1
|
Siech C, Wenzel M, Lange C, Cano Garcia C, Humke C, Tian Z, Karakiewicz PI, Traumann M, Kluth LA, Chun FKH, Hoeh B, Mandel P. The Association between Patient Characteristics and Biochemical Recurrence after Radical Prostatectomy. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1119. [PMID: 39064548 PMCID: PMC11278823 DOI: 10.3390/medicina60071119] [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: 05/20/2024] [Revised: 06/23/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
Background: Biochemical recurrence (BCR) represents the rise of prostate-specific antigen (PSA) levels after treatment with curative radical prostatectomy (RP) or radiation for prostate cancer. The objective of the current study was to test for the association between patient characteristics, namely age, body mass index (BMI), as well as prostate volume at surgery, and BCR after RP. Material and Methods: Within a tertiary care database, patients with prostate cancer treated with RP between January 2014 and June 2023 were included. Kaplan-Meier survival analyses and Cox regression models addressed BCR after RP according to patient characteristics. Results: Of 821 patients, the median age was 66 years (interquartile range [IQR] 61-71 years), BMI was 26.2 kg/m2 (IQR 24.3-28.8 kg/m2), and prostate volume was 40 cm3 (IQR 30-55 cm3). Median follow-up was 20 months. In survival analyses, the three-year BCR-free survival rates were 81 vs. 84 vs. 81% in patients aged ≤60 vs. 61-69 vs. 70 years (p = 0.1). In patients with BMI < 25.0 vs. 25.0-29.9 vs. ≥30.0 kg/m2, the three-year BCR-free survival rates were 84 vs. 81 vs. 84% (p = 0.7). In patients with prostate volume ≤40 vs. >40 cm3, the three-year BCR-free survival rates were 85 vs. 80% (p = 0.004). In multivariable Cox regression models accounting for patient and pathologic tumor characteristics and adjuvant radiation therapy, a higher prostate volume independently predicted BCR as continuous (hazard ratio 1.012, 95% confidence interval 1.005-1.019; p < 0.001), as well as categorized the variable based on the median (hazard ratio 1.66, 95% confidence interval 1.17-2.36; p = 0.005). Conversely, neither age nor BMI were significantly associated with BCR after RP. Conclusions: The higher prostate volume independently predicted BCR after RP, but not age or BMI at surgery. Consequently, patients with an elevated prostate volume should be considered for closer postoperative follow-up.
Collapse
Affiliation(s)
- Carolin Siech
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada
| | - Mike Wenzel
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Carsten Lange
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Cristina Cano Garcia
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Clara Humke
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, QC H2X 3E4, Canada
| | - Miriam Traumann
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Luis A. Kluth
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Felix K. H. Chun
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Benedikt Hoeh
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| |
Collapse
|
2
|
Soputro NA, Chavali JS, Ferguson EL, Ramos-Carpinteyro R, Calvo RS, Nguyen J, Moschovas MC, Wilder S, Okhawere K, De La Rosa RS, Saini I, Peabody J, Badani KK, Rogers C, Joseph J, Nix J, Patel V, Stifelman M, Ahmed M, Crivellaro S, Kim M, Kaouk JH. Complications of single-port robot-assisted radical prostatectomy: multi-institutional analysis from the Single-Port Advanced Research Consortium (SPARC). BJU Int 2024; 134:54-62. [PMID: 37971182 DOI: 10.1111/bju.16228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To evaluate the perioperative complications of single-port robot-assisted radical prostatectomy (SP-RARP). PATIENTS AND METHODS A retrospective review was performed on the prospectively maintained, Institutional Review Board-approved, multi-institutional Single-Port Advanced Research Consortium (SPARC) database. A total of 1103 patients were identified who underwent three different approaches of SP-RARP between 2019 and 2022 using the purpose-built SP robotic platform. In addition to baseline clinical, perioperative outcomes, this study comprehensively analysed for any evidence of intraoperative complication, as well as postoperative complication and readmission within 90 days of the respective surgery. RESULTS Of the 244, 712, and 147 patients who underwent transperitoneal, extraperitoneal, and transvesical SP-RARP, respectively, intraoperative complications were noted in five patients (0.4%), all of which occurred during the transperitoneal approach. Two patients had bowel serosal tears, two had posterior button-holing of the bladder necessitating repair, and one patient had an obturator nerve injury. Postoperative complications were noted in 143 patients (13%) with major complications (Clavien-Dindo Grade ≥III) only identified in 3.7% of the total cohort. The most common complications were lymphocele (3.9%), acute urinary retention (2%), and urinary tract infection (1.9%). The 90-day re-admission rate was 3.9%. CONCLUSION The SP-RARP is a safe and effective procedure with low complication and readmission rates regardless of the approach. These results are comparable to current multi-port RARP literature.
