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Masterson JM, Luu M, Naser-Tavakolian A, Freedland SJ, Sandler H, Zumsteg ZS, Daskivich TJ. Concurrent prognostic utility of lymph node count and lymph node density for men with pathological node-positive prostate cancer. Prostate Cancer Prostatic Dis 2024; 27:264-271. [PMID: 36600045 DOI: 10.1038/s41391-022-00635-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/05/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND While both the number (+LN) and density (LND) of metastatic lymph nodes on radical prostatectomy lymphadenectomy predict mortality in prostate cancer, the independent impact of each on overall mortality (OM) is unknown. METHODS We sampled men who underwent radical prostatectomy and lymphadenectomy between 2004 and 2013 from the National Cancer Database. Multivariable Cox proportional hazards analysis with restricted cubic spline was used to assess the non-linear association of +LN count and LND with OM. RESULTS Of 229,547 men in our sample, 3% (n = 7507) had +LNs, of which 89% had 1-3 +LN and 11% had ≥4 +LN. In multivariable Cox analysis across all patients, OM increased with each additional +LN up to four (HR 1.14, 95%CI 1.06-1.23 per node), with no increase beyond 4 +LN. LND was an independent predictor of OM (HR 1.09, 95%CI 1.06-1.12 per 10% increase). However, after excluding patients with inadequate nodal sampling (<5 LN examined), the variation in OM explained by LND was negligible for patients with ≤3 +LN. In men with 1, 2, and 3 +LN, there was a 0.28%, 0.02%, and 0.50% increase in OM for each 10% increase in LND, compared with 1.9% and 1.6% for men with 4 or 5+ LNs. CONCLUSIONS While +LN count and LND independently predict OM, the impact of LND is negligible in men with ≤3 +LN, who comprise the vast majority of men with +LN. Pathological nodal staging should primarily rely on LN count rather than LND.
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Affiliation(s)
- John M Masterson
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Michael Luu
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Aurash Naser-Tavakolian
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Stephen J Freedland
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Section of Urology, Durham VA Medical Center, Durham, NC, USA
| | - Howard Sandler
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Zachary S Zumsteg
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Timothy J Daskivich
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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2
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de Pablos-Rodríguez P, Claps F, Rebez G, Vidal Crespo N, Gómez-Ferrer Á, Mascarós JM, Collado Serra A, Caltrava Fons A, Rubio-Briones J, Casanova Ramon Borja J, Ramírez Backhaus M. Personalised indocyanine-guided lymphadenectomy for prostate cancer: a randomised clinical trial. BJU Int 2023; 132:591-599. [PMID: 37410659 DOI: 10.1111/bju.16117] [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: 07/08/2023]
Abstract
OBJECTIVES To study the safety and efficacy of a personalised indocyanine-guided pelvic lymph node dissection (PLND) against extended PLND (ePLND) during radical prostatectomy (RP). PATIENTS AND METHODS Patients who were candidates for RP and lymphadenectomy, with intermediate- or high-risk prostate cancer (PCa) according to the National Comprehensive Cancer Network guidelines, were enrolled in this randomised clinical trial. Randomisation was made 1:1 to indocyanine green (ICG)-PLND (only ICG-stained LNs) or ePLND (obturator fossa, external, internal, and common iliac and presacral LNs). The primary endpoint was the complication rate within 3 months after RP. Secondary endpoints included: rate of major complications (Clavien-Dindo Grade III-IV), time to drainage removal, length of stay, percentage of patients classified as pN1, number of LNs removed, number of metastatic LNs, rate of patients with undetectable prostate-specific antigen (PSA), biochemical recurrence (BCR)-free survival, and rate of patients with androgen-deprivation therapy at 24 months. RESULTS A total of 108 patients were included with a median follow-up of 16 months. In all, 54 were randomised to ICG-PLND and 54 to ePLND. The postoperative complication rate was higher in the ePLND (70%) vs the ICG-PLND group (32%) (P < 0.001). Differences between major complications in both groups were not statically significant (P = 0.7). The pN1 detection rate was higher in the ICG-PLND group (28%) vs the ePLND group (22%); however, this difference was not statistically significant (P = 0.7). The rate of undetectable PSA at 12 months was 83% in the ICG-PLND vs 76% in the ePLND group, which was not statistically significant. Additionally, there were no statistically significant differences in BCR-free survival between groups at the end of the analysis. CONCLUSIONS Personalised ICG-guided PLND is a promising technique to stage patients with intermediate- and high-risk PCa properly. It has shown a lower complication rate than ePLND with similar oncological outcomes at short-term follow-up.
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Affiliation(s)
- Pedro de Pablos-Rodríguez
- Department of Urology, Research Institute of Biomedical and Health Sciences, Doctoral School of University of Las Palmas de Gran Canaria, Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Francesco Claps
- Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Giacomo Rebez
- Urology Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Natalia Vidal Crespo
- Department of Urology, Hospital General Universitario Santa Lucía, Murcia, Italy
| | - Álvaro Gómez-Ferrer
- Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | | | | | - Ana Caltrava Fons
- Department of Pathology, Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - José Rubio-Briones
- Department of Urology, Instituto Valenciano de Oncología (IVO), Valencia, Spain
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3
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Rodrigues Pessoa R, Nabavizadeh R, Shah P, Frank I, Tollefson M, Sharma V, Rangel LJ, Cheville JC, Karnes RJ, Boorjian SA. Relative impact of lymph-node metastasis and seminal vesical invasion on oncologic outcomes following radical prostatectomy. Prostate Cancer Prostatic Dis 2023:10.1038/s41391-023-00724-9. [PMID: 37714961 DOI: 10.1038/s41391-023-00724-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND While both seminal vesicle (SVI) and lymph-node invasion (LNI) have been identified as adverse prognostic variables among men undergoing radical prostatectomy (RP), the relative impact of each of these features on subsequent oncologic outcomes has not been well defined. We assessed the impact of LNI on long-term oncologic outcomes among patients with SVI at RP. METHODS We reviewed 19,519 patients who underwent RP and identified 2043 with SVI. Metastasis-free (MFS), cancer-specific (CSS), and overall survival (OS) were estimated for patients with SVI, stratified by the presence and number of pelvic lymph node metastases. Cox proportional hazards models were used to evaluate the independent association of the number of metastatic nodes and lymph node density with oncologic outcomes among patients with SVI, controlling for age, year of surgery, margin status, preoperative PSA, pathologic Gleason score, extraprostatic extension, and use of adjuvant therapies. RESULTS At a median follow up of 12.1 years (IQR 7.0,18.6), 548 patients developed metastatic disease and 1331 died, including 406 who died from prostate cancer (PCa). We found that, among patients with SVI, the presence of a single positive lymph node was not associated with incrementally adverse oncologic outcomes compared to no nodal metastasis at RP, with 10-year MFS, CSS, and OS rates of 81.3% versus 78.3%(p = 0.18), 86.5% versus 89.8%(p = 0.32), and 72.8% versus 76.7%(p = 0.53), respectively. In contrast, on multivariable analyses, the presence of ≥2 metastatic nodes and a 20% lymph-node density cut off remained independently associated with worse survival. CONCLUSIONS SVI represents an adverse pathologic feature such that the presence of a single positive pelvic lymph node did not further adversely impact prognosis. Meanwhile, a significant number of involved nodes was associated with decreased survival. These findings may aid in risk-stratification as well as clinical trial design for such high-risk patients following surgery.
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Affiliation(s)
| | | | - Paras Shah
- Mayo Clinic, Department of Urology, Rochester, MN, USA
| | - Igor Frank
- Mayo Clinic, Department of Urology, Rochester, MN, USA
| | | | - Vidit Sharma
- Mayo Clinic, Department of Urology, Rochester, MN, USA
| | - Laureano J Rangel
- Mayo Clinic, Department of Quantitative Health Sciences, Rochester, MN, USA
| | - John C Cheville
- Mayo Clinic, Department of Laboratory Medicine and Pathology, Rochester, MN, USA
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4
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Saito T, Matsumoto K, Kosaka T, Yasumizu Y, Tanaka N, Takeda T, Morita S, Mizuno R, Asanuma H, Oya M. Strategy for PSA progression in patients undergoing salvage radiation for biochemical recurrence after radical prostatectomy. Int J Clin Oncol 2023; 28:707-715. [PMID: 36929093 DOI: 10.1007/s10147-023-02322-0] [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: 07/21/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND The treatment strategy for prostate-specific antigen (PSA) progression in patients who receive salvage radiation therapy (RT) for biochemical recurrence (BCR) after radical prostatectomy (RP) is salvage androgen deprivation therapy (ADT). However, its optimal timing is highly controversial. METHODS The study sample consisted of 77 men who underwent RP, received salvage RT against BCR, and underwent salvage ADT for PSA progression. The endpoint of this study was development to castration-resistant prostate cancer (CRPC), from the start of salvage RT. RESULTS The median follow-up time was 9.5 years, and 20 patients experienced CRPC. The multivariable analysis identified PSA-doubling time (PSA-DT) ≤ 12 months (hazard ratio, 3.5) and seminal vesicle invasion (SVI) (hazard ratio, 4.4) as independent risk factors. We defined the high-risk and low-risk groups as those with one or two risk factors and no risk factors, respectively. In the high-risk group, a significant difference in time to CRPC was observed between patients who received salvage ADT at PSA ≤ 1.0 ng/mL (n = 8) and at > 1.0 ng/mL (n = 27) (10-year non-CRPC rate: 100.0% vs. 46.3%, respectively). In contrast, in the low-risk group, no significant difference in CRPC-free survival was observed between patients who received salvage ADT at PSA ≤ 1.0 ng/mL (n = 14) and at > 1.0 ng/mL (n = 28) (10-year non-CRPC rate: 86.4% vs. 80.8%, respectively). CONCLUSION In high-risk patients (PSA-DT ≤ 12 months and/or SVI), salvage ADT for PSA progression after salvage RT should be started before the PSA levels exceed 1.0 ng/mL.
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Affiliation(s)
- Takafumi Saito
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yota Yasumizu
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Nobuyuki Tanaka
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinya Morita
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Asanuma
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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5
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Meijer D, Ettema RH, van Leeuwen PJ, van der Kwast TH, van der Poel HG, Donswijk ML, Oprea-Lager DE, Bekers EM, Vis AN. The prognostic value of lymph node staging with prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and extended pelvic lymph node dissection in node-positive patients with prostate cancer. BJU Int 2023; 131:330-338. [PMID: 36069585 DOI: 10.1111/bju.15881] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate whether patients with suspected pelvic lymph node metastases (molecular imaging [mi] N1) on staging prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) had a different oncological outcome compared to those in whom the PSMA PET/CT did not reveal any pelvic lymph node metastases (miN0). PATIENTS AND METHODS All patients with pelvic lymph node metastatic (pN1) disease after robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) between January 2017 and December 2020 were included. To assess predictors of biochemical progression of disease after RARP, a multivariable Cox regression analysis was performed, including number of tumour-positive lymph nodes, diameter of the largest nodal metastasis, and extranodal extension. RESULTS In total, 145 patients were diagnosed with pN1 disease after ePLND. The median biochemical progression-free survival in patients with miN0 on PSMA PET/CT was 13.7 months, compared to 7.9 months in patients with miN1 disease (P = 0.006). On multivariable Cox regression analysis, both number of tumour-positive lymph nodes (>2 vs 1-2: hazard ratio [HR] 1.97; P = 0.005) and diameter of the largest nodal metastasis (HR 1.12; P < 0.001) were significant independent predictors of biochemical progression of disease. CONCLUSION Patients in whom pelvic lymph node metastases were suspected on preoperative PSMA imaging (miN1), patients diagnosed with >2 tumour-positive lymph nodes, and patients with a larger diameter of the largest nodal metastasis had a significantly increased risk of biochemical disease progression after surgery.
