1
|
Walker RJB, Stukel TA, de Mestral C, Nathens A, Breau RH, Hanna WC, Hopkins L, Schlachta CM, Jackson TD, Shayegan B, Pautler SE, Karanicolas PJ. Hospital volume-outcome relationships for robot-assisted surgeries: a population-based analysis. Surg Endosc 2024:10.1007/s00464-024-10998-2. [PMID: 38937312 DOI: 10.1007/s00464-024-10998-2] [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: 12/18/2023] [Accepted: 06/09/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Associations between procedure volumes and outcomes can inform minimum volume standards and the regionalization of health services. Robot-assisted surgery continues to expand globally; however, data are limited regarding which hospitals should be using the technology. STUDY DESIGN Using administrative health data for all residents of Ontario, Canada, this retrospective cohort study included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using 4 arms (RPL-4) between January 2010 and September 2021. Associations between yearly hospital volumes and 90-day major complications were evaluated using multivariable logistic regression models adjusted for patient characteristics and clustering at the level of the hospital. RESULTS A total of 10,879 patients were included, with 7567, 1776, 724, and 812 undergoing a RARP, TRH, RAPN, and RPL-4, respectively. Yearly hospital volume was not associated with 90-day complications for any procedure. Doubling of yearly volume was associated with a 17-min decrease in operative time for RARP (95% confidence interval [CI] - 23 to - 10), 8-min decrease for RAPN (95% CI - 14 to - 2), 24-min decrease for RPL-4 (95% CI - 29 to - 19), and no significant change for TRH (- 7 min; 95% CI - 17 to 3). CONCLUSION The risk of 90-day major complications does not appear to be higher in low volume hospitals; however, they may not be as efficient with operating room utilization. Careful case selection may have contributed to the lack of an observed association between volumes and complications.
Collapse
Affiliation(s)
- Richard J B Walker
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Thérèse A Stukel
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Charles de Mestral
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Avery Nathens
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 16, TorontoToronto, ON, M4N 3M5, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Waël C Hanna
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Laura Hopkins
- Division of Oncology, Saskatchewan Cancer Agency, Saskatoon, Canada
| | | | - Timothy D Jackson
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Bobby Shayegan
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Stephen E Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, Canada
| | - Paul J Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 16, TorontoToronto, ON, M4N 3M5, Canada.
| |
Collapse
|
2
|
Walker RJB, Stukel TA, de Mestral C, Nathens A, Breau RH, Hanna WC, Hopkins L, Schlachta CM, Jackson TD, Shayegan B, Pautler SE, Karanicolas PJ. Hospital learning curves for robot-assisted surgeries: a population-based analysis. Surg Endosc 2024; 38:1367-1378. [PMID: 38127120 DOI: 10.1007/s00464-023-10625-6] [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] [Received: 09/07/2023] [Accepted: 11/29/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Robot-assisted surgery has been rapidly adopted. It is important to define the learning curve to inform credentialling requirements, training programs, identify fast and slow learners, and protect patients. This study aimed to characterize the hospital learning curve for common robot-assisted procedures. STUDY DESIGN This cohort study, using administrative health data for Ontario, Canada, included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using four arms (RPL-4) between 2010 and 2021. The association between cumulative hospital volume of a robot-assisted procedure and major complications was evaluated using multivariable logistic models adjusted for patient characteristics and clustering at the hospital level. RESULTS A total of 6814 patients were included, with 5230, 543, 465, and 576 patients in the RARP, TRH, RAPN, and RPL-4 cohorts, respectively. There was no association between cumulative hospital volume and major complications. Visual inspection of learning curves demonstrated a transient worsening of outcomes followed by subsequent improvements with experience. Operative time decreased for all procedures with increasing volume and reached plateaus after approximately 300 RARPs, 75 TRHs, and 150 RPL-4s. The odds of a prolonged length of stay decreased with increasing volume for patients undergoing a RARP (OR 0.87; 95% CI 0.82-0.92) or RPL-4 (OR 0.77; 95% CI 0.68-0.87). CONCLUSION Hospitals may adopt robot-assisted surgery without significantly increasing the risk of major complications for patients early in the learning curve and with an expectation of increasing efficiency.
Collapse
Affiliation(s)
- Richard J B Walker
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Thérèse A Stukel
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - Charles de Mestral
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Avery Nathens
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Rodney H Breau
- Division of Urology, Department of Surgery, University of Ottawa, Ottawa, Canada
- Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Waël C Hanna
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
| | - Laura Hopkins
- Division of Oncology, Saskatchewan Cancer Agency, Saskatoon, Canada
| | | | - Timothy D Jackson
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Bobby Shayegan
- Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Stephen E Pautler
- Divisions of Urology and Surgical Oncology, Departments of Surgery and Oncology, Western University, London, Canada
| | - Paul J Karanicolas
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- Division of General Surgery, Sunnybrook Health Sciences Centre, Toronto, Canada.
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 16, Toronto, ON, M4N 3M5, Canada.
| |
Collapse
|
3
|
Yajima S, Nakanishi Y, Umino Y, Okubo N, Tanabe K, Kataoka M, Masuda H. Salvage Robot-Assisted Radical Prostatectomy (sRARP) for Radiation-Recurrent Prostate Cancer: a Single-Center Experience. Indian J Surg Oncol 2023; 14:361-365. [PMID: 37324313 PMCID: PMC10267029 DOI: 10.1007/s13193-022-01671-y] [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: 02/13/2022] [Accepted: 10/19/2022] [Indexed: 11/27/2022] Open
Abstract
This case series reported on five patients with radiation-recurrent localized prostate cancer (PCa) who underwent salvage robot-assisted radical prostatectomy (sRARP). Median postoperative follow-up period was 8 months. Median (range) peri-operative parameters such as operative time, the estimated blood loss, and length of hospital stay were 127 min (113-158), 61 ml (54-111), and 9 days (8-11), respectively. None of the five patients required conversion to an open approach or required a blood transfusion, or experienced a rectal/ureteral injury. Urinary leakage was present in one patient (20%) at the initial cystogram. Transurethral electrocoagulation under spinal anesthesia was required to control hematuria in one patient (20%). Two patients (40%) experienced biochemical progression; no patient died from PCa or other causes during the follow-up period. Of five patients, three (60%) were continent. For patients with radiation-recurrent localized PCa, sRARP might become a feasible surgical option with acceptable outcomes.
Collapse
Affiliation(s)
- Shugo Yajima
- National Cancer Center Hospital East, 6-5-1 Kashiwa No Ha, Kashiwa City, Chiba, 277-8577 Japan
| | - Yasukazu Nakanishi
- National Cancer Center Hospital East, 6-5-1 Kashiwa No Ha, Kashiwa City, Chiba, 277-8577 Japan
| | - Yosuke Umino
- National Cancer Center Hospital East, 6-5-1 Kashiwa No Ha, Kashiwa City, Chiba, 277-8577 Japan
| | - Naoya Okubo
- National Cancer Center Hospital East, 6-5-1 Kashiwa No Ha, Kashiwa City, Chiba, 277-8577 Japan
| | - Kenji Tanabe
- National Cancer Center Hospital East, 6-5-1 Kashiwa No Ha, Kashiwa City, Chiba, 277-8577 Japan
| | - Madoka Kataoka
- National Cancer Center Hospital East, 6-5-1 Kashiwa No Ha, Kashiwa City, Chiba, 277-8577 Japan
| | - Hitoshi Masuda
- National Cancer Center Hospital East, 6-5-1 Kashiwa No Ha, Kashiwa City, Chiba, 277-8577 Japan
| |
Collapse
|
4
|
Salvage Retzius-Sparing Radical Prostatectomy: A Review of Complications, Functional Outcomes, and Oncologic Outcomes. Curr Oncol 2022; 29:9733-9743. [PMID: 36547178 PMCID: PMC9777071 DOI: 10.3390/curroncol29120764] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/30/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022] Open
Abstract
(Background) Radiation failure for localized prostate cancer is seen in 20-60% of patients who do not undergo extirpative surgery. Though potentially curative, salvage prostatectomy (SS) has not been frequently performed historically due to high rates of complications and postoperative incontinence. With the advent of robotic-assisted radical prostatectomy, these rates appear to be improved. Retzius-sparing approaches have additionally been shown to improve continence outcomes in the index setting, and may further improve continence outcomes in salvage cases while maintaining oncologic integrity. (Methods) We performed a literature review and qualitative analysis of published papers on salvage Retzius-sparing robotic-assisted radical prostatectomy (SRS). Three studies met criteria and were included in analysis. (Results) There were more patients with Gleason Grade Group 1 disease after initial treatment in the SRS group vs. SS (22% vs. 8%). Patients most frequently underwent external beam radiation therapy in both groups (52% vs. 49%). 30-day complication rates were 10% and 26% for SRS and SS, respectively. Continence outcomes were significantly improved in SRS with 59% of continence (based on study criteria) compared to 38% in SS. Time to continence was similarly improved for SRS. Positive surgical margins and biochemical recurrence were not significantly different between SRS and SS in any study. (Conclusions) SRS is a safe and feasible option for salvage treatment of localized prostate cancer and may improve postoperative continence outcomes. Positive surgical margin and biochemical recurrence rates are similar to those reported in SS.