Collapse
Affiliation(s)
- Nicolas A Soputro
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Jaya Sai Chavali
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ethan L Ferguson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | | | | | | | | | | | | | - Indu Saini
- Mount Sinai Hospital, New York City, NY, USA
| | | | | | | | - Jean Joseph
- University of Rochester Medical Center, Rochester, NY, USA
| | - Jeffrey Nix
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vipul Patel
- Advent Health Medical Group Urology, Celebration, FL, USA
| | - Michael Stifelman
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | - Mutahar Ahmed
- Hackensack University Medical Center, Hackensack, NJ, USA
- Hackensack Meridien School of Medicine, Hackensack, NJ, USA
| | | | - Moses Kim
- Orange County Urology Associates, Laguna Hills, CA, USA
| | - Jihad H Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| |
Collapse
|
3
|
Xia Z, Fu X, Li J, Yuan X, Wu J, Tang L. Application of robot-assisted radical prostatectomy in men over 75 years: an analysis of comparative outcomes. Aging Male 2023; 26:2166919. [PMID: 36988199 DOI: 10.1080/13685538.2023.2166919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE This study aimed to summarize the current evidence regarding the feasibility of robot-assisted radical prostatectomy (RARP) in men aged over 75 years. METHOD A comprehensive search of four electronic databases (China National Knowledge Infrastructure, PubMed, Web of Science, and Cochrane Library) was performed to identify eligible comparative studies as of April 2022. Parameters, including perioperative results and oncological and functional outcomes, were evaluated. RESULTS Seven articles with 7575 patients undergoing RARP were included in this study. Patients with prostate cancer were grouped by age ≥ 75 years versus < 75 years. Our results demonstrated that compared with the older group, the younger group had better potency (p < .00001). However, there were no significant differences in operation time (p = .29), estimated blood loss (p = .13), length of hospital stay (p = .48), complications (p = .22), continence (p = .21), positive surgical margin (p = .28), and biochemical recurrence (p = .74) between the groups. CONCLUSION Our study revealed that the perioperative, oncological, and functional outcomes in men aged over 75 years undergoing RARP were not significantly different from those of their younger counterparts. RARP is feasible in men aged over 75 years.
Collapse
Affiliation(s)
- Zhongyou Xia
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Xueqin Fu
- Department of Breast Surgery, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jinze Li
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinzhu Yuan
- Blood Purification Center of Department of Nephrology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Nanchong, Sichuan, China
| | - Ji Wu
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, Sichuan, China
| | - Lingtong Tang
- Department of Clinical Laboratory, The People's Hospital of Gao County, Yibin, Sichuan, China
| |
Collapse
|
4
|
Degener S, Schmalz O, Tosch M, Gödde D, von Rundstedt FC, Piroth MD. [Prostate cancer in older men : Special features of the diagnostics and treatment]. Z Gerontol Geriatr 2023:10.1007/s00391-023-02194-z. [PMID: 37306771 DOI: 10.1007/s00391-023-02194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/14/2023] [Indexed: 06/13/2023]
Abstract
Prostate cancer is the most frequent cancer in men. For localized prostate cancer, surgery and radiotherapy are the standard treatment, with active surveillance also used in low-risk cases. For advanced/metastatic disease, androgen deprivation treatment is carried out. Further options include inhibitors of the androgen receptor axis and taxane-based chemotherapy. The avoidance of side effects should be considered, e.g., by dose adjustment. New options include poly(ADP-ribose) polymerase (PARP) inhibitors, and radioligand treatment. The existing guidelines only provide a few treatment recommendations for older patients; however, the treatment of older patients should primarily consider not only chronological age but also the patient's psychological and physical condition and preferences. In this context, the geriatric assessment represents an important instrument for determining the treatment strategy.
