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Ishikawa Y, Suzuki M, Seto I, Takagawa Y, Murakami M. Long-Term Control With Proton Beam Therapy for Recurrent Prostate Cancer in the Right Perineum Following Intensity-Modulated Radiation Therapy: A Case Report. Cureus 2024; 16:e58386. [PMID: 38633140 PMCID: PMC11022003 DOI: 10.7759/cureus.58386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 04/19/2024] Open
Abstract
Radiation therapy (RT) is commonly used for the treatment of prostate cancer, with intensity-modulated radiation therapy (IMRT) and proton beam therapy (PBT) being the utilized modalities. This case report outlines the treatment course of a recurrent prostate cancer lesion in the right perineal musculature managed with proton therapy following IMRT. A 64-year-old Japanese man, diagnosed with prostate cancer and categorized as high risk according to the National Comprehensive Cancer Network guidelines, underwent six months of androgen deprivation therapy, which included bicalutamide and degarelix acetate. Six months after completing 78 Gy in 39 fractions of IMRT, the patient reported perineal to anal pain. Laboratory tests showed an elevated serum prostate-specific antigen (PSA) level, and pelvic MRI showed a mass lesion in the right perineal musculature. Consequently, the patient was diagnosed with recurrent prostate cancer. Thereafter, the patient underwent eight cycles of systemic chemotherapy with docetaxel; however, his pain progressively worsened. Subsequently, the treatment was switched to 12 cycles of cabazitaxel, which led to gradual pain relief. The patient received PBT at 60 Gy relative biological effectiveness in 30 fractions for the recurrent lesion. Five years after PBT, pelvic MRI showed no mass lesions in the prostate or surrounding tissues. The PSA levels remained low, less than 0.008 ng/ml, and there were no apparent late complications.
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Affiliation(s)
- Yojiro Ishikawa
- Department of Radiology, Tohoku Medical and Pharmaceutical University, Sendai, JPN
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Motohisa Suzuki
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Ichiro Seto
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Yoshiaki Takagawa
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Koriyama, JPN
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, JPN
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Tomisaki I, Ikuta H, Higashijima K, Onishi R, Minato A, Fujimoto N. Oncological Outcome After Radical Prostatectomy without Pelvic Lymph Node Dissection for Localized Prostate Cancer: Follow-up Results in a Single Institution. Cancer Invest 2019; 37:524-530. [PMID: 31597501 DOI: 10.1080/07357907.2019.1675076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The oncological benefit of pelvic lymph node dissection (PLND) is still debatable because data on clinical outcomes of radical prostatectomy (RP) without PLND are lacking. In this study, we reported oncological outcome in consecutive 146 patients who underwent RP without PLND. Although 27% of our patients developed biochemical recurrence, the estimated 5-year overall survival rates were 100%, 96.3%, and 95.7% in the low-, intermediate-, and high-risk groups, respectively. These data in our patients were not inferior to those in previous reports that investigated the survivals in patients who received PLND during RP. The therapeutic significance of PLND should be re-evaluated.
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Affiliation(s)
- Ikko Tomisaki
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Hirofumi Ikuta
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Katsuyoshi Higashijima
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Rei Onishi
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Akinori Minato
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
| | - Naohiro Fujimoto
- Department of Urology, University of Occupational and Environmental Health, Kitakyushu City, Japan
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Nordström T, Jäderling F, Carlsson S, Aly M, Grönberg H, Eklund M. Does a novel diagnostic pathway including blood-based risk prediction and MRI-targeted biopsies outperform prostate cancer screening using prostate-specific antigen and systematic prostate biopsies? - protocol of the randomised study STHLM3MRI. BMJ Open 2019; 9:e027816. [PMID: 31201191 PMCID: PMC6576112 DOI: 10.1136/bmjopen-2018-027816] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Prostate cancer is a leading cause of cancer death among men in the Western world. Early detection of prostate cancer has been shown to decrease mortality, but has limitations with low specificity leading to unnecessary biopsies and overdiagnosis of low-risk cancers. The STHLM3 trial has paved way for improved specificity in early detection of prostate cancer using the blood-based STHLM3 test for identifying men at increased risk of harbouring significant prostate cancer. Targeted prostate biopsies based on MRI images have shown non-inferior sensitivity to detect significant prostate cancer and decrease the number of biopsies and non-significant cancers among men referred for prostate biopsy in clinical practice. The strategy of the STHLM3-MRI project is to study an improved diagnostic pathway including an improved blood-based test for identification of men with increased risk of prostate cancer and use of MRI to select men for diagnostic workup with targeted prostate biopsies. METHODS This study compares prostate cancer detection using prostate-specific antigen (PSA) and systematic biopsies to the improved pathway for prostate cancer detection using the STHLM3 test and targeted biopsies in a screening context. The study will recruit 10 000 participants during 1 June 2018 to 1 June 2020 combining a paired and randomised design. Participants are grouped by PSA and Stockholm3 test level. Men with Stockholm3 ≥11% or PSA ≥3 ng/mL are randomised to systematic or MRI-targeted biopsies. This protocol follows SPIRIT guidelines. Endpoints include the number of detected prostate cancers, number of performed biopsy procedures and number of performed MRIs. Additional aims include to assess the health economic consequences and development of automated image-analysis. ETHICS AND DISSEMINATION The study is approved by the regional ethical review board in Stockholm (2017-1280/31). The study findings will be published in peer-review journals. Findings will also be disseminated by conference/departmental presentations and by media. TRIAL REGISTRATION NUMBER NCT03377881; Pre-results.
