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Thakker PU, Sandberg M, Hemal AK, Rodriguez AR. A Comprehensive Review of the Current State of Robot-assisted Laparoscopic Salvage Prostatectomy. Int Braz J Urol 2024; 50:398-414. [PMID: 38701186 PMCID: PMC11262726 DOI: 10.1590/s1677-5538.ibju.2024.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Salvage robot assisted radical prostatectomy (sRARP) is performed for patients with biochemical or biopsy proven, localized prostate cancer recurrences after radiation or ablative therapies. Traditionally, sRARP has been avoided by lower volume surgeons due to technical demand and high complication rates. Post-radiation sRARP outcomes studies exist but remain few in number. With increasing use of whole gland and focal ablative therapies, updates on sRARP in this setting are needed. The aim of this narrative review is to provide an overview of recently reviewed studies on the oncologic outcomes, functional outcomes, and complications after post-radiation and post-ablative sRARP. Tips and tricks are provided to guide surgeons who may perform sRARP. MATERIALS AND METHODS We performed a non-systematic literature search of PubMed and MEDLINE for the most relevant articles pertaining to the outlined topics from 2010-2022 without limitation on study design. Only case reports, editorial comments, letters, and manuscripts in non-English languages were excluded. Key Content and Findings: Salvage robotic radical prostatectomy is performed in cases of biochemical recurrence after radiation or ablative therapies. Oncologic outcomes after sRARP are worse compared to primary surgery (pRARP) though improvements have been made with the robotic approach when compared to open salvage prostatectomy. Higher pre-sRARP PSA levels and more advanced pathologic stage portend worse oncologic outcomes. Patients meeting low-risk, EAU-biochemical recurrence criteria have improved oncologic outcomes compared to those with high-risk BCR. While complication rates in sRARP are higher compared to pRARP, Retzius sparing approaches may reduce complication rates, particularly rectal injuries. In comparison to the traditional open approach, sRARP is associated with a lower rate of bladder neck contracture. In terms of functional outcomes, potency rates after sRARP are poor and continence rates are low, though Retzius sparing approaches demonstrate acceptable recovery of urinary continence by 1 year, post-operatively. CONCLUSIONS Advances in the robotic platform and improvement in robotic experience have resulted in acceptable complication rates after sRARP. However, oncologic and functional outcomes after sRARP in both the post-radiation and post-ablation settings are worse compared to pRARP. Thus, when engaging in shared decision making with patients regarding the initial management of localized prostate cancer, patients should be educated regarding oncologic and functional outcomes and complications in the case of biochemically recurrent prostate cancer that may require sRARP.
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Affiliation(s)
- Parth U Thakker
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Maxwell Sandberg
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Ashok K Hemal
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
| | - Alejandro R Rodriguez
- Department of Urology, Atrium Health Wake Forest Baptist Medical Center, Winston-Salem, NC, USA
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Fung KFK, Cazzato RL, Tricard T, Marini PDE, Bertucci G, Autrusseau PA, Koch G, Weiss J, Garnon J, Lang H, Gangi A. MR-Guided Transurethral Ultrasound Ablation (TULSA)-An Emerging Minimally Invasive Treatment Option for Localised Prostate Cancer. Cardiovasc Intervent Radiol 2024; 47:689-701. [PMID: 38491163 DOI: 10.1007/s00270-024-03696-y] [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] [Received: 01/07/2024] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
The optimal treatment strategy for men with localised prostatic cancer of low and intermediate risk is an actively evolving field. It is important to strike a balance between maximal oncological control and minimal treatment-related complications, which helps preserve the patients' quality of life. MR-guided transurethral ultrasound ablation (TULSA) has emerged as a minimally invasive treatment option for this group of patients. This article aims to provide of a background on TULSA technology, a step-by-step procedural guide of MR-guided TULSA and to summarise the current evidence of TULSA in management of localised prostatic cancer, as well as other potential indications.
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Affiliation(s)
- Kin Fen Kevin Fung
- Department of Radiology, University of Hong Kong, Hong Kong, Hong Kong.
- Department of Radiology, Hong Kong Children's Hospital, Hong Kong, Hong Kong.
| | - Roberto Luigi Cazzato
- Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France
| | - Thibault Tricard
- Department of Urology, University Hospital Strasbourg, Strasbourg, France
| | - Pierre D E Marini
- Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France
| | - Gregory Bertucci
- Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France
| | | | - Guillaume Koch
- Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France
- Department of Human Anatomy, University of Strasbourg, Strasbourg, France
| | - Julia Weiss
- Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France
| | - Julien Garnon
- Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France
| | - Hervé Lang
- Department of Urology, University Hospital Strasbourg, Strasbourg, France
| | - Afshin Gangi
- Department of Interventional Radiology, University Hospital Strasbourg, Strasbourg, France
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Adamo DA, Greenwood BM, Ghanouni P, Arora S. MR Imaging-Guided Prostate Cancer Therapies. Radiol Clin North Am 2024; 62:121-133. [PMID: 37973238 DOI: 10.1016/j.rcl.2023.06.012] [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
Prostate cancer is the most common malignancy diagnosed in men. MR imaging-guided therapies for prostate cancer have become an increasingly common treatment alternative to traditional whole-gland therapies, such as radical prostatectomy or radiation therapy. This is especially true in men with localized, low- to intermediate-risk prostate cancer. Although long-term oncologic data remain limited, the authors describe several MR imaging-guided therapeutic options for the treatment of prostate cancer, including cryoablation, laser ablation, transrectal high-intensity focused ultrasound, and transurethral ultrasound ablation.