Collapse
|
5
|
Schuetz V, Reimold P, Goertz M, Hofer L, Dieffenbacher S, Nyarangi-Dix J, Duensing S, Hohenfellner M, Hatiboglu G. Evolution of Salvage Radical Prostatectomy from Open to Robotic and Further to Retzius Sparing Surgery. J Clin Med 2021; 11:jcm11010202. [PMID: 35011942 PMCID: PMC8745561 DOI: 10.3390/jcm11010202] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/16/2021] [Accepted: 12/28/2021] [Indexed: 11/16/2022] Open
Abstract
Salvage radical prostatectomy (sRP) has evolved from open to minimally invasive approaches. sRP can be offered to patients with local recurrence to improve biochemical recurrence (BCR)-free and overall survival. We evaluate oncological outcome and continence after retropubic (RRP), conventional (cRARP), and Retzius-sparing robotic (rsRARP) surgery. Materials/methods: A total of 53 patients undergoing sRP between 2010 and 2020 were included. Follow-up included oncological outcome and continence. Results: sRP was done as RRP (n = 25), cRARP (n = 7), or rsRARP (n = 21). Median blood loss was 900 mL, 500 mL, and 300 mL for RRP, cRARP, and rsRARP, respectively. At 12 months, 5 (20%), 0, and 4 (19%) patients were continent, 9 (36%), 3 (43%), and 7 (33%) had grade 1 incontinence, 5 (20%), 2 (29%), and 3 (14%) had grade 2 incontinence, and 3 (12%), 2 (29%), and 4 (19%) had grade 3 incontinence for RRP, cRARP, or rsRARP, respectively. During a mean follow-up of 52.6 months, 16 (64%), 4 (57%), and 3 (14%) developed BCR in the RRP-, cRARP-, and rsRARP-group, respectively. Conclusions: Over the years, sRP has shifted from open to laparoscopic/robotic surgery. RARP shows good oncological and functional outcome. rsRARP ensures direct vision on the rectum during preparation and can therefore increase safety and surgeon’s confidence, especially in the salvage setting.
Collapse
Affiliation(s)
- Viktoria Schuetz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
- Correspondence: (V.S.); (G.H.); Tel.: +49-6221-6110 (V.S. & G.H.)
| | - Philipp Reimold
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
| | - Magdalena Goertz
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
| | - Luisa Hofer
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
| | - Svenja Dieffenbacher
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
| | - Joanne Nyarangi-Dix
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
| | - Stefan Duensing
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
- Section of Molecular Urooncology, Department of Urology, Medical Faculty Heidelberg, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Markus Hohenfellner
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
| | - Gencay Hatiboglu
- Department of Urology, University Hospital Heidelberg, 69120 Heidelberg, Germany; (P.R.); (M.G.); (L.H.); (S.D.); (J.N.-D.); (S.D.); (M.H.)
- Correspondence: (V.S.); (G.H.); Tel.: +49-6221-6110 (V.S. & G.H.)
| |
Collapse
|
6
|
Lavi A, Nair SM, Halstuch D, Chin JL. Prostatic dystrophic calcification following salvage cryotherapy for prostate cancer - an under-reported entity? Scand J Urol 2020; 55:33-35. [PMID: 33222581 DOI: 10.1080/21681805.2020.1849388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Salvage cryoablation (SCA) is an accepted treatment for radio-recurrent prostate cancer with well-established oncological and functional outcomes. Based on one of the longest reported prospective follow-ups in the literature (median 12 years) on 187 patients, this study reports what appears to be an under-appreciated finding in eight patients with dystrophic calcifications (DC) of the prostate following SCA, causing severe bladder outlet obstruction. MATERIALS AND METHODS Between 1995 and 2004, 187 patients underwent SCA, with a median follow-up of 12 years. This database was reviewed for functional and oncological outcomes and DC were evaluated. RESULTS Functional data was available in 85 patients, amongst whom eight patients were found to develop DC (9.4%) proven when the patients presented with urinary difficulties and attempted transurethral resection was undertaken for bladder outlet obstruction. Mean time for emergence of significant symptoms of bladder outlet obstruction was 8.6 years from SCA (standard deviation (SD) = 6 years). All eightpatients required permanent drainage (seven suprapubic catheters, one nephrostomy). All patients with DC experienced biochemical recurrence (BCR), compared to 57.1% of the patients with no DC (p = 0.01). CONCLUSION DC following SCA appears to be an under-reported late adverse effect which may only become evident with long follow-up, and should be included in preoperative counselling.
Collapse
Affiliation(s)
- Arnon Lavi
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Shiva M Nair
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Daniel Halstuch
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Joseph L Chin
- Urology Division, Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| |
Collapse
|
7
|
Gaullier M, Tricard T, Garnon J, Cazzato RL, Munier P, De Marini P, Werle P, Lindner V, Gangi A, Lang H. [Percutaneous MR-guided prostate cancer cryoablation: Predictive factors and oncologic outcomes]. Prog Urol 2019; 30:12-18. [PMID: 31837926 DOI: 10.1016/j.purol.2019.10.006] [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: 03/31/2019] [Revised: 10/10/2019] [Accepted: 10/24/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the pejorative predictive factors on oncologic outcomes of percutaneous MR-guided whole gland prostate cancer cryoablation (CA). METHODS Medical records of patients treated from 2009 to 2012, to assess medium-term oncologic outcomes, were reviewed. Prostate biopsies were performed in local recurrence suspicion (biochemical failure, MR follow-up failure). RESULTS Among 18 patients, mean age of 72.6 (61-78), 2 (11 %) and 7 (38.9 %) biological and reported biopsy-proven local recurrence respectively with our initial technic of CA. Mean follow-up and recurrence were 56.3 (±21.7) and 20.7 (±13.9) months respectively. A previous treatment of prostate cancer (P=0.5), pre-treatment PSA (P=0.2), pre-treatment Gleason/ISUP score (P=0.4), nadir PSA post-CA (P=0.22) were not associated with recurrence. Bilateral positive cores appears as a pejorative predictive factor (P=0.04). However mean pre-treatment positive cores percentage, 25 (±16.5) in responding patients versus 40.7 (±25.2) in case of recurrence, and maximum percentage of cancer extent in each positive core, 10.6 (±9.3) in responding patients versus 18.7 (±16.5) in case of recurrence, seemed associated with local recurrence after prostate CA but our analysis wasn't able to find a difference (P=0.09 and P=0.3 respectively) due to a lack of power. CONCLUSION Bilateral positive cores appears as a pejorative predictive factor. In our experience, important tumor volume seem to be a pejorative predictive factor for oncologic outcomes after PCA whereas treatment, PSA, Gleason/ISUP score, nadir PSA are not. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- M Gaullier
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - T Tricard
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - J Garnon
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - R-L Cazzato
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P Munier
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P De Marini
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - P Werle
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - V Lindner
- Service d'anatomopathologie, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - A Gangi
- Service d'imagerie interventionnelle, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, nouvel hopital civil, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France
| |
Collapse
|
8
|
Mohler JL, Halabi S, Ryan ST, Al-Daghmin A, Sokoloff MH, Steinberg GD, Sanford BL, Eastham JA, Walther PJ, Morris MJ, Small EJ. Management of recurrent prostate cancer after radiotherapy: long-term results from CALGB 9687 (Alliance), a prospective multi-institutional salvage prostatectomy series. Prostate Cancer Prostatic Dis 2018; 22:309-316. [PMID: 30385835 DOI: 10.1038/s41391-018-0106-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/09/2018] [Accepted: 09/29/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND To evaluate efficacy and morbidity prospectively in a contemporary multi-institutional salvage radical prostatectomy (SRP) series. METHODS Forty-one men were enrolled between 1997 and 2006, who suffered biopsy-proven recurrent prostate cancer (CaP) after receiving ≥ 60c Gy radiation as primary treatment for cT1-2NXM0 disease. Surgical morbidity, quality of life, biochemical progression-free survival (BPFS) and overall survival (OS) were evaluated. RESULTS Twenty-four men had undergone external beam radiotherapy, 11 brachytherapy, and six both. Median time between radiation and SRP was 64 months. Median age at SRP was 64 years. Pathologic staging revealed 44% pT2, 54% pT3, and 3% pT4. Surgical margins were positive in 17 and 88% were pN0. Twenty-two percent required intraoperative blood transfusion. Three rectal and one obturator nerve injuries occurred. Seventeen of 38 evaluable patients (45%) had urinary incontinence ( ≥ 3 pads/day) prior to SRP; 88% reported urinary incontinence at 6 months, 85% at 12 months, 63% at 24 months after SRP. Furthermore, 37% of men reported impotence prior to SRP; 78% reported impotence at 6 months, 82% at 12 months, and 44% at 24 months after SRP. The 2-, 5- and 10-year BPFS rates were 51, 39, and 33% respectively; the 2-, 5- and 10-year OS rates were 100, 89, and 52%, respectively, at median follow-up 91 months. CONCLUSIONS Modern surgical techniques continue to be associated with significant peri-operative complication rates. Nevertheless, SRP may benefit carefully selected patients through durable oncologic control.