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Affiliation(s)
- Tobias Nordström
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Solna, Sweden
| | - Fredrik Jäderling
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Diagnostic Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Carlsson
- Patient area Pelvic Cancer, Theme Cance Karolinska University Hospital Solna, Stockholm, Sweden
| | - Markus Aly
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Patient area Pelvic Cancer, Theme Cance Karolinska University Hospital Solna, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Martin Eklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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Varca V, Benelli A, Perri D, Gozen AS, Fiedler M, de la Taille A, Casazza G, Salomon L, Rassweiler J, Gregori A, Gaboardi F. Laparoscopic Radical Prostatectomy in Patients with High-Risk Prostate Cancer: Feasibility and Safety. Results of a Multicentric Study. J Endourol 2018; 32:843-851. [PMID: 30027748 DOI: 10.1089/end.2018.0086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION In Western countries about 25% of prostate cancer (PCa) are high-risk tumors at presentation and its treatment is still a matter of debate among urologists. When a surgical approach is preferred the use of a mininvasive tecnique is still difficult due to the lack of data supporting it in literature. The aim of this study is to evaluate feasibility and safety of laparoscopic radical prostatectomy (LRP) for high-risk PCa. MATERIALS AND METHODS The study included 1114 patients with high-risk PCa submitted to LRP between 1998 and 2014. High-risk patients were defined according to D'Amico classification. We collected functional and oncological long-term outcomes and evaluated with univariate and multivariate analyses the role of predictive factors for survival and biochemical recurrence (BR). RESULTS Mean age at treatment was 62 ± 8 years; mean follow-up was 74 ± 50 months. We obtained an overall survival (OS) of 96.6% at a mean follow-up of 74 months (1076 patients) and a disease-free survival of 66.2% (737 patients). Age (p = 0.0006), pT (p < 0.0001), pN (p = 0.0018), and surgical margins (p = 0.0076) resulted as independent predictors for BR in multivariate analysis. pN (p = 0.0025) and Gs (p = 0.0003) are independent predictors for OS and cancer-specific survival in a univariate analysis; just the Gs results significant in the multivariate model. CONCLUSIONS According to our encouraging data about oncological and functional outcomes we believe that radical prostatectomy represents an effective treatment for patients with high-risk PCa and that laparoscopy is a safe approach offering a mini-invasive alternative to open surgery.
