitate the local spread of PCa through the chemo-attraction of tumor cells. Clinical studies demonstrate that obesity might have clinical implications also in disease detection and management. Obese men have been shown to be less likely to be diagnosed with early-stage disease. Moreover, they are at increased risk of experiencing upgrading and upstaging when managed with active surveillance. However, the association between obesity and the risk of PCa recurrence and mortality after radical treatment is still debated. SUMMARY Obesity may facilitate the development and progression of PCa trough different biologic mechanisms that may pose obese men at higher risk of advanced and high-grade disease. However, the association between obesity and long-term oncologic outcome after radical treatments appears unclear.
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Haahr MK, Azawi NH, Andersen LG, Carlson S, Lund L. A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark. Sex Med 2017; 5:e156-e162. [PMID: 28778680 PMCID: PMC5562492 DOI: 10.1016/j.esxm.2017.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/08/2017] [Accepted: 06/08/2017] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Radical prostatectomy (RP) offers a good long-term cancer control for clinically localized prostate cancer. However, complications such as erectile dysfunction and substantial decreases quality of life of the afflicted men and their sexual partners. Identification of pre-, per-, and postoperative factors that correlate with poor postoperative erectile status must be considered an important step to improving penile rehabilitation. AIM To describe postoperative erectile function after RP in a Danish cohort. METHODS The medical records of 1,127 patients undergoing RP from March 2003 through September 2014 were reviewed retrospectively with a 12-month follow-up after surgery. In all, 704 patients fulfilling the inclusion criteria were included in the final analysis. Recovery was defined as self-reported erection sufficient for intercourse (ESI) with or without usage of erectile aids. MAIN OUTCOME MEASURES Subjective reporting of erectile function and usage erectile aids 12 months after RP. RESULTS ESI with or without erectile aids was reported by 226 men (32.1%), among whom 109 (48.2%) required erectile aids. Erectile dysfunction (ED) was reported by 478 men (67.9%) and by 121 (25.3%) despite use of erectile aids. Of men with ED, 155 (22%) stated not being interested in penile rehabilitation, 26 (3.7%) stated not having resumed their sex life 12 months after RP, and 241 (34.2%) had ED and were unsatisfied with the condition. We found that 134 of 445 men (30.1%) who underwent non-nerve-sparing RP had ESI 12 months after RP. Age older than 60.5 years, a high body mass index, comorbidity, and a high American Society of Anesthesiologists score were negative predictors of erectile function 12 months after RP. CONCLUSION Twelve months after RP, 32.1% of men had ESI; half these men required the use of erectile aids. Age older than 60.5 years, a high body mass index, comorbidity, and a high American Society of Anesthesiologists score were negative predictors for ED 12 months after RP. Haahr MK, Azawi NH, Andersen LG, et al. A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark. Sex Med 2017;5:e156-e162.
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Affiliation(s)
- Martha Kirstine Haahr
- Department of Urology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløvparken, Denmark.
| | - Nessn H Azawi
- Department of Urology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløvparken, Denmark; Department of Urology, Zealand University Hospital, Sygehusvej, Denmark
| | | | - Steen Carlson
- Department of Urology, Odense University Hospital, Odense, Denmark
| | - Lars Lund
- Department of Urology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Winsløvparken, Denmark
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Mandel P, Preisser F, Graefen M, Steuber T, Salomon G, Haese A, Michl U, Huland H, Tilki D. High Chance of Late Recovery of Urinary and Erectile Function Beyond 12 Months After Radical Prostatectomy. Eur Urol 2017; 71:848-850. [DOI: 10.1016/j.eururo.2016.09.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 09/16/2016] [Indexed: 11/17/2022]
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15
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Beyer B, Mandel P, Michl U, Pompe RS, Veleva V, Steuber T, Huland H, Graefen M, Tilki D. Oncological, functional and perioperative outcomes in transplant patients after radical prostatectomy. World J Urol 2016; 34:1101-5. [DOI: 10.1007/s00345-015-1758-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022] Open
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Altay B, Erkurt B, Guzelburc V, Kiremit MC, Boz MY, Albayrak S. Impact of obesity on functional and oncological outcomes in radical perineal prostatectomy. Can Urol Assoc J 2015; 9:E766-E769. [PMID: 26600881 PMCID: PMC4639424 DOI: 10.5489/cuaj.3094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
INTRODUCTION We evaluated the impact of obesity on perioperative morbidity, functional, and oncological outcomes after radical perineal prostatectomy (RPP). METHODS A total of 298 consecutive patients underwent RPP at our institution. Patients were categorized into 3 groups based on their body mass index (BMI): Normal weight <25 kg/m(2) (Group 1), overweight 25 to <30 kg/m(2) (Group 2), and obese ≥30 kg/m(2) (Group 3). We compared the groups with respect to perioperative data, postoperative oncologic, and functional outcomes. Evaluation of urinary continence and erectile function was performed using a patient-reported questionnaire and the International Index of Erectile Function-5 questionnaire, respectively, administered preoperatively and at 3, 6, and 12 months. Limitations included short follow-up time, retrospective design and lack of a morbidly obese group. RESULTS No significant differences were found among the 3 groups with regard to operative time, estimated blood loss, length of hospital stay, catheter removal time, positive surgical margin, and complication rates. At 12 months, 94.7%, 95% and 95% of normal, overweight and obese patients, respectively, were continent (free of pad use) (p = 0.81). At 12 months, 30.6%, 29.8% and 30.4% of patients had spontaneous erections and were able to penetrate and complete intercourse in Group 1, Group 2, and Group 3, respectively (p = 0.63). CONCLUSIONS In this cohort of patients, no clinically relevant risks were associated with increasing BMI.
