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Sekito S, Onishi T, Okamoto T, Terabe T, Kajiwara S, Shibahara T. Predictive Factors for Extracapsular Extension of Prostate Cancer to Select the Candidates for Nerve-sparing Radical Prostatectomy. Indian J Surg Oncol 2024; 15:213-217. [PMID: 38741620 PMCID: PMC11088566 DOI: 10.1007/s13193-024-01913-1] [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: 11/06/2022] [Accepted: 02/27/2024] [Indexed: 05/16/2024] Open
Abstract
Nerve-sparing radical prostatectomy (NSRP) for prostate cancer (PC) enables better postoperative recovery of continence and potency but may increase the risk of positive surgical margins. This study aimed to investigate preoperative predictive factors for extracapsular extension (ECE) of PC to select patients for NSRP. We retrospectively evaluated 288 patients with PC (576 lobes) diagnosed with 12-core transrectal ultrasound-guided biopsy and magnetic resonance imaging (MRI) who underwent laparoscopic or robot-assisted radical prostatectomy at our institution. Surgical specimens and preoperative parameters (prostate-specific antigen, prostate volume, biopsy and MRI findings, preoperative therapy) were analyzed. Of 576 prostate lobes, the incidence Ipsilateral ECE was identified in 97 (16.8%) lobes. The higher number of unilateral positive biopsy cores, the highest Gleason score 8 or more and positive unilateral findings on MRI are significant higher in prostate sides with ECE in univariate analysis. In multivariate analysis, positive unilateral MRI findings (odds ratio [OR], 2.86; p < 0.001) and unilateral biopsy positive core ≥ 3 (OR, 3.73; p < 0.001) were independent predictors of unilateral ECE. The detection rate of unilateral ECE in those cases with two factors (side-specific positive biopsy core 2 or less and side-specific MRI findings negative) was 7.1% (19/269). Patients with fewer unilateral positive biopsy cores and negative unilateral MRI findings might be good candidates for NSRP.
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Affiliation(s)
- Sho Sekito
- Department Urology, Ise Red Cross Hospital, 471-2 Hunae, Ise, Mie 516-8512 Japan
| | - Takehisa Onishi
- Department Urology, Ise Red Cross Hospital, 471-2 Hunae, Ise, Mie 516-8512 Japan
| | - Takashi Okamoto
- Department Urology, Ise Red Cross Hospital, 471-2 Hunae, Ise, Mie 516-8512 Japan
| | - Takashi Terabe
- Department Urology, Ise Red Cross Hospital, 471-2 Hunae, Ise, Mie 516-8512 Japan
| | - Shinya Kajiwara
- Department Urology, Ise Red Cross Hospital, 471-2 Hunae, Ise, Mie 516-8512 Japan
| | - Takuji Shibahara
- Department Urology, Ise Red Cross Hospital, 471-2 Hunae, Ise, Mie 516-8512 Japan
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Wu S, Jiang Y, Liang Z, Chen S, Sun G, Ma S, Chen K, Liu R. Comprehensive analysis of predictive factors for upstaging in intraprostatic cancer after radical prostatectomy: Different patterns of spread exist in lesions at different locations. Cancer Med 2023; 12:17776-17787. [PMID: 37537798 PMCID: PMC10524000 DOI: 10.1002/cam4.6401] [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: 03/08/2023] [Revised: 07/14/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Accurate assessment of the clinical staging is crucial for determining the need for radical prostatectomy (RP) in prostate cancer (PCa). However, the current methods for PCa staging may yield incorrect results. This study aimed to comprehensively analyze independent predictors of postoperative upstaging of intraprostatic cancer. METHODS We conducted a retrospective analysis of data from intraprostatic cancer patients who underwent radical surgery between March 2019 and December 2022. Intraprostatic cancer was defined as a lesion confined to the prostate, excluding cases where multiparameter magnetic resonance imaging (mpMRI) showed the lesion in contact with the prostatic capsule. We assessed independent predictors of extraprostatic extension (EPE) and analyzed their association with positive surgical margin (PSM) status. In addition, based on the distance of the lesion from the capsule on mpMRI, we divided the patients into non-transition zone and transition zone groups for further analysis. RESULTS A total of 500 patients were included in our study. Logistic regression analysis revealed that biopsy Gleason grade group (GG) (odds ratio, OR: 1.370, 95% confidence interval, CI: 1.093-1.718) and perineural invasion (PNI) (OR: 2.746, 95% CI: 1.420-5.309) were predictive factors for postoperative EPE. Both biopsy GG and PNI were associated with lateral (GG: OR: 1.270, 95% CI: 1.074-1.501; PNI: OR: 2.733, 95% CI: 1.521-4.911) and basal (GG: OR: 1.491, 95% CI: 1.194-1.862; PNI: OR: 3.730, 95% CI: 1.929-7.214) PSM but not with apex PSM (GG: OR: 1.176, 95% CI: 0.989-1.399; PNI: OR: 1.204, 95% CI: 0.609-2.381) after RP. Finally, PNI was an independent predictor of EPE in the transition zone (OR: 11.235, 95% CI: 2.779-45.428) but not in the non-transition zone (OR: 1.942, 95% CI: 0.920-4.098). CONCLUSION PNI and higher GG may indicate upstaging of tumors in patients with intraprostatic carcinoma. These two factors are associated with PSM in locations other than the apex of the prostate. Importantly, cancer in the transition zone of the prostate is more likely to spread externally through nerve invasion than cancer in the non-transition zone.
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Affiliation(s)
- Shangrong Wu
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Yuchen Jiang
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Zhengxin Liang
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Shuaiqi Chen
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Guangyu Sun
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Shenfei Ma
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Kaifei Chen
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
| | - Ranlu Liu
- Department of UrologyThe Second Hospital of Tianjin Medical UniversityTianjinChina
- Tianjin Institute of UrologyTianjinChina
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Zhao J, Epstein J. Significance of extraprostatic extension by Grade Groups 1-3 prostatic carcinoma on needle biopsy. Prostate 2023; 83:809-813. [PMID: 36946608 DOI: 10.1002/pros.24520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/17/2023] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND It is rare for extraprostatic extension (EPE) on biopsy to be seen with Grade Groups (GG) 1-3 (Gleason scores 3 + 3 = 6; 3 + 4 = 7; 4 + 3 = 7) prostatic adenocarcinoma, and there is no data whether this finding should be a contraindication for performing radical prostatectomy (RP). METHODS Thirty eight cases with GG 1-3 prostatic adenocarcinoma as the highest grade in the case with EPE on biopsy were identified from our consultation files. Highly unfavorable findings at RP were those that if they could have been predicted preoperatively, might have factored into the decision of whether to proceed with surgery. For these purposes, highly unfavorable pathology at RP was defined as either the presence of seminal vesicle invasion or lymph node metastases or GG5 (Gleason score 9-10). RESULTS Among 37 patients with clinical follow-up data, 18 (49%) received radiation and/or hormonal therapy (RT/HT), 13 patients (35%) either underwent (n = 11) or are planning (n = 2) RP, and 6 patients (16%) received either ablation therapy or active surveillance. Based on the 11 RP pathology reports, 8 were GG2, one GG3 with tertiary pattern 5, and two GG3. Ten cases were reported to have EPE and six cases had positive margins. Only one had highly unfavorable pathology with pT3bN1 disease. The only difference between the RP and the RT/HT groups in their pretreatment parameters was the mean age of the RP patients was 61 compared with 69 for the RT/HT men (p = 0.02); the lack of many cases with highly unfavorable pathology at RP cannot be attributable to a selection bias of men with lower volume cancer on biopsy or lower serum prostate-specific antigen levels choosing RP over RT/HT. CONCLUSIONS Despite EPE on biopsy, most men do not have highly unfavorable pathology at RP, and this treatment should remain an option in this setting.
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Affiliation(s)
- Jianping Zhao
- Departments of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Jonathan Epstein
- Departments of Pathology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
- Departments of Urology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
- Departments of Oncology, The Johns Hopkins Hospital, Baltimore, Maryland, United States
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Washino S, Ito K, Miyagawa T. Prostate-specific antigen level, biopsy grade group, and tumor-capsular contact length on magnetic resonance imaging are independently associated with an extraprostatic extension. Int J Urol 2022; 29:1455-1461. [PMID: 36001632 DOI: 10.1111/iju.15012] [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: 11/28/2021] [Accepted: 07/21/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To define the clinicopathological and radiological factors independently associated with the existence of an extraprostatic extension in radical prostatectomy specimens. METHODS A total of 202 patients who underwent robotic prostatectomy following biparametric magnetic resonance imaging were assessed. We evaluated the clinicopathological and magnetic resonance imaging variables. We performed receiver-operating characteristic curve analyses to identify factors associated with extraprostatic extension. We engaged in multivariate analysis to identify factors independently associated with such extension. RESULTS Extraprostatic extensions were apparent in the final prostatectomy specimens of 62 patients (31%). The areas under the curves of the prostate-specific antigen level, the biopsy grade group, and the tumor-capsular contact length on magnetic resonance imaging were 0.76, 0.71, and 0.70, respectively, in receiver-operating characteristic analysis when used to predict extraprostatic extension; thus, higher than the areas under the curves of the other variables (0.61-0.68). The prostate-specific antigen level (odds ratio 1.090, p = 0.004), the biopsy grade group (odds ratios 2.678 and 6.358, p = 0.017 and p < 0.001 for grade group 3-4 and 5), and the tumor-capsular contact length (odds ratio 1.079, p = 0.001) were independently associated with extraprostatic extension. When the three factors were combined, the area under the receiver-operator characteristic curve increased to 0.79. CONCLUSIONS The prostate-specific antigen level, the biopsy grade group, and the tumor-capsular contact length on magnetic resonance imaging were independently associated with extracapsular extension.