Collapse
Affiliation(s)
- James L Mohler
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States.
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics and Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - Stephen T Ryan
- University of California San Diego, La Jolla, CA, United States
| | - Ali Al-Daghmin
- Roswell Park Cancer Institute, Buffalo, NY, CA59518, United States
| | | | | | - Ben L Sanford
- Alliance Statistics and Data Center, Duke University, Durham, NC, CA33601, United States
| | - James A Eastham
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Philip J Walther
- Duke University Medical Center, Durham, NC, CA47577, United States
| | - Michael J Morris
- Memorial Sloan Kettering Cancer Center, New York, NY, CA77651, United States
| | - Eric J Small
- University of California at San Francisco, San Francisco, CA, CA60138, United States
| |
Collapse
|
9
|
Re: Prevalence and Prognosis of Low-volume, Oligorecurrent, Hormone-sensitive Prostate Cancer Amenable to Lesion Ablative Therapy. Eur Urol 2018; 74:234-235. [DOI: 10.1016/j.eururo.2018.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
|
10
|
Bandini M, Gandaglia G, Fossati N, Montorsi F, Briganti A. Anastomotic leaks and catheter time after salvage robot-assisted radical prostatectomy. Transl Androl Urol 2018; 7:S141-S143. [PMID: 29644184 PMCID: PMC5881216 DOI: 10.21037/tau.2017.03.86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco Bandini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
11
|
Huang H, Wang Q, Du T, Lin C, Lai Y, Zhu D, Wu W, Ma X, Bai S, Li Z, Liu L, Li Q. Matrine inhibits the progression of prostate cancer by promoting expression of GADD45B. Prostate 2018; 78:327-335. [PMID: 29356020 DOI: 10.1002/pros.23469] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/29/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Matrine is a naturally occurring alkaloid extracted from the Chinese herb Sophora flavescens. It has been demonstrated to exhibit antiproliferative properties, promote apoptosis, and inhibit cell invasion in a number of cancer cell lines by modulating the NF-κB pathway to downregulate the expression of MMP2 and MM9. It has also been shown to improve the efficacy of chemotherapy when it is combined with other chemotherapy drugs. However, the therapeutic potential of matrine for prostate cancer needs to be further studied. METHODS We analyzed KEGG pathways of differential gene expression between matrine-treated and untreated prostate cancer cell lines and identified GADD45B as one of major target genes of matrine based on its role in apoptosis and prognosis value for prostate cancer patients in TCGA database. We further analyzed the expression of GADD45B protein in a tissue microarray and mRNA in TCGA database, and tested the synergistic impacts of matrine and GADD45B overexpression on proliferation, apoptosis, migration and invasion of prostate cancer cell DU145. RESULTS Matrine promoted the expression of GADD45B, a tumor suppressive gene that is involved in the regulation of cell cycle, DNA damage repair, cell survival, aging, apoptosis and other cellular processes through p38/JNK, ROS-GADD45B-p38, or other signal pathways. Although GADD45B is elevated in prostate cancer tissues, levels of GADD45B in prostate tumor tissues are reduced at late stage of tumor invasion, and higher levels of GADD45B predict better survivals of prostate cancer patients. CONCLUSIONS Matrine may be used to treat prostate cancer patients to increase the levels of GADD45B to inhibit tumor invasion and improve patient survivals.
Collapse
Affiliation(s)
- Hai Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Center for Translational Cancer Research, Texas A&M Institute of Biosciences and Technology, Texas A&M University, Houston, Texas
| | - Qiong Wang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Tao Du
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Department of Obstetrics and Gynecology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Chunhao Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yiming Lai
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Dingjun Zhu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Wanhua Wu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoming Ma
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Soumin Bai
- Department of Radiation Oncology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zean Li
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Leyuan Liu
- Center for Translational Cancer Research, Texas A&M Institute of Biosciences and Technology, Texas A&M University, Houston, Texas
- Department of Molecular and Cellular Medicine, College of Medicine, Texas A&M University, College Station, Texas
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Qi Li
- Department of Clinical Laboratory, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| |
Collapse
|
12
|
De Cicco L, Vavassori A, Cattani F, Jereczek-Fossa BA, Orecchia R. Salvage High Dose Rate Brachytherapy after Primary External Beam Irradiation in Localized Prostate Cancer: A Case Report. TUMORI JOURNAL 2018; 95:553-6. [DOI: 10.1177/030089160909500429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
No standard treatment exists for locally relapsed prostate cancer after primary external beam radiotherapy with no evidence of distant metastases. Radical prostatectomy, brachytherapy, cryotherapy and high-intensity focused ultrasound are currently used as local salvage treatments. Data on the safety and effectiveness of high dose rate (HDR) brachytherapy in this scenario are limited. We report on a patient who has no evidence of disease and no late urinary or gastrointestinal toxicity 33 months after receiving HDR treatment for recurrent prostate cancer.