Collapse
Affiliation(s)
- Stephan Degener
- Klinik für Urologie und Kinderurologie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Deutschland.
| | - Oliver Schmalz
- Klinik für Hämatologie, Onkologie und Palliativmedizin, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Marco Tosch
- Klinik für Nuklearmedizin, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Daniel Gödde
- Institut für Pathologie und Molekularpathologie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Friedrich-Carl von Rundstedt
- Klinik für Urologie und Kinderurologie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Heusnerstraße 40, 42283, Wuppertal, Deutschland
| | - Marc D Piroth
- Klinik für Strahlentherapie und Radio-Onkologie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| |
Collapse
|
5
|
Mothes AR, Kather A, Cepraga I, Esber A, Kwetkat A, Runnebaum IB. Robotic-assisted Gynecological Surgery in Older Patients - a Comparative Cohort Study of Perioperative Outcomes. Geburtshilfe Frauenheilkd 2023; 83:437-445. [PMID: 37153652 PMCID: PMC10155232 DOI: 10.1055/a-1902-4577] [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: 07/15/2022] [Accepted: 11/28/2022] [Indexed: 05/10/2023] Open
Abstract
Study design Because of current demographic developments, a hypothesis was proposed whereby older female patients aged > 65 years can be safely operated using minimally invasive, robotic-assisted surgery, despite having more preoperative comorbidities. A comparative cohort study was designed to compare the age group ≥ 65 years (older age group, OAG) with the age group < 65 years (younger age group, YAG) after robotic-assisted gynecological surgery (RAS) in two German centers. Patients and methods Consecutive RAS procedures performed between 2016 and 2021 at the Women's University Hospital of Jena and the Robotic Center Eisenach to treat benign or oncological indications were included in the study. The age groups were compared according to their preoperative comorbidities (ASA, Charlson comorbidity index [CCI], cumulative illness rating scale - geriatric version [CIRS-G]) and perioperative parameters such as Clavien-Dindo (CD) classification of surgical complications. Analysis was performed using Welch's t -test, chi 2 test, and Fisher's exact test. Results A total of 242 datasets were identified, of which 63 (73 ± 5 years) were OAG and 179 were YAG (48 ± 10 years). Patient characteristics and the percentage of benign or oncological indications did not differ between the two age groups. Comorbidity scores and the percentage of obese patients were higher in the OAG group: CCI (2.7 ± 2.0 vs. 1.5 ± 1.3; p < 0.001), CIRS-G (9.7 ± 3.9 vs. 5.4 ± 2.9; p < 0.001), ASA class II/III (91.8% vs. 74.1%; p = 0.004), obesity (54.1% vs. 38.2%; p = 0.030). There was no difference between age groups, even grouped for benign or oncological indications, with regard to perioperative parameters such as duration of surgery (p = 0.088; p = 0.368), length of hospital stay (p = 0.786; p = 0.814), decrease in Hb levels (p = 0.811; p = 0.058), conversion rate (p = 1.000; p = 1.000) and CD complications (p = 0.433; p = 0.745). Conclusion Although preoperative comorbidity was higher in the group of older female patients, no differences were found between age groups with regard to perioperative outcomes following robotic-assisted gynecological surgery. Patient age is not a contraindication for robotic gynecological surgery.