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Affiliation(s)
- Satoshi Washino
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Koichi Ito
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Tomoaki Miyagawa
- Department of Urology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Diamand R, Roche JB, Lievore E, Lacetera V, Chiacchio G, Beatrici V, Mastroianni R, Simone G, Windisch O, Benamran D, Favre MM, Fourcade A, Nguyen TA, Fournier G, Fiard G, Ploussard G, Roumeguère T, Peltier A, Albisinni S. External Validation of Models for Prediction of Side-specific Extracapsular Extension in Prostate Cancer Patients Undergoing Radical Prostatectomy. Eur Urol Focus 2022; 9:309-316. [PMID: 36153227 DOI: 10.1016/j.euf.2022.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/29/2022] [Accepted: 09/08/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Predicting the risk of side-specific extracapsular extension (ECE) is essential for planning nerve-sparing radical prostatectomy (RP) in patients with prostate cancer (PCa). OBJECTIVE To externally validate available models for prediction of ECE. DESIGN, SETTING, AND PARTICIPANTS Sixteen models were assessed in a cohort of 737 consecutive PCa patients diagnosed via multiparametric magnetic resonance imaging (MRI)-targeted and systematic biopsies and treated with RP between January 2016 and November 2021 at eight referral centers. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Model performance was evaluated in terms of discrimination using area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA). RESULTS AND LIMITATIONS Overall, ECE was identified in 308/1474 (21%) prostatic lobes. Prostatic lobes with ECE had higher side-specific clinical stage on digital rectal examination and MRI, number of positive biopsy cores, and International Society of Urological Pathology grade group in comparison to those without ECE (all p < 0.0001). Less optimistic performance was observed in comparison to previous published studies, although the models described by Pak, Patel, Martini, and Soeterik achieved the highest accuracy (AUC ranging from 0.73 to 0.77), adequate calibration for a probability threshold <40%, and the highest net benefit for a probability threshold >8% on DCA. Inclusion of MRI-targeted biopsy data and MRI information in models improved patient selection and clinical usefulness. Using model-derived cutoffs suggested by their authors, approximately 15% of positive surgical margins could have been avoided. Some available models were not included because of missing data, which constitutes a limitation of the study. CONCLUSIONS We report an external validation of models predicting ECE and identified the four with the best performance. These models should be applied for preoperative planning and patient counseling. PATIENT SUMMARY We validated several tools for predicting extension of prostate cancer outside the prostate gland. These tools can improve patient selection for surgery that spares nerves affecting recovery of sexual potency after removal of the prostate. They could potentially reduce the risk of finding cancer cells at the edge of specimens taken for pathology, a finding that suggests that not all of the cancer has been removed.
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Affiliation(s)
- Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
| | | | - Elena Lievore
- Department of Urology, Clinique Saint-Augustin, Bordeaux, France; Department of Urology, IRCCS IEO Istituto Europeo di Oncologia, Milan, Italy
| | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giuseppe Chiacchio
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Valerio Beatrici
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Riccardo Mastroianni
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Truong An Nguyen
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium
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Zhu Z, Zhu Y, Xiao Y, Hu S. Indications for nerve-sparing surgery for radical prostatectomy: Results from a single-center study. Front Oncol 2022; 12:896033. [PMID: 35965515 PMCID: PMC9372405 DOI: 10.3389/fonc.2022.896033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose To explore the clinical indications of using the nerve-sparing technique in radical prostatectomy. Patients and methods We retrospectively analyzed the clinical and pathological data of 101 patients who underwent radical prostatectomy (RP) at our institution. Twenty-five patients underwent open surgery, and 76 patients underwent laparoscopic surgery. The biochemical recurrence (BCR) rate was analyzed by the method of Kaplan–Meier. The distance between the ipsilateral neurovascular bundles (NVBs) and foci of prostate tumor (N-T distance) was measured in postoperative specimens. We defined the N-T distance >2 mm as the threshold to perform nerve-sparing (NS) in RP. Through logistic regression analysis, we determined the preoperative clinical indications for the nerve-sparing technique in RP. Results The average BCR-free survival time was 53.2 months in these 101 patients with RP, with the 3- and 5-year BCR-free rates being 87.9% and 85.8%, respectively. The N-T distance was measured in 184 prostate sides from postoperative specimens of 101 patients. Univariate analysis showed that the percent of side-specific biopsy cores with cancer (≥1/3), maximum tumor length in biopsy core (≥5 mm), average percent involvement of each positive core (≥50%), PI-RADS score, and prostate MP-MRI imaging (extra-capsular extension) were associated with the N-T distance (p < 0.003). Furthermore, the percent of side-specific biopsy cores with cancer (≥1/3) (OR = 4.11, p = 0.0047) and prostate MP-MRI imaging (extra-capsular extension) (OR = 3.92, p = 0.0061) were found to be statistically significant independent predictors of the N-T distance in multivariate analysis. Conclusions The clinical indications of nerve-sparing RP were <1/3 side-specific biopsy cores with cancer and no extra-capsular extension by prostate MP-MRI examination.
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Affiliation(s)
- Zaisheng Zhu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
- *Correspondence: Zaisheng Zhu,
| | - Yiyi Zhu
- National Health Commission (NHC) Key Laboratory of Endocrinology, Department of Endocrinology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yunyuan Xiao
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
| | - Shengye Hu
- Department of Urology, Jinhua Hospital Affiliated to Zhejiang University School of Medicine, Jinhua, China
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7
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Moris L, Gandaglia G, Vilaseca A, Van den Broeck T, Briers E, De Santis M, Gillessen S, Grivas N, O'Hanlon S, Henry A, Lam TB, Lardas M, Mason M, Oprea-Lager D, Ploussard G, Rouviere O, Schoots IG, van der Poel H, Wiegel T, Willemse PP, Yuan CY, Grummet JP, Tilki D, van den Bergh RCN, Cornford P, Mottet N. Evaluation of Oncological Outcomes and Data Quality in Studies Assessing Nerve-sparing Versus Non-Nerve-sparing Radical Prostatectomy in Nonmetastatic Prostate Cancer: A Systematic Review. Eur Urol Focus 2021; 8:690-700. [PMID: 34147405 DOI: 10.1016/j.euf.2021.05.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/10/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
CONTEXT Surgical techniques aimed at preserving the neurovascular bundles during radical prostatectomy (RP) have been proposed to improve functional outcomes. However, it remains unclear if nerve-sparing (NS) surgery adversely affects oncological metrics. OBJECTIVE To explore the oncological safety of NS versus non-NS (NNS) surgery and to identify factors affecting the oncological outcomes of NS surgery. EVIDENCE ACQUISITION Relevant databases were searched for English language articles published between January 1, 1990 and May 8, 2020. Comparative studies for patients with nonmetastatic prostate cancer (PCa) treated with primary RP were included. NS and NNS techniques were compared. The main outcomes were side-specific positive surgical margins (ssPSM) and biochemical recurrence (BCR). Risk of bias (RoB) and confounding assessments were performed. EVIDENCE SYNTHESIS Out of 1573 articles identified, 18 studies recruiting a total of 21 654 patients were included. The overall RoB and confounding were high across all domains. The most common selection criteria for NS RP identified were characteristic of low-risk disease, including low core-biopsy involvement. Seven studies evaluated the link with ssPSM and showed an increase in ssPSM after adjustment for side-specific confounders, with the relative risk for NS RP ranging from 1.50 to 1.53. Thirteen papers assessing BCR showed no difference in outcomes with at least 12 mo of follow-up. Lack of data prevented any subgroup analysis for potentially important variables. The definitions of NS were heterogeneous and poorly described in most studies. CONCLUSIONS Current data revealed an association between NS surgery and an increase in the risk of ssPSM. This did not translate into a negative impact on BCR, although follow-up was short and many men harbored low-risk PCa. There are significant knowledge gaps in terms of how various patient, disease, and surgical factors affect outcomes. Adequately powered and well-designed prospective trials and cohort studies accounting for these issues with long-term follow-up are recommended. PATIENT SUMMARY Neurovascular bundles (NVBs) are structures containing nerves and blood vessels. The NVBs close to the prostate are responsible for erections. We reviewed the literature to determine if a technique to preserve the NVBs during removal of the prostate causes worse cancer outcomes. We found that NVB preservation was poorly defined but, if applied, was associated with a higher risk of cancer at the margins of the tissue removed, even in patients with low-risk prostate cancer. The long-term importance of this finding for patients is unclear. More data are needed to provide recommendations.
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Affiliation(s)
- Lisa Moris
- Department of Urology, University Hospitals Leuven, Leuven, Belgium.