Collapse
Affiliation(s)
- Luigi De Cicco
- Division of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Andrea Vavassori
- Division of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Division of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Division of Radiotherapy, European Institute of Oncology, Milan, Italy
- Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| | - Roberto Orecchia
- Division of Radiotherapy, European Institute of Oncology, Milan, Italy
- Faculty of Medicine and Surgery, University of Milan, Milan, Italy
| |
Collapse
|
13
|
Vavassori A, Jereczek-Fossa BA, Beltramo G, De Cicco L, Fariselli L, Bianchi LC, Possanzini M, Bergantin A, DeCobelli O, Orecchia R. Image-Guided Robotic Radiosurgery as Salvage Therapy for Locally Recurrent Prostate Cancer after External Beam Irradiation: Retrospective Feasibility Study on Six Cases. TUMORI JOURNAL 2018; 96:71-5. [DOI: 10.1177/030089161009600112] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Technological advances in treatment planning and execution are providing new potential opportunities in the treatment of recurrent prostate cancer. This study was conducted to evaluate the feasibility and safety of reirradiation with image-guided radiosurgery using CyberKnife, a robotic arm-driven compact linear accelerator, for intraprostatic recurrence after external beam radiotherapy (EBRT). Methods Between September 2007 and May 2008, 6 patients diagnosed with locally recurrent prostate cancer after EBRT were treated using the CyberKnife system. The total reirradiation dose was 30 Gy in five fractions. Prior to radiosurgery four patients were treated with androgen-deprivation therapy. Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria and the Houston-Phoenix definition (PSA nadir + 2 ng/mL) were used for toxicity and biochemical failure evaluation, respectively. Results After a median follow-up of 11.2 months (range, 9.6–18.6 months), all patients are alive with no evidence of severe urinary or rectal acute morbidity. Local control cannot be exactly determined due to the short follow-up and the bias of the use of androgen ablation. Four patients had biochemical failure, three of them with clinical failure evidence (lymph node, bone and lung metastasis, respectively): none of these patients had clinical evidence of tumor persistence in the prostate. Conclusions Salvage radiosurgery with CyberKnife after irradiation is feasible with low urinary and rectal morbidity. A longer follow-up and a larger number of patients are necessary to evaluate its effectiveness and optimal patient selection criteria.
Collapse
Affiliation(s)
- Andrea Vavassori
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | | | - Giancarlo Beltramo
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Luigi De Cicco
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
| | - Laura Fariselli
- Radiotherapy Unit of the C Besta Neurological Institute Foundation, Milan, Italy
| | - Livia Corinna Bianchi
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Marco Possanzini
- Department of Radiotherapy, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Achille Bergantin
- Department of Medical Physics, CyberKnife Unit, Centro Diagnostico Italiano, Milan, Italy
| | - Ottavio DeCobelli
- University of Milan, Milan, Italy
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Orecchia
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| |
Collapse
|
14
|
Valle LF, Greer MD, Shih JH, Barrett T, Law YM, Rosenkrantz AB, Shebel H, Muthigi A, Su D, Merino MJ, Wood BJ, Pinto PA, Krauze AV, Kaushal A, Choyke PL, Türkbey B, Citrin DE. Multiparametric MRI for the detection of local recurrence of prostate cancer in the setting of biochemical recurrence after low dose rate brachytherapy. Diagn Interv Radiol 2018; 24:46-53. [PMID: 29317377 PMCID: PMC5765929 DOI: 10.5152/dir.2018.17285] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 10/20/2017] [Accepted: 11/13/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE Prostate multiparametric magnetic resonance imaging (mpMRI) has utility in detecting post-radiotherapy local recurrence. We conducted a multireader study to evaluate the diagnostic performance of mpMRI for local recurrence after low dose rate (LDR) brachytherapy. METHODS A total of 19 patients with biochemical recurrence after LDR brachytherapy underwent 3T endorectal coil mpMRI with T2-weighted imaging, dynamic contrast-enhanced imaging (DCE) and diffusion-weighted imaging (DWI) with pathologic confirmation. Prospective reads by an experienced prostate radiologist were compared with reads from 4 radiologists of varying experience. Readers identified suspicious lesions and rated each MRI detection parameter. MRI-detected lesions were considered true-positive with ipsilateral pathologic confirmation. Inferences for sensitivity, specificity, positive predictive value (PPV), kappa, and index of specific agreement were made with the use of bootstrap resampling. RESULTS Pathologically confirmed recurrence was found in 15 of 19 patients. True positive recurrences identified by mpMRI were frequently located in the transition zone (46.7%) and seminal vesicles (30%). On patient-based analysis, average sensitivity of mpMRI was 88% (standard error [SE], 3.5%). For highly suspicious lesions, specificity of mpMRI was 75% (SE, 16.5%). On lesion-based analysis, the average PPV was 62% (SE, 6.7%) for all lesions and 78.7% (SE, 10.3%) for highly suspicious lesions. The average PPV for lesions invading the seminal vesicles was 88.8% (n=13). The average PPV was 66.6% (SE, 5.8%) for lesions identified with T2-weighted imaging, 64.9% (SE, 7.3%) for DCE, and 70% (SE, 7.3%) for DWI. CONCLUSION This series provides evidence that mpMRI after LDR brachytherapy is feasible with a high patient-based cancer detection rate. Radiologists of varying experience demonstrated moderate agreement in detecting recurrence.
Collapse
Affiliation(s)
- Luca F. Valle
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Matthew D. Greer
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Joanna H. Shih
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Tristan Barrett
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Yan Mee Law
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Andrew B. Rosenkrantz
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Haytham Shebel
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Akhil Muthigi
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Daniel Su
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Maria J. Merino
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Bradford J. Wood
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Peter A. Pinto
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Andra V. Krauze
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Aradhana Kaushal
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Peter L. Choyke
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Barış Türkbey
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| | - Deborah E. Citrin
- From Radiation Oncology Branch (L.F.V., A.V.K., A.K., D.E.C. ), Molecular Imaging Program (M.D.G., P.L.C., B.T.), Biometric Research Program (J.H.S.), Urologic Oncology Branch (A.M., P.A.P.), Laboratory of Pathology (M.J.M.), Center for Interventional Oncology (B.J.W.), National Cancer Institute, National Institutes of Health, Maryland, USA; Department of Radiology (T.B.), University of Cambridge School of Clinical Medicine, Cambridge, UK; Department of Diagnostic Radiology (Y.M.L.), Singapore General Hospital, Singapore; Department of Radiology (A.B.R.), Center for Biomedical Imaging, NYU School of Medicine, New York, USA; Department of Radiology (H.S.), Urology and Nephrology Center, Mansoura University, Mansoura City, Egypt; Orange Country Urology Associates (D.S.), Laguna Hills, USA
| |
Collapse
|
15
|
Biochemical Recurrence After Radiation Therapy. Prostate Cancer 2018. [DOI: 10.1007/978-3-319-78646-9_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
|
16
|
Georgiou PS, Jaros J, Payne H, Allen C, Shah TT, Ahmed HU, Gibson E, Barratt D, Treeby BE. Beam distortion due to gold fiducial markers during salvage high-intensity focused ultrasound in the prostate. Med Phys 2016; 44:679-693. [PMID: 28032342 DOI: 10.1002/mp.12044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/21/2016] [Accepted: 11/17/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE High intensity focused ultrasound (HIFU) provides a non-invasive salvage treatment option for patients with recurrence after external beam radiation therapy (EBRT). As part of EBRT the prostate is frequently implanted with permanent fiducial markers. To date, the impact of these markers on subsequent HIFU treatment is unknown. The objective of this work was to systematically investigate, using computational simulations, how these fiducial markers affect the delivery of HIFU treatment. METHODS A series of simulations was performed modelling the propagation of ultrasound pressure waves in the prostate with a single spherical or cylindrical gold marker at different positions and orientations. For each marker configuration, a set of metrics (spatial-peak temporal-average intensity, focus shift, focal volume) was evaluated to quantify the distortion introduced at the focus. An analytical model was also developed describing the marker effect on the intensity at the focus. The model was used to examine the marker's impact in a clinical setting through case studies. RESULTS The simulations show that the presence of the marker in the pre-focal region causes reflections which induce a decrease in the focal intensity and focal volume, and a shift of the maximum pressure point away from the transducer's focus. These effects depend on the shape and orientation of the marker and become more pronounced as its distance from the transducer's focus decreases, with the distortion introduced by the marker greatly increasing when placed within 5 mm of the focus. The analytical model approximates the marker's effect and can be used as an alternative method to the computationally intensive and time consuming simulations for quickly estimating the intensity at the focus. A retrospective review of a small patient cohort selected for focal HIFU after failed EBRT indicates that the presence of the marker may affect HIFU treatment delivery. CONCLUSIONS The distortion introduced by the marker to the HIFU beam when positioned close to the focus may result in an undertreated region beyond the marker due to less energy arriving at the focus, and an overtreated region due to reflections. Further work is necessary to investigate whether the results presented here justify the revision of the patient selection criteria or the markers' placement protocol.
