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Acosta-Vega NL, Varela R, Mesa JA, Garai J, Gómez-Gutiérrez A, Serrano-Gómez SJ, Zabaleta J, Sanabria-Salas MC, Combita AL. Genetic ancestry and radical prostatectomy findings in Hispanic/Latino patients. Front Oncol 2024; 14:1338250. [PMID: 38634046 PMCID: PMC11021589 DOI: 10.3389/fonc.2024.1338250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/18/2024] [Indexed: 04/19/2024] Open
Abstract
Background African ancestry is a known factor associated with the presentation and aggressiveness of prostate cancer (PC). Hispanic/Latino populations exhibit varying degrees of genetic admixture across Latin American countries, leading to diverse levels of African ancestry. However, it remains unclear whether genetic ancestry plays a role in the aggressiveness of PC in Hispanic/Latino patients. We explored the associations between genetic ancestry and the clinicopathological data in Hispanic/Latino PC patients from Colombia. Patients and methods We estimated the European, Indigenous and African genetic ancestry, of 230 Colombian patients with localized/regionally advanced PC through a validated panel for genotypification of 106 Ancestry Informative Markers. We examined the associations of the genetic ancestry components with the Gleason Grade Groups (GG) and the clinicopathological characteristics. Results No association was observed between the genetic ancestry with the biochemical recurrence or Gleason GG; however, in a two groups comparison, there were statistically significant differences between GG3 and GG4/GG5 for European ancestry, with a higher mean ancestry proportion in GG4/GG5. A lower risk of being diagnosed at an advanced age was observed for patients with high African ancestry than those with low African ancestry patients (OR: 0.96, CI: 0.92-0.99, p=0.03). Conclusion Our findings revealed an increased risk of presentation of PC at an earlier age in patients with higher African ancestry compared to patients with lower African ancestry in our Hispanic/Latino patients.
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Affiliation(s)
- Natalia L. Acosta-Vega
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
- Programa de doctorado en Ciencias Biológicas, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Rodolfo Varela
- Departamento de Urología, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - Jorge Andrés Mesa
- Departamento de Patología Oncológica, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
| | - Jone Garai
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - Alberto Gómez-Gutiérrez
- Instituto de Genética Humana, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá D.C., Colombia
| | - Silvia J. Serrano-Gómez
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
| | - Jovanny Zabaleta
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA, United States
- Department of Interdisciplinary Oncology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, United States
| | - María Carolina Sanabria-Salas
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
| | - Alba L. Combita
- Grupo de Investigación en Biología del Cáncer, Instituto Nacional de Cancerología de Colombia, Bogotá D.C., Colombia
- Departamento de Microbiología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá D.C., Colombia
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Activin B and Activin C Have Opposing Effects on Prostate Cancer Progression and Cell Growth. Cancers (Basel) 2022; 15:cancers15010147. [PMID: 36612143 PMCID: PMC9817897 DOI: 10.3390/cancers15010147] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/21/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
Current prognostic and diagnostic tests for prostate cancer are not able to accurately distinguish between aggressive and latent cancer. Members of the transforming growth factor-β (TGFB) family are known to be important in regulating prostate cell growth and some have been shown to be dysregulated in prostate cancer. Therefore, the aims of this study were to examine expression of TGFB family members in primary prostate tumour tissue and the phenotypic effect of activins on prostate cell growth. Tissue cores of prostate adenocarcinoma and normal prostate were immuno-stained and protein expression was compared between samples with different Gleason grades. The effect of exogenous treatment with, or overexpression of, activins on prostate cell line growth and migration was examined. Activin B expression was increased in cores containing higher Gleason patterns and overexpression of activin B inhibited growth of PNT1A cells but increased growth and migration of the metastatic PC3 cells compared to empty vector controls. In contrast, activin C expression decreased in higher Gleason grades and overexpression increased growth of PNT1A cells and decreased growth of PC3 cells. In conclusion, increased activin B and decreased activin C expression is associated with increasing prostate tumor grade and therefore have potential as prognostic markers of aggressive prostate cancer.