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Affiliation(s)
- Bulent Altay
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Bulent Erkurt
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Vahit Guzelburc
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Murat Can Kiremit
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Mustafa Yucel Boz
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
| | - Selami Albayrak
- Department of Urology, Istanbul Medipol University, Istanbul, Turkey
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Harrison LE, Yiengpruksawan A, Patel J, Itskovich A, Lee B, Korst R. Robotic gastrectomy and esophagogastrectomy: A single center experience of 105 cases. J Surg Oncol 2015; 112:888-93. [PMID: 26487124 DOI: 10.1002/jso.24073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/08/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND A robotic approach to general surgery procedures may provide improved postoperative outcomes compared to either open or laparoscopic approaches. The role of robotics for gastroesophageal surgery, however, is still being evaluated. STUDY DESIGN A review of the prospective database for robotic surgery at Valley Hospital between January 2002 and March 2014 identified 105 patients who underwent robotic gastric and esophageal resection. Patient demographics and perioperative factors were studied. RESULTS Over a 12 years period, 105 patients underwent robotic gastroesophageal resection. The median operative time for distal gastrectomy (230 min [112-327]) was significantly less compared to either total gastrectomy (302 min [214-364]) or esophagogastrectomy (309 min [190-682]). The length of stay for patients undergoing distal gastrectomy (6 days [4-32]) was also significantly less than patients undergoing total gastrectomy (11 days [7-43]), as well as esophagogastrectomy (9 days [5-64]). In regard to the learning curve to perform robotic gastroesophageal surgery, there was a significant correlation between operative time and overall experience. CONCLUSIONS This study demonstrated that robotic gastroesophageal surgery is feasible and can be safely performed. Assuming familiarity with the open procedures and acquisition of basic robotic skills, the learning curve for robotic gastroesophageal surgery requires approximately 20 cases.
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Affiliation(s)
- Lawrence E Harrison
- The Daniel and Gloria Blumenthal Cancer Center, Valley Health System, One Valley Health Plaza, Paramus, New Jersey
| | - Anusak Yiengpruksawan
- The Daniel and Gloria Blumenthal Cancer Center, Valley Health System, One Valley Health Plaza, Paramus, New Jersey
| | - Jay Patel
- The Daniel and Gloria Blumenthal Cancer Center, Valley Health System, One Valley Health Plaza, Paramus, New Jersey
| | - Alex Itskovich
- The Daniel and Gloria Blumenthal Cancer Center, Valley Health System, One Valley Health Plaza, Paramus, New Jersey
| | - Benjamin Lee
- The Daniel and Gloria Blumenthal Cancer Center, Valley Health System, One Valley Health Plaza, Paramus, New Jersey
| | - Robert Korst
- The Daniel and Gloria Blumenthal Cancer Center, Valley Health System, One Valley Health Plaza, Paramus, New Jersey
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Mandel P, Weinhold P, Michl U, Huland H, Graefen M, Tilki D. Impact of prostate volume on oncologic, perioperative, and functional outcomes after radical prostatectomy. Prostate 2015; 75:1436-46. [PMID: 26074139 DOI: 10.1002/pros.23023] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 04/30/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The impact of prostate volume (PV) on oncologic, perioperative and functional outcomes after radical prostatectomy (RP) remains controversial, as recent studies present inconsistent results. We studied the influence of PV on outcomes in a large single center dataset and summarized the existing literature. METHODS 5,477 patients who underwent RP between January 2008 and December 2011 were analyzed. The impact of PV on biochemical recurrence (BCR) and metastasis-free survival (MFS) was assessed using Kaplan-Meier curves and multivariate Cox proportional hazard model. Uni- and multivariate logistic regressions were used to estimate the impact of PV on surgical margin (SM), 1-week, 3-months and 12-months continence and 3-months and 12-months potency. Finally, the impact of PV on intraoperative blood loss was analyzed using uni- and multivariate linear regressions. RESULTS Median follow-up was 36.1 months. Overall, 16.5% of patients recurred during the follow-up period. The mean preoperative PV was 43.3 ml. One-week, 3-months and 12-months continence rates were 55.6%, 69.3%, and 87.4% for patients with PV ≥ 70 compared to 64.4%, 78.3%, and 92.1% for patients with PV < 30, respectively. Three-months and 12-months potency rates were 37.1% and 54.8% for men with large glands (≥70) and 56.3% and 65.0% for men with PV < 30. In multivariate analysis, continence at 1 week, 3 months and 12 months was significantly worse in patients with glands ≥70 ml, while potency was not influenced by PV in multivariate analysis. There was a higher mean blood loss (P < 0.001) in patients with larger glands. In univariate analysis, higher PV was significantly associated with lower BCR (P = 0.019), but not with metastasis free survival (P = 0.112). CONCLUSIONS PV significantly influences BCR-free survival only in univariate analysis. Especially early (1-week and 3-months) postoperative continence is negatively affected by higher PV in multivariate analysis, while PV did not influence potency after adjusting for further covariates in a specialized high-volume institution.