Collapse
Affiliation(s)
- P S Georgiou
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - J Jaros
- Faculty of Information Technology, Brno University of Technology, Brno, Czech Republic
| | - H Payne
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Oncology, University College London Hospitals, London, UK
| | - C Allen
- Department of Oncology, University College London Hospitals, London, UK
| | - T T Shah
- Division of Surgery and Interventional Science, University College London, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
| | - E Gibson
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - D Barratt
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - B E Treeby
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| |
Collapse
|
17
|
Baust JG, Gage AA, Klossner D, Clarke D, Miller R, Cohen J, Katz A, Polascik T, Clarke H, Baust JM. Issues Critical to the Successful Application of Cryosurgical Ablation of the Prostate. Technol Cancer Res Treat 2016; 6:97-109. [PMID: 17375972 DOI: 10.1177/153303460700600206] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The techniques of present-day cryosurgery performed with multiprobe freezing apparatus and advanced imaging techniques yield predictable and encouraging results in the treatment of prostatic and renal cancers. Nevertheless, and not unique to cryosurgical treatment, the rates of persistent disease demonstrate the need for improvement in technique and emphasize the need for proper management of the therapeutic margin. The causes of persistent disease often relate to a range of factors including selection of patients, understanding of the extent of the tumor, limitations of the imaging techniques, and failure to freeze the tumor periphery in an efficacious manner. Of these diverse factors, the one most readily managed, but subject to therapeutic error, is the technique of freezing the tumor and appropriate margin to a lethal temperature [Baust, J. G., Gage, A. A. The Molecular Basis of Cryosurgery. BJU Int 95, 1187–1191 (2005)]. This article describes the recent experiments that examine the molecular basis of cryosurgery, clarifies the actions of the components of the freeze-thaw cycle, and defines the resultant effect on the cryogenic lesion from a clinical perspective. Further, this review addresses the important issue of management of the margin of the tumor through adjunctive therapy. Accordingly, a goal of this review is to identify the technical and future adjunctive therapeutic practices that should improve the efficacy of cryoablative techniques for the treatment of malignant lesions.
Collapse
Affiliation(s)
- J G Baust
- Institute of Biomedical Technology, SUNY Binghamton, Binghamton, NY, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Siddiqui KM, Billia M, Williams A, Alzahrani A, Chin JL. Comparative morbidity of ablative energy-based salvage treatments for radio-recurrent prostate cancer. Can Urol Assoc J 2015; 9:325-9. [PMID: 26644804 DOI: 10.5489/cuaj.3113] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We compared the morbidity of whole gland salvage ablation using cryotherapy (CRYO) and high-intensity focused ultrasound (HIFU) for radio recurrent prostate cancer at a single centre over a 17-year period. METHODS Patients were divided in 3 cohorts. Group 1 included the first 65 patients treated with CRYO (1995-1998); Group 2 included the last 65 patients treated with CRYO (2002-2004), and Group 3 included 65 patients treated with HIFU (2006-2011). We analyzed the complications reported within at least 90 days of treatment or up to the last follow-up. RESULTS We tallied Clavien grade complications. For Groups 1, 2 and 3, we recorded the following Clavien I-II complications: 78, 49 and 13, respectively. For Clavien grade IIIa, 2, 5 and 4 for Groups 1, 2 and 3, respectively. For Clavien grade IIIb, 8, 2 and 3 for Groups 1, 2 and 3, respectively. Clavien grade II complications were statistically higher in Group 1 versus Group 2 (p = 0.005) and in Group 2 versus Group 3 (p = 0.0001). The rate of mild-moderate incontinence was significantly higher in the CRYO group compared to the HIFU cohort (p ≤ 0.05). The rate of urinary retention was significantly higher in Group 2 compared to Group 3 (p = 0.0005). The rates of severe incontinence (range: 1.5%-5%), need for surgical intervention (uniform at 1.5%), and recto-urethral fistulae (range: 1.5%-3%) were not statistically different. CONCLUSIONS CRYO was associated with higher overall morbidity. The morbidity during the early experience with HIFU was lower than both subgroups of CRYO. This may reflect the advancement of technology or cumulative learning experience.
Collapse
Affiliation(s)
| | | | | | - Ali Alzahrani
- Department of Urology, University of Dammam, Saudi Arabia
| | | |
Collapse
|
19
|
Salomon L, Ploussard G, Hennequin C, Richaud P, Soulié M. Traitements complémentaires de la chirurgie du cancer de la prostate et chirurgie de la récidive. Prog Urol 2015; 25:1086-107. [DOI: 10.1016/j.purol.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
|
20
|
Kanthabalan A, Shah T, Arya M, Punwani S, Bomanji J, Haroon A, Illing RO, Latifoltojar A, Freeman A, Jameson C, van der Meulen J, Charman S, Emberton M, Ahmed HU. The FORECAST study - Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer. Contemp Clin Trials 2015; 44:175-186. [PMID: 26184343 DOI: 10.1016/j.cct.2015.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND One-third of men may experience biochemical failure by 8years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and characterised. AIM FORECAST - Focal Recurrent Assessment and Salvage Treatment - is a study designed to evaluate a novel imaging-based diagnostic and therapeutic complex intervention pathway for men who fail radiotherapy. METHODS Men with biochemical failure following radical prostate radiotherapy, prior to salvage therapy will be recruited. They will undergo whole-body multi-parametric MRI (WB-MRI), choline PET/CT, bone-scan and pelvic-mpMRI and then MRI transperineal-targeted biopsies (MRI-TB) and Transperineal Template Prostate Mapping Biopsy (TPM). Those suitable for FST will undergo either high intensity focused ultrasound (HIFU) or cryotherapy. RESULTS Primary outcome measures: a) the accuracy of WB-MRI to detect distant metastatic disease; b) accuracy of prostate mpMRI in local detection of radiorecurrent prostate cancer; c) detection accuracy of MRI-TB; and d) rate of urinary incontinence following FST. CONCLUSION Focal salvage therapy may confer lower rates of morbidity whilst retaining disease control. In order to deliver FST, intra- and extra-prostatic disease must be detected early and localised accurately. Novel diagnostic techniques including WB-MRI and MRI-TB may improve the detection of distant and local disease whilst reducing healthcare burdens compared with current imaging and biopsy strategies.
Collapse
Affiliation(s)
- A Kanthabalan
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK.