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Affiliation(s)
- Dennie Meijer
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Rosemarijn H Ettema
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Henk G van der Poel
- Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.,Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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6
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Gödde D, Degener S, Walles C, Keller R, Dreger NM, Graf K, von Rundstedt FC, Kvasnicka HM, Krege S, Störkel S. Influence of lymph node degeneration on metastases in prostate cancer: or why we must look for a needle in a haystack. BMC Urol 2023; 23:6. [PMID: 36609261 PMCID: PMC9824975 DOI: 10.1186/s12894-022-01167-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To evaluate the incidence of lymph node degeneration and its association with nodal metastatic pattern in prostate cancer. METHODS A retrospective analysis of the submitted lymph node specimen of 390 prostatectomies in 2011 was performed. All lymph nodes were histologically re-evaluated and the degree of lymph node degeneration e.g. lipomatous atrophy, capsular and framework fibrosis, and calcifications as well as the lymph node size were recorded. Lymph node degeneration was compared in the anatomic regions of the pelvis as well as in lymph nodes with and without metastases of prostatic cancer. RESULTS Eighty-one of 6026 lymph nodes demonstrated metastases. Complete histologic examination with analysis of a complete cross-section was possible in 5173 lymph nodes including all lymph nodes with metastases. The incidence of lymph node degeneration was different across the various landing sites. Lymph node metastases were primarily detected in less degenerative and therefore more functional lymph nodes. In metastatic versus non-metastatic lymph nodes low lipomatous atrophy was reported in 84.0% versus 66.7% (p = 0.004), capsular fibrosis in 14.8% versus 35.4% (p < 0.001), calcifications in 35.8% versus 46.1% (p = 0.072) and framework fibrosis in 69.8% versus 75.3% (p = 0.53). Metastases were also identified more frequently in larger than in smaller lymph nodes (63.0% vs. 47.5%; p = 0.007). CONCLUSIONS Degenerative changes in pelvic lymph nodes are commonly detectable but occur with variable frequency in the various nodal landing sites in the pelvis. The degree of lymph node degeneration of single lymph nodes has a significant influence on whether a lymph node is infiltrated by tumor cells and may harbour metastases.
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Affiliation(s)
- Daniel Gödde
- grid.412581.b0000 0000 9024 6397Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Stephan Degener
- grid.412581.b0000 0000 9024 6397Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Christine Walles
- grid.412581.b0000 0000 9024 6397Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Rosalie Keller
- Clinic for Otolaryngology, Helios Hospital Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Nici Markus Dreger
- grid.412581.b0000 0000 9024 6397Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Katharina Graf
- grid.412581.b0000 0000 9024 6397Center for Clinical Trials, Witten/Herdecke University, Alfred-Herrhausen-Str. 50, 58448 Witten, Germany
| | - Friedrich-Carl von Rundstedt
- grid.412581.b0000 0000 9024 6397Department of Urology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Hans Michael Kvasnicka
- grid.412581.b0000 0000 9024 6397Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Susanne Krege
- grid.461714.10000 0001 0006 4176Department of Urology, Evang. Kliniken Essen-Mitte, Henricistr. 92, 45136 Essen, Germany
| | - Stephan Störkel
- grid.412581.b0000 0000 9024 6397Department of Pathology and Molecular Pathology, Helios University Hospital Wuppertal, Witten/Herdecke University, Heusnerstr. 40, 42283 Wuppertal, Germany
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7
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Marolleau J, Nguyen TA, Doucet L, Coste A, Schoentgen N, Rousseau B, Valeri A, Fournier G. [Morbidity of extended pelvic lymphadenectomy during robot-assisted laparoscopic prostatectomy for localized cancer prostate]. Prog Urol 2022; 32:1455-1461. [PMID: 36088200 DOI: 10.1016/j.purol.2022.07.138] [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: 04/22/2022] [Revised: 07/02/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the morbidity specific of extended pelvic lymphadenectomy during robot-assisted laparoscopic radical prostatectomy in a 8 year retrospective study. MATERIAL We carried out a single-center, single-surgeon retrospective study on 342 consecutive patients who underwent a robot-assisted laparoscopic radical prostatectomy and extended pelvic lymphadenectomy, from July 2010 to March 2018. Postoperative complications were recorded up to 3 months after the operation. RESULTS Thirty (8.8%) patients had at least one complication related to lymphadenectomy including 1 vascular injury (0.3%), 7 injuries of the obturator nerve (2%), 5 venous thromboembolic complications (1.5%) including 4 pulmonary embolisms, 10 symptomatic lymphoceles (2.9%) and 8 lymphoedemas (2.3%). Of these complications, 13 were classified Clavien 1 (43.3%), 8 Clavien 2 (26.7%), 7 Clavien 3a (23.3%) and 2 Clavien 3b (6.7%). In univariate analysis a high age (P=0.04), high BMI (P<0.01) and pT stage (P=0.02) were significantly associated with complication whereas in multivariate analysis, only age (P=0.02) and BMI (P<0.01) lived were. In univariate analysis high BMI (P=0.04) and lymph node involvement (P=0.04) were associated with lymphatic complication. We did not find any other specific risk factor for the other complications. CONCLUSION With 8.8% of overall complications related to lymphadenectomy and 5% of complication classified Clavien grade 2 or higher, extended pelvic lymphadenectomy was not very morbid. Age and BMI were risk factors for a overall complication. BMI and lymph node involvement were risk factors for lymphatic complications. LEVEL OF PROOF 4.
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Affiliation(s)
| | - T A Nguyen
- Service d'urologie, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France
| | - L Doucet
- Laboratoire d'anatomo-pathologie, CHU, Brest, France
| | - A Coste
- LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France; Service de médecine infectieuse et tropicale, CHU, Brest, France
| | | | | | - A Valeri
- Service d'urologie, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France; CeRePP, Paris, France
| | - G Fournier
- Service d'urologie, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France; CeRePP, Paris, France
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8
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Mandoorah Q, Benamran D, Pinar U, Seisen T, Abdessater M, Iselin C, Rouprêt M. Biochemical relapse predictive factors in patients with lymph node metastases during radical prostatectomy. Prog Urol 2022; 32:1462-1468. [DOI: 10.1016/j.purol.2022.07.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 07/10/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
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9
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Iwamura H, Hatakeyama S, Narita T, Ozaki Y, Konishi S, Horiguchi H, Kodama H, Kojima Y, Fujita N, Okamoto T, Tobisawa Y, Yoneyama T, Yamamoto H, Yoneyama T, Hashimoto Y, Ohyama C. Significance of pelvic lymph node dissection during radical prostatectomy in high-risk prostate cancer patients receiving neoadjuvant chemohormonal therapy. Sci Rep 2022; 12:9675. [PMID: 35690635 PMCID: PMC9188590 DOI: 10.1038/s41598-022-13651-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
We aimed to determine the survival and staging benefit of limited pelvic lymph node dissection (PLND) during radical prostatectomy (RP) in high-risk prostate cancer (PC) patients treated with neoadjuvant chemohormonal therapy. We retrospectively analyzed 516 patients with high-risk localized PC (< cT4N0M0) who received neoadjuvant androgen-deprivation therapy plus estramustine phosphate followed by RP between January 2010 and March 2020. Since we stopped limited PLND for such patients in October 2015, we compared the surgical outcomes and biochemical recurrence-free survival (BCR-FS) between the limited-PLND group (before October 2015, n = 283) and the non-PLND group (after November 2015, n = 233). The rate of node metastases in the limited-PLND group were 0.8% (2/283). Operation time was significantly longer (176 vs. 162 min) and the rate of surgical complications were much higher (all grades; 19 vs. 6%, grade ≥ 3; 3 vs. 0%) in the limited-PLND group. The inverse probability of treatment weighting-Cox analysis revealed limited PLND had no significant impact on BCR-FS (hazard ratio, 1.44; P = 0.469). Limited PLND during RP after neoadjuvant chemohormonal therapy showed quite low rate of positive nodes, higher rate of complications, and no significant impact on BCR-FS.
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Affiliation(s)
- Hiromichi Iwamura
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - Takuma Narita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yusuke Ozaki
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Sakae Konishi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotaka Horiguchi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hirotake Kodama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuta Kojima
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Teppei Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Blood Purification Therapy, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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10
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Qin XP, Lu QJ, Yang CH, Wang J, Chen JF, Liu K, Chen X, Zhou J, Pan YH, Li YH, Ren SC, Liu JM, Liu WP, Qian HJ, Yi XL, Lai CY, Qu LJ, Gao X, Xu YS, Chen Z, Zhuo YM. CRMP4 CpG Hypermethylation Predicts Upgrading to Gleason Score ≥ 8 in Prostate Cancer. Front Oncol 2022; 12:840950. [PMID: 35359369 PMCID: PMC8960729 DOI: 10.3389/fonc.2022.840950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/21/2022] [Indexed: 01/07/2023] Open
Abstract
Background This study determined the predictive value of CRMP4 promoter methylation in prostate tissues collected by core needle biopsies for a postoperative upgrade of Gleason Score (GS) to ≥8 in patients with low-risk PCa. Method A retrospective analysis of the clinical data was conducted from 631 patients diagnosed with low-risk PCa by core needle biopsy at multiple centers and then underwent Radical Prostatectomy (RP) from 2014-2019. Specimens were collected by core needle biopsy to detect CRMP4 promoter methylation. The pathologic factors correlated with the postoperative GS upgrade to ≥8 were analyzed by logistic regression. The cut-off value for CRMP4 promoter methylation in the prostate tissues collected by core needle biopsy was estimated from the ROC curve in patients with a postoperative GS upgrade to ≥8. Result Multivariate logistic regression showed that prostate volume, number of positive cores, and CRMP4 promoter methylation were predictive factors for a GS upgrade to ≥8 (OR: 0.94, 95% CI: 0.91-0.98, P=0.003; OR: 3.16, 95% CI: 1.81-5.53, P<0.001; and OR: 1.43, 95% CI: 1.32-1.55, P<0.001, respectively). The positive predictive rate was 85.2%, the negative predictive rate was 99.3%, and the overall predictive rate was 97.9%. When the CRMP4 promoter methylation rate was >18.00%, the low-risk PCa patients were more likely to escalate to high-risk patients. The predictive sensitivity and specificity were 86.9% and 98.8%, respectively. The area under the ROC curve (AUC) was 0.929 (95% CI: 0.883-0.976; P<0.001). The biochemical recurrence (BCR)-free survival, progression-free survival (PFS), and cancer-specific survival (CSS) were worse in patients with CRMP4 methylation >18.0% and postoperative GS upgrade to ≥8 than in patients without an upgrade (P ≤ 0.002). Conclusion A CRMP4 promoter methylation rate >18.00% in prostate cancer tissues indicated that patients were more likely to escalate from low-to-high risk after undergoing an RP. We recommend determining CRMP4 promoter methylation before RP for low-risk PCa patients.