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Antoni Vilaseca
- Uro-Oncology Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | | | - Maria De Santis
- Department of Urology, Charité University Hospital Berlin, Berlin, Germany; Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Nikos Grivas
- Department of Urology, Hatzikosta General Hospital, Ioannina, Greece
| | - Shane O'Hanlon
- Medicine for Older People, Saint Vincent's University Hospital, Dublin, Ireland
| | - Ann Henry
- Leeds Cancer Centre, St. James's University Hospital and University of Leeds, Leeds, UK
| | - Thomas B Lam
- Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Michael Lardas
- Department of Urology, Metropolitan General Hospital, Athens, Greece
| | - Malcolm Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, UK
| | - Daniela Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | | | - Olivier Rouviere
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ivo G Schoots
- Department of Radiology & Nuclear Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Radiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, Ulm, Germany
| | - Peter-Paul Willemse
- Department of Oncological Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cathy Y Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - Jeremy P Grummet
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center and Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - Philip Cornford
- Department of Urology, Liverpool University Hospitals NHS Trust, Liverpool, UK
| | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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Covas Moschovas M, Chew C, Bhat S, Sandri M, Rogers T, Dell'Oglio P, Roof S, Reddy S, Sighinolfi MC, Rocco B, Patel V. Association Between Oncotype DX Genomic Prostate Score and Adverse Tumor Pathology After Radical Prostatectomy. Eur Urol Focus 2021; 8:418-424. [PMID: 33757735 DOI: 10.1016/j.euf.2021.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 03/09/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The Oncotype DX assay is a clinically validated 17-gene genomic assay that provides a genomic prostate score (GPS; scale 0-100) measuring the heterogeneous nature of prostate tumors. The test is performed on prostate tissue collected during biopsy. There is a lack of data on the association between the GPS and tumor pathology after radical prostatectomy (RP). OBJECTIVE To investigate the association between GPS and final pathology, including extraprostatic extension (EPE), positive surgical margin (PSM), and seminal vesicle invasion (SVI). DESIGN, SETTING, AND PARTICIPANTS Data for the 749 patients who underwent Oncotype DX assay and RP at a referral prostate cancer center between 2015 and 2019 were retrospectively assessed to evaluate the association between GPS and unfavorable pathology parameters. INTERVENTION After a GPS genetic test, patients underwent robotic RP performed by the same surgeon. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Multivariable logistic regression analyses were performed to assess the association between GPS and EPE, PSM, and SVI. The models were adjusted for age, clinical stage, prostate-specific antigen (PSA) level, Gleason score, and time between the genomic assay and surgery. The median time between Oncotype DX assay and surgery was 176 d (interquartile range [IQR] 141-226). The median age was 63 yr (IQR 58-68), median GPS was 29 (IQR 21-39), and median PSA was 5.7 ng/ml (IQR 4.6-7.7). In multivariable analyses assessing the odds ratio (OR) per 20-point change in GPS, GPS was an independent predictor of EPE (OR 1.8, 95% confidence interval [CI] 1.4-2.3) and SVI (OR 2.1, 95% CI 1.3-3.4). In addition, when patients were grouped by GPS quartile, the percentage of cases with EPE and SVI increased with the GPS quartile. CONCLUSIONS We provide evidence that the Oncotype DX GPS is significantly associated with adverse pathology after RP. Specifically, the risk of EPE and SVI increases with the GPS. Therefore, use of the Oncotype DX GPS may help clinicians to improve preoperative patient counseling and develop surgical strategies for patients with a higher chance of EPE or unfavorable pathological features. PATIENT SUMMARY We studied whether the score for a prostate genetic test was associated with prostate cancer pathology findings for patients who had their prostate removed. We found that the risk of prostate cancer spread outside the gland and to the seminal vesicle increases with higher test scores. These findings may help surgeons in counseling patients on surgical options for prostate cancer.
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Affiliation(s)
| | - Christopher Chew
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Seetharam Bhat
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Marco Sandri
- Big and Open Data Innovation Laboratory, University of Brescia, Brescia, Italy
| | - Travis Rogers
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Paolo Dell'Oglio
- Department of Urology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Shannon Roof
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | - Sunil Reddy
- AdventHealth Global Robotics Institute, Celebration, FL, USA
| | | | | | - Vipul Patel
- AdventHealth Global Robotics Institute, Celebration, FL, USA
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Kim TH, Woo S, Han S, Suh CH, Ghafoor S, Hricak H, Vargas HA. The Diagnostic Performance of the Length of Tumor Capsular Contact on MRI for Detecting Prostate Cancer Extraprostatic Extension: A Systematic Review and Meta-Analysis. Korean J Radiol 2020; 21:684-694. [PMID: 32410407 PMCID: PMC7231615 DOI: 10.3348/kjr.2019.0842] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 01/06/2020] [Accepted: 02/09/2020] [Indexed: 01/23/2023] Open
Affiliation(s)
- Tae Hyung Kim
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Naval Pohang Hospital, Pohang, Korea
| | - Sungmin Woo
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
| | - Sangwon Han
- Department of Nuclear Medicine, Armed Forces Daejeon Hospital, Daejeon, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Korea
| | - Soleen Ghafoor
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Hedvig Hricak
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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10
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Çelik S, Aslan G, Sözen S, Özen H, Akdoğan B, Baltaci S, İzol V, Tansuğ Z, Türkeri L. Factors Affecting Surgical Margin Positivity after Radical Prostatectomy in the Turkish Population: A Multicenter Study of the Urooncology Association. Urol Int 2020; 104:724-730. [PMID: 32353851 DOI: 10.1159/000507268] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 03/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prediction of positive surgical margins (SM) after radical prostatectomy (RP) is important for planning the surgical modality and adjuvant therapy in patients with prostate cancer (PCa). OBJECTIVES To investigate factors affecting SM positivity in patients diagnosed with PCa who underwent RP using the PCa database of the Urooncology Association (Turkey). METHODS Patients who underwent RP due to clinically T1c-T3 PCa and who had detailed SM data for the RP specimen were included in the study. Pathological data of 12 core transrectal ultrasound prostate biopsies and RP were evaluated. Patients were divided into 2 groups (SM positive and SM negative) according to SM status after RP. Data were compared between the groups. Factors affecting SM positivity, the number of positive SM sites, and the location of positive SM were separately evaluated with regression models. RESULTS A total of 2,643 patients from 6 different centers (median age: 63 years) with a prostate-specific antigen (PSA) level of 7.3 ng/mL were investigated in the study. BMI, PSA, biopsy Gleason score (GS), and perineural invasion (PNI) were found to be independent predictive factors for SM positivity and the number of positive SM locations, respectively (p < 0.05). According to the positive SM location, PSA was found to be associated with positive SM in apex, anterior prostate, and bladder neck locations. Also, according to posterolateral SM status, PNI and nerve-sparing RP (nsRP) rates were 21.3 and 44% for patients with negative posterolateral SM, and rates were 35.4 and 50.6% for patients with positive posterolateral SM, respectively (p < 0.05). In patients who underwent nsRP, positive SM was present in 22.2% of patients who did not have PNI on prostate biopsy, whereas positive SM was present in 40.6% of patients with PNI (p < 0.001). Similarly, 10.9% of patients without PNI had positive posterolateral SM, whereas 17.3% of patients with PNI had positive posterolateral SM (p = 0.031). CONCLUSIONS BMI, PSA, biopsy GS, and biopsy PNI positivity were found to be predictive factors affecting SM positivity. The most important factors affecting posterolateral positive SM were biopsy PNI and nsRP, indicating that the nsRP approach may cause positive SM in the posterolateral margin of the prostate (neurovascular bundle location) in patients with positive PNI on biopsy.
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Affiliation(s)
- Serdar Çelik
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Health Sciences University, Izmir, Turkey, .,Department of Basic Oncology, Institute of Oncology, Dokuz Eylul University, Izmir, Turkey,
| | - Güven Aslan
- Department of Urology, Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Sinan Sözen
- Department of Urology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Haluk Özen
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Bülent Akdoğan
- Department of Urology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sümer Baltaci
- Department of Urology, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Volkan İzol
- Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Zühtü Tansuğ
- Department of Urology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Levent Türkeri
- Department of Urology, Acibadem Altunizade Hospital, Mehmet Ali Aydınlar University, Istanbul, Turkey
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11
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Is Extraprostatic Extension of Cancer Predictable? A Review of Predictive Tools and an External Validation Based on a Large and a Single Center Cohort of Prostate Cancer Patients. Urology 2019; 129:8-20. [DOI: 10.1016/j.urology.2019.03.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 11/20/2022]
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12
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Krishna S, Lim CS, McInnes MDF, Flood TA, Shabana WM, Lim RS, Schieda N. Evaluation of MRI for diagnosis of extraprostatic extension in prostate cancer. J Magn Reson Imaging 2017; 47:176-185. [PMID: 28387981 DOI: 10.1002/jmri.25729] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 03/23/2017] [Indexed: 12/24/2022] Open
Abstract
PURPOSE To assess the ability of magnetic resonance imaging (MRI) to diagnose extraprostatic extension (EPE) in prostate cancer. MATERIALS AND METHODS With Institutional Review Board (IRB) approval, 149 men with 170 ≥0.5 mL tumors underwent preoperative 3T MRI followed by radical prostatectomy (RP) between 2012-2015. Two blinded radiologists (R1/R2) assessed tumors using Prostate Imaging Reporting and Data System (PI-RADS) v2, subjectively evaluated for the presence of EPE, measured tumor size, and length of capsular contact (LCC). A third blinded radiologist, using MRI-RP-maps, measured whole-lesion: apparent diffusion coefficient (ADC) mean/centile and histogram features. Comparisons were performed using chi-square, logistic regression, and receiver operator characteristic (ROC) analysis. RESULTS The subjective EPE assessment showed high specificity (SPEC = 75.4/91.3% [R1/R2]), low sensitivity (SENS = 43.3/43.6% [R1/R2]), and area-under (AU) ROC curve = 0.67 (confidence interval [CI] 0.61-0.73) R1 and 0.61 (CI 0.53-0.70) R2; (k = 0.33). PI-RADS v2 scores were strongly associated with EPE (P < 0.001 / P = 0.008; R1/R2) with AU-ROC curve = 0.72 (0.64-0.79) R1 and 0.61 (0.53-0.70) R2; (k = 0.44). Tumors with EPE were larger (18.8 ± 7.8 [median 17, range 6-51] vs. 18.8 ± 4.9 [12, 6-28] mm) and had greater LCC (21.1 ± 14.9 [16, 1-85] vs. 13.6 ± 6.1 [11.5, 4-30] mm); P < 0.001 and 0.002, respectively. AU-ROC for size was 0.73 (0.64-0.80) and LCC was 0.69 (0.60-0.76), respectively. Optimal SENS/SPEC for diagnosis of EPE were: size ≥15 mm = 67.7/66.7% and LCC ≥11 mm = 84.9/44.8%. 10th -centile ADC and ADC entropy were both associated with EPE (P = 0.02 and < 0.001), with AU-ROC = 0.56 (0.47-0.65) and 0.76 (0.69-0.83), respectively. Optimal SENS/SPEC for diagnosis of EPE with entropy ≥6.99 was 63.3/75.0%. 25th -centile ADC trended towards being significantly lower with EPE (P = 0.06) with no difference in other ADC metrics (P = 0.25-0.88). Size, LCC, and ADC entropy improved sensitivity but reduced specificity compared with subjective analysis with no difference in overall accuracy (P = 0.38). CONCLUSION Measurements of tumor size, capsular contact, and ADC entropy improve sensitivity but reduce specificity for diagnosis of EPE compared to subjective assessment. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:176-185.