| | - T Shah
- Division of Surgery and Interventional Science, University College London, UK
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, UK
| | - S Punwani
- Department of Radiology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK
| | - J Bomanji
- Institute of Nuclear Medicine, UCLH NHS Foundation Trust, UK
| | - A Haroon
- Centre for Medical Imaging and Computing, University College London, UK
| | - R O Illing
- Department of Radiology, UCLH NHS Foundation Trust, UK
| | - A Latifoltojar
- Department of Urology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK
| | - A Freeman
- Department of Pathology, UCLH NHS Foundation Trust, UK
| | - C Jameson
- Department of Pathology, UCLH NHS Foundation Trust, UK
| | | | - S Charman
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
| |
Collapse
|
21
|
Pearce SM, Richards KA, Patel SG, Pariser JJ, Eggener SE. Population-based analysis of salvage radical prostatectomy with examination of factors associated with adverse perioperative outcomes. Urol Oncol 2015; 33:163.e1-6. [PMID: 25708953 DOI: 10.1016/j.urolonc.2015.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 01/19/2015] [Accepted: 01/21/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Salvage radical prostatectomy (SRP) is a potentially curative operation performed for recurrent prostate cancer after radiation therapy (RT). The purpose of this study was to examine perioperative and pathologic outcomes of SRP in a national cohort. MATERIALS AND METHODS The National Cancer Database from 1998 to 2011 was used to identify 408 patients who underwent SRP. We evaluated the demographic data, clinical variables, and pathologic and perioperative outcomes. Primary outcomes of interest were length of stay (LOS) and positive surgical margins (PSM). A multivariable logistic regression model was employed to identify preoperative predictors of LOS ≥ 3 days and PSM following SRP. RESULTS Among patients undergoing SRP, the mean age was 62.5 ± 6.8 years, mean prostate-specific antigen (PSA) level was 12.6 ± 15.6 ng/ml, and 64% were categorized as clinical stage T1. External beam RT (89%), followed by brachytherapy (11%), was the most common modalities for primary RT. Most SRPs were performed at high-volume centers (57%) in metropolitan locations (83%). Most patients underwent a lymph node dissection (75%) and the mean node count was 15.0 ± 30.1. On final pathology, 73% had intermediate- or high-grade disease (Gleason score 7 in 43% and Gleason score 8-10 in 30%), 49% had pT3 or pT4 disease, 6.2% had positive lymph nodes, and 34% had PSM. The mean LOS was 3.5 ± 9.9 days, and 43% of patients had a LOS ≥ 3 days. The 30-day readmission rate was 6.5% after SRP, and 30- and 90-day postoperative mortality rates were extremely low at 0.4% (n = 1). On multivariable analysis of the entire cohort, PSA level > 20 ng/ml was an independent predictor of PSM (OR = 3.68, 95% CI: 1.2-10.9, P = 0.018). PSA level > 20 ng/ml (OR = 4.37, 95% CI: 1.2-16.2, P = 0.027) and cT2 or greater disease (OR = 2.52, 95% CI: 1.0-6.2, P = 0.046) were associated with prolonged LOS (LOS ≥ 3d), whereas surgery at an academic facility (OR = 0.30, 95% CI: 0.1-0.8, P = 0.02) reduced the odds of LOS ≥ 3 days. CONCLUSIONS In select patients derived from a population-based cohort, SRP results in effective local cancer control with acceptable perioperative outcomes. PSA level > 20 ng/ml is independently associated with PSM and prolonged LOS after SRP. Clinical stage T2 or greater disease is also associated with prolonged LOS, whereas surgery at an academic facility reduced this risk.
Collapse
Affiliation(s)
- Shane M Pearce
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL.
| | - Kyle A Richards
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL; Department of Urology, The University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Sanjay G Patel
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Joseph J Pariser
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| | - Scott E Eggener
- Section of Urology, Department of Surgery, University of Chicago Medicine and Biological Sciences, Chicago, IL
| |
Collapse
|
22
|
Soulié M, Salomon L. Traitements de rattrapage après irradiation prostatique : place de l’urologue. Cancer Radiother 2014; 18:535-9. [DOI: 10.1016/j.canrad.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 11/15/2022]
|
23
|
Salvage low-dose-rate (125)I partial prostate brachytherapy after dose-escalated external beam radiotherapy. J Contemp Brachytherapy 2014; 6:304-10. [PMID: 25337135 PMCID: PMC4200181 DOI: 10.5114/jcb.2014.45134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 07/17/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
Purpose To report outcomes on 5 patients treated with salvage partial low-dose-rate (LDR) 125-iodine (125I) permanent prostate seed brachytherapy (BT) for biopsy-proven locally persistent prostate cancer, following failure of dose-escalated external beam radiotherapy (EBRT). Material and methods A retrospective review of the Fox Chase Cancer Center prostate cancer database identified five patients treated with salvage partial LDR 125I seed implant for locally persistent disease following dose-escalated EBRT to 76-84 Gy in 2 Gy per fraction equivalent. All patients had post-EBRT biopsies confirming unilateral locally persistent prostate cancer. Pre-treatment, EBRT and BT details, as well as post-treatment characteristics were documented and assessed. Results The median follow-up post-implant was 41 months. All five patients exhibited low acute genitourinary and gastrointestinal toxicities. Increased erectile dysfunction was noted in three patients. There were no biochemical failures following salvage LDR 125I seed BT to date, with a median post-salvage PSA of 0.4 ng/mL. Conclusions In carefully selected patients with local persistence of disease, partial LDR 125I permanent prostate seed implant appears to be a feasible option for salvage local therapy with an acceptable toxicity profile. Further study is needed to determine long-term results of this approach.
Collapse
|
24
|
Robotic radical prostatectomy in patients with previous prostate surgery and radiotherapy. Prostate Cancer 2014; 2014:367675. [PMID: 25120933 PMCID: PMC4120925 DOI: 10.1155/2014/367675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 01/22/2023] Open
Abstract
Herein, we will review the available literature about robot-assisted radical prostatectomy in patients who have undergone prostate surgery or radiotherapy. Current data about this topic consists of small case series with limited follow-up. Despite being technically demanding, robot-assisted radical prostatectomy (RARP) can be considered feasible in either setting. Prostate surgery or prostatic irradiation should not be considered as a contraindication for robot-assisted radical prostatectomy. Nevertheless, patient counseling about the possible complications and the need for reintervention is of extreme importance in this patient population. Early oncologic and functional results of RARP performed in case of radiorecurrent prostate cancer look promising. Regarding postprostate surgery RARP, some series have reported comparable results, while some have demonstrated more inferior outcomes than those of naive cases. In order to assess the exact functional and oncologic outcome of RARP in patients with previous prostate surgery and radiotherapy, studies enrolling higher number of patients and providing longer follow-up data are needed.
Collapse
|
25
|
Song W, Jung US, Suh YS, Jang HJ, Sung HH, Jeon HG, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after radiotherapy. Korean J Urol 2014; 55:91-6. [PMID: 24578803 PMCID: PMC3935076 DOI: 10.4111/kju.2014.55.2.91] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/01/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the oncologic outcomes and postoperative complications of high-intensity focused ultrasound (HIFU) as a salvage therapy after external-beam radiotherapy (EBRT) failure in patients with prostate cancer. Materials and Methods Between February 2002 and August 2010, we retrospectively reviewed the medical records of all patients who underwent salvage HIFU for transrectal ultrasound-guided, biopsy-proven locally recurred prostate cancer after EBRT failure (by ASTRO definition: prostate-specific antigen [PSA] failure after three consecutive PSA increases after a nadir, with the date of failure as the point halfway between the nadir date and the first increase or any increase great enough to provoke initiation of therapy). All patients underwent prostate magnetic resonance imaging and bone scintigraphy and had no evidence of distant metastasis. Biochemical recurrence (BCR) was defined according to the Stuttgart definition (PSA nadir plus 1.2 ng/mL). Results A total of 13 patients with a median age of 68 years (range, 60-76 years) were included. The median pre-EBRT PSA was 21.12 ng/mL, the pre-HIFU PSA was 4.63 ng/mL, and the period of salvage HIFU after EBRT was 32.7 months. The median follow-up after salvage HIFU was 44.5 months. The overall BCR-free rate was 53.8%. In the univariate analysis, predictive factors for BCR after salvage HIFU were higher pre-EBRT PSA (p=0.037), pre-HIFU PSA (p=0.015), and short time to nadir (p=0.036). In the multivariate analysis, there were no significant predictive factors for BCR. The complication rate requiring intervention was 38.5%. Conclusions Salvage HIFU for prostate cancer provides effective oncologic outcomes for local recurrence after EBRT failure. However, salvage HIFU had a relatively high rate of complications.