Collapse
Affiliation(s)
- Anke R. Mothes
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
| | - Angela Kather
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Irina Cepraga
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anke Esber
- Klinik für Frauenheilkunde und Robotisches Zentrum, St. Georg Klinikum Eisenach, Akademisches Lehrkrankenhaus des Universitätsklinikums Jena, Eisenach, Germany
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Anja Kwetkat
- Klinik für Geriatrie und Palliativmedizin, Klinikum Osnabrück GmbH, Osnabrück, Germany
| | - Ingo B. Runnebaum
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Germany
- Correspondence Prof. Dr. Ingo B. Runnebaum, MBA Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin,
Universitätsklinikum JenaAm Klinikum 107747
JenaGermany
| |
Collapse
|
6
|
Porcaro AB, Panunzio A, Bianchi A, Cerrato C, Gallina S, Serafin E, Mazzucato G, Vidiri S, D’Aietti D, Orlando R, Brusa D, Brunelli M, Siracusano S, Pagliarulo V, Cerruto MA, Tafuri A, Antonelli A. Normal preoperative endogenous testosterone levels predict prostate cancer progression in elderly patients after radical prostatectomy. Ther Adv Urol 2023; 15:17562872231154150. [PMID: 36846295 PMCID: PMC9950604 DOI: 10.1177/17562872231154150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/13/2023] [Indexed: 02/24/2023] Open
Abstract
Background The impact of senior age on prostate cancer (PCa) oncological outcomes following radical prostatectomy (RP) is controversial, and further clinical factors could help stratifying risk categories in these patients. Objective We tested the association between endogenous testosterone (ET) and risk of PCa progression in elderly patients treated with RP. Design Data from PCa patients treated with RP at a single tertiary referral center, between November 2014 and December 2019 with available follow-up, were retrospectively evaluated. Methods Preoperative ET (classified as normal if >350 ng/dl) was measured for each patient. Patients were divided according to a cut-off age of 70 years. Unfavorable pathology consisted of International Society of Urologic Pathology (ISUP) grade group >2, seminal vesicle, and pelvic lymph node invasion. Cox regression models tested the association between clinical/pathological tumor features and risk of PCa progression in each age subgroup. Results Of 651 included patients, 190 (29.2%) were elderly. Abnormal ET levels were detected in 195 (30.0%) cases. Compared with their younger counterparts, elderly patients were more likely to have pathological ISUP grade group >2 (49.0% versus 63.2%). Disease progression occurred in 108 (16.6%) cases with no statistically significant difference between age subgroups. Among the elderly, clinically progressing patients were more likely to have normal ET levels (77.4% versus 67.9%) and unfavorable tumor grades (90.3% versus 57.9%) than patients who did not progress. In multivariable Cox regression models, normal ET [hazard ratio (HR) = 3.29; 95% confidence interval (CI) = 1.27-8.55; p = 0.014] and pathological ISUP grade group >2 (HR = 5.62; 95% CI = 1.60-19.79; p = 0.007) were independent predictors of PCa progression. On clinical multivariable models, elderly patients were more likely to progress for normal ET levels (HR = 3.42; 95% CI = 1.34-8.70; p = 0.010), independently by belonging to high-risk category. Elderly patients with normal ET progressed more rapidly than those with abnormal ET. Conclusion In elderly patients, normal preoperative ET independently predicted PCa progression. Elderly patients with normal ET progressed more rapidly than controls, suggesting that longer exposure time to high-grade tumors could adversely impact sequential cancer mutations, where normal ET is not anymore protective on disease progression.