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Affiliation(s)
- Xiao-Ping Qin
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qi-Ji Lu
- Department of Urology, Affiliated Xiaolan Hospital, Southern Medical University, Zhongshan, China
| | - Cheng-Huizi Yang
- Department of Thoracic Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jue Wang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jian-Fan Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Kan Liu
- Department of Urology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xin Chen
- Department of Pathology, The Third Medical Centre, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Jing Zhou
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Hang Pan
- Department of Pathology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong-Hong Li
- Department of Urology, Cancer Center, Sun Yat-sen University, Guangzhou, China
| | - Shan-Cheng Ren
- Department of Urology, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Jiu-Min Liu
- Department of Urology, Guangdong General Hospital, Guangzhou, China
| | - Wei-Peng Liu
- Department of Urology, The First Affiliated Hospital, Nanchang University, Nanchang, China
| | - Hui-Jun Qian
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xian-Lin Yi
- Department of Urology, Cancer Hospital, Guangxi Medical University, Nanning, China
| | - Cai-Yong Lai
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Li-Jun Qu
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xin Gao
- Department of Urology, The Third Affiliated Hospital of Sun Yet-Sen University, Guangzhou, China
| | - Yu-Sheng Xu
- Department of Emergency, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zheng Chen
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yu-Min Zhuo
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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11
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Covas Moschovas M, Helman T, Reddy S, Bhat S, Rogers T, Sandri M, Noel J, Patel V. Minimally Invasive Lymphocele Drainage Using the Da Vinci Single-Port Platform: Step-By-Step Technique of a Prostate Cancer Referral Center. J Endourol 2021; 35:1357-1364. [PMID: 33724057 DOI: 10.1089/end.2020.1175] [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] [Indexed: 11/12/2022] Open
Abstract
Background: Some reports in the literature describe lymphocele formation in as much as half of patients after pelvic lymph node dissection (PLND) in robot-assisted radical prostatectomy (RARP), with 1%-2% requiring intervention. Several treatment modalities for symptomatic lymphoceles are available, including percutaneous drainage, sclerosing agents, and surgical marsupialization, typically performed by laparoscopy or with a multiport robotic platform. The advantage of surgical approach is permanent excision of the lymphocele capsule and fewer days with pelvic drains compared to percutaneous drainage. This study aims to describe and illustrate, for the first time, the step-by-step surgical management of symptomatic lymphoceles using a less invasive robotic platform, the da Vinci® Single Port (SP). Materials and Methods: We describe the outcomes of three patients who underwent lymphocelectomy and marsupialization with the da Vinci SP for symptomatic lymphoceles after RARP and PLND with the da Vinci Xi. Results: Operative time for cases 1, 2, and 3 was 84, 80, and 79 minutes. The blood loss for each surgery was 25 mL. Patient 2 was discharged in 3 days, whereas patients 1 and 3 were discharged in 4 days. No intraoperative or postoperative complications were reported. All patients had their drain removed in under 24 hours after surgery. The mean follow-up period was 7.7 months (3.5-15.8). No patients were readmitted or had lymphocele recurrence. Conclusion: Da Vinci SP lymphocelectomy is safe and feasible with satisfactory outcomes. The SP enables definitive treatment of the lymphocele sac, reducing the number of days with abdominal drains, and allows further decrease in surgical invasiveness with fewer incisions and better cosmesis.
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Affiliation(s)
- Marcio Covas Moschovas
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Talia Helman
- Department of Urology, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Sunil Reddy
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Seetharam Bhat
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Travis Rogers
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Marco Sandri
- Big and Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Jonathan Noel
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
| | - Vipul Patel
- Department of Urology, Advent Health Global Robotics Institute, Celebration, Florida, USA
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12
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Pathologically Node-Positive Prostate Cancer: Casting for Cure When the Die Is Cast? ACTA ACUST UNITED AC 2021; 26:58-63. [PMID: 31977387 DOI: 10.1097/ppo.0000000000000426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The postoperative management of men with lymph node involved prostate cancer (pN+) remains a challenge as there is a general lack of randomized trial data and a range of management strategies. Retrospective studies suggest a variable clinic course for patients with pN+ prostate cancer. Some men progress rapidly to metastatic disease despite further therapies, whereas other men can have a period of prolonged quiescence without adjuvant androgen deprivation therapy (ADT) or radiation therapy (RT). For men who have undergone radical prostatectomy, randomized trial data indicate that the addition of ADT in pN+ disease extends metastasis-free, prostate cancer-specific, and overall survival. Additional retrospective studies suggest that adding RT is potentially beneficial in this setting, improving overall and cancer-specific survival especially in men with certain pathologic parameters. Conversely, men with lower disease burden in their lymph nodes have longer times to progression and may be candidates for observation and salvage therapy as opposed to adjuvant ADT/RT.
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13
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Touijer KA, Sjoberg DD, Benfante N, Laudone VP, Ehdaie B, Eastham JA, Scardino PT, Vickers A. Limited versus Extended Pelvic Lymph Node Dissection for Prostate Cancer: A Randomized Clinical Trial. Eur Urol Oncol 2021; 4:532-539. [PMID: 33865797 DOI: 10.1016/j.euo.2021.03.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 01/23/2023]
Abstract
BACKGROUND Pelvic lymph node dissection (PLND) is the most reliable procedure for lymph node staging. However, the therapeutic benefit remains unproven; although most radical prostatectomies at academic centers are accompanied by PLND, there is no consensus regarding the optimal anatomical extent of PLND. OBJECTIVE To evaluate whether extended PLND results in a lower biochemical recurrence rate. DESIGN, SETTING, AND PARTICIPANTS We conducted a single-center randomized trial. Patients, enrolled between October 2011 and March 2017, were scheduled to undergo radical prostatectomy and PLND. Patients were assigned to limited or extended PLND by cluster randomization. Specifically, surgeons were randomized to perform limited or extended PLND for 3-mo periods. INTERVENTION Randomization to limited (external iliac nodes) or extended (external iliac, obturator fossa and hypogastric nodes) PLND. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary endpoint was the rate of biochemical recurrence. RESULTS AND LIMITATIONS Of 1440 patients included in the final analysis, 700 were randomized to limited PLND and 740 to extended PLND. The median number of nodes retrieved was 12 (interquartile range [IQR] 8-17) for limited PLND and 14 (IQR 10-20) extended PLND; the corresponding rate of positive nodes was 12% and 14% (difference -1.9%, 95% confidence interval [CI] -5.4% to 1.5%; p = 0.3). With median follow-up of 3.1 yr, there was no significant difference in the rate of biochemical recurrence between the groups (hazard ratio 1.04, 95% CI 0.93-1.15; p = 0.5). Rates for grade 2 and 3 complications were similar at 7.3% for limited versus 6.4% for extended PLND; there were no grade 4 or 5 complications. CONCLUSIONS Extended PLND did not improve freedom from biochemical recurrence over limited PLND for men with clinically localized prostate cancer. However, there were smaller than expected differences in nodal count and the rate of positive nodes between the two templates. A randomized trial comparing PLND to no node dissection is warranted. PATIENT SUMMARY In this clinical trial we did not find a difference in the rate of biochemical recurrence of prostate cancer between limited and extended dissection of lymph nodes in the pelvis. This study is registered on ClinicalTrials.gov as NCT01407263.
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Affiliation(s)
- Karim A Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole Benfante
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Vincent P Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Behfar Ehdaie
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James A Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter T Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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14
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Heidenreich A. Still Unanswered: The Role of Extended Pelvic Lymphadenectomy in Improving Oncological Outcomes in Prostate Cancer. Eur Urol 2021; 79:605-606. [PMID: 33593651 DOI: 10.1016/j.eururo.2021.01.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Onology, Robot-Assisted and Specialized Urologic Surgery, University of Cologne, Cologne, Germany.
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15
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Chuang YF, Ou YC, Lin YS, Huang LH, Weng WC, Chang YK, Chen HL, Hsu CY, Tung MC, Lu CH. Pelvic lymph node dissection using indocyanine green fluorescence lymphangiography in robotic assisted radical prostatectomy for non-lymph node or distant metastasis prostate cancer patients. UROLOGICAL SCIENCE 2021. [DOI: 10.4103/uros.uros_96_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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16
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Frumer M, Milk N, Rinott Mizrahi G, Bistritzky S, Sternberg I, Leibovitch I, Dekel Y, Amiel GE, Zisman A, Baniel J, Haifler M, Gal J, Hoffman A, Sagy I, Rosenzweig B, Haramaty R, Golan S. A comparison between 68Ga-labeled prostate-specific membrane antigen-PET/CT and multiparametric MRI for excluding regional metastases prior to radical prostatectomy. Abdom Radiol (NY) 2020; 45:4194-4201. [PMID: 32671440 DOI: 10.1007/s00261-020-02640-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/24/2020] [Accepted: 07/04/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare the ability of 68Ga -PSMA PET/CT (PSMA PET/CT) and multiparametric MRI (mpMRI) to exclude lymph node invasion (LNI) in patients who undergo radical prostatectomy (RP). MATERIALS AND METHODS A multicenter cohort of patients who underwent PSMA PET/CT and pelvic mpMRI prior to RP with pelvic lymph node dissection (PLND) was analyzed. Increased Ga68-PSMA uptake on PET/CT and enlarged (> 10 mm) or abnormal lymph nodes on mpMRI were considered positive findings. The final surgical pathology served as the standard of reference. The negative predictive value (NPV) was calculated for each modality separately, as well as the combined value. RESULTS Included were 89 patients with D'Amico intermediate (45%) or high-risk (55%) prostate cancer. The median number of extracted LN was 9 (IQR 6-14). LNI was found in 12 (13.5%) patients. The NPV of mpMRI, PSMA PET/CT, and the two tests combined were 87%, 89%, and 90%, in the entire cohort, 95%, 97%, and 97% in patients with intermediate-risk disease, and 80%, 82%, and 83% in patients with high-risk disease, respectively. The median diameter of LN missed by both imaging and the median intranodal tumor diameter was 5.5 (IQR 3-10) mm and 1 (IQR 1-3) mm, respectively. CONCLUSIONS PSMA PET/CT and mpMRI demonstrated similar performance in excluding pelvic LNI with NPV of approximately 90%. The combination of both tests does not improve NPV significantly. Therefore, even in the era of advanced imaging, PLND is still recommended for accurate staging, especially in the high-risk population.