Collapse
Affiliation(s)
- Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - U Seok Jung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Seok Suh
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jun Jang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
26
|
Zugor V, Labanaris AP, Porres D, Heidenreich A, Witt JH. Robot-Assisted Radical Prostatectomy for the Treatment of Radiation-Resistant Prostate Cancer: Surgical, Oncological and Short-Term Functional Outcomes. Urol Int 2014; 92:20-6. [DOI: 10.1159/000351948] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 04/22/2013] [Indexed: 11/19/2022]
|
27
|
Morbidity and costs of salvage vs. primary radical prostatectomy in older men. Urol Oncol 2013; 31:1477-82. [DOI: 10.1016/j.urolonc.2012.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Revised: 03/29/2012] [Accepted: 04/04/2012] [Indexed: 11/20/2022]
|
28
|
Role of focal salvage ablative therapy in localised radiorecurrent prostate cancer. World J Urol 2013; 31:1361-8. [DOI: 10.1007/s00345-013-1100-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022] Open
|
29
|
Locally recurrent prostate cancer after initial radiation therapy: Early salvage high-intensity focused ultrasound improves oncologic outcomes. Radiother Oncol 2012; 105:198-202. [DOI: 10.1016/j.radonc.2012.09.014] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Revised: 09/19/2012] [Accepted: 09/20/2012] [Indexed: 11/17/2022]
|
30
|
Uddin Ahmed H, Cathcart P, Chalasani V, Williams A, McCartan N, Freeman A, Kirkham A, Allen C, Chin J, Emberton M. Whole-gland salvage high-intensity focused ultrasound therapy for localized prostate cancer recurrence after external beam radiation therapy. Cancer 2012; 118:3071-3078. [DOI: 10.1002/cncr.26631] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
31
|
Mouraviev V, Spiess PE, Jones JS. Salvage Cryoablation for Locally Recurrent Prostate Cancer Following Primary Radiotherapy. Eur Urol 2012; 61:1204-11. [PMID: 22421081 DOI: 10.1016/j.eururo.2012.02.051] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 02/29/2012] [Indexed: 11/24/2022]
|
32
|
Rouvière O. Imaging techniques for local recurrence of prostate cancer: for whom, why and how? Diagn Interv Imaging 2012; 93:279-90. [PMID: 22464995 DOI: 10.1016/j.diii.2012.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Since there are salvage solutions, it is important to detect local recurrence of prostate cancer as early as possible. The first sign is "biochemical failure" in that the prostate specific antigen (PSA) concentration rises again. The definition of biochemical failure varies depending on the initial treatment: PSA greater than 0.2ng/mL after prostatectomy, nadir+2ng/mL after radiotherapy. There is no standardised definition of biochemical failure after cryotherapy, focused ultrasound, or brachytherapy. Magnetic resonance imaging (MRI) (particularly dynamic MRI) can detect local recurrence with good sensitivity. The role of spectroscopy is still under discussion. For the moment, ultrasound techniques are less effective than MRI.
Collapse
Affiliation(s)
- O Rouvière
- Department of Urinary and Vascular Imaging, hospices civils de Lyon, hôpital Édouard-Herriot, 5, place d'Arsonval, 69437 Lyon, France.
| |
Collapse
|
33
|
Current Status of Salvage Robot-Assisted Laparoscopic Prostatectomy for Radiorecurrent Prostate Cancer. Curr Urol Rep 2012; 13:195-201. [DOI: 10.1007/s11934-012-0245-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Oon SF, Pennington SR, Fitzpatrick JM, Watson RWG. Biomarker research in prostate cancer--towards utility, not futility. Nat Rev Urol 2012; 8:131-8. [PMID: 21394176 DOI: 10.1038/nrurol.2011.11] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The identification of an appropriate clinical question is critical for any biomarker project. Despite rapid advances in technology, few biomarkers have been forthcoming for prostate cancer. This could be because the clinical questions under investigation have not actually originated from clinical practice. These clinical questions are difficult to identify in the complex and heterogeneous pathogenesis of prostate cancer. In this Review, we have developed a prostate cancer 'roadmap' to identify the aspects of prostate cancer that may be amenable to biomarker discovery and serve as a guide for future projects in prostate cancer biomarker research.
Collapse
Affiliation(s)
- Sheng Fei Oon
- UCD School of Medicine and Medical Science, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Belfield, Dublin 4, Ireland.
| | | | | | | |
Collapse
|
35
|
Philippou P, Yap T, Chinegwundoh F. Third-Generation Salvage Cryotherapy for Radiorecurrent Prostate Cancer: A Centres Experience. Urol Int 2012; 88:137-44. [DOI: 10.1159/000332220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Accepted: 08/01/2011] [Indexed: 11/19/2022]
|
36
|
Finley DS, Belldegrun AS. Salvage cryotherapy for radiation-recurrent prostate cancer: outcomes and complications. Curr Urol Rep 2011; 12:209-15. [PMID: 21394596 PMCID: PMC3090573 DOI: 10.1007/s11934-011-0182-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Potentially curative salvage options for radio-recurrent prostate cancer include prostatectomy, brachytherapy, high-intensity focused ultrasound, and cryotherapy. Salvage cryoablation technology, surgical technique, oncologic outcomes, and complication rates have improved dramatically over the past few decades, shifting this treatment modality from investigational status to an established therapeutic option. In this review, we focus on the most up-to-date oncologic and functional outcomes, as well as complications of salvage cryotherapy for radiation-recurrent prostate cancer.
Collapse
Affiliation(s)
- David S Finley
- Institute of Urologic Oncology, David Geffen School of Medicine at UCLA, 924 Westwood Boulevard, Suite 1050, Box 957207, Los Angeles, CA 90095-7207, USA.
| | | |
Collapse
|
37
|
Loblaw DA, Pickles T, Cheung PC, Lukka H, Faria S, Klotz L. Hormone use after radiotherapy failure: a survey of Canadian uro-oncology specialists. Can Urol Assoc J 2011; 3:460-4. [PMID: 20019973 DOI: 10.5489/cuaj.1175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A survey of Canadian uro-oncology specialists was performed to assess practice patterns of patients with recurrent prostate cancer postradiotherapy and to assess the feasibility of conducting a trial in this setting. METHODS There were 14 survey questions and 1 demographic question. Responses were reported by frequency. RESULTS There were 96 respondents. Most respondents use both prostate-specific antigen doubling time (PSAdt) and PSA level when deciding to start androgen deprivation therapy (ADT) in asymptomatic patients. About half of respondents start ADT when PSA is greater than 10 ng/mL or when the PSAdt is less than 6 months. Eighty-six percent felt that the timing of ADT was an important research question. Over 1500 patients per year were estimated as being available for such a trial. CONCLUSION After radiotherapy failure, respondents initiated ADT about half of the time when PSA is less than 10 ng/mL and/or PSAdt is less than 6 months. A clinical trial examining the timing of ADT has strong support and appears to be feasible.
Collapse
Affiliation(s)
- D Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Toronto, ON
| | | | | | | | | | | |
Collapse
|
38
|
Experimental measurements and Monte Carlo simulations of dose perturbation around a nonradioactive brachytherapy seed due to 6- and 18-MV photons. Brachytherapy 2011; 11:413-20. [PMID: 21737357 DOI: 10.1016/j.brachy.2011.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 05/23/2011] [Accepted: 05/25/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE Radioactive seeds used in permanent prostate brachytherapy are composed of high-Z metals and may exceed 100 in a patient. If supplemental external beam treatment is administered afterward, the seeds may cause substantial dose perturbation, which is being investigated in this article. METHODS AND MATERIALS Film measurements using 6-MV beam were primarily carried out using Kodak XV2 film layered above and below a nonradioactive iodine-125 ((125)I) seed. Monte Carlo simulations were carried out using DOSXYZnrc. Other experimental comparisons looked at changing beam energy, depth, and field size, including two opposing fields' pair. Effect of multiple seeds spatially spaced 0.5cm vertically was also studied. RESULTS For a single (125)I seed, on XV film, there is a localized dose enhancement of 6.3% upstream and -10.9% downstream. With two opposing fields, a cold spot around the seed of ∼3% was noticed. Increasing beam energy and field size decreased the magnitude of this effect, whereas the effect was found to increase with the increasing Z of material. DOSXYZnrc and EBT-2 film verified maximum dose enhancement of +15% upstream and -20% downstream of the (125)I seed surface. CONCLUSIONS In general, the dose perturbation because of the seeds was spatially limited to ∼2mm upstream and ∼5mm downstream to the incident beam. Similar to other heterogeneities, the seeds perturbation depends on incident beam energy, field size, and its Z. With multiple seeds spatially apart and multiple radiation fields routinely used in external beam radiotherapy, the cumulative effect may not result in clinically significant dose perturbation.