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Zhang H, Doucette C, Yang H, Bandyopadhyay S, Grossman CE, Messing EM, Chen Y. Risk of adverse pathological features for intermediate risk prostate cancer: Clinical implications for definitive radiation therapy. PLoS One 2021; 16:e0253936. [PMID: 34264975 PMCID: PMC8281993 DOI: 10.1371/journal.pone.0253936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intermediate risk prostate cancer represents a largely heterogeneous group with diverse disease extent. We sought to establish rates of adverse pathological features important for radiation planning by analyzing surgical specimens from men with intermediate risk prostate cancer who underwent immediate radical prostatectomy, and to define clinical pathologic features that may predict adverse outcomes. MATERIALS AND METHODS A total of 1552 men diagnosed with intermediate risk prostate cancer who underwent immediate radical prostatectomy between 1/1/2005 and 12/31/2015 were reviewed. Inclusion criteria included available preoperative PSA level, pathology reports of transrectal ultrasound-guided prostate biopsy, and radical prostatectomy. Incidences of various pathological adverse features were evaluated. Patient characteristics and clinical disease features were analyzed for their predictive values. RESULTS Fifty percent of men with high risk features (defined as PSA >10 but <20 or biopsy primary Gleason pattern of 4) had pathological upstage to T3 or higher disease. The incidence of upgrade to Gleason score of 8 or higher and the incidence of lymph node positive disease was low. Biopsy primary Gleason pattern of 4, and PSA greater than 10 but less than 20, affected adverse pathology in addition to age and percent positive biopsy cores. Older age and increased percentage of positive cores were significant risk factors of adverse pathology. CONCLUSION Our findings underscore the importance of comprehensive staging beyond PSA level, prostate biopsy, and CT/bone scan for men with intermediate risk prostate cancer proceeding with radiation in the era of highly conformal treatment.
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Affiliation(s)
- Hong Zhang
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Christopher Doucette
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hongmei Yang
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Sanjukta Bandyopadhyay
- Department of Biostatistics and Computational Biology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Craig E. Grossman
- Department of Radiation Oncology, Stony Brook University Hospital, Stony Brook, NY, United States of America
| | - Edward M. Messing
- Department of Urology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Yuhchyau Chen
- Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, United States of America
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Immunohistochemistry for Prostate Biopsy-Impact on Histological Prostate Cancer Diagnoses and Clinical Decision Making. ACTA ACUST UNITED AC 2021; 28:2123-2133. [PMID: 34207594 PMCID: PMC8293248 DOI: 10.3390/curroncol28030197] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/15/2021] [Accepted: 06/07/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND To test the value of immunohistochemistry (IHC) staining in prostate biopsies for changes in biopsy results and its impact on treatment decision-making. METHODS Between January 2017-June 2020, all patients undergoing prostate biopsies were identified and evaluated regarding additional IHC staining for diagnostic purpose. Final pathologic results after radical prostatectomy (RP) were analyzed regarding the effect of IHC at biopsy. RESULTS Of 606 biopsies, 350 (58.7%) received additional IHC staining. Of those, prostate cancer (PCa) was found in 208 patients (59.4%); while in 142 patients (40.6%), PCa could be ruled out through IHC. IHC patients harbored significantly more often Gleason 6 in biopsy (p < 0.01) and less suspicious baseline characteristics than patients without IHC. Of 185 patients with positive IHC and PCa detection, IHC led to a change in biopsy results in 81 (43.8%) patients. Of these patients with changes in biopsy results due to IHC, 42 (51.9%) underwent RP with 59.5% harboring ≥pT3 and/or Gleason 7-10. CONCLUSIONS Patients with IHC stains had less suspicious characteristics than patients without IHC. Moreover, in patients with positive IHC and PCa detection, a change in biopsy results was observed in >40%. Patients with changes in biopsy results partly underwent RP, in which 60% harbored significant PCa.