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Affiliation(s)
- Michael Frumer
- Section of Urology, Rabin Medical Center, Jabotinsky St 39, 4941492, Petah Tikva, Israel.
| | | | | | | | - Itay Sternberg
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Meir Medical Center, Kfar Saba, Israel
| | - Ilan Leibovitch
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Meir Medical Center, Kfar Saba, Israel
| | - Yoram Dekel
- Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Gilad E Amiel
- Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Amnon Zisman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center, Tzrifin, Israel
| | - Jack Baniel
- Section of Urology, Rabin Medical Center, Jabotinsky St 39, 4941492, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Miki Haifler
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Shamir Medical Center, Tzrifin, Israel
| | | | - Azik Hoffman
- Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Itay Sagy
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Meir Medical Center, Kfar Saba, Israel
- Carmel Medical Center, Haifa, Israel
| | - Barak Rosenzweig
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Chaim Sheba Medical Center, Ramat Gan, Israel
| | | | - Shay Golan
- Section of Urology, Rabin Medical Center, Jabotinsky St 39, 4941492, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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17
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Cysouw MCF, Jansen BHE, van de Brug T, Oprea-Lager DE, Pfaehler E, de Vries BM, van Moorselaar RJA, Hoekstra OS, Vis AN, Boellaard R. Machine learning-based analysis of [ 18F]DCFPyL PET radiomics for risk stratification in primary prostate cancer. Eur J Nucl Med Mol Imaging 2020; 48:340-349. [PMID: 32737518 PMCID: PMC7835295 DOI: 10.1007/s00259-020-04971-z] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/22/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE Quantitative prostate-specific membrane antigen (PSMA) PET analysis may provide for non-invasive and objective risk stratification of primary prostate cancer (PCa) patients. We determined the ability of machine learning-based analysis of quantitative [18F]DCFPyL PET metrics to predict metastatic disease or high-risk pathological tumor features. METHODS In a prospective cohort study, 76 patients with intermediate- to high-risk PCa scheduled for robot-assisted radical prostatectomy with extended pelvic lymph node dissection underwent pre-operative [18F]DCFPyL PET-CT. Primary tumors were delineated using 50-70% peak isocontour thresholds on images with and without partial-volume correction (PVC). Four hundred and eighty standardized radiomic features were extracted per tumor. Random forest models were trained to predict lymph node involvement (LNI), presence of any metastasis, Gleason score ≥ 8, and presence of extracapsular extension (ECE). For comparison, models were also trained using standard PET features (SUVs, volume, total PSMA uptake). Model performance was validated using 50 times repeated 5-fold cross-validation yielding the mean receiver-operator characteristic curve AUC. RESULTS The radiomics-based machine learning models predicted LNI (AUC 0.86 ± 0.15, p < 0.01), nodal or distant metastasis (AUC 0.86 ± 0.14, p < 0.01), Gleason score (0.81 ± 0.16, p < 0.01), and ECE (0.76 ± 0.12, p < 0.01). The highest AUCs reached using standard PET metrics were lower than those of radiomics-based models. For LNI and metastasis prediction, PVC and a higher delineation threshold improved model stability. Machine learning pre-processing methods had a minor impact on model performance. CONCLUSION Machine learning-based analysis of quantitative [18F]DCFPyL PET metrics can predict LNI and high-risk pathological tumor features in primary PCa patients. These findings indicate that PSMA expression detected on PET is related to both primary tumor histopathology and metastatic tendency. Multicenter external validation is needed to determine the benefits of using radiomics versus standard PET metrics in clinical practice.
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Affiliation(s)
- Matthijs C F Cysouw
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands.
| | - Bernard H E Jansen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands.,Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Urology, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Tim van de Brug
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Daniela E Oprea-Lager
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Elisabeth Pfaehler
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center, University of Groningen, Groningen, the Netherlands
| | - Bart M de Vries
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Reindert J A van Moorselaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Urology, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Otto S Hoekstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - André N Vis
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Urology, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
| | - Ronald Boellaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, De Boelelaan, 1117, Amsterdam, the Netherlands
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18
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Sforza S, Tellini R, Grosso AA, Zaccaro C, Viola L, Di Maida F, Mari A, Carini M, Minervini A, Masieri L. Can we predict the development of symptomatic lymphocele following robot-assisted radical prostatectomy and lymph node dissection? Results from a tertiary referral Centre. Scand J Urol 2020; 54:328-333. [PMID: 32588704 DOI: 10.1080/21681805.2020.1784270] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objectives: Robot-assisted radical prostatectomy (RARP) has been established as first-line surgical therapy for organ-confined prostate cancer (PCa). Pelvic lymph node dissection (PLND) is recommended in case of intermediate and high-risk localized PCa however symptomatic lymphocele (SL) formation is a common complication. Still no certain clinical and surgical predictors of SL have been found in the robotic era. Aim of this study was to identify clinical and surgical predictors of SL after RARP and PLND.Methods: We retrospectively evaluated all consecutive patients undergone RARP and PLND from 01/2017 to 06/2019, at our institution. All procedures were performed by experienced robotic surgeons. Baseline patients' characteristics, as well as peri- and post-operative features, were recorded and compared among those patients experiencing SL after surgery and those who did not.Results: Overall, 282 patients were included. Of these, 21 (7.5%) developed SL after surgery. Patients with SL showed higher median BMI (30.4 vs 25.8) and a more frequent history of vascular surgery or lymph-vascular disease (23.8% vs 8.4%) compared to patients without SL (p < 0.05). The lymphadenectomy technique adopted during the surgery was also found different in patients diagnosed with SL. At the multivariable analysis (MVA), only the increase of BMI (OR 1.72; CI: 1.47 - 2.81) was found predictor of developing SL.Conclusion: In our experience, the increase of BMI was a significant predictor of SL development in pCa patients submitted to RARP and PLND. This further evidence may be of great help for clinicians in daily clinical practice, in particular during preoperative counseling.
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Affiliation(s)
- Simone Sforza
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Tellini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Claudia Zaccaro
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Viola
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Fabrizio Di Maida
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Lorenzo Masieri
- Department of Oncologic, Minimally-Invasive Urology and Andrology, Careggi Hospital, University of Florence, Florence, Italy
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19
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Huang Y, Hakamivala A, Li S, Nair A, Saxena R, Hsieh JT, Tang L. Chemokine releasing particle implants for trapping circulating prostate cancer cells. Sci Rep 2020; 10:4433. [PMID: 32157115 PMCID: PMC7064596 DOI: 10.1038/s41598-020-60696-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 02/04/2020] [Indexed: 12/19/2022] Open
Abstract
Prostate cancer (PCa) is the most prevalent cancer in U.S. men and many other countries. Although primary PCa can be controlled with surgery or radiation, treatment options of preventing metastatic PCa are still limited. To develop a new treatment of eradicating metastatic PCa, we have created an injectable cancer trap that can actively recruit cancer cells in bloodstream. The cancer trap is composed of hyaluronic acid microparticles that have good cell and tissue compatibility and can extend the release of chemokines to 4 days in vitro. We find that erythropoietin (EPO) and stromal derived factor-1α can attract PCa in vitro. Animal results show that EPO-releasing cancer trap attracted large number of circulating PCa and significantly reduced cancer spreading to other organs compared with controls. These results support that cancer trap may serve as a unique device to sequester circulating PCa cells and subsequently reduce distant metastasis.
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Affiliation(s)
- YiHui Huang
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019, USA
| | - Amirhossein Hakamivala
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019, USA
| | - Shuxin Li
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019, USA
| | - Ashwin Nair
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019, USA
| | - Ramesh Saxena
- Division of Nephrology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA
| | - Jer-Tsong Hsieh
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, 75390, USA
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, 807, Taiwan
| | - Liping Tang
- Department of Bioengineering, the University of Texas at Arlington, Arlington, Texas, 76019, USA.
- Department of Biomedical Science and Environmental Biology, Kaohsiung Medical University, Kaohsiung, 807, Taiwan.
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20
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Guo L, Zhu Z, Zhang X. Adding radiotherapy to androgen deprivation therapy in men with node-positive prostate cancer after radical prostatectomy: A meta-analysis. Medicine (Baltimore) 2020; 99:e19153. [PMID: 32150055 PMCID: PMC7478562 DOI: 10.1097/md.0000000000019153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several studies have tested the addition of adjuvant radiotherapy (RT) to androgen deprivation therapy (ADT) in node-positive prostate cancer (PCa) after radical prostatectomy (RP). This meta-analysis aims to assess the effects of adding RT to ADT in the treatment of PCa patients with lymph node invasion. METHODS We systematically searched PubMed and Embase through June 2018 for human studies comparing RT plus ADT versus ADT in men with node-positive PCa after RP. The primary end point was overall survival (OS). Secondary end point was cancer-specific survival (CSS). Hazard ratios (HRs) with 95% confidence intervals (CIs) for the effects of RT plus ADT on OS and CSS were combined across studies using meta-analysis. RESULTS Five studies were selected for inclusion. Overall, 15,524 patients were enrolled in the 5 studies. This included 6309 (40.6%) patients receiving ADT, 4389 (28.3%) patients receiving adjuvant RT plus ADT, and 4826 (31.1%) patients receiving observation. In lymph node-positive PCa patients, the addition of adjuvant RT was associated with improved OS (HR: 0.74; 95% CI, 0.59-0.92; P = .008). Moreover, the addition of adjuvant RT was also associated with a dramatic CSS improvement (HR: 0.40; 95% CI, 0.27-0.59; P = .000). CONCLUSIONS Adding RT to ADT may be a clinically effective treatment option for men with lymph node-positive PCa after RP.
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Affiliation(s)
- Lijuan Guo
- Department of Disease Prevention and Control
| | - Zhaowei Zhu
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
| | - Xuepei Zhang
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, PR China
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21
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Furubayashi N, Negishi T, Uozumi T, Shiraishi K, Taguchi K, Shimokawa M, Nakamura M. Eliminating microscopic lymph node metastasis by performing pelvic lymph node dissection during radical prostatectomy for prostate cancer. Mol Clin Oncol 2019; 12:104-110. [PMID: 31929879 PMCID: PMC6951226 DOI: 10.3892/mco.2019.1965] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 11/25/2019] [Indexed: 11/27/2022] Open
Abstract
The oncological benefit of pelvic lymph node dissection (PLND) for prostate cancer (PCa) remains unclear. The therapeutic effect of PLND on the elimination of microscopic metastases during radical prostatectomy (RP) for PCa was examined in the current study. A total of 348 Japanese patients with high- or intermediate-risk PCa without lymph node metastasis, who underwent antegrade RP at the Kyushu Cancer Center (Fukuoka, Japan) between August 1998 and May 2013 were retrospectively analyzed. The patients were divided into the standard (obturator + internal iliac nodes) group and the expanded (standard + additional nodes) group according to the extent of PLND. Preoperative and postoperative characteristics were also analyzed to determine the factors associated with prostate-specific antigen (PSA) failure. Standard and expanded PLND were performed in 70.9% (247/348) and 29.1% (101/348) of cases, respectively. The results revealed that preoperative PSA levels were the only marked difference between the two groups. No differences were observed in the other preoperative and postoperative characteristics. Furthermore, the rate of PSA recurrence in each group did not differ to a statistically significant extent (P=0.3622). Reducing the area of dissection from expanded PLND to standard PLND significantly reduced the number of dissected lymph nodes (P<0.0001). Additionally, the PSA level, clinical tumor stage, Gleason score of the biopsy specimen, pathological tumor stage and extent of PLND were all associated with PSA recurrence, as determined via multivariate Cox hazards regression analysis (P=0.0177, P=0.0023, P=0.0027, P<0.0001 and P=0.0164, respectively). In high- and intermediate-risk patients without lymph node metastasis, a greater number of lymph nodes were dissected when the extent of dissection was greater. Furthermore, the extent of PLND was a significantly associated with PSA failure. The results indicated that PLND exerted a therapeutic effect by eliminating microscopic pelvic lymph node metastases that were not detected by routine pathological examinations.
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Affiliation(s)
- Nobuki Furubayashi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Takahito Negishi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Tomoharu Uozumi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Kouichi Shiraishi
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Mototsugu Shimokawa
- Institute for Clinical Research, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
| | - Motonobu Nakamura
- Department of Urology, National Hospital Organization Kyushu Cancer Center, Fukuoka 811-1395, Japan
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22
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Tomisaki I, Ikuta H, Higashijima K, Onishi R, Minato A, Fujimoto N. Oncological Outcome After Radical Prostatectomy without Pelvic Lymph Node Dissection for Localized Prostate Cancer: Follow-up Results in a Single Institution. Cancer Invest 2019; 37:524-530. [PMID: 31597501 DOI: 10.1080/07357907.2019.1675076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The oncological benefit of pelvic lymph node dissection (PLND) is still debatable because data on clinical outcomes of radical prostatectomy (RP) without PLND are lacking. In this study, we reported oncological outcome in consecutive 146 patients who underwent RP without PLND. Although 27% of our patients developed biochemical recurrence, the estimated 5-year overall survival rates were 100%, 96.3%, and 95.7% in the low-, intermediate-, and high-risk groups, respectively. These data in our patients were not inferior to those in previous reports that investigated the survivals in patients who received PLND during RP. The therapeutic significance of PLND should be re-evaluated.