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Affiliation(s)
- Satheesh Krishna
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Christopher S Lim
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew D F McInnes
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Trevor A Flood
- Department of Anatomical Pathology, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Wael M Shabana
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Robert S Lim
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Medical Imaging, Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
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13
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Niroomand H, Nowroozi M, Ayati M, Jamshidian H, Arbab A, Momeni SA, Ghadian A, Ghorbani H. Relationship Between Perineural Invasion in Prostate Needle Biopsy Specimens and Pathologic Staging After Radical Prostatectomy. Nephrourol Mon 2016; 8:e36022. [PMID: 27635390 PMCID: PMC5011638 DOI: 10.5812/numonthly.36022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Accepted: 02/20/2016] [Indexed: 11/16/2022] Open
Abstract
Background Prostate cancer is the second most common malignancy among men worldwide and the sixth cause of cancer-related death. Some authors have reported a relationship between perineural invasion (PNI), Gleason score, and the invasion of peripheral organs during prostatectomy. However, it is not yet clear whether pathological evidence of PNI is necessary for risk stratification in selecting treatment type. Objectives The clinical and pathological stages of prostate cancer are compared in patients under radical prostatectomy and in patients without perineural invasion. Patients and Methods This cross-sectional study was conducted using a sample of 109 patients who attended a tertiary health care center from 2008 to 2013. The selection criteria were PNI in prostate biopsy with Gleason scores less than six, seven, and eight to ten. The participants were enrolled in a census manner, and they underwent clinical staging. After radical prostatectomy, the rates of pathological staging were compared. The under-staging and over-staging rates among those with and without perineural invasion in biopsy samples were compared. Results The concordance between Gleason scores according to biopsy and pathology was 36.7% (40 subjects). The concordance rate was 46.4% and 33.3% among those with and without PNI, respectively. The concordance rates were significantly varied in different subclasses of Gleason scores in patients without PNI (P = 0.003); the highest concordance rate was a Gleason score of 7 (63.6%) and the lowest was a Gleason score of eight to ten (25%). However, there were no significant differences in patients with PNI (P > 0.05). Conclusions Although the presence of PNI in prostate biopsy is accompanied by higher surgical stages, PNI is not an appropriate independent factor in risk stratification.
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Affiliation(s)
- Hassan Niroomand
- Imam Reza Hospital, AJA University of Medical Sciences, Tehran, IR Iran
| | - Mohammadreza Nowroozi
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mohsen Ayati
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Hassan Jamshidian
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Amir Arbab
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Seyed Ali Momeni
- Uro-Oncology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Ghadian
- Nephrology and Urology Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hamidreza Ghorbani
- Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran
- Corresponding author: Hamidreza Ghorbani, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IR Iran. Tel: +98-5138598946, E-mail:
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Newcomb LF, Thompson IM, Boyer HD, Brooks JD, Carroll PR, Cooperberg MR, Dash A, Ellis WJ, Fazli L, Feng Z, Gleave ME, Kunju P, Lance RS, McKenney JK, Meng MV, Nicolas MM, Sanda MG, Simko J, So A, Tretiakova MS, Troyer DA, True LD, Vakar-Lopez F, Virgin J, Wagner AA, Wei JT, Zheng Y, Nelson PS, Lin DW. Outcomes of Active Surveillance for Clinically Localized Prostate Cancer in the Prospective, Multi-Institutional Canary PASS Cohort. J Urol 2015; 195:313-20. [PMID: 26327354 DOI: 10.1016/j.juro.2015.08.087] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/18/2022]
Abstract
PURPOSE Active surveillance represents a strategy to address the overtreatment of prostate cancer, yet uncertainty regarding individual patient outcomes remains a concern. We evaluated outcomes in a prospective multicenter study of active surveillance. MATERIALS AND METHODS We studied 905 men in the prospective Canary PASS enrolled between 2008 and 2013. We collected clinical data at study entry and at prespecified intervals, and determined associations with adverse reclassification, defined as increased Gleason grade or greater cancer volume on followup biopsy. We also evaluated the relationships of clinical parameters with pathology findings in participants who underwent surgery after a period of active surveillance. RESULTS At a median followup of 28 months 24% of participants experienced adverse reclassification, of whom 53% underwent treatment while 31% continued on active surveillance. Overall 19% of participants received treatment, 68% with adverse reclassification, while 32% opted for treatment without disease reclassification. In multivariate Cox proportional hazards modeling the percent of biopsy cores with cancer, body mass index and prostate specific antigen density were associated with adverse reclassification (p=0.01, 0.04, 0.04, respectively). Of 103 participants subsequently treated with radical prostatectomy 34% had adverse pathology, defined as primary pattern 4-5 or nonorgan confined disease, including 2 with positive lymph nodes, with no significant relationship between risk category at diagnosis and findings at surgery (p=0.76). CONCLUSIONS Most men remain on active surveillance at 5 years without adverse reclassification or adverse pathology at surgery. However, clinical factors had only a modest association with disease reclassification, supporting the need for approaches that improve the prediction of this outcome.
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Affiliation(s)
- Lisa F Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington
| | - Ian M Thompson
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Hilary D Boyer
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Peter R Carroll
- University of California San Francisco, San Francisco, California
| | | | - Atreya Dash
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - Ladan Fazli
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ziding Feng
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Martin E Gleave
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Maxwell V Meng
- University of California San Francisco, San Francisco, California
| | - Marlo M Nicolas
- University of Texas Health Sciences Center at San Antonio, San Antonio, Texas
| | - Martin G Sanda
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jeffry Simko
- University of California San Francisco, San Francisco, California
| | - Alan So
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Jeff Virgin
- Veterans Affairs Puget Sound Health Care System, Seattle, Washington
| | | | - John T Wei
- University of Michigan, Ann Arbor, Michigan
| | - Yingye Zheng
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Peter S Nelson
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Daniel W Lin
- Fred Hutchinson Cancer Research Center, Seattle, Washington; University of Washington, Seattle, Washington; Veterans Affairs Puget Sound Health Care System, Seattle, Washington.
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15
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Lim C, Flood TA, Hakim SW, Shabana WM, Quon JS, El-Khodary M, Thornhill RE, El Hallani S, Schieda N. Evaluation of apparent diffusion coefficient and MR volumetry as independent associative factors for extra-prostatic extension (EPE) in prostatic carcinoma. J Magn Reson Imaging 2015; 43:726-36. [DOI: 10.1002/jmri.25033] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 08/05/2015] [Indexed: 12/24/2022] Open
Affiliation(s)
- Christopher Lim
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Trevor A. Flood
- The Ottawa Hospital, The University of Ottawa Department of Anatomical Pathology; Ottawa Ontario Canada
| | - Shaheed W. Hakim
- The Ottawa Hospital, The University of Ottawa Department of Anatomical Pathology; Ottawa Ontario Canada
| | - Wael M. Shabana
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Jeffrey S. Quon
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Mohamed El-Khodary
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Rebecca E. Thornhill
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
| | - Soufiane El Hallani
- The Ottawa Hospital, The University of Ottawa Department of Anatomical Pathology; Ottawa Ontario Canada
| | - Nicola Schieda
- The Ottawa Hospital, The University of Ottawa Department of Radiology, Civic Campus C1; Ottawa Ontario Canada
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17
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Abstract
PURPOSE OF REVIEW A variety of techniques have emerged for the optimization of prostate biopsy. In this review, we summarize and critically discuss the most recent developments regarding the optimal systematic biopsy and sampling labeling along with multiparametric MRI and magnetic resonance-targeted biopsies. RECENT FINDINGS The use of 10-12-core-extended sampling protocols increases cancer detection rates compared with traditional sextant sampling and reduces the likelihood that patients will require a repeat biopsy, ultimately allowing more accurate risk stratification without increasing the likelihood of detecting insignificant cancers. As the number of cores increases above 12 cores, the increase in diagnostic yield becomes marginal. However, the limitations of this technique include undersampling, oversampling, and the need for repetitive biopsy. MRI and magnetic resonance-targeted biopsies have demonstrated superiority over systematic biopsies for the detection of clinically significant disease and representation of disease burden, while deploying fewer cores and may have applications in men undergoing initial or repeat biopsy and those with low-risk cancer on or considering active surveillance. SUMMARY A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoidance of a repeat biopsy while minimizing the detection of insignificant prostate cancers. MRI-guided prostate biopsy has an evolving role in both initial and repeat prostate biopsy strategies, as well as active surveillance, potentially improving sampling efficiency, increasing the detection of clinically significant cancers, and reducing the detection of insignificant cancers.