Collapse
|
39
|
Radiorecurrent prostate cancer: an emerging and largely mismanaged epidemic. Eur Urol 2011; 60:411-2. [PMID: 21247684 DOI: 10.1016/j.eururo.2011.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 01/05/2011] [Indexed: 11/23/2022]
|
40
|
Salvage robotic assisted laparoscopic radical prostatectomy: indications and outcomes. World J Urol 2010; 31:431-4. [DOI: 10.1007/s00345-010-0619-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 11/09/2010] [Indexed: 01/22/2023] Open
|
41
|
Paparel P, Soulie M, Mongiat-Artus P, Cornud F, Borgogno C. Prostatectomie de rattrapage après échec de radiothérapie externe pour cancer de la prostate localisé : enquête de pratique, indications, morbidité et résultats. Travail du CCAFU sous-comité prostate. Prog Urol 2010; 20:317-26. [DOI: 10.1016/j.purol.2009.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 11/05/2009] [Indexed: 10/20/2022]
|
42
|
Berge V, Baco E, Karlsen SJ. A prospective study of salvage high-intensity focused ultrasound for locally radiorecurrent prostate cancer: Early results. ACTA ACUST UNITED AC 2010; 44:223-7. [DOI: 10.3109/00365591003727551] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Viktor Berge
- Department of Urology, Oslo University Hospital, Aker, Oslo, Norway
| | - Eduard Baco
- Department of Urology, Oslo University Hospital, Aker, Oslo, Norway
| | - Steinar Johan Karlsen
- Department of Urology, Oslo University Hospital, Aker, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| |
Collapse
|
43
|
|
44
|
Robotic Assisted Laparoscopic Salvage Prostatectomy for Radiation Resistant Prostate Cancer. J Urol 2010; 183:133-7. [DOI: 10.1016/j.juro.2009.08.134] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Indexed: 11/24/2022]
|
45
|
Rouvière O, Vitry T, Lyonnet D. Imaging of prostate cancer local recurrences: why and how? Eur Radiol 2009; 20:1254-66. [DOI: 10.1007/s00330-009-1647-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2009] [Revised: 09/07/2009] [Accepted: 10/09/2009] [Indexed: 10/20/2022]
|
46
|
Spiess PE, Katz AE, Chin JL, Bahn D, Cohen JK, Shinohara K, Hernandez M, Bossier J, Kassouf W, Pisters LL. A pretreatment nomogram predicting biochemical failure after salvage cryotherapy for locally recurrent prostate cancer. BJU Int 2009; 106:194-8. [PMID: 19922545 DOI: 10.1111/j.1464-410x.2009.09078.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To gather a pooled database from six tertiary-care referral centres using salvage cryotherapy (SC) for locally recurrent prostate cancer, and develop a pretreatment nomogram allowing a prediction of the probability of biochemical failure after SC, based on pretreatment clinical variables. PATIENTS AND METHODS We retrospectively analysed 797 men treated at six tertiary-care referral centres with SC for locally recurrent disease after primary radiotherapy with curative intent. The median duration of follow-up from the time of SC to the date of last contact was 3.4 years. The primary study endpoint was biochemical failure, defined as a serum prostate-specific antigen (PSA) level after SC of >0.5 ng/mL. RESULTS Overall, the rate of biochemical failure was 66% with a median of 3.4 years of follow-up. A logistic regression model was used to predict biochemical failure. Covariates included serum PSA level at diagnosis, initial clinical T stage, and initial biopsy Gleason score. On the basis of these results, a pretreatment nomogram was developed which can be used to help select patients best suited for SC. Our pretreatment nomogram was internally validated using 500 bootstrap samples, with the concordance index of the model being 0.70. CONCLUSION A pretreatment nomogram based on several diagnostic variables (serum PSA level at diagnosis, biopsy Gleason grade, and initial clinical T stage) was developed and might allow the selection of ideal candidates for SC.
Collapse
|
47
|
Abstract
The European Association of Urology guidelines on prostate cancer state that cryotherapy is a true therapeutic alternative for patients with clinically localized prostate cancer. The aim of this paper is to establish a uniform practice for performing prostate cryoablation. A collaboration has been set up among five European centres with experience in almost 1000 prostate cancer patients on the use of cryotherapy. The present recommendations were developed through sharing of experience and thorough discussions within the group. This first paper from the group establishes the technical recommendations for use of prostate cryotherapy.
Collapse
|
48
|
Wondergem N, De La Rosette JJMCH. HIFU and cryoablation – non or minimal touch techniques for the treatment of prostate cancer. Is there a role for contrast enhanced ultrasound? MINIM INVASIV THER 2009; 16:22-30. [PMID: 17365674 DOI: 10.1080/13645700601157786] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The incidence of prostate cancer is increasing, and therefore also the need for optimal treatment. Because of the appearance of many different disease stages different treatment modalities are desirable for the treatment of localized prostate cancer. The established therapies, radical prostatectomy and radiation therapy, are associated with a lot of risks, complications and co-morbidity, and not all patients are eligible for these treatments. That is why the need for reliable minimally invasive alternatives has developed. For this paper a literature search was conducted on published studies and review articles to determine the role of HIFU (high intensity focused ultrasound) and cryoablation as minimally invasive treatment modalities for localized prostate cancer. Both therapies are being used as a primary or secondary (salvage) treatment, but can they replace surgery or radiation? And is there a role for contrast enhanced ultrasound (CEUS) of the prostate to improve diagnostics, treatment outcomes and follow-up? To date the outcomes of both therapies are promising but no prospective and comparative randomized studies with a long term follow-up were available for analysis. From this review we can conclude that until those studies are available, HIFU and cryoablation are good alternatives for patients not eligible for prostatectomy or radiation. They should not be used as a first treatment option as long as diagnostics and follow-up have not improved.
Collapse
Affiliation(s)
- N Wondergem
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands.
| | | |
Collapse
|
49
|
Kimura M, Mouraviev V, Tsivian M, Mayes JM, Satoh T, Polascik TJ. Current salvage methods for recurrent prostate cancer after failure of primary radiotherapy. BJU Int 2009; 105:191-201. [PMID: 19583717 DOI: 10.1111/j.1464-410x.2009.08715.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
We reviewed the current salvage methods for patients with local recurrent prostate cancer after primary radiotherapy (RT), using a search of relevant Medline/PubMed articles published from 1982 to 2008, with the following search terms: 'radiorecurrent prostate cancer, local salvage treatment, salvage radical prostatectomy (RP), salvage cryoablation, salvage brachytherapy, salvage high-intensity focused ultrasound (HIFU)', and permutations of the above. Only articles written in English were included. The objectives of this review were to analyse the eligibility criteria for careful selection of appropriate patients and to evaluate the oncological results and complications for each method. There are four whole-gland re-treatment options (salvage RP, salvage cryoablation, salvage brachytherapy, salvage HIFU) for RT failure, although others might be in development or investigations. Salvage RP has the longest follow-up with acceptable oncological results, but it is a challenging technique with a high complication rate. Salvage cryoablation is a feasible option, especially using third-generation technology, whereby the average biochemical disease-free survival rate is 50-70% and there are fewer occurrences of severe complications such as recto-urethral fistula. Salvage brachytherapy, with short-term cancer control, is comparable to other salvage methods but depends on cumulative dosage limitation to target tissues. HIFU is a relatively recent option in the salvage setting. Both salvage brachytherapy and HIFU require more detailed studies with intermediate and long-term follow-up. As these are not prospective, randomized studies and the definitions of biochemical failure varied, there are limited comparisons among these different salvage methods, including efficacy. In the focal therapy salvage setting, the increased use of thermoablative methods for eligible patients might contribute to reducing complications and maintaining quality of life. The problem to effectively salvage patients with locally recurrent disease after RT is the lack of diagnostic examinations with sufficient sensitivity and specificity to detect local recurrence at an early curable stage. Therefore, a more strict definition of biochemical failure, improved imaging techniques, and accurate specimen mapping are needed as diagnostic tools. Furthermore, universal selection criteria and an integrated definition of biochemical failure for all salvage methods are required to determine which provides the best oncological efficacy and least comorbidity.
Collapse
Affiliation(s)
- Masaki Kimura
- Duke Prostate Center and Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | | | | | | | | | | |
Collapse
|
50
|
|