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Affiliation(s)
- Ikko Tomisaki
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Hirofumi Ikuta
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Katsuyoshi Higashijima
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Rei Onishi
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Akinori Minato
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
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23
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Banapour P, Schumacher A, Lin JC, Finley DS. Radical Prostatectomy and Pelvic Lymph Node Dissection in Kaiser Permanente Southern California: 15-Year Experience. Perm J 2019; 23:17-233. [PMID: 30939263 DOI: 10.7812/tpp/17-233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Radical prostatectomy (RP) with pelvic lymph node dissection (PLND) is the standard treatment of high-risk prostate cancer. High-risk patients and those with lymph node metastasis (LNM) require further treatment. We review outcomes of RP+PLND in Kaiser Permanente Southern California (KPSC). METHODS Patients who underwent RP+PLND in KPSC from January 1, 2001, to July 1, 2015 were included. Patient charts were retrospectively reviewed for demographic information and clinicopathologic data which were used to calculate positive surgical margin rate, LNM, adjuvant treatment, 5-year biochemical recurrence, and overall survival. Univariate and multivariate logistic regression analyses were used to identify factors associated with margin positivity. RESULTS Patients (N = 1829) underwent RP+PLND (241 high-risk, 943 intermediate-risk, 645 low-risk). Positive margin rates were 17.8%, 14.8%, and 11.9% in the high, intermediate- and low-risk groups. Biochemical recurrence rates were 22% in high-risk and 12.1% in the low-risk category. Androgen deprivation use was 4.1% in the high-risk group and 0.9% in the low-risk group. Five-year overall survival was 92.5% in lymph node-positive patients and 94.9% in lymph node-negative patients (p = 0.8). On multivariate analysis, age (odds ratio [OR] = 1.02, p = 0.02), prebiopsy prostate-specific antigen (OR = 1.02, p < 0.001), and clinical T stage (OR = 1.49, p = 0.01) were associated with margin positivity. CONCLUSION In KPSC, RP+PLND was performed in patients with low-, intermediate-, and high-risk prostate cancer. Age, prebiopsy prostate-specific antigen, and clinical stage were associated with positive surgical margins in patients with LNM. Recipients of RP+PLND with LNM and positive surgical margins required adjuvant treatment.
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Affiliation(s)
- Pooya Banapour
- Department of Urology, Sunset Medical Center, Los Angeles, CA
| | | | - Jane C Lin
- Department of Research and Evaluation, Pasadena, CA
| | - David S Finley
- Department of Urology, Sunset Medical Center, Los Angeles, CA
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Bourdais R, Achkar S, Chauffert-Yvart L, Pasquier D, Sargos P, Blanchard P, Latorzeff I. [Prophylactic nodal radiotherapy in prostate cancer]. Cancer Radiother 2019; 23:688-695. [PMID: 31451356 DOI: 10.1016/j.canrad.2019.07.149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/30/2022]
Abstract
The risk of lymph node invasion, in case of prostate cancer, increases with the clinical stage of the disease, the Gleason score of prostate biopsies and the value of PSA at diagnosis. Historically, beyond 15% risk of lymph node involvement, irradiation of the pelvic areas was performed with prostate radiotherapy (RT) to take into account the risk of occult lymph node metastasis in patients at risk, but the benefit of this therapeutic approach remains to be demonstrated. The data from surgical lymph node dissection seem to question the risk levels, the escalation of the dose on the prostate increases the survival without relapse, the contribution of image-guided radiotherapy, (IGRT) and modulation of intensity (IMRT), decreases the toxicity of pelvic RT. This article reviews the principles of prophylactic ganglion irradiation for prostate cancer and discusses its relevance, current uncertainties, and prospective trials.
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Affiliation(s)
- R Bourdais
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - S Achkar
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - L Chauffert-Yvart
- Service d'oncologie radiothérapie, GHU La Pitié-Salpêtrière-Charles-Foix, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - D Pasquier
- Département de radiothérapie, Centre Oscar-Lambret, 3, rue Combemale, 59020 Lille cedex; Université de Lille et Centre de Recherche en Informatique Signal et Automatique de Lille CRISTAL UMR CNRS 9189, 59000 Lille, France.
| | - P Sargos
- Département de radiothérapie, Institut Bergonié, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - P Blanchard
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94800 Villejuif, France.
| | - I Latorzeff
- Département de radiothérapie-oncologie, Bât Atrium, Clinique Pasteur, 1, rue de la petite vitesse, 31300 Toulouse, France.
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25
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[Advanced Prostate Cancer Consensus Conference 2017 : Discussion of the recommendations for diagnosis and treatment of metastatic prostate cancer by a German panel of experts]. Urologe A 2019; 57:813-820. [PMID: 29808368 DOI: 10.1007/s00120-018-0680-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
In March 2017 the 'Advanced Prostate Cancer Consensus Conference' (APCCC) took place in St. Gallen (Switzerland). The APCCC-panelists are internationally well known experts. With the actual data in mind they discussed treatment options for patients with advanced prostate cancer in order to update the international APCCC-recommendations from the previous meeting in 2015. Recently these consensus recommendations have been published in "European Urology".A group of German experts discussed this year APCCC-votes during the meeting and the recommendations that were concluded from the votes from the German perspective. Reasons for an additional German discussion are country-specific variations that may have influenced the APCCC-votes und recommendations. Due to the concept of the APCCC-meeting the wording of the questions could not always be as necessary.One focus of this year consensus discussion was the treatment of metastatic castration-naive prostate cancer (mCNPC). There are new data which may also influence the therapeutic situation of patients with metastatic castration-resistant prostate cancer (mCRPC). Further points of discussion were the impact of new imaging procedures in the clinical setting as well as the treatment of oligometastatic prostate cancer.
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26
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Savolainen H, Volpe A, Phinikaridou A, Douek M, Fruhwirth G, de Rosales RTM. 68Ga-Sienna+ for PET-MRI Guided Sentinel Lymph Node Biopsy: Synthesis and Preclinical Evaluation in a Metastatic Breast Cancer Model. Nanotheranostics 2019; 3:255-265. [PMID: 31263657 PMCID: PMC6584137 DOI: 10.7150/ntno.34727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/31/2019] [Indexed: 12/17/2022] Open
Abstract
Sentinel lymph node biopsy (SLNB) is commonly performed in cancers that metastasise via the lymphatic system. It involves excision and histology of sentinel lymph nodes (SLNs) and presents two main challenges: (i) sensitive whole-body localisation of SLNs, and (ii) lack of pre-operative knowledge of their metastatic status, resulting in a high number (>70%) of healthy SLN excisions. To improve SLNB, whole-body imaging could improve detection and potentially prevent unnecessary surgery by identifying healthy and metastatic SLNs. In this context, radiolabelled SPIOs and PET-MRI could find applications to locate SLNs with high sensitivity at the whole-body level (using PET) and guide high-resolution MRI to evaluate their metastatic status. Here we evaluate this approach by synthesising a GMP-compatible 68Ga-SPIO (68Ga-Sienna+) followed by PET-MR imaging and histology studies in a metastatic breast cancer mouse model. Methods. A clinically approved SPIO for SLN localisation (Sienna+) was radiolabelled with 68Ga without a chelator. Radiochemical stability was tested in human serum. In vitro cell uptake was compared between 3E.Δ.NT breast cancer cells, expressing the hNIS reporter gene, and macrophage cell lines (J774A.1; RAW264.7.GFP). NSG-mice were inoculated with 3E.Δ.NT cells. Left axillary SLN metastasis was monitored by hNIS/SPECT-CT and compared to the healthy right axillary SLN. 68Ga-Sienna+ was injected into front paws and followed by PET-MRI. Imaging results were confirmed by histology. Results.68Ga-Sienna+ was produced in high radiochemical purity (>93%) without the need for purification and was stable in vitro. In vitro uptake of 68Ga-Sienna+ in macrophage cells (J774A.1) was significantly higher (12 ± 1%) than in cancer cells (2.0 ± 0.1%; P < 0.001). SPECT-CT confirmed metastasis in the left axillary SLNs of tumour mice. In PET, significantly higher 68Ga-Sienna+ uptake was measured in healthy axillary SLNs (2.2 ± 0.9 %ID/mL), than in metastatic SLNs (1.1 ± 0.2 %ID/mL; P = 0.006). In MRI, 68Ga-Sienna+ uptake in healthy SLNs was observed by decreased MR signal in T2/T2*-weighted sequences, whereas fully metastatic SLNs appeared unchanged. Conclusion.68Ga-Sienna+ in combination with PET-MRI can locate and distinguish healthy from metastatic SLNs and could be a useful preoperative imaging tool to guide SLN biopsy and prevent unnecessary excisions.
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Affiliation(s)
- Heli Savolainen
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alessia Volpe
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Alkystis Phinikaridou
- Department of Biomedical Engineering, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Michael Douek
- Department of Research Oncology, School of Cancer & Pharmaceutical Sciences, King's College London, London, United Kingdom
| | - Gilbert Fruhwirth
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
| | - Rafael T. M. de Rosales
- Department of Imaging Chemistry and Biology, School of Biomedical Engineering & Imaging Sciences, King's College London, London, United Kingdom
- London Centre for Nanotechnology, King's College London, Strand Campus, London, WC2R 2LS, United Kingdom (UK)
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Kim JK, Jeong CW, Ku JH, Kim HH, Kwak C. Prostate specific antigen (PSA) persistence 6 weeks after radical prostatectomy and pelvic lymph node dissection as predictive factor of radiographic progression in node-positive prostate cancer patients. J Cancer 2019; 10:2237-2242. [PMID: 31258727 PMCID: PMC6584413 DOI: 10.7150/jca.29714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 03/31/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose: To evaluate the prognostic value of early postoperative prostate specific antigen (PSA) levels after radical prostatectomy (RP) and pelvic lymph node dissection (PLND) in prostate cancer patients with lymph node invasion (LNI). Materials and Methods: The retrospective analysis involved 96 patients who had a diagnosis of LNI with available data on the first PSA level at postoperative 6 weeks after RP and PLND between 2002 and 2014 at our institution. PSA persistence was defined as PSA ≥ 0.1 ng/ml at 6 weeks after surgery. Radiographic progression was defined as positive imaging during follow-up after the onset of biochemical recurrence, consisting of a bone scan and/or computed tomography (CT) and/or magnetic resonance imaging and/or 18F-(2-deoxy-2-fluoro-D-glucose positron emission tomography/CT scan. Comparative analysis of patients with and without PSA persistence was done, and Kaplan-Meier curve analysis with log-rank test and Cox proportional hazard regression models assessed radiographic progression free survival (PFS). Results: Fifty two (54.2%) patients displayed PSA persistence. Kaplan-Meier curve analysis showed significantly decreased 5-year radiographic PFS (64.2% vs. 93.2%, log-rank, p=0.009) in the PSA persistence group compared to the no PSA persistence group. In a multivariate analysis, PSA persistence was a statistically significant predictor of radiographic PFS. Conclusions: Early assessment of PSA after surgery is important for predicting radiographic progression in node-positive prostate cancer patients. Risk stratification based on the early PSA value after surgery would be helpful to identify patients who may benefit from early adjuvant therapies.