Collapse
Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata Verona, Piazzale Stefani 1,
37126 Verona, Italy
| | - Andrea Panunzio
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alberto Bianchi
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sebastian Gallina
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Emanuele Serafin
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni Mazzucato
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Vidiri
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Damiano D’Aietti
- Department of Urology, University of Verona and
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Rossella Orlando
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Brusa
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona,
Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Siracusano
- Department of Life, Health and Environmental
Sciences, University of L’Aquila, L’Aquila, Italy
| | | | - Maria Angela Cerruto
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Alessandro Antonelli
- Department of Urology, University of Verona
and Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| |
Collapse
|
7
|
Suitability of conventional systematic vs. MRI-guided targeted biopsy approaches to assess surgical treatment delay for radical prostatectomy. World J Urol 2022; 40:2955-2961. [DOI: 10.1007/s00345-022-04207-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/27/2022] [Indexed: 11/12/2022] Open
|
8
|
Yamada Y, Taguchi S, Kume H. Surgical Tolerability and Frailty in Elderly Patients Undergoing Robot-Assisted Radical Prostatectomy: A Narrative Review. Cancers (Basel) 2022; 14:cancers14205061. [PMID: 36291845 PMCID: PMC9599577 DOI: 10.3390/cancers14205061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Life expectancy in Western countries and East Asian countries has incremented over the past decades, resulting in a rapidly aging world, while in general, radical prostatectomy (RP) is not recommended in elderly men aged ≥75 years. Together with the evolving technique of robotic surgeries, surgical indications for RP should be reconsidered in ‘elderly’ and ‘frail’ men, since this procedure has now become one of the safest and most effective cancer treatments for prostate cancer. One important element to determine surgical indications is surgical tolerability. However, evidence is scarce regarding the surgical tolerability in elderly men undergoing robot-assisted radical prostatectomy (RARP). In this review, we focused on the surgical tolerability in ‘elderly’ and/or ‘frail’ men undergoing RARP, with the intent to provide up-to-date information on this matter and to support the decision making of therapeutic options in this spectrum of patients. Abstract Robot-assisted radical prostatectomy (RARP) has now become the gold standard treatment for localized prostate cancer. There are multiple elements in decision making for the treatment of prostate cancer. One of the important elements is life expectancy, which the current guidelines recommend as an indicator for choosing treatment options. However, determination of life expectancy can be complicated and difficult in some cases. In addition, surgical tolerability is also an important issue. Since frailty may be a major concern, it may be logical to use geriatric assessment tools to discriminate ‘surgically fit’ patients from unfit patients. Landmark studies show two valid models such as the phenotype model and the cumulative deficit model that allow for the diagnosis of frailty. Many studies have also developed geriatric screening tools such as VES-13 and G8. These tools may have the potential to directly sort out unfit patients for surgery preoperatively.
Collapse
Affiliation(s)
- Yuta Yamada
- Correspondence: ; Tel.: +81-3-5800-8662; Fax: +81-5800-8917
| | | | | |
Collapse
|
9
|
Liakos N, Witt JH, Rachubinski P, Leyh-Bannurah SR. The Dilemma of Misclassification Rates in Senior Patients With Prostate Cancer, Who Were Treated With Robot-Assisted Radical Prostatectomy: Implications for Patient Counseling and Diagnostics. Front Surg 2022; 9:838477. [PMID: 35252339 PMCID: PMC8888518 DOI: 10.3389/fsurg.2022.838477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/17/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES There is a recent paradigm shift to extend robot-assisted radical prostatectomy (RARP) to very senior prostate cancer (PCa) patients based on biological fitness, comorbidities, and clinical PCa assessment that approximates the true risk of progression. Thus, we aimed to assess misclassification rates between clinical vs. pathological PCa burden. MATERIALS AND METHODS We compared senior patients with PCa ≥75 y (n = 847), who were propensity score matched with younger patients <75 y (n = 3,388) in a 1:4 ratio. Matching was based on the number of biopsy cores, prostate volume, and preoperative Cancer of the Prostate Risk Assessment (CAPRA) risk groups score. Multivariable logistic regression models (LRMs) predicted surgical CAPRA (CAPRA-S) upgrade, which was defined as a higher risk of the CAPRA-S in the presence of lower-risk preoperative CAPRA score. LRM incorporated the same variables as propensity score matching. Moreover, patients were categorized as low-, intermediate-, and high-risk, preoperative and according to their CAPRA and CAPRA-S scores. RESULTS Surgical CAPRA risk strata significantly differed between the groups. Greater proportions of unfavorable intermediate risk (39 vs. 32%) or high risk (30 vs. 28%; p < 0.001) were observed. These proportions are driven by greater proportions of International Society of Urological Pathology (ISUP) Gleason Grade Group 4 or 5 (33 vs. 26%; p = 0.001) and pathological tumor stage (≥T3a 54 vs. 45%; p < 0.001). Increasing age was identified as an independent predictor of CAPRA-S-based upgrade (age odds ratio [OR] 1.028 95% CI 1.02-1.037; p < 0.001). CONCLUSION Approximately every second senior patient has a misclassification in (i.e., any up or downgrade) and each 4.5th senior patient specifically has an upgrade in his final pathology that directly translates to an unfavorable PCa prognosis. It is imperative to take such substantial misclassification rates into account for this sensitive PCa demographic of senior men. Future prospective studies are warranted to further optimize PCa workflow and diagnostics, such as to incorporate modern imaging, molecular profiling and implement these into biopsy strategies to identify true PCa burden.