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18
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Koie T, Mitsuzuka K, Yoneyama T, Narita S, Kawamura S, Kaiho Y, Tsuchiya N, Tochigi T, Habuchi T, Arai Y, Ohyama C, Yoneyama T, Tobisawa Y. Prostate-specific antigen density predicts extracapsular extension and increased risk of biochemical recurrence in patients with high-risk prostate cancer who underwent radical prostatectomy. Int J Clin Oncol 2014; 20:176-81. [PMID: 24771079 DOI: 10.1007/s10147-014-0696-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 04/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Patients with advanced local-stage, high-grade prostate cancer (Pca) and high pretreatment prostate-specific antigen (PSA) levels have inferior outcomes compared to their counterparts with more favorable clinical characteristics. However, some patients exhibit favorable pathological features or experience long-term PSA-free survival after radical prostatectomy (RP). We retrospectively examined the ability of preoperative characteristics to predict pathological and oncological outcomes in high-risk Pca patients who underwent RP. METHODS We examined data of 1,268 consecutive Pca patients treated with RP alone at 4 hospitals from the Michinoku Urological Cancer Study Group database. Preoperative predictors included age, PSA level, biopsy Gleason score, clinical T stage, and PSA density (PSAD). The outcome measures pathological T stage and PSA-free survival were evaluated by multivariate analysis. RESULTS We identified 380 high-risk Pca patients, of which 44 % patients had extracapsular extension. Logistic regression analysis indicated that PSAD was an independent predictor of adverse pathologic stage. The 5-year PSA-free survival rates were 82.9 % for patients with PSAD ≤0.468 ng mL(-1) cm(-2) and 50.7 % for those with PSAD >0.468 ng mL(-1) cm(-2) (P < 0.0001). Multivariate analyses revealed that PSAD, cT, and the number of preoperative high-risk Pca criteria were independent predictors of PSA-free survival. CONCLUSIONS PSAD may be an independent predictor of advanced pathological features and biochemical recurrence in high-risk Pca patients treated with RP alone. PSAD may be used for further risk stratification of high-risk Pca patients.
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Affiliation(s)
- Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, 5 Zaifucho, Hirosaki, 036-8562, Japan
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Park BH, Jeon HG, Jeong BC, Seo SI, Lee HM, Choi HY, Jeon SS. Influence of magnetic resonance imaging in the decision to preserve or resect neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. J Urol 2014; 192:82-8. [PMID: 24440235 DOI: 10.1016/j.juro.2014.01.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2014] [Indexed: 01/04/2023]
Abstract
PURPOSE We evaluated the accuracy of preoperative multiparametric 3.0-T magnetic resonance imaging for local staging of prostate cancer and its influence in the decision to preserve neurovascular bundles at robotic assisted laparoscopic radical prostatectomy. MATERIALS AND METHODS The study included 353 patients who had confirmed prostate cancer and underwent preoperative magnetic resonance imaging and robotic assisted laparoscopic radical prostatectomy between 2008 and 2011. The extent of neurovascular bundle sparing was initially determined on the basis of the clinical information and the nerve sparing surgical plan was reevaluated after review of the magnetic resonance imaging report. The value of preoperative magnetic resonance imaging in the prediction of extracapsular extension and in the decision of surgical plan according to D'Amico risk classification was analyzed. RESULTS The magnetic resonance imaging performed correct staging, over staging and under staging in 261 (73.9%), 43 (12.2%), and 49 (13.9%) patients, respectively. After review of the magnetic resonance imaging reports, the initial surgical plan was not changed in 260 patients (74%) and was changed in 93 patients (26%). Robotic assisted laparoscopic radical prostatectomy was changed to a more preservable neurovascular bundle sparing procedure in 53 patients (57%) and changed to a more aggressive neurovascular bundle resecting procedure in 40 patients (43%). For the patients with a change to more conservative surgery, the appropriateness was 91%. The sensitivity of magnetic resonance imaging in predicting extracapsular extension showed a tendency to increase from low to high risk groups (33%, 46%, 80%, respectively, p <0.001). In intermediate and high risk groups, there was a surgical plan change in 40 patients (of 129, 31%) and 27 patients (of 67, 40%), respectively. CONCLUSIONS Preoperative magnetic resonance imaging significantly improves the decision making to preserve or resect the neurovascular bundle at robotic assisted laparoscopic radical prostatectomy, which lacks haptic feedback.
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Affiliation(s)
- Bong Hee Park
- 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
| | - Byong 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
| | - Hyun Moo Lee
- 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
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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20
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Pak S, Park S, Ryu J, Hong S, Song SH, You D, Jeong IG, Song C, Hong JH, Kim CS, Ahn H. Preoperative factors predictive of posterolateral extracapsular extension after radical prostatectomy. Korean J Urol 2013; 54:824-9. [PMID: 24363862 PMCID: PMC3866284 DOI: 10.4111/kju.2013.54.12.824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 08/22/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose In radical prostatectomy (RP) procedures, sparing the neurovascular bundles adjacent to the posterolateral aspect of the prostatic fascia has often been suggested as a possible risk factor for positive surgical margins. Here we aimed to quantify the probability of extracapsular extension (ECE) at the posterolateral side of the prostate to aid in nerve-sparing decision making. Materials and Methods We evaluated 472 patients who underwent RP between July 2007 and January 2012. All patients underwent preoperative magnetic resonance imaging (MRI) with diffusion-weighted imaging and apparent diffusion coefficient mapping. We analyzed 944 side-specific prostate lobes with preoperative variables. To quantify the risk of side-specific posterolateral ECE after RP, we developed a risk-stratification scoring system through logistic regression analysis. Results Overall, 20.6% of 944 prostate lobes had ECE. In the multivariate analysis, prostate-specific antigen (PSA), biopsy Gleason score ≥7, percentage of side-specific cores with tumor, and posterolateral ECE on MRI were independent predictive factors of posterolateral ECE. On internal and external validation to calculate the predicted risk, the Hosmer-Lemeshow goodness-of-fit test showed good calibration (p=0.396). Conclusions PSA, biopsy Gleason score, percentage of side-specific cores with tumor, and posterolateral ECE on MRI are independent predictors of posterolateral ECE. The scoring system derived from this study will provide objective parameters for use when deciding if the neurovascular bundle can be safely spared.
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Affiliation(s)
- Sahyun Pak
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sejun Park
- Department of Urology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
| | - Jeman Ryu
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sungwoo Hong
- Department of Urology, Dankook University College of Medicine, Cheonan, Korea
| | - Sang Hoon Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dalsan You
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Gab Jeong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jun Hyuk Hong
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choung-Soo Kim
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hanjong Ahn
- Department of Urology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Focal therapy for prostate cancer is a nascent and emerging field. As such, the patient selection criteria for this new treatment paradigm are evolving in parallel to both the technology on which this approach depends and to our unfolding understanding of the natural history of prostate cancer. Until, and while, prospective trials of focal therapy are being reported, patient selection criteria will be flexible and very dependent on the therapeutic goals. We must carefully define the therapeutic intentions of focal therapy before engaging in the actual process of determining optimal patient selection. The therapeutic intent will define the most appropriate candidate for such therapy. Patient selection encompasses multiple complex issues including the type of prostate biopsy (12 core transrectal versus mapping transperineal) to the type of imaging (multiparametric magnetic resonance imaging or enhanced ultrasound) to the specific anatomical location of the disease within the prostate (apex, mid-prostate, base) and a comprehensive assessment of the patient's overall health and life expectancy. It is not as simple as saying a patient with a certain grade or a certain number of cores is or is not appropriate for focal therapy. There are many more considerations for a reasonable and thoughtful approach to this new treatment.
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Affiliation(s)
- John F Ward
- Associate Professor, Department of Urology, The University of Texas, MD Anderson Cancer Center, Houston, TX 77030, USA
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Lin DW, Newcomb LF, Brown EC, Brooks JD, Carroll PR, Feng Z, Gleave ME, Lance RS, Sanda MG, Thompson IM, Wei JT, Nelson PS. Urinary TMPRSS2:ERG and PCA3 in an active surveillance cohort: results from a baseline analysis in the Canary Prostate Active Surveillance Study. Clin Cancer Res 2013; 19:2442-50. [PMID: 23515404 DOI: 10.1158/1078-0432.ccr-12-3283] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE Active surveillance is used to manage low-risk prostate cancer. Both PCA3 and TMPRSS2:ERG are promising biomarkers that may be associated with aggressive disease. This study examines the correlation of these biomarkers with higher cancer volume and grade determined at the time of biopsy in an active surveillance cohort. EXPERIMENTAL DESIGN Urine was collected after digital rectal examination prospectively as part of the multi-institutional Canary Prostate Active Surveillance Study (PASS). PCA3 and TMPRSS2:ERG levels were analyzed in urine collected at study entry. Biomarker scores were correlated to clinical and pathologic variables. RESULTS In 387 men, both PCA3 and TMPRSS2:ERG scores were significantly associated with higher volume disease. For a negative repeat biopsy, and 1% to 10%, 11% to 33%, 34% or more positive cores, median PCA3, and TMPRSS2:ERG scores increased incrementally (P < 0.005). Both PCA3 and TMPRSS2:ERG scores were also significantly associated with the presence of high-grade disease. For a negative repeat biopsy, Gleason 6 and Gleason ≥7 cancers, the median PCA3, and TMPRSS2:ERG scores also increased incrementally (P = 0.02 and P = 0.001, respectively). Using the marker scores as continuous variables, the ORs for a biopsy in which cancer was detected versus a negative repeat biopsy (ref) on modeling was 1.41 (95% CI: 1.07-1.85), P = 0.01 for PCA3 and 1.28 (95% CI: 1.10-1.49), P = 0.001 for TMPRSS2:ERG. CONCLUSIONS For men on active surveillance, both PCA3 and TMPRSS2:ERG seem to stratify the risk of having aggressive cancer as defined by tumor volume or Gleason score.