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Affiliation(s)
- Virginia Varca
- 1 Department of Urology, ASST-Rhodense, Garbagnate, Milan, Italy
| | - Andrea Benelli
- 1 Department of Urology, ASST-Rhodense, Garbagnate, Milan, Italy
| | - Davide Perri
- 2 Department of Urology, University of Novara , Novara, Italy
| | - Ali Sedar Gozen
- 3 Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg , Heilbronn, Germany
| | - Marcel Fiedler
- 3 Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg , Heilbronn, Germany
| | | | - Giovanni Casazza
- 5 Department of biochemical and Clinical Science, University of Milan, Milan, Italy
| | - Laurent Salomon
- 4 Urology Creteil, Hopital Henri Mondor , Île-de-France, France
| | - Jens Rassweiler
- 3 Department of Urology, SLK-Kliniken Heilbronn, University of Heidelberg , Heilbronn, Germany
| | - Andrea Gregori
- 1 Department of Urology, ASST-Rhodense, Garbagnate, Milan, Italy
| | - Franco Gaboardi
- 6 Division of Experimental Oncology, Department of Urology, Vita-Salute San Raffaele University of Milan , Milan, Italy
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Goolam AS, la Rosa AHD, Manoharan M. Surgical Management of Organ-Confined Prostate Cancer with Review of Literature and Evolving Evidence. Indian J Surg Oncol 2018; 9:225-231. [PMID: 29887706 DOI: 10.1007/s13193-016-0594-1] [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: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 11/29/2022] Open
Abstract
Prostate cancer is the most common solid organ malignancy in men in the USA with an annual incidence of 105 and an annual mortality rate of 19 per 100,000 people. With the advent of PSA screening, the majority of prostate cancer diagnosed is organ confined. Recent studies including the SPCG-4 and PIVOT trials have demonstrated a survival benefit for those undergoing active treatment for localized prostate cancer. The foremost surgical option has been radical prostatectomy (RP). The gold standard has been open radical retropubic prostatectomy (RRP); however, minimally invasive approaches including laparoscopic and robotic approaches are commonplace and increasing in popularity. We aim to describe the surgical options for the treatment of localized prostate cancer by reviewing the literature. A review of the literature was undertaken using MEDLINE and PubMed. Articles addressing the topic of radical prostatectomy by open, laparoscopic and robotic approaches were selected. Studies comparing the different modalities were also identified. These articles were reviewed for data pertaining to perioperative, oncological and functional outcomes. There is a paucity of randomized studies comparing the three modalities. The published data has demonstrated a benefit in favour of robotically assisted laparoscopic prostatectomy (RALP) over laparoscopic radical prostatectomy (LRP) and traditional open RRP in perioperative outcomes. When reviewing the best-reported outcomes for RALP compared to LRP and RRP, operative times are lower (105 vs. 138 vs. 138 min), estimated blood loss rates are lower (111 vs. 200 vs. 300 ml) and blood transfusion rates are lower as in the length of stay (1 vs. 2 vs. 2.3 days) and overall complication rates (4.3 vs. 5 vs. 20%). Similarly, when reviewing functional outcomes, RALP compared to LRP was not inferior. At 12 months, the reported continence was 97 vs. 94 vs. 89% and potency was 94 vs. 77 vs. 90%. In comparative studies, however, these differences did not always meet statistical significance. With respect to oncological outcomes, there was no clear evidence of superiority of one modality over another. RALP is now the most common modality for surgical treatment of organ-confined prostate cancer. Individual series appear to support better perioperative outcomes and perhaps quicker return to functional outcomes. There does not appear to be a clear advantage to date in oncological parameters; however, RALP does not appear to be inferior to either LRP or RRP. It is anticipated that further high quality randomized studies will shed more light on the clinical and statistical significance in the comparison between these modalities.
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Affiliation(s)
- Ahmed Saeed Goolam
- 1Department of Urology, University of Miami Miller School of Medicine, PO Box 016960(M814), Miami, FL 33101 USA
| | - Alfredo Harb-De la Rosa
- 1Department of Urology, University of Miami Miller School of Medicine, PO Box 016960(M814), Miami, FL 33101 USA
| | - Murugesan Manoharan
- Division of Urologic Oncology, Miami Cancer Institute, 8900 N Kendall Drive, Miami, FL 33176 USA