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Affiliation(s)
- Jung Kwon Kim
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Hyun Hoe Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University Hospital, Seoul, Korea
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Cacciamani GE, Porcaro AB, Sebben M, Tafuri A, Rizzetto R, De Luyk N, Ciocchetta E, Processali T, Pirozzi M, Amigoni N, Corsi P, Brunelli M, De Marco V, Artibani W. Extended pelvic lymphadenectomy for prostate cancer: should the Cloquet's nodes dissection be considered only an option? MINERVA UROL NEFROL 2019; 71:136-145. [DOI: 10.23736/s0393-2249.19.03342-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Smith CP, Laucis A, Harmon S, Mena E, Lindenberg L, Choyke PL, Turkbey B. Novel Imaging in Detection of Metastatic Prostate Cancer. Curr Oncol Rep 2019; 21:31. [DOI: 10.1007/s11912-019-0780-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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30
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Machine learning models for predicting post-cystectomy recurrence and survival in bladder cancer patients. PLoS One 2019; 14:e0210976. [PMID: 30785915 PMCID: PMC6382101 DOI: 10.1371/journal.pone.0210976] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/04/2019] [Indexed: 12/11/2022] Open
Abstract
Currently in patients with bladder cancer, various clinical evaluations (imaging, operative findings at transurethral resection and radical cystectomy, pathology) are collectively used to determine disease status and prognosis, and recommend neoadjuvant, definitive and adjuvant treatments. We analyze the predictive power of these measurements in forecasting two key long-term outcomes following radical cystectomy, i.e., cancer recurrence and survival. Information theory and machine learning algorithms are employed to create predictive models using a large prospective, continuously collected, temporally resolved, primary bladder cancer dataset comprised of 3503 patients (1971-2016). Patient recurrence and survival one, three, and five years after cystectomy can be predicted with greater than 70% sensitivity and specificity. Such predictions may inform patient monitoring schedules and post-cystectomy treatments. The machine learning models provide a benchmark for predicting oncologic outcomes in patients undergoing radical cystectomy and highlight opportunities for improving care using optimal preoperative and operative data collection.
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31
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De Luca S, Passera R, Fiori C, Garrou D, Manfredi M, Aimar R, Amparore D, Checcucci E, Bollito E, Porpiglia F. The role of side-specific biopsy and dominant tumor location at radical prostatectomy in predicting the side of nodal metastases in organ confined prostate cancer: is lymphatic spread really unpredictable? MINERVA UROL NEFROL 2018; 71:146-153. [PMID: 30421597 DOI: 10.23736/s0393-2249.18.03286-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the correlation between the location of prostate cancer (PCa) either at biopsy or at radical prostatectomy (RP) specimens and the side of positive lymph nodes (LNs). Furthermore, we assessed the risk of contralateral LN metastasis (LNMs) in patients with unilateral positive biopsy and/or dominant lesion at RP. METHODS We reviewed retrospectively our prospectively maintained database of patients with LNM treated with robot-assisted RP and bilateral robot-assisted extended pelvic lymph node dissection (EPLND) for PCa from January 2014 to May 2018 at a surgical high-volume center. All men with a suspicion for PCa underwent a 12-cores prostate biopsy. In case of a first negative biopsy but the persistence of suspicion, all the patients underwent prostate multiparametric magnetic resonance imaging (mpMRI) and subsequently either fusion targeted biopsy (TBx) or systematic standard biopsy (SBx), in case of positive or negative mpMRI, respectively. All patients underwent a robot-assisted RP. Whole-mount histological sections resected from the RP specimens were used as reference standards. RESULTS Eighty-seven patients were enrolled for the study. Median number of LNs retrieved per patient was 26, specifically 13 and 12, on the left and right side, respectively. Seven of 24 (29.1%) right lobe positive biopsy showed positive LNs on the left side (one exclusively left, 6 bilateral LNMs). Again, 12 of 26 (46.1%) left lobe positive biopsy showed positive LNs on the right side (one exclusively right, 11 bilateral LNMs). No significant differences of performance to predict the side of LNMs were recorded in the SBx and TBx groups. Concerning RP specimens, only five of 22 (22.7%) right lobe dominant cases showed positive LNs on the left side (two exclusively left, 3 bilateral LN metastases). Again, none of 16 left lobe dominant cases showed positive LNs on the contralateral side (15 exclusively right, 1 bilateral LNMs). CONCLUSIONS Our results suggest confirmed that a unilateral LN dissection limited to the tumor-bearing side of the gland evaluated by biopsy specimens should not be recommended due to the substantial risk of missing contralateral LNMs.
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Affiliation(s)
- Stefano De Luca
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberto Passera
- Department of Nuclear Medicine, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Cristian Fiori
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Diletta Garrou
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Matteo Manfredi
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Roberta Aimar
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Daniele Amparore
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Checcucci
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Enrico Bollito
- Department of Pathology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - Francesco Porpiglia
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy -
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Pathak RA, Hemal AK. Developing a personalized template for lymph node dissection during radical prostatectomy. Transl Androl Urol 2018; 7:S498-S504. [PMID: 30363470 PMCID: PMC6178311 DOI: 10.21037/tau.2018.03.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Lymph node dissection (LND) represents a critical step in order to determine lymph node invasion (LNI), not only for prognostic means but also as a therapeutic strategy in the management of patients with prostate cancer (CaP). Indications for performing LND are inconsistent with the American Urologic Association (AUA), European Association of Urology (EAU), and National Comprehensive Cancer Network (NCCN) recommendations differing. A thorough appreciation of lymph node drainage patterns and extent of LND has reshaped our understanding of this disease. Moreover, newer research into this field has directly resulted in refinements to current nomograms with utilization of various prostate-specific antigen (PSA) parameters and genomic medicine. Lastly, the application of newer imaging modalities in combination with molecular-guided robotic surgery has personalized the approach of LND espousing excellent safety, efficacy, and oncologic outcomes in these patients.
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Affiliation(s)
- Ram A Pathak
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
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33
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Caglic I, Barrett T. Diffusion-weighted imaging (DWI) in lymph node staging for prostate cancer. Transl Androl Urol 2018; 7:814-823. [PMID: 30456184 PMCID: PMC6212625 DOI: 10.21037/tau.2018.08.04] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In patients with prostate cancer, the presence of lymph node (LN) metastases is a critical prognostic factor and is essential for treatment planning. Conventional cross-sectional imaging performs poorly for nodal staging as both computed tomography (CT) and magnetic resonance imaging (MRI) are mainly dependent on size and basic morphological criteria. Therefore, extended pelvic LN dissection (ePLND) remains the gold standard for LN staging, however, it is an invasive procedure with its own drawbacks, thus creating a need for accurate preoperative imaging test. Incorporating functional MRI by using diffusion-weighted MRI has proven superior to conventional MRI protocol by means of both qualitative and quantitative assessment. Currently, the increased diagnostic performance remains insufficient to replace ePLND and the future role of DWI may be through combination with MR lymphangiography or with novel positron emission tomography (PET) tracers. In this article, the current state of data supporting DWI in LN staging of patients with prostate cancer is discussed.
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Affiliation(s)
- Iztok Caglic
- Department of Radiology, Norfolk & Norwich University Hospital, Norwich, UK
| | - Tristan Barrett
- Department of Radiology, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK.,CamPARI Clinic, Addenbrooke's Hospital and University of Cambridge, Cambridge, UK
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Mehralivand S, van der Poel H, Winter A, Choyke PL, Pinto PA, Turkbey B. Sentinel lymph node imaging in urologic oncology. Transl Androl Urol 2018; 7:887-902. [PMID: 30456192 PMCID: PMC6212622 DOI: 10.21037/tau.2018.08.23] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 08/19/2018] [Indexed: 12/15/2022] Open
Abstract
Lymph node (LN) metastases in urological malignancies correlate with poor oncological outcomes. Accurate LN staging is of great importance since patients can benefit from an optimal staging, accordingly aligned therapy and more radical treatments. Current conventional cross-sectional imaging modalities [e.g., computed tomography (CT) and magnetic resonance imaging (MRI)] are not accurate enough to reliably detect early LN metastases as they rely on size criteria. Radical lymphadenectomy, the surgical removal of regional LNs, is the gold standard of invasive LN staging. The LN dissection is guided by anatomic considerations of lymphatic drainage pathways of the primary tumor. Selection of patients for lymphadenectomy heavily relies on preoperative risk stratification and nomograms and, as a result a considerable number of patients unnecessarily undergo invasive staging with associated morbidity. On the other hand, due to individual variability in lymphatic drainage, LN metastases can occur outside of standard lymphadenectomy templates leading to potential understaging and undertreatment. In theory, metastases from the primary tumor need to pass through the chain of LNs, where the initial node is defined as the sentinel LN. In theory, identifying and removing this LN could lead to accurate assessment of metastatic status. Radiotracers and more recently fluorescent dyes and superparamagnetic iron oxide nanoparticles (SPION) are injected into the primary tumor or peritumoral and the sentinel LNs are identified intraoperatively by a gamma probe, fluorescent camera or a handheld magnetometer. Preoperative imaging [e.g., single-photon emission computed tomography (SPECT)/CT or MRI] after tracer injection can further improve preoperative planning of LN dissection. While sentinel LN biopsy is an accepted and widely used approach in melanoma and breast cancer staging, its use in urological malignancies is still limited. Most data published so far is in penile cancer staging since this cancer has a typical echelon-based lymphatic metastasizing pattern. More recent data is encouraging with low false-negative rates, but its use is limited to centers with high expertise. Current guidelines recommend sentinel LN biopsy as an accepted alternative to modified inguinal lymphadenectomy in patients with pT1G2 disease and non-palpable inguinal LNs. In prostate cancer, a high diagnostic accuracy could be demonstrated for the sentinel approach. Nevertheless, due to lack of data or high false-negative rates in other urological malignancies, sentinel LN biopsy is still considered experimental in other urological malignancies. More high-level evidence and longitudinal data is needed to determine its final value in those malignancies. In this manuscript, we will review sentinel node imaging for urologic malignancies.
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Affiliation(s)
- Sherif Mehralivand
- Department of Urology and Pediatric Urology, University Medical Center, Mainz, Germany
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Henk van der Poel
- Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, the Netherlands
| | - Alexander Winter
- University Hospital for Urology, Oldenburg Hospital, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Peter L. Choyke
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Peter A. Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baris Turkbey
- Molecular Imaging Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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Pesapane F, Czarniecki M, Suter MB, Turkbey B, Villeirs G. Imaging of distant metastases of prostate cancer. Med Oncol 2018; 35:148. [DOI: 10.1007/s12032-018-1208-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023]
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Varca V, Benelli A, Perri D, Gozen AS, Fiedler M, de la Taille A, Casazza G, Salomon L, Rassweiler J, Gregori A, Gaboardi F. Laparoscopic Radical Prostatectomy in Patients with High-Risk Prostate Cancer: Feasibility and Safety. Results of a Multicentric Study. J Endourol 2018; 32:843-851. [PMID: 30027748 DOI: 10.1089/end.2018.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In Western countries about 25% of prostate cancer (PCa) are high-risk tumors at presentation and its treatment is still a matter of debate among urologists. When a surgical approach is preferred the use of a mininvasive tecnique is still difficult due to the lack of data supporting it in literature. The aim of this study is to evaluate feasibility and safety of laparoscopic radical prostatectomy (LRP) for high-risk PCa. MATERIALS AND METHODS The study included 1114 patients with high-risk PCa submitted to LRP between 1998 and 2014. High-risk patients were defined according to D'Amico classification. We collected functional and oncological long-term outcomes and evaluated with univariate and multivariate analyses the role of predictive factors for survival and biochemical recurrence (BR). RESULTS Mean age at treatment was 62 ± 8 years; mean follow-up was 74 ± 50 months. We obtained an overall survival (OS) of 96.6% at a mean follow-up of 74 months (1076 patients) and a disease-free survival of 66.2% (737 patients). Age (p = 0.0006), pT (p < 0.0001), pN (p = 0.0018), and surgical margins (p = 0.0076) resulted as independent predictors for BR in multivariate analysis. pN (p = 0.0025) and Gs (p = 0.0003) are independent predictors for OS and cancer-specific survival in a univariate analysis; just the Gs results significant in the multivariate model. CONCLUSIONS According to our encouraging data about oncological and functional outcomes we believe that radical prostatectomy represents an effective treatment for patients with high-risk PCa and that laparoscopy is a safe approach offering a mini-invasive alternative to open surgery.