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Affiliation(s)
- Daniel W Lin
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Cozzi G, Rocco BM, Grasso A, Rosso M, Abed El Rahman D, Oliva I, Talso M, Costa B, Tafa A, Palumbo C, Gadda F, Rocco F. Perineural invasion as a predictor of extraprostatic extension of prostate cancer: a systematic review and meta-analysis. Scand J Urol 2013; 47:443-8. [PMID: 23495828 DOI: 10.3109/21681805.2013.776106] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A systematic review of the literature was performed to assess the relationship between the presence of perineural invasion (PNI) at prostate biopsy and extraprostatic extension (EPE) of prostate cancer. In August 2012, Medline, Embase, Scopus and Web of Science databases were searched. A "free-text" protocol using the terms "perineural invasion prostate cancer" was applied. Studies published only as abstracts and reports from meetings were not included in this review. In total, 341 records were retrieved from Medline, 507 from Embase, 374 from Scopus and 65 from the Web of Science database. The records were reviewed to identify studies correlating the presence of PNI with that of EPE. A cumulative analysis was conducted using Review Manager software v. 5.1 (Cochrane Collaboration, Oxford, UK). In univariate analysis, PNI showed a statistically significant association with pT3 tumours (p < 0.00001), which could be observed for both pT3a (p < 0.0001) and pT3b (p < 0.0001). In conclusion, the cumulative analysis shows a statistically significant higher incidence of EPE in patients who had PNI at needle biopsy. The main limitation of the analysis was that it was not possible to perform a multivariate analysis. Further attempts to build a nomogram for the prediction of EPE could include the presence of PNI at needle biopsy.
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Affiliation(s)
- Gabriele Cozzi
- Università degli Studi di Milano, Clinica Urologica I, Fondazione IRCCS, Ca' Granda - Ospedale Maggiore Policlinico , Milan , Italy
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24
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Bjurlin MA, Carter HB, Schellhammer P, Cookson MS, Gomella LG, Troyer D, Wheeler TM, Schlossberg S, Penson DF, Taneja SS. Optimization of initial prostate biopsy in clinical practice: sampling, labeling and specimen processing. J Urol 2013; 189:2039-46. [PMID: 23485507 DOI: 10.1016/j.juro.2013.02.072] [Citation(s) in RCA: 144] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE An optimal prostate biopsy in clinical practice is based on a balance among adequate detection of clinically significant prostate cancers (sensitivity), assuredness regarding the accuracy of negative sampling (negative predictive value), limited detection of clinically insignificant cancers and good concordance with whole gland surgical pathology results to allow accurate risk stratification and disease localization for treatment selection. Inherent within this optimization is variation of the core number, location, labeling and processing for pathological evaluation. To date, there is no consensus in this regard. The purpose of this review is to 1) define the optimal number and location of biopsy cores during primary prostate biopsy among men with suspected prostate cancer, 2) define the optimal method of labeling prostate biopsy cores for pathological processing which will provide relevant and necessary clinical information for all potential clinical scenarios, and 3) determine the maximal number of prostate biopsy cores allowable within a specimen jar which would not preclude accurate histological evaluation of the tissue. MATERIALS AND METHODS A bibliographic search using PubMed® covering the period up to July 2012 yielded approximately 550 articles. Articles were reviewed and categorized based on which of the 3 objectives of this review was addressed. Data were extracted, analyzed and summarized. Recommendations are provided based on this literature review and our clinical experience. RESULTS The use of 10 to 12-core extended sampling protocols increases cancer detection rates compared to traditional sextant sampling methods and reduces the likelihood of repeat biopsy by increasing negative predictive value, ultimately allowing more accurate risk stratification without increasing the likelihood of detecting insignificant cancers. As the number of cores increases above 12, the increase in diagnostic yield becomes marginal. Only limited evidence supports the use of initial biopsy schemes involving more than 12 cores or saturation. Apical and laterally directed sampling of the peripheral zone increases cancer detection rate, reduces the need for repeat biopsies and predicts pathological features on prostatectomy while transition zone biopsies do not. There are little data to suggest that knowing the exact site of an individual positive biopsy core provides meaningful clinical information. However, determining laterality of cancer on biopsy may be helpful for predicting sites of extracapsular extension and therapeutic planning. Placement of multiple biopsy cores in a single container (greater than 2) appears to compromise pathological evaluation, which can reduce cancer detection rate and increase the likelihood of equivocal diagnoses. CONCLUSIONS A 12-core systematic biopsy that incorporates apical and far-lateral cores in the template distribution allows maximal cancer detection, avoids repeat biopsy, and provides information adequate for identifying men who need therapy and planning that therapy while minimizing the detection of occult, indolent prostate cancers. This literature review does not provide compelling evidence that individual site specific labeling of cores benefits clinical decision making regarding the management of prostate cancer. Based on the available literature, we recommend packaging no more than 2 cores in each jar to avoid reduction of the cancer detection rate through inadequate tissue sampling.
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Affiliation(s)
- Marc A Bjurlin
- Division of Urologic Oncology, Department of Urology, New York University Langone Medical Center, New York, New York 10016, USA
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Osunkoya AO, Grignon DJ. Practical issues and pitfalls in staging tumors of the genitourinary tract. Semin Diagn Pathol 2012; 29:154-66. [DOI: 10.1053/j.semdp.2011.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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Oh JJ, Hong SK, Lee JK, Lee BK, Lee S, Kwon OS, Byun SS, Lee SE. Prostate-specific antigen vs prostate-specific antigen density as a predictor of upgrading in men diagnosed with Gleason 6 prostate cancer by contemporary multicore prostate biopsy. BJU Int 2012; 110:E494-9. [DOI: 10.1111/j.1464-410x.2012.11182.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anatomic Grading of Nerve Sparing During Robot-Assisted Radical Prostatectomy. Eur Urol 2012; 61:796-802. [DOI: 10.1016/j.eururo.2011.12.048] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 12/23/2011] [Indexed: 11/23/2022]
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Nerve-sparing robotic prostatectomy in preoperatively high-risk patients is safe and efficacious. Urol Oncol 2012; 30:26-32. [DOI: 10.1016/j.urolonc.2009.11.023] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2009] [Revised: 11/23/2009] [Accepted: 11/23/2009] [Indexed: 11/23/2022]
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Chang JS, Choi H, Chang YS, Kim JB, Oh MM, Moon DG, Bae JH, Cheon J. Prostate-Specific Antigen Density as a Powerful Predictor of Extracapsular Extension and Positive Surgical Margin in Radical Prostatectomy Patients with Prostate-Specific Antigen Levels of Less than 10 ng/ml. Korean J Urol 2011; 52:809-14. [PMID: 22216391 PMCID: PMC3246511 DOI: 10.4111/kju.2011.52.12.809] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Accepted: 09/20/2011] [Indexed: 11/18/2022] Open
Abstract
Purpose To assess the ability of preoperative variables to predict extracapsular extension (ECE) and positive surgical margin (PSM) in radical prostatectomy patients with prostate-specific antigen (PSA) levels of less than 10 ng/ml. Materials and Methods From January 2008 to December 2009, 121 patients with prostate cancer with PSA levels lower than 10 ng/ml who underwent radical prostatectomy were enrolled in the study. The differences in clinical factors (age, PSA, PSA density [PSAD], digital rectal examination [DRE] positivity, positive magnetic resonance imaging [MRI], Gleason sum, positive core number, and positive biopsy core percentage) with ECE and the presence of positive margins were determined and their independent predictive significances were analyzed. Results The ECE-positive patients had higher PSA, PSAD, and MRI-positive percentages, and PSM patients had higher PSA, PSAD, MRI-positive percentages, Gleason sum, and positive biopsy core percentages for prostate cancer. In the multivariate analysis, PSAD and MRI positivity were the best independent predictors for ECE, and PSA and PSAD were the best independent predictors of PSM. By receiver operating characteristic curve analysis, PSAD had better discriminative area under the curve value than did PSA for ECE (0.765 vs 0.661) and PSM (0.780 vs 0.624). The best predictive PSAD value was 0.29 ng/ml/cc for ECE and 0.27 ng/ml/cc for PSM. Conclusions PSAD has relevance to ECE (plus MRI findings) and PSM (plus PSA). PSAD might be a powerful predictor of ECE and PSM preoperatively in patients undergoing a radical prostatectomy with PSA levels of less than 10 ng/ml.
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Affiliation(s)
- Jin-Seok Chang
- Department of Urology, Konyang Universtiy College of Medicine, Daejeon, Korea
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30
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Kim SJ, Park CM, Seong KT, Kim SY, Kim HK, Park JY. pT3 Predictive Factors in Patients with a Gleason Score of 6 in Prostate Biopsies. Korean J Urol 2011; 52:598-602. [PMID: 22025953 PMCID: PMC3198231 DOI: 10.4111/kju.2011.52.9.598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/03/2011] [Indexed: 12/13/2022] Open
Abstract
Purpose Often, a diagnosis of pT3 is made on the basis of radical retropubic prostatectomy specimens, despite a Gleason score of 6 on the preoperative prostate biopsy. Thus, we investigated the preoperative variables in patients displaying these characteristics. Materials and Methods Study subjects comprised patients at our institute from 1996 to July 2010 who had exhibited a Gleason score of 6 on their prostate biopsies and had undergone a radical retropubic prostatectomy. Through univariate and multivariate analysis, we investigated pT3 predictive factors including age, preoperative prostate-specific antigen (PSA) levels, transrectal ultrasonography (TRUS)-weighted prostate volume, digital rectal examination findings, bilaterality via prostate biopsy, prostatic cancer in prostate base cores via prostate biopsy, maximum length and percent of prostatic cancer, and number of cores detected in prostatic cancer via prostate biopsy. Results In the univariate logistic regression mode, a PSA value of 7.4 ng/ml or higher, TRUS-weighted PSA density of 0.2 ng/ml/cc or higher, prostate cancer detected in the basal core, and prostate cancer detected in 2 or more cores out of 12 were predictive factors for extraprostatic extension. Independent predictive factors for stage pT3 were a PSA of 7.4 ng/ml or higher and prostate cancer detected in 2 or more cores out of 12. Conclusions In the case of patients with the foregoing risk factors, it is advisable not to perform nerve-sparing surgery but to prepare for the possibility of a pT3 stage.