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Leyh-Bannurah SR, Wagner C, Schuette A, Addali M, Liakos N, Urbanova K, Mendrek M, Oelke M, Witt JH. The impact of age on pathological insignificant prostate cancer rates in contemporary robot-assisted prostatectomy patients despite active surveillance eligibility. Minerva Urol Nephrol 2021; 74:437-444. [PMID: 33887890 DOI: 10.23736/s2724-6051.21.04174-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To assess insignificant prostate cancer(iPCa) rates after robot-assisted radical prostatectomy (RARP) in contemporary patients who were preoperatively eligible for active surveillance(AS). IPCa indicates no risk of PCa progression. METHODS We retrospectively analysed 2,837 RARP patients (2010-2019) who fulfilled at least one AS entry criteria set - Prostate Cancer Research International - Active Surveillance(PRIAS), University of California San Francisco(UCSF), National Comprehensive Cancer Network(NCCN) or University of Toronto. We utilized four different iPCa definitions, (1) based on pT2 and Gleason score ≤6 and also cumulative tumor-volume (2) ≤2.5mL, (3) ≤0.7mL or (4) ≤0.5mL. For each AS set we tested the rates of iPCa and compared between age <70 vs. ≥70 yrs. This was complemented by multivariable logistic regression(LRM) predicting iPCa, adjusted for age and clinical AS variables. Finally, within the subgroup, who had iPCa, we tested rate of those, who were deemed preoperatively AS ineligible. RESULTS Between most(PRIAS) and least stringent(TORONTO) AS sets, iPCa(1) was correctly predicted in 70-57%. Similarly, for iPCa definitions 2-4, rates were (2)59-42%, (3)34-19% and (4)27-14%. Senior patients harbored decreased proportions of iPCa. LRM confirmed that advanced age is associated with a lower chance of iPCa. More stringent AS sets lead to higher rates of AS ineligibility, e.g. 53% for PRIAS, despite iPCa. CONCLUSIONS AS sets show limited accuracy for stricter iPCa definitions, which further declined with advanced age. Greater AS stringency resulted in more AS ineligible patients despite harboring iPCa. In consequence, patients are at risk for overtreatment. Clinicians must consider age and different AS sets that result in highly variable detection rates of iPCa.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany -
| | - Christian Wagner
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Andreas Schuette
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Mustapha Addali
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Nikolaos Liakos
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Katarina Urbanova
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Mikolaj Mendrek
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Matthias Oelke
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
| | - Jorn H Witt
- Prostate Center Northwest, Department of Urology, Pediatric Urology and Uro-Oncology, St. Antonius-Hospital, Gronau, Germany
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LacdiNAc-Glycosylated Prostate-specific Antigen Density is a Potential Biomarker of Prostate Cancer. Clin Genitourin Cancer 2019; 18:e28-e36. [PMID: 31711843 DOI: 10.1016/j.clgc.2019.10.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/22/2019] [Accepted: 10/06/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Serum LacdiNAc-glycosylated prostate-specific antigen (LDN-PSA) and LDN-PSA density together with PSA and PSA density (PSAD) were measured as a diagnostic tool for prostate cancer (PCa). PATIENTS AND METHODS We included 150 patients with PCa without hormonal therapy and 41 patients without PCa obtained from the Kyoto University Hospital between 2012 and 2017. LDN-PSA levels were measured through a WFA-anti-PSA antibody sandwich immunoassay using a highly sensitive surface plasmon field-enhanced fluorescence spectroscopy (SPFS) system. Diagnostic performance of serum LDN-PSA and LDN-PSAD was evaluated by measuring the area under the receiver-operating characteristic curve (AUC). RESULTS The AUCs of LDN-PSA, LDN-PSAD, and PSAD levels (0.780, 0.848, and 0.835, respectively) detected in patients with PCa were significantly higher (P = .0001, P < .0001, and P < .0001, respectively) than that of PSA (0.590). Moreover, among 143 patients with PCa who received radical prostatectomy (RP), the AUCs of LDN-PSA, LDN-PSAD, and PSAD levels (0.750, 0.812, and 0.769, respectively) detected in patients with a pathologic Gleason grade group ≥ 2 were significantly higher (P = .0170, P = .0028, and P = .0003, respectively) than that of PSA (0.578). In the group comprising 35 patients who received RP with a Gleason grade group 1-graded biopsy, the LDN-PSA, LDN-PSAD, and PSAD levels were significantly different (P = .0097, P = .0024, and P = .0312, respectively). However, PSA alone could not discriminate cases with adverse features (P = .454). CONCLUSIONS LDN-PSAD is a potential marker for detecting PCa and selecting candidates for RP.