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Affiliation(s)
- Philipp Mandel
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Weinhold
- Department of Urology, University Hospital Munich-Gro, ß, hadern, Munich, Germany
| | - Uwe Michl
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Clinic Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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Mandel P, Steuber T, Ahyai S, Kriegmair M, Schiffmann J, Boehm K, Heinzer H, Michl U, Schlomm T, Haese A, Huland H, Graefen M, Tilki D. Salvage radical prostatectomy for recurrent prostate cancer: verification of European Association of Urology guideline criteria. BJU Int 2015; 117:55-61. [DOI: 10.1111/bju.13103] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Philipp Mandel
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thomas Steuber
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Sascha Ahyai
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | | | - Jonas Schiffmann
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Katharina Boehm
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Hans Heinzer
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Uwe Michl
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Thorsten Schlomm
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Alexander Haese
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Hartwig Huland
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Markus Graefen
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Derya Tilki
- Martini-Clinic Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
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The effect of age on functional outcomes after radical prostatectomy. Urol Oncol 2015; 33:203.e11-8. [DOI: 10.1016/j.urolonc.2015.01.015] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 12/28/2014] [Accepted: 01/20/2015] [Indexed: 11/21/2022]
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Xu T, Wang X, Xia L, Zhang X, Qin L, Zhong S, Shen Z. Robot-Assisted Prostatectomy in Obese Patients: How Influential Is Obesity on Operative Outcomes? J Endourol 2015; 29:198-208. [PMID: 25178054 DOI: 10.1089/end.2014.0354] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Tianyuan Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xianjin Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Leilei Xia
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xiaohua Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liang Qin
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shan Zhong
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Zhoujun Shen
- Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Strine AC, Rice KR, Masterson TA. Metabolic syndrome in the development and progression of prostate cancer. World J Clin Urol 2014; 3:168-183. [DOI: 10.5410/wjcu.v3.i3.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Revised: 06/12/2014] [Accepted: 07/14/2014] [Indexed: 02/06/2023] Open
Abstract
Prostate cancer (PCa) is the most common noncutaneous malignancy and second leading cause of cancer-specific mortality for men in the United States. There is a wide spectrum of aggressiveness ranging from biologically significant to indolent disease, which has led to an interest in the identification of risk factors for its development and progression. Emerging evidence has suggested an association between metabolic syndrome (MetS) and PCa. MetS represents a cluster of metabolic derangements that confer an increased risk of cardiovascular disease and type 2 diabetes mellitus. Its individual components include obesity, dyslipidemias, high blood pressure, and high fasting glucose levels. MetS has become pervasive and is currently associated with a high socioeconomic cost in both industrialized and developing countries throughout the world. The relationship between MetS and PCa is complex and yet to be fully defined. A better understanding of this relationship will facilitate the development of novel therapeutic targets for the prevention of PCa and improvement of outcomes among diagnosed men in the future. In this review, we evaluate the current evidence on the role of MetS in the development and progression of PCa. We also discuss the clinical implications on the management of PCa and consider the future direction of this subject.
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