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Affiliation(s)
- Sung Jin Kim
- Department of Urology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
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Specimen orientation by marking the peripheral end: (potential) clinical advantages in prostate biopsy. Prostate Cancer 2011; 2011:270403. [PMID: 22096654 PMCID: PMC3200280 DOI: 10.1155/2011/270403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 05/25/2011] [Indexed: 11/30/2022] Open
Abstract
The aim of this paper is to identify advantages that could be obtained by orientation of the biopsy specimen using the marking technique. We reviewed our experience (4,500 cases) and the published literature. The peripheral (proximal) end of the fresh specimen is marked with ink soon after needle delivering in a few minutes. It is performed easily in association with pre-embedding method.
Five potential clinical advantages were identified: (1) tumor localization, (2) atypical lesions localization and planning rebiopsy strategy, (3) planning surgical strategy, (4) selection criteria for focal therapy and active surveillance, and (5) cost reduction. Peripheral end marking is low cost, easy and reproducible. It drives several potential advantages in cancer diagnosis or isolated atypical lesions, in particular, spatial localization within the biopsy (transition versus peripheral zone, anterior versus posterior, subcapsular versus intraparenchima, and extraprostatic extension) should be easy and reliable. We can add a new pathological parameter: pathological orientation or biopsy polarity.
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What is the optimal management of high risk, clinically localized prostate cancer? Urol Oncol 2010; 28:557-67. [PMID: 20816616 DOI: 10.1016/j.urolonc.2009.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Revised: 12/14/2009] [Accepted: 12/15/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To summarize the presentations and debate regarding the optimal treatment of localized high-risk prostate cancer as presented at the 2009 Spring Meeting of the Society of Urologic Oncology. MATERIALS AND METHODS The debate was centered on presentations arguing for radical prostatectomy (RP) or radiotherapy as the optimal treatment for this condition. The meeting presentations are summarized by their respective presenters herein. RESULTS Dr. James Eastham presents the varied definitions for "high-risk" prostate cancer as strongly influencing which patients end up in this cohort. Based upon this, between 3% and 38% of patients with high-risk features could be defined as "high-risk". Despite that, these men do not have a uniformly poor prognosis after RP, and attention to surgical principles as outlined improve outcomes. Disease-specific survival at 12 years is excellent and up to one-half of these men may not need adjuvant or salvage therapies, depending on their specific disease characteristics. Adjuvant or salvage radiotherapies improve outcomes and are part of a sequential approach to treating these patients. Dr. Anthony Zietman presented radiotherapy as the gold-standard based upon large, randomized clinical trials of intermediate- and high-risk prostate cancer patients. Compared with androgen deprivation alone, the addition of radiotherapy provided a 12% cancer-specific survival advantage and 10% overall survival advantage. Dose escalation seems to confer further improvements in cancer control without significant escalation of toxicities, with more data forthcoming. CONCLUSIONS There are no randomized trials comparing RP to radiotherapy for any risk category. In high-risk prostate cancer patients, both approaches have potential benefits and cumulative toxicities that must be matched to disease characteristics and patient expectations in selecting a treatment course.
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Correa JJ, Pow-Sang JM. Optimizing Cancer Control and Functional Outcomes following Robotic Prostatectomy. Cancer Control 2010; 17:233-44. [DOI: 10.1177/107327481001700404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Background Since robotic-assisted laparoscopic radical prostatectomy was introduced, different modifications in the technique have been described to improve cancer control and minimize the possibility of erectile dysfunction and incontinence. Methods We reviewed the recent English literature on specific topics including when to preserve the neurovascular bundle (NVB), and we describe techniques to diminish the rate of positive margins and to preserve continence and potency. Results Identifying predictor factors of local advanced disease helps in deciding when to preserve the NVB without compromising cancer control. Techniques to decrease the positive margins based on experience and modifications of the apical dissection are reviewed. Minimal disruption or reconstruction of the anatomic structures of the periprostatic tissues helps to maintain continence. Different degrees of NVB preservation can be performed based on the characteristics of the cancer. Cautery-free techniques and other modifications in the dissection to minimize the NVB injury are also discussed. Conclusions The understanding of the predictor factors of local advanced disease, together with modifications in the technique, helps to not only achieve cancer control but also improve quality of life after robotic-assisted laparoscopic radical prostatectomy.
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Affiliation(s)
- Joséa J. Correa
- Department of Genitourinary Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Julio M. Pow-Sang
- Department of Genitourinary Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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Chung JS, Choi HY, Song HR, Byun SS, Seo SI, Song C, Cho JS, Lee SE, Ahn H, Lee ES, Kim WJ, Chung MK, Jung TY, Yu HS, Choi YD. Preoperative nomograms for predicting extracapsular extension in Korean men with localized prostate cancer: a multi-institutional clinicopathologic study. J Korean Med Sci 2010; 25:1443-8. [PMID: 20890424 PMCID: PMC2946653 DOI: 10.3346/jkms.2010.25.10.1443] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 04/30/2010] [Indexed: 11/29/2022] Open
Abstract
We developed a nomogram to predict the probability of extracapsular extension (ECE) in localized prostate cancer and to determine when the neurovascular bundle (NVB) may be spared. Total 1,471 Korean men who underwent radical prostatectomy for prostate cancer between 1995 and 2008 were included. We drew nonrandom samples of 1,031 for nomogram development, leaving 440 samples for nomogram validation. With multivariate logistic regression analyses, we made a nomogram to predicts the ECE probability at radical prostatectomy. Receiver operating characteristic (ROC) analyses were also performed to assess the predictive value of each variable alone and in combination. The internal validation was performed from 200 bootstrap re-samples and the external validation was also performed from the another cohort. Overall, 314 patients (30.5%) had ECE. Age, Prostate specific antigen (PSA), biopsy Gleason score, positive core ratio, and maximum percentage of biopsy tumor were independent predictors of the presence of ECE (all P values <0.05). The nomogram predicted ECE with good discrimination (an area under the ROC curve of 0.777). Our nomogram allows for the preoperative identification of patients with an ECE and may prove useful in selecting patients to receive nerve sparing radical prostatectomy.
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Affiliation(s)
- Jae Seung Chung
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Han Yong Choi
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Ryoung Song
- Department of Biostatistics and Research Affairs, Yonsei University College of Medicine, Seoul, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong il Seo
- Department of Urology, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheryn Song
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin Seon Cho
- Department of Urology, Hallym University College of Medicine, Chuncheon, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hanjong Ahn
- Department of Urology, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun Sik Lee
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
| | - Won-Jae Kim
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Moon Kee Chung
- Department of Urology, Pusan National University School of Medicine, Busan, Korea
| | - Tae Young Jung
- Department of Urology, Seoul Veterans Hospital, Seoul, Korea
| | - Ho Song Yu
- Department of Urology, Inje University Haeundae Paik Hospital, Busan, Korea
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Billis A, Quintal MMD, Meirelles L, Freitas LLL, Magna LA, Ferreira U. Does tumor extent on needle prostatic biopsies influence the value of perineural invasion to predict pathologic stage > T2 in radical prostatectomies? Int Braz J Urol 2010; 36:439-47; discussion 448, 448-9. [DOI: 10.1590/s1677-55382010000400007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2010] [Indexed: 11/21/2022] Open
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36
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37
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Hashimoto K, Hisasue SI, Masumori N, Kobayashi K, Kato R, Fukuta F, Takahashi A, Hasegawa T, Tsukamoto T. Clinical Safety and Feasibility of a Newly Developed, Simple Algorithm for Decision-making on Neurovascular Bundle Preservation in Radical Prostatectomy. Jpn J Clin Oncol 2009; 40:343-8. [DOI: 10.1093/jjco/hyp157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Namiki S, Ishidoya S, Tochigi T, Ito A, Arai Y. Quality of life after radical prostatectomy in elderly men. Int J Urol 2009; 16:813-9. [DOI: 10.1111/j.1442-2042.2009.02371.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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39
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Uro-Onkologie – Update 2009. Urologe A 2009; 48:1056-8. [DOI: 10.1007/s00120-009-2083-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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40
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Loeb S, Epstein JI, Humphreys EB, Walsh PC. Does perineural invasion on prostate biopsy predict adverse prostatectomy outcomes? BJU Int 2009; 105:1510-3. [PMID: 19694710 DOI: 10.1111/j.1464-410x.2009.08845.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the relationship between perineural invasion (PNI) on prostate biopsy and radical prostatectomy (RP) outcomes in a contemporary RP series, as there is conflicting evidence on the prognostic significance of PNI in prostate needle biopsy specimens. PATIENTS AND METHODS From 2002 to 2007, 1256 men had RP by one surgeon. Multivariable logistic regression and Cox proportional hazards models were used to examine the relationship of PNI with pathological tumour features and biochemical progression, respectively, after adjusting for prostate-specific antigen level, clinical stage and biopsy Gleason score. Additional Cox models were used to examine the relationship between nerve-sparing and biochemical progression among men with PNI. RESULTS PNI was found in 188 (15%) patients, and was significantly associated with aggressive pathology and biochemical progression. On multivariate analysis, PNI was significantly associated with extraprostatic extension and seminal vesicle invasion (P < 0.001). Biochemical progression occurred in 10.5% of patients with PNI, vs 3.5% of those without PNI (unadjusted hazard ratio 3.12, 95% confidence interval 1.77-5.52, P < 0.001). However, PNI was not a significant independent predictor of biochemical progression on multivariate analysis. Finally, nerve-sparing did not adversely affect biochemical progression even among men with PNI. CONCLUSION PNI is an independent risk factor for aggressive pathology features and a non-independent risk factor for biochemical progression after RP. However, bilateral nerve-sparing surgery did not compromise the oncological outcomes for patients with PNI on biopsy.