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Affiliation(s)
- Daniel A Adamo
- Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA
| | | | - Pejman Ghanouni
- Department of Radiology, Stanford University, Lucas Center for Imaging, 1201 Welch Road, Room P267, Stanford, CA 94305, USA
| | - Sandeep Arora
- Yale University School of Medicine, Department of Radiology & Biomedical Imaging, 330 Cedar Street, TE-2, PO Box 208042, New Haven, CT 06520-8042, USA.
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Mäkelä P, Anttinen M, Wright C, Sainio T, Boström PJ, Sequeiros RB. Evolution of non-perfused volume after transurethral ultrasound ablation of prostate: A retrospective 12-month analysis. Eur J Radiol Open 2023; 11:100506. [PMID: 37456928 PMCID: PMC10339207 DOI: 10.1016/j.ejro.2023.100506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023] Open
Abstract
Background A detailed understanding of the non-perfused volume (NPV) evolution after prostate ablation therapy is lacking. The impact of different diseased prostate tissues on NPV evolution post-ablation is unknown. Purpose To characterize the NPV evolution for three treatment groups undergoing heat-based prostate ablation therapy, including benign prostatic hyperplasia (BPH), primary prostate cancer (PCa), and radiorecurrent PCa. Materials and methods Study design and data analysis were performed retrospectively. All patients received MRI-guided transurethral ultrasound ablation (TULSA). 21 BPH, 28 radiorecurrent PCa and 40 primary PCa patients were included. Using the T1-weighted contrast-enhanced MR image, the NPV was manually contoured by an experienced radiologist. All patients received an MRI immediately following the ablation. Follow-up included MRI at 3- and 12 months for BPH and radiorecurrent PCa patients and at 6- and 12 months for primary PCa patients. Results A significant difference between BPH and radiorecurrent PCa patients was observed at three months (p < 0.0001, Wilcoxon rank sum test), with the median NPV decreasing by 77 % for BPH patients but increasing by 4 % for radiorecurrent PCa patients. At six months, the median NPV decreased by 97 % for primary PCa. Across all groups, although 40 % of patients had residual NPV at 12 months, it tended to be < 1 mL. Conclusion The resolution of necrotic tissue after ablation was markedly slower for irradiated than treatment-naïve prostate tissue. These results may account for the increased toxicity observed after radiorecurrent salvage therapy. By 12 months, most necrotic prostate tissue had disappeared in every treatment group.
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Affiliation(s)
- Pietari Mäkelä
- Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland
| | - Mikael Anttinen
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Cameron Wright
- Department of Diagnostic Radiology, Turku University Hospital, Turku, Finland
- Department of Urology, Turku University Hospital, Turku, Finland
| | - Teija Sainio
- Department of Medical Physics, Turku University Hospital, Finland
| | - Peter J. Boström
- Department of Urology, Turku University Hospital, Turku, Finland
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Anttinen M, Blanco Sequeiros R, Boström PJ, Taimen P. Evolving imaging methods of prostate cancer and the emergence of magnetic resonance imaging guided ablation techniques. Front Oncol 2022; 12:1043688. [DOI: 10.3389/fonc.2022.1043688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/21/2022] [Indexed: 11/18/2022] Open
Abstract
Established therapies for prostate cancer (PCa), surgery and radiotherapy, treat the entire gland regardless of the location of the cancerous lesion within the prostate. Although effective, these methods include a significant risk of worsening genitourinary outcomes. Targeted image-guided cancer therapy has gained acceptance through improved PCa detection, localization, and characterization by magnetic resonance imaging (MRI). Minimally-invasive ablative techniques aim to achieve comparable oncological outcomes to radical treatment while preserving genitourinary function. Transurethral ultrasound ablation (TULSA) and next-generation transrectal high-intensity focused ultrasound (HIFU) utilize MRI guidance to thermally ablate prostate tissue under real-time MRI monitoring and active temperature feedback control. Previous trials performed by our group and others, including a large multicenter study in men with localized favorable-risk disease, have demonstrated that TULSA provides effective prostate ablation with a favorable safety profile and low impact on quality of life. Recently, MRI-guided HIFU focal therapy was also shown as a safe and effective treatment of intermediate-risk PCa. Here we review the current literature on ablative techniques in the treatment of localized PCa with a focus on TULSA and HIFU methods.
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The role of surgery for loco-regional and advanced urological cancers. Curr Opin Urol 2022; 32:634-642. [PMID: 36101519 DOI: 10.1097/mou.0000000000001036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is a general misconception that surgery is the antithesis of palliation. However, symptom mitigation, the basic tenet of palliative interventions, can be achieved by invasive procedures. Surgical care, thus, plays an important role in palliative oncology, alongside radiation and systemic therapy. There is global movement to improve palliation in oncology, and thus it is timely to evaluate the role of surgical interventions can play in this setting. RECENT FINDINGS Many of the surgical interventions done with palliative intent were first established as curative options. Most studies looked at interventions for local control of primary tumour including extirpative surgeries, while some studies studied pain relief for bone metastases. Results show that patients have an acceptable survival outcome and complication rate comparable to those done in the curative setting. However, not all studies report functional outcomes and symptom-relief consistently, highlighting an unmet need. SUMMARY More studies are needed to further define the role of surgery in palliative care. Randomized controlled trials studying surgical intervention in the palliative setting will be challenging because of lack of equipoise, inherent bias in patient and disease characteristics in those who undergo surgery. Nonetheless, studies should endeavour to study symptom-free survival and PROMs as meaningful endpoints of interventions performed in a palliative setting rather than solely focus on hard oncological endpoints of survival.
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