Collapse
Affiliation(s)
- Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | | | | | | |
Collapse
|
10
|
Porcaro AB, Bianchi A, Gallina S, Serafin E, Mazzucato G, Vidiri S, D’Aietti D, Rizzetto R, Tafuri A, Cerrato C, Panunzio A, Orlando R, Brusa D, Brunelli M, Siracusano S, Cerruto MA, Antonelli A. Advanced age portends poorer prognosis after radical prostatectomy: a single center experience. Aging Clin Exp Res 2022; 34:2857-2863. [PMID: 35976572 PMCID: PMC9675672 DOI: 10.1007/s40520-022-02213-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/25/2022] [Indexed: 01/04/2023]
Abstract
INTRODUCTION AND OBJECTIVE Although advanced age doesn't seem to impair oncological outcomes after robot-assisted radical prostatectomy (RARP), elderly patients have increased rates of prostate cancer (PCa) related deaths due to a higher incidence of high-risk disease. The potential unfavorable impact of advanced age on oncological outcomes following RARP remains an unsettled issue. We aimed to evaluate the oncological outcome of PCa patients > 69 years old in a single tertiary center. MATERIALS AND METHODS 1143 patients with clinically localized PCa underwent RARP from January 2013 to October 2020. Analysis was performed on 901 patients with available follow-up. Patients ≥ 70 years old were considered elderly. Unfavorable pathology included ISUP grade group > 2, seminal vesicle, and pelvic lymph node invasion. Disease progression was defined as biochemical and/or local recurrence and/or distant metastases. RESULTS 243 cases (27%) were classified as elderly patients (median age 72 years). Median (IQR) follow-up was 40.4 (38.7-42.2) months. Disease progression occurred in 159 cases (17.6%). Elderly patients were more likely to belong to EAU high-risk class, have unfavorable pathology, and experience disease progression after surgery (HR = 5.300; 95% CI 1.844-15.237; p = 0.002) compared to the younger patients. CONCLUSIONS Elderly patients eligible for RARP are more likely to belong to the EAU high-risk category and to have unfavorable pathology that are independent predictors of disease progression. Advanced age adversely impacts on oncological outcomes when evaluated inside these unfavorable categories. Accordingly, elderly patients belonging to the EAU high-risk should be counseled about the increased risk of disease progression after surgery.
Collapse
Affiliation(s)
- Antonio Benito Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Alberto Bianchi
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Sebastian Gallina
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Emanuele Serafin
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Giovanni Mazzucato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Stefano Vidiri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Damiano D’Aietti
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Riccardo Rizzetto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy ,Department of Urology, Vito Fazzi Hospital, Lecce, Italy
| | - Clara Cerrato
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Andrea Panunzio
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Rossella Orlando
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Davide Brusa
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Matteo Brunelli
- Department of Pathology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Siracusano
- Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, Italy
| | - Maria Angela Cerruto
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Piazzale Stefani 1, 37126 Verona, Italy
| |
Collapse
|