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Affiliation(s)
- Stacy Loeb
- James Buchanan Brady Urological Institute and the Department of Urology, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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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.
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Affiliation(s)
- N Wondergem
- Department of Urology, Academic Medical Center, Amsterdam, the Netherlands.
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Yadav R, Tu JJ, Jhaveri J, Leung RA, Rao S, Tewari AK. Prostate volume and the incidence of extraprostatic extension: is there a relation? J Endourol 2009; 23:383-6. [PMID: 19193138 DOI: 10.1089/end.2008.0247] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Extraprostatic extension (EPE) of tumor is an important prognostic indicator that has an impact on long-term survival after radical prostatectomy. We investigated whether the prostate size has any association with the tumor volume and the incidence of EPE. PATIENTS AND METHODS Seven hundred consecutive robot-assisted radical prostatectomy procedures performed by a single surgeon at a single center were studied. Preoperative parameters (demographic details, prostate-specific antigen (PSA) level, biopsy characteristics, and tumor volume) and the postoperative histopathologic details of the specimen (prostate volume, Gleason sum, EPE, and surgical margin status) were compared among the small prostate (< 40 cc), intermediate size (40-70 cc), and large prostate (> 70 cc) groups. Chi-square analysis was performed for comparison of groups with nominal variables while continuous variables were compared using analysis of variance. A double-sided P value of less than 0.05 was considered statistically significant. RESULTS A greater proportion of patients in the large prostate group had T(1c) tumor compared with those in the small prostate group (90.2% v 78.3%). Younger men and smaller prostates had lower preoperative PSA levels (P < 0.001). A significantly higher PSA density (0.16 v 0.07) and cancer density (0.0102 v 0.0025), however, was observed in patients with small prostates compared with those with large prostates. A total of 102 (14.6%) patients had EPE on the final pathologic analysis while 8.6% of the patients had positive surgical margins. Greater incidence of EPE was observed in the group with smaller prostates compared to those in the large prostate group (16.7% v 7.3%). CONCLUSION Small prostates have a higher cancer density and a greater incidence of EPE of tumor.
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Affiliation(s)
- Rajiv Yadav
- Department of Urology and Urologic Oncologic Outcomes, Weill Medical College of Cornell University, New York, New York 10021, USA
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Bivalacqua TJ, Pierorazio PM, Su LM. Open, laparoscopic and robotic radical prostatectomy: optimizing the surgical approach. Surg Oncol 2009; 18:233-41. [PMID: 19286370 DOI: 10.1016/j.suronc.2009.02.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
As advances in the understanding of prostatic anatomy led to improvements in functional and oncologic outcomes after prostatectomy of the past few decades, advances in technology and surgical technique have made minimally-invasive prostate surgery a reality. Today patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past including open, laparoscopic and robot-assisted laparoscopic radical prostatectomy. Advantages and disadvantages exist for each modality and lead to subtle differences in the technical execution of the procedure. Evidence from centers of excellence and from experienced surgeons demonstrates that both laparoscopic and robotic-assisted laparoscopic radical prostatectomy appear to be comparable to outcomes achieved with open radical retropubic prostatectomy series. Individual surgeon skill, experience and clinical judgment are likely the stronger predictors of outcome rather than the technique chosen. However, learning curves, oncologic outcomes and cost-efficacy remain important considerations in the dissemination of minimally-invasive prostate surgery. A greater appreciation of the periprostatic anatomy and further modification of surgical technique will result in continued improvement in functional outcomes and oncological control for patients undergoing radical prostatectomy, whether by open or minimally-invasive surgery.
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Affiliation(s)
- Trinity J Bivalacqua
- James Buchanan Brady Urological Institute, The Johns Hopkins Medical Institution, Baltimore, MD, United States
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Abstract
The surgical treatment of prostate cancer ideally removes the entire cancer, avoids excessive blood loss or serious perioperative complications, and results in complete recovery of continence and potency. To achieve this, the surgeon must excise sufficient periprostatic tissue to cure the cancer while preserving the cavernosal nerves required for erectile function and the neuromusculature required for normal urinary and bowel function. Here we will examine recent trends in radical prostatectomy, focusing on surgical technique.
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Affiliation(s)
- James Eastham
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
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Prediction of Extraprostatic Extension in Men With Biopsy Gleason Score of 8 or Greater. J Urol 2008; 180:2441-5; discussion 2445-6. [DOI: 10.1016/j.juro.2008.08.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Indexed: 11/20/2022]
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High Anterior Release of the Levator Fascia Improves Sexual Function Following Open Radical Retropubic Prostatectomy. J Urol 2008; 180:2557-64; discussion 2564. [DOI: 10.1016/j.juro.2008.08.047] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Namiki S, Ishidoya S, Ito A, Kawamura S, Tochigi T, Saito S, Arai Y. Quality of life after radical prostatectomy in Japanese men: a 5-Year follow up study. Int J Urol 2008; 16:75-81. [PMID: 19054169 DOI: 10.1111/j.1442-2042.2008.02197.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To measure health-related quality of life (HRQOL) after radical prostatectomy (RP) in Japanese men with localized prostate cancer. METHODS A total of 154 patients who underwent RP were included in this 5-year longitudinal survey. The Short Form 36-Item Health Survey, the University of California, Los Angeles, Prostate Cancer Index and the International Prostate Symptom Score questionnaires were administered at diagnosis and nine times afterwards. RESULTS Patients undergoing RP showed problems in some physical domains of general HRQOL, but these problems diminished over time. Mental health and social functions significantly improved during the follow-up period. The urinary function substantially declined at 3 months and continued to recover gradually but never returned to baseline. Most patients (95%) recovered to their baseline urinary bother score within 60 months. The overall mean total International Prostate Symptom Score progressively improved with time. On the other hand, at 60 months after RP, only 34% of subjects had fully returned to baseline sexual function. By 5 years postoperatively, 78% of the men had reached baseline sexual bother and the mean recovery time was 8.6 months. Adverse effects of RP on sexual function and bother were mitigated by bilateral nerve-sparing procedures up to 5 years after the operation. CONCLUSIONS Despite reported problems with sexuality and urinary continence, general HRQOL was mostly unaffected by RP after 6 months in our survey with functional outcomes remaining relatively stable in the majority of patients.
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Affiliation(s)
- Shunichi Namiki
- Department of Urology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Numao N, Kawakami S, Yonese J, Koga F, Saito K, Fujii Y, Ishikawa Y, Fukui I, Kihara K. Three-dimensional 26-core biopsy-based patient selection criteria for nerve-sparing radical prostatectomy. Int J Urol 2008; 15:1061-6. [DOI: 10.1111/j.1442-2042.2008.02162.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Yossepowitch O, Bjartell A, Eastham JA, Graefen M, Guillonneau BD, Karakiewicz PI, Montironi R, Montorsi F. Positive surgical margins in radical prostatectomy: outlining the problem and its long-term consequences. Eur Urol 2008; 55:87-99. [PMID: 18838211 DOI: 10.1016/j.eururo.2008.09.051] [Citation(s) in RCA: 182] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2008] [Accepted: 09/23/2008] [Indexed: 11/28/2022]
Abstract
CONTEXT This review focuses on positive surgical margins (PSM) in radical prostatectomy (RP). OBJECTIVE To address the etiology, incidence, and oncologic impact of PSM and discuss technical points to help surgeons minimize their positive margin rate. An evidence-based approach to assist clinicians in counseling patients with a PSM is provided. EVIDENCE ACQUISITION A literature search in English was performed using the National Library of Medicine database and the following key words: prostate cancer, surgical margins, and radical prostatectomy. Seven hundred sixty-eight references were scrutinized, and 73 were selected for rigorous review based on their pertinence, study size, and overall contribution to the field. EVIDENCE SYNTHESIS In contemporary series, PSM are reported in 11-38% of patients undergoing RP. Although variability exists in the pathologic interpretation of surgical margins, PSM are associated with an increased hazard of biochemical recurrence (BCR) and local disease recurrence as well as the need for secondary cancer treatment. A posterolateral PSM appears to confer the greatest risk of recurrence, whereas the prognostic significance of positive apical margins remains controversial. The role of preoperative imaging and intraoperative frozen section analysis are being investigated to reduce margin positivity rates. Level-1 evidence indicates that adjuvant radiotherapy (RT) in men with PSM reduces BCR rates and clinical progression and possibly improves overall survival (OS). CONCLUSIONS PSM in RP specimens are uniformly considered an adverse outcome. Regardless of approach (open or laparoscopic), attention to surgical detail is essential to minimize rates. For patients with a PSM destined to experience a cancer recurrence, RT is the only established treatment with curative potential. A randomized trial in patients with PSM comparing immediate postoperative RT to salvage RT is critically needed before definitive recommendations can be made.
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Radical prostatectomy for high-risk prostate cancer. World J Urol 2008; 26:219-24. [DOI: 10.1007/s00345-008-0247-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 02/19/2008] [Indexed: 10/22/2022] Open
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