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Rajan P, Hagman A, Sooriakumaran P, Nyberg T, Wallerstedt A, Adding C, Akre O, Carlsson S, Hosseini A, Olsson M, Egevad L, Wiklund F, Steineck G, Wiklund NP. Oncologic Outcomes After Robot-assisted Radical Prostatectomy: A Large European Single-centre Cohort with Median 10-Year Follow-up. Eur Urol Focus 2018; 4:351-359. [PMID: 28753802 DOI: 10.1016/j.euf.2016.10.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) treatment has been widely adopted with limited evidence for long-term (>5 yr) oncologic efficacy. OBJECTIVE To evaluate long-term oncologic outcomes following RARP. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 885 patients who underwent RARP as monotherapy for PCa between 2002 and 2006 in a single European centre and followed up until 2016. INTERVENTION RARP as monotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Biochemical recurrence (BCR)-free survival (BCRFS), salvage therapy (ST)-free survival (STFS), prostate cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method, and event-time distributions were compared using the log-rank test. Variables predictive of BCR and ST were identified using Cox proportional hazards models. RESULTS AND LIMITATIONS We identified 167 BCRs, 110 STs, 16 PCa-related deaths, and 51 deaths from other/unknown causes. BCRFS, STFS, CSS, and OS rates were 81.8%, 87.5%, 98.5%, and 93.0%, respectively, at median follow-up of 10.5 yr. On multivariable analysis, the strongest independent predictors of both BCR and ST were preoperative Gleason score, pathological T stage, positive surgical margins (PSMs), and preoperative prostate-specific antigen. PSM >3mm/multifocal but not ≤3mm independently affected the risk of both BCR and ST. Study limitations include a lack of centralised histopathologic reporting, lymph node and post-operative tumour volume data in a historical cohort, and patient-reported outcomes. CONCLUSIONS RARP appears to confer effective long-term oncologic efficacy. The risk of BCR or ST is unaffected by ≤3mm PSM, but further follow-up is required to determine any impact on CSS. PATIENT SUMMARY Robot-assisted surgery for prostate cancer is effective 10 yr after treatment. Very small (<3mm) amounts of cancer at the cut edge of the prostate do not appear to impact on recurrence risk and the need for additional treatment, but it is not yet known whether this affects the risk of death from prostate cancer.
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Affiliation(s)
- Prabhakar Rajan
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, London, UK; Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Anna Hagman
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Prasanna Sooriakumaran
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tommy Nyberg
- Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Wallerstedt
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Christofer Adding
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Carlsson
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Abolfazl Hosseini
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Olsson
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - N Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden.
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Hashine K, Kakuda T, Iuchi S, Hosokawa T, Ninomiya I. Prospective longitudinal outcomes of quality of life after laparoscopic radical prostatectomy compared with retropubic radical prostatectomy. Health Qual Life Outcomes 2018; 16:7. [PMID: 29304808 PMCID: PMC5756410 DOI: 10.1186/s12955-017-0835-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/28/2017] [Indexed: 12/02/2022] Open
Abstract
Background There have been few reports on health-related quality of life (HRQOL) after laparoscopic radical prostatectomy (LRP) in Japanese patients. The aim of this study is to assess changes in HRQOL during 36 months after LRP compared with retropubic radical prostatectomy (RRP). Methods The subjects were 105 consecutive patients treated with LRP between 2011 and 2012. HRQOL was evaluated using the International Prostate Symptom Score (IPSS), Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and Expanded Prostate Cancer Index Composite (EPIC) at baseline and 1, 3, 6, 12 and 36 months after surgery. These results were compared with data for 107 consecutive patients treated with RRP between 2005 and 2007. The comparison between LRP and RRP was examined at every time point by Mann-Whitney U-test and chi-square test. Multiple linear regression analysis was used to identify independent factors related to the urinary domain in EPIC. Results The IPSS change was similar in both groups. The LRP group had a better SF-8 mental component summary score at baseline and a better SF-8 physical component summary score at 1 month after surgery. In EPIC, urinary function and bother were worse after LRP, but improved at 12 months and did not differ significantly from those after RRP; however, these factors then worsened again at 36 months after LRP. Urinary incontinence was also worse at 36 months after LRP, compared to RRP. In patients treated with nerve-sparing surgery, urinary function and urinary incontinence were similar and good at 12 and 36 months in both groups. Bowel function and bother, and sexual function and bother were similar in both groups and showed no changes from 12 to 36 months. Age and salvage radiotherapy were independent predictors of incontinence (daily use of two or more pads) in multivariate analysis. Surgical procedure was not an independent factor for incontinence, but incontinence defined as use of one pad or more was associated with the surgical procedure. Conclusions Urinary function and bother at 36 months were worse after LRP than after RRP. Age, salvage radiotherapy and surgical procedure were associated with urinary incontinence after 36 months.