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Zeuschner P, Linxweiler J, Junker K. Non-coding RNAs as biomarkers in liquid biopsies with a special emphasis on extracellular vesicles in urological malignancies. Expert Rev Mol Diagn 2019; 20:151-167. [DOI: 10.1080/14737159.2019.1665998] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg, Germany
| | - Johannes Linxweiler
- Department of Urology and Pediatric Urology, Saarland University, Homburg, Germany
| | - Kerstin Junker
- Department of Urology and Pediatric Urology, Saarland University, Homburg, Germany
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8
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Leyh-Bannurah SR, Dell’Oglio P, Zaffuto E, Briganti A, Schiffmann J, Pompe RS, Tilki D, Heinzer H, Graefen M, Karakiewicz PI, Budäus L. Assessment of Oncological Outcomes After Radical Prostatectomy According to Preoperative and Postoperative Cancer of the Prostate Risk Assessment Scores: Results from a Large, Two-center Experience. Eur Urol Focus 2019; 5:568-576. [DOI: 10.1016/j.euf.2017.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 10/03/2017] [Accepted: 10/24/2017] [Indexed: 12/16/2022]
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9
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Bekelman JE, Rumble RB, Chen RC, Pisansky TM, Finelli A, Feifer A, Nguyen PL, Loblaw DA, Tagawa ST, Gillessen S, Morgan TM, Liu G, Vapiwala N, Haluschak JJ, Stephenson A, Touijer K, Kungel T, Freedland SJ. Clinically Localized Prostate Cancer: ASCO Clinical Practice Guideline Endorsement of an American Urological Association/American Society for Radiation Oncology/Society of Urologic Oncology Guideline. J Clin Oncol 2018; 36:3251-3258. [PMID: 30183466 DOI: 10.1200/jco.18.00606] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose In April 2017, the American Urological Association, American Society for Radiation Oncology, and Society of Urologic Oncology released a joint evidence-based practice guideline on clinically localized prostate cancer. The American Society of Clinical Oncology (ASCO) has a policy and set of procedures for endorsing clinical practice guidelines that have been developed by other professional organizations. Methods The Clinically Localized Prostate Cancer guideline was reviewed for developmental rigor by methodologists. An ASCO Expert Panel then reviewed the content and the recommendations. Results The ASCO Expert Panel determined that the recommendations from the Clinically Localized Prostate Cancer guideline were clear, thorough, and based upon the most relevant scientific evidence. ASCO endorsed the Clinically Localized Prostate Cancer guideline except for two recommendations on cryosurgery. The two recommendations covering cryosurgery were not endorsed because the panel found that there is insufficient evidence to support the use of cryotherapy in this setting. Recommendations The ASCO Expert Panel endorsed all but two of the original guideline recommendations as written and offered a series of discussion points to guide practice.