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Affiliation(s)
- Virginia Varca
- 1 Department of Urology, ASST-Rhodense, Garbagnate, Milan, Italy
| | - Andrea Benelli
- 1 Department of Urology, ASST-Rhodense, Garbagnate, Milan, Italy
| | - Davide Perri
- 2 Department of Urology, University of Novara , Novara, Italy
| | - Ali Sedar Gozen
- 3 Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg , Heilbronn, Germany
| | - Marcel Fiedler
- 3 Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg , Heilbronn, Germany
| | | | - Giovanni Casazza
- 5 Department of biochemical and Clinical Science, University of Milan, Milan, Italy
| | - Laurent Salomon
- 4 Urology Creteil, Hopital Henri Mondor , Île-de-France, France
| | - Jens Rassweiler
- 3 Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg , Heilbronn, Germany
| | - Andrea Gregori
- 1 Department of Urology, ASST-Rhodense, Garbagnate, Milan, Italy
| | - Franco Gaboardi
- 6 Division of Experimental Oncology, Department of Urology, Vita-Salute San Raffaele University of Milan , Milan, Italy
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Brandi F, Grupp K, Hube-Magg C, Kluth M, Lang D, Minner S, Möller-Koop C, Graefen M, Heinzer H, Tsourlakis MC, Wittmer C, Jacobsen F, Huland H, Steurer S, Lebok P, Hinsch A, Wilczak W, Schlomm T, Simon R. High concordance of TMPRSS-ERG fusion between primary prostate cancer and its lymph node metastases. Oncol Lett 2018; 16:6238-6244. [PMID: 30333886 PMCID: PMC6176457 DOI: 10.3892/ol.2018.9417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 08/02/2018] [Indexed: 01/14/2023] Open
Abstract
Approximately 50% of prostate cancer types harbor the transmembrane protease, serine 2: Erythroblast transformation-specific-related gene (ERG) fusion, resulting in oncogenic expression of the ERG transcription factor. ERG represents an attractive target for potential future anticancer therapy in advanced and metastatic prostate cancer. To better understand whether the analysis of the primary cancer is sufficient to estimate the ERG expression status of the lymph node metastases, the present study examined patterns of immunohistochemical ERG expression in a tissue microarray created from multiple primary and metastatic sites of 77 prostate cancer tissues. Among the identified tumor types, 80% were either entirely ERG-positive (38%) or ERG-negative (42%) across all (at least 9) analyzed different tumor sites. The results were heterogeneous in 20% of the tumor types and typically resulted from small ERG-negative areas within otherwise ERG-positive tumor types. Comparison of the ERG expression status in 51 primary cancer types with at least three interpretable lymph node metastases revealed an entirely identical ERG status in all tumor sites in 75% of the cases, including 16 ERG-positive and 22 ERG-negative cancer types. The remaining 13 cancer types exhibited ERG heterogeneity within the primary tumor, while all metastases had an identical (12 positive and 1 negative) ERG status. The results of the present study revealed a high degree of concordance of the ERG expression status between primary prostate cancer types and their lymph node metastases. Therefore, potential anti-ERG therapy may also be effective against lymph node metastases in the majority of cases of ERG-positive metastatic prostate cancer.
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Affiliation(s)
- Franziska Brandi
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Katharina Grupp
- General, Visceral and Thoracic Surgery Department and Clinic, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Claudia Hube-Magg
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Martina Kluth
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Dagmar Lang
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Sarah Minner
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Christina Möller-Koop
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Markus Graefen
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Hans Heinzer
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | | | - Corinna Wittmer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Frank Jacobsen
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Hartwig Huland
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Stefan Steurer
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Patrick Lebok
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Andrea Hinsch
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Waldemar Wilczak
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Thorsten Schlomm
- Martini-Clinic, Prostate Cancer Center, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany.,Department of Urology, Section for Translational Prostate Cancer Research, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
| | - Ronald Simon
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg D-20246, Germany
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Sentinel node evaluation in prostate cancer. Clin Exp Metastasis 2018; 35:471-485. [PMID: 30187286 DOI: 10.1007/s10585-018-9936-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 08/29/2018] [Indexed: 12/17/2022]
Abstract
Sentinel lymph node (SLN) based pelvic lymph node dissection (PLND) in prostate cancer (PCa) is appealing over the time, cost and morbidity classically attributed to conventional PLND during radical prostatectomy. The initial report of feasibility of the SLN concept in prostate cancer was nearly 20 years ago. However, PLND based on the SLN concept, either SLN biopsy of a single node or targeted SLN dissection of multiple nodes, is still considered investigational in PCa. To better appreciate the challenges, and potential solutions, associated with SLN-based PLND in PCa, this review will discuss the rationale behind PLND in PCa and evaluate current SLN efforts in the most commonly diagnosed malignancy in men in the US.
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Tourinho-Barbosa R, Srougi V, Nunes-Silva I, Baghdadi M, Rembeyo G, Eiffel SS, Barret E, Rozet F, Galiano M, Cathelineau X, Sanchez-Salas R. Biochemical recurrence after radical prostatectomy: what does it mean? Int Braz J Urol 2018; 44:14-21. [PMID: 29039897 PMCID: PMC5815528 DOI: 10.1590/s1677-5538.ibju.2016.0656] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 04/02/2017] [Indexed: 01/19/2023] Open
Abstract
Background Radical prostatectomy (RP) has been used as the main primary treatment for prostate cancer (PCa) for many years with excellent oncologic results. However, approximately 20-40% of those patients has failed to RP and presented biochemical recurrence (BCR). Prostatic specific antigen (PSA) has been the pivotal tool for recurrence diagnosis, but there is no consensus about the best PSA threshold to define BCR until this moment. The natural history of BCR after surgical procedure is highly variable, but it is important to distinguish biochemical and clinical recurrence and to find the correct timing to start multimodal treatment strategy. Also, it is important to understand the role of each clinical and pathological feature of prostate cancer in BCR, progression to metastatic disease and cancer specific mortality (CSM). Review design A simple review was made in Medline for articles written in English language about biochemical recurrence after radical prostatectomy. Objective To provide an updated assessment of BCR definition, its meaning, PCa natural history after BCR and the weight of each clinical/pathological feature and risk group classifications in BCR, metastatic disease and CSM.
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Affiliation(s)
- Rafael Tourinho-Barbosa
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.,Divisão de Urologia, Faculdade de Medicina ABC, São Paulo, Brasil
| | - Victor Srougi
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France.,Divisão de Urologia, Universidade de São Paulo, São Paulo, Brasil
| | - Igor Nunes-Silva
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Gregory Rembeyo
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Sophie S Eiffel
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Eric Barret
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Francois Rozet
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Montsouris, Université Paris-Descartes, Paris, France
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40
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Gupta M, Patel HD, Schwen ZR, Tran PT, Partin AW. Adjuvant radiation with androgen-deprivation therapy for men with lymph node metastases after radical prostatectomy: identifying men who benefit. BJU Int 2018; 123:252-260. [DOI: 10.1111/bju.14241] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mohit Gupta
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Hiten D. Patel
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Zeyad R. Schwen
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Phuoc T. Tran
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
- Department of Radiation Oncology and Molecular Radiation Sciences and Oncology; The Sidney Kimmel Comprehensive Cancer Center; Johns Hopkins Medical Institutions; Baltimore MD USA
| | - Alan W. Partin
- Department of Urology; James Buchanan Brady Urological Institute; Johns Hopkins Medical Institutions; Baltimore MD USA
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Loi M, Incrocci L, Desideri I, Bonomo P, Detti B, Simontacchi G, Greto D, Olmetto E, Francolini G, Meattini I, Livi L. Prognostic impact of nodal relapse in definitive prostate-only irradiation. Radiol Med 2018; 123:631-637. [PMID: 29651712 DOI: 10.1007/s11547-018-0888-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 04/05/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Whole pelvic irradiation in prostate cancer patients might prevent metastatic spread of cancer cells through lymphatic drainages in patients eligible for definitive radiotherapy, but its use has declined in the last decades in favor of prostate-only irradiation (POI). The aim of our study is to assess the incidence of pelvic lymph nodal relapse and outcome in prostate cancer patients receiving POI. MATERIALS AND METHODS Data from 207 consecutive patients were collected. Clinical and treatment variables were collected. Biochemical relapse-free survival (BRFS), pelvic nodal relapse-free survival (PNRFS), distant metastasis-free survival (DMFS), disease-specific survival (DSS) and overall survival (OS) were calculated; analysis of prognostic variables was performed. RESULTS Five-year BRFS, PNRFS, DMFS, DSS and OS were, respectively, 90, 98, 96, 97 and 91%. On multivariate analysis, independent negative predictors of BRFS were Gleason score ≥ 7 (HR: 3.25) and PSA nadir ≥ 0.08 (HR: 4.86). Pelvic nodal relapse was not correlated to impaired outcome. CONCLUSIONS Lymph nodal pelvic relapse occurs in 2% of patients at 5 years and does not correlate with impaired outcome, suggesting the lack of theoretical benefit of a prophylactic nodal irradiation. Tumor biology and response to treatment are the main determinants of outcome.
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Affiliation(s)
- Mauro Loi
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy.
- Radiotherapy Department, Erasmus MC Hospital, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands.
| | - Luca Incrocci
- Radiotherapy Department, Erasmus MC Hospital, Groene Hilledijk 301, 3075 EA, Rotterdam, The Netherlands
| | - Isacco Desideri
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Pierluigi Bonomo
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Beatrice Detti
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Gabriele Simontacchi
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Daniela Greto
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Emanuela Olmetto
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Giulio Francolini
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Icro Meattini
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit, University of Florence, L.go brambilla 3, Florence, Italy
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PSMA-PET guided hook-wire localization of nodal metastases in prostate cancer: a targeted approach. World J Urol 2018; 37:1251-1254. [PMID: 29616296 DOI: 10.1007/s00345-018-2282-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/24/2018] [Indexed: 12/17/2022] Open
Abstract
Prostate Specific Membrane Antigen Positron Emission Tomography/Computed Tomography (PSMA-PET/CT) has increased the sensitivity and specificity of imaging to identify metastatic prostate cancer in the group of patients with early biochemical recurrence when compared to conventional imaging. In patients who develop biochemical recurrence of prostate cancer following surgical resection, salvage lymph node dissection may reduce prostate specific antigen (PSA) levels and delay the time for commencement of systemic therapies. However, PLND may be an anatomically and technically difficult procedure, particularly with small metastatic diseases which can be problematic for intra-operative identification. We describe the technique using PSMA-PET imaging to pre-operatively localise areas of low-volume nodal metastatic disease with hookwire to allow targeted lymph node dissection with direct visualisation and palpation to ensure adequate clearance of involved nodes.