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Affiliation(s)
- Katsuyoshi Hashine
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan.
| | - Toshio Kakuda
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
| | - Shunsuke Iuchi
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
| | - Tadanori Hosokawa
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
| | - Iku Ninomiya
- Department of Urology, National Hospital Organization Shikoku Cancer Center, 160 Minamiumemoto, Matsuyama, 791-0280, Japan
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Dias JA, Dall'oglio MF, Colombo JR, Coelho RF, Nahas WC. The influence of previous robotic experience in the initial learning curve of laparoscopic radical prostatectomy. Int Braz J Urol 2017; 43:871-879. [PMID: 28537691 PMCID: PMC5678518 DOI: 10.1590/s1677-5538.ibju.2016.0526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 03/19/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction: This study analyzed the impact of the experience with Robotic-Assisted Laparoscopic Prostatectomy (RALP) on the initial experience with Laparoscopic Radical Prostatectomy (LRP) by examining perioperative results and early outcomes of 110 patients. LRPs were performed by two ro-botic fellowship trained surgeons with daily practice in RALP. Patients and Methods: 110 LRP were performed to treat aleatory selected patients. The patients were divided into 4 groups for prospective analyses. A transperitoneal approach that simulates the RALP technique was used. Results: The median operative time was 163 minutes (110-240), and this time significantly decreased through case 40, when the time plateaued (p=0.0007). The median blood loss was 250mL. No patients required blood transfusion. There were no life-threatening complications or deaths. Minor complications were uniformly distributed along the series (P=0.6401). The overall positive surgical margins (PSM) rate was 28.2% (20% in pT2 and 43.6% in pT3). PSM was in the prostate apex in 61.3% of cases. At the 12-month follow-up, 88% of men were continent (0-1 pad). Conclusions: The present study shows that there are multiple learning curves for LRP. The shallowest learning curve was seen for the operative time. Surgeons transitioning between the RALP and LRP techniques were considered competent based on the low perioperative complication rate, absence of major complications, and lack of blood transfusions. This study shows that a learning curve still exists and that there are factors that must be considered by surgeons transitioning between the two techniques.
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Affiliation(s)
- José Anastácio Dias
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - Marcos F Dall'oglio
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - João Roberto Colombo
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - Rafael F Coelho
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
| | - William Carlos Nahas
- Divisão de Urologia, Universidade de São Paulo Escola Médica, São Paulo, SP, Brasil
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Wang L, Wang B, Ai Q, Zhang Y, Lv X, Li H, Ma X, Zhang X. Long-term cancer control outcomes of robot-assisted radical prostatectomy for prostate cancer treatment: a meta-analysis. Int Urol Nephrol 2017; 49:995-1005. [DOI: 10.1007/s11255-017-1552-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/21/2017] [Indexed: 01/11/2023]
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10
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Laparoscopic radical prostatectomy and resection of rectum performed together: first experience. Wideochir Inne Tech Maloinwazyjne 2015; 10:442-4. [PMID: 26649093 PMCID: PMC4653253 DOI: 10.5114/wiitm.2015.54054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/09/2015] [Accepted: 08/19/2015] [Indexed: 12/04/2022] Open
Abstract
Introduction Laparoscopy is an increasingly used approach in the surgical treatment of rectal cancer and prostate cancer. The anatomical proximity of the two organs is the main reason to consider performing both procedures simultaneously. Aim To present our first experience of laparoscopic rectal resection and radical prostatectomy, performed simultaneously, in 3 patients. Material and methods The first patient was diagnosed with locally advanced rectal cancer and tumor infiltration of the prostate and seminal vesicles. The other 2 patients were diagnosed with tumor duplicity. The surgery of the first patient started with laparoscopic prostatectomy except division of the prostate from the rectal wall. The next step was resection of the rectum, extralevator amputation of the rectum and vesicourethral anastomosis. In the other patients, resection of the rectum, followed by radical prostatectomy, was performed. Results The median follow-up was 12 months. The median operation time was 4 h 40 min, with blood loss of 300 ml. The operations and postoperative course were without incident in the case of 2 patients. However, 1 patient had stercoral peritonitis and a vesicorectal fistula in the early postoperative stage. Sigmoidostomy and postponed ureteroileal conduit were carried out. All patients were in oncologic remission. Conclusions Combined laparoscopic rectal resection and radical prostatectomy is a viable option for selected patients with locally advanced rectal cancer or tumor duplication. The procedures were completed without complications in 2 out of 3 patients.
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Thompson RH. Future directions in urological oncology. BJU Int 2015; 115:499. [PMID: 25808707 DOI: 10.1111/bju.13076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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