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43
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Altok M, Babaian K, Achim MF, Achim GC, Troncoso P, Matin SF, Chapin BF, Davis JW. Surgeon-led prostate cancer lymph node staging: pathological outcomes stratified by robot-assisted dissection templates and patient selection. BJU Int 2018; 122:66-75. [DOI: 10.1111/bju.14164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Muammer Altok
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Kara Babaian
- Department of Urology; The Louisiana State University (LSU); LSU Health Shreveport; Shreveport LA USA
| | - Mary F. Achim
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Grace C. Achim
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Patricia Troncoso
- Department of Pathology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Surena F. Matin
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - Brian F. Chapin
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
| | - John W. Davis
- Department of Urology; MD Anderson Cancer Center; The University of Texas; Houston TX USA
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44
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Multicenter evaluation of guideline adherence for pelvic lymph node dissection in patients undergoing open retropubic vs. laparoscopic or robot assisted radical prostatectomy according to the recent German S3 guideline on prostate cancer. World J Urol 2018; 36:855-861. [DOI: 10.1007/s00345-018-2195-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/19/2018] [Indexed: 12/22/2022] Open
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45
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Sanda MG, Cadeddu JA, Kirkby E, Chen RC, Crispino T, Fontanarosa J, Freedland SJ, Greene K, Klotz LH, Makarov DV, Nelson JB, Rodrigues G, Sandler HM, Taplin ME, Treadwell JR. Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline. Part II: Recommended Approaches and Details of Specific Care Options. J Urol 2018; 199:990-997. [PMID: 29331546 DOI: 10.1016/j.juro.2018.01.002] [Citation(s) in RCA: 226] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 01/14/2023]
Abstract
PURPOSE This guideline is structured to provide a clinical framework stratified by cancer severity to facilitate care decisions and guide the specifics of implementing the selected management options. The summary presented herein represents Part II of the two-part series dedicated to Clinically Localized Prostate Cancer: AUA/ASTRO/SUO Guideline discussing risk stratification and care options by cancer severity. Please refer to Part I for discussion of specific care options and outcome expectations and management. MATERIALS AND METHODS The systematic review utilized in the creation of this guideline was completed by the Agency for Healthcare Research and Quality and through additional supplementation by ECRI Institute. This review included articles published between January 2007 and March 2014 with an update search conducted through August 2016. When sufficient evidence existed, the body of evidence for a particular treatment was assigned a strength rating of A (high), B (moderate), or C (low) for support of Strong, Moderate, or Conditional Recommendations. Additional information is provided as Clinical Principles and Expert Opinions (table 2 in supplementary unabridged guideline, http://jurology.com/). RESULTS The AUA (American Urological Association), ASTRO, and SUO (Society of Urologic Oncology) formulated an evidence-based guideline based on a risk stratified clinical framework for the management of localized prostate cancer. CONCLUSIONS This guideline attempts to improve a clinician's ability to treat patients diagnosed with localized prostate cancer, but higher quality evidence in future trials will be essential to improve the level of care for these patients. In all cases, patient preferences should be considered when choosing a management strategy.
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Affiliation(s)
- Martin G Sanda
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Jeffrey A Cadeddu
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Erin Kirkby
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Ronald C Chen
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Tony Crispino
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Joann Fontanarosa
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Stephen J Freedland
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Kirsten Greene
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Laurence H Klotz
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Danil V Makarov
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Joel B Nelson
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - George Rodrigues
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Howard M Sandler
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Mary Ellen Taplin
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
| | - Jonathan R Treadwell
- American Urological Association Education and Research, Inc., Linthicum, Maryland; ASTRO, Arlington, Virginia; Society of Urologic Oncology, Schamburg, Illinois
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Open Techniques and Extent (Including Pelvic Lymphadenectomy). Bladder Cancer 2018. [DOI: 10.1016/b978-0-12-809939-1.00024-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thoeny HC, Barbieri S, Froehlich JM, Turkbey B, Choyke PL. Functional and Targeted Lymph Node Imaging in Prostate Cancer: Current Status and Future Challenges. Radiology 2017; 285:728-743. [PMID: 29155624 DOI: 10.1148/radiol.2017161517] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patients with prostate cancer who have regional lymph node (LN) metastases face an increased risk of death from disease and are therefore treated aggressively. Surgical LN dissection is the established method of staging regional nodes; however, this invasive technique carries substantial morbidities and a noninvasive imaging method is needed to reduce or eliminate the need for extended pelvic LN dissections (ePLND). Conventional computed tomography and magnetic resonance (MR) imaging have proven insensitive and nonspecific because both use nodal size criteria, which is notoriously inaccurate. Novel imaging techniques such as functional MR imaging by using diffusion-weighted MR imaging, MR lymphography with iron oxide particles, and targeted positron emission tomography imaging are currently under development and appear to improve LN staging of prostate cancer. Although progress is being made in staging nodes with imaging, it has not reached the point of replacing ePLND. In this review, the strengths and limitations of these new functional and targeted LN imaging techniques for prostate cancer are discussed. © RSNA, 2017.
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Affiliation(s)
- Harriet C Thoeny
- From the Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland (H.C.T., S.B., J.M.F.); and Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B69F, Bethesda, MD 20892 (B.T., P.L.C.)
| | - Sebastiano Barbieri
- From the Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland (H.C.T., S.B., J.M.F.); and Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B69F, Bethesda, MD 20892 (B.T., P.L.C.)
| | - Johannes M Froehlich
- From the Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland (H.C.T., S.B., J.M.F.); and Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B69F, Bethesda, MD 20892 (B.T., P.L.C.)
| | - Baris Turkbey
- From the Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland (H.C.T., S.B., J.M.F.); and Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B69F, Bethesda, MD 20892 (B.T., P.L.C.)
| | - Peter L Choyke
- From the Department of Diagnostic, Pediatric, and Interventional Radiology, Inselspital University Hospital, Bern, Switzerland (H.C.T., S.B., J.M.F.); and Molecular Imaging Program, National Cancer Institute, National Institutes of Health, 10 Center Dr, Room B3B69F, Bethesda, MD 20892 (B.T., P.L.C.)
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Kim YJ, Song C, Eom KY, Kim IA, Kim JS. Lymph node ratio determines the benefit of adjuvant radiotherapy in pathologically 3 or less lymph node-positive prostate cancer after radical prostatectomy: a population-based analysis with propensity-score matching. Oncotarget 2017; 8:110625-110634. [PMID: 29299174 PMCID: PMC5746409 DOI: 10.18632/oncotarget.22610] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/29/2017] [Indexed: 11/25/2022] Open
Abstract
Background The survival benefit of adjuvant radiotherapy (ART) in prostate adenocarcinoma, with limited numbers of pathologically involved lymph nodes (LNs) after radical prostatectomy (RP), is controversial. Materials and Methods From 2004 to 2014, data for prostate cancer patients categorized as N1M0 after RP were retrieved from the Surveillance, Epidemiology, and End Results (SEER) database. After propensity-score matching, the 10-year cancer-specific survival (CSS) rates between patients who received ART (ART group) or did not/unknown (no-ART group) were compared for each stratum of lymph node ratio (LNR) (%) according to the number of involved LNs. Results Optimal matching formed pairs of no-ART (n = 905) and ART (n = 905) groups. ART increased the CSS rate, even in patients with up to 3 positive LNs when the LNR is 7% or higher. Conclusions ART after RP showed a CSS benefit in prostate adenocarcinoma with 4 or more involved LNs irrespective of LNR. In prostate adenocarcinoma with up to 3 involved LNs after RP, ART may provide CSS benefits when the LNR is 7% or higher. The number of LN dissections required to achieve an LNR below 7% is 15, 29, and 43 or more for 1, 2, and 3 involved LNs, respectively.
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Affiliation(s)
- Yi-Jun Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Keun-Yong Eom
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - In Ah Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jae-Sung Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Al-Amiri B, Lundin F, Waldén M. Extended pelvic lymph-node dissection and radiotherapy with curative intent in high-risk lymph-node-positive prostate cancer: a possible curative strategy? Scand J Urol 2017; 52:101-107. [PMID: 29020868 DOI: 10.1080/21681805.2017.1382568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study evaluated the outcome with a treatment strategy for high-risk prostate cancer (PCa) using extended pelvic lymph-node dissection (eLND) followed by external beam radiation therapy (EBRT) in lymph-node-positive (LNpos) and lymph-node-negative (LNneg) cases compared with the strategy with limited pelvic lymph-node dissection (lLND) and only giving EBRT to LNneg cases. MATERIALS AND METHODS From 2000 to 2006, 124 men with high-risk PCa underwent lLND and initiated androgen deprivation therapy (ADT) before planned EBRT. LNpos patients were excluded from EBRT following the SPCG-7 study strategy (group I). From 2007 to 2013, 111 patients underwent eLND and started ADT before EBRT, and LNneg and most LNpos patients received EBRT (group II). Using Kaplan-Meier plots and multivariable Cox regression, biochemical recurrence-free, metastasis-free, cancer-specific survival and overall survival were compared during a 10 year follow-up. RESULTS PSA progression-free survival rates after 2, 4, 6, 8 and 10 years were 78%, 66%, 52%, 45% and 41% in group I, and 88%, 83%, 78%, 69% and 69% in group II (p < 0.001), respectively. Group II had a lower risk of PSA progression [hazard ratio (HR) = 0.43, 95% confidence interval (CI) 0.27,0.69, p = 0.001], metastasis development (HR = 0.51, 95% CI 0.27,0.97, p = 0.040) and overall mortality (HR = 0.49, 95% CI 0.26,0.92, p = 0.027), but not of PCa-specific death (HR = 0.45, 95% CI 0.19,1.08, p = 0.074). CONCLUSION A treatment strategy for high-risk PCa with eLND combined with EBRT in LNneg and LNpos cases may improve outcome compared to a strategy with lLND and offering EBRT only to LNneg cases but ADT to LNpos cases.
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Affiliation(s)
- Bashar Al-Amiri
- a Department of Surgery and Urology , Central Hospital , Karlstad , Sweden
| | - Fredrik Lundin
- b Center for Clinical Research , County Council of Värmland , Karlstad , Sweden
| | - Mauritz Waldén
- a Department of Surgery and Urology , Central Hospital , Karlstad , Sweden
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Abstract
PURPOSE The accurate detection of lymph node metastases in prostate cancer patients is important to direct treatment decisions. Our goal was to develop an intraoperative imaging approach to distinguish normal from metastasized lymph nodes. We aimed at developing and testing gold-silica surface-enhanced resonance Raman spectroscopy (SERRS) nanoparticles that demonstrate high uptake within normal lymphatic tissue and negligible uptake in areas of metastatic replacement. PROCEDURES We evaluated the ability of SERRS nanoparticles to delineate lymph node metastases in an orthotopic prostate cancer mouse model using PC-3 cells transduced with mCherry fluorescent protein. Tumor-bearing mice (n = 6) and non-tumor-bearing control animals (n = 4) were injected intravenously with 30 fmol/g SERRS nanoparticles. After 16-18 h, the retroperitoneal lymph nodes were scanned in situ and ex vivo with a Raman imaging system and a handheld Raman scanner and data corroborated with fluorescence imaging for mCherry protein expression and histology. RESULTS The SERRS nanoparticles demonstrated avid homing to normal lymph nodes, but not to metastasized lymph nodes. In cases where lymph nodes were partially infiltrated by tumor cells, the SERRS signal correctly identified, with sub-millimeter precision, healthy from metastasized components. CONCLUSIONS This study serves as a first proof-of-principle that SERRS nanoparticles enable high precision and rapid intraoperative discrimination between normal and metastasized lymph nodes.
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