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Affiliation(s)
- Justin E. Bekelman
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - R. Bryan Rumble
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Ronald C. Chen
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Thomas M. Pisansky
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Antonio Finelli
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Andrew Feifer
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Paul L. Nguyen
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - D. Andrew Loblaw
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Scott T. Tagawa
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Silke Gillessen
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Todd M. Morgan
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Glenn Liu
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Neha Vapiwala
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - John J. Haluschak
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Andrew Stephenson
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Karim Touijer
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Terry Kungel
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
| | - Stephen J. Freedland
- Justin E. Bekelman and Neha Vapiwala, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; R. Bryan Rumble, American Society of Clinical Oncology, Alexandria, VA; Ronald C. Chen, University of North Carolina at Chapel Hill, Chapel Hill; Stephen J. Freedland, Durham VA Medical Center, Durham, NC; Thomas M. Pisansky, Mayo Clinic, Rochester, MN; Antonio Finelli, Princess Margaret Cancer Centre, University Health Network; Andrew Feifer, Trillium Health Partners, University of Toronto; D
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Glaser ZA, Porter KK, Thomas JV, Gordetsky JB, Rais-Bahrami S. MRI findings guiding selection of active surveillance for prostate cancer: a review of emerging evidence. Transl Androl Urol 2018; 7:S411-S419. [PMID: 30363494 PMCID: PMC6178314 DOI: 10.21037/tau.2018.03.21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Active surveillance (AS) for prostate cancer (PCa) is generally considered to be a safe strategy for men with low-risk, localized disease. However, as many as 1 in 4 patients may be incorrectly classified as AS-eligible using traditional inclusion criteria. The use of multiparametric magnetic resonance imaging (mpMRI) may offer improved risk stratification in both the initial diagnostic and disease monitoring setting. We performed a review of recently published studies to evaluate the utility of this imaging modality for this clinical setting. An English literature search was conducted on PubMed for original investigations on localized PCa, AS, and magnetic resonance imaging. Our Boolean criteria included the following terms: PCa, AS, imaging, MRI, mpMRI, prospective, retrospective, and comparative. Our search excluded publication types such as comments, editorials, guidelines, reviews, or interviews. Our literature review identified 71 original investigations. Among these, 52 met our inclusion criteria. Evidence suggests mpMRI improves characterization of clinically significant prostate cancer (csPCa) foci, and the enhanced detection and risk-stratification afforded by this modality may keep men from being inappropriately placed on AS. Use of serial mpMRI may also permit longer intervals between confirmatory biopsies. Multiple studies demonstrate the benefit of MRI-targeted biopsies. The use of mpMRI of the prostate offers improved confidence in risk-stratification for men with clinically low-risk PCa considering AS. While on AS, serial mpMRI and MRI-targeted biopsy aid in the detection of aggressive disease transformation or foci of clinically-significant cancer undetected on prior biopsy sessions.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
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11
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Leyh-Bannurah SR, Kachanov M, Beyersdorff D, Preisser F, Tilki D, Fisch M, Graefen M, Budäus L. Anterior Localization of Prostate Cancer Suspicious Lesions in 1,161 Patients Undergoing Magnetic Resonance Imaging/Ultrasound Fusion Guided Targeted Biopsies. J Urol 2018; 200:1035-1040. [PMID: 29935274 DOI: 10.1016/j.juro.2018.06.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Based on findings in transrectal ultrasound guided biopsy series standard sampling of the prostate targets the posterior/peripheral zone. However, a substantial proportion of lesions that are prostate cancer suspicious and PI-RADS™ (Prostate Imaging Reporting and Data System) 3 or greater on magnetic resonance imaging is located in the anterior segment of the prostate, requiring deeper placement and targeting of the biopsy needle. MATERIALS AND METHODS Overall 1,161 patients underwent magnetic resonance imaging/ultrasound fusion guided targeted biopsy. Prostate cancer suspicious lesions on magnetic resonance imaging were dichotomized into anterior vs posterior prostate segments. Patients were stratified by the number of prior negative systematic biopsy sessions. Descriptive statistics included the frequency and proportion of multiparametric magnetic resonance imaging findings and corresponding histological results. RESULTS Targeted biopsy was performed in 513 patients (44%) who were systematic biopsy naïve, 396 (34%) with 1 prior negative systematic biopsy and 252 (22%) with 2 or more prior negative systematic biopsies. When patients were stratified by the number of prior systematic biopsy sessions, the proportion with exclusively anterior, PI-RADS 3 or greater lesions on magnetic resonance imaging increased from 3.5% to 9.1% (p = 0.006). Unfavorable 3 + 4 and 4 + 3 or greater primary Gleason patterns were identified in exclusively anterior vs posterior lesions in 31% vs 21% of the 448 patients, of whom 64 had exclusively anterior and 384 had posterior PI-RADS 3 or greater lesions, respectively, on magnetic resonance imaging. Multivariable logistic regression analyses confirmed these findings. CONCLUSIONS After multiple previous negative systematic biopsy sessions the proportion of anterior lesions on magnetic resonance imaging increased. Such lesions harbored a greater amount of unfavorable prostate cancer. Therefore, image guidance for precise targeting should be considered, especially after initially negative transrectal ultrasound guided systematic biopsy.
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Affiliation(s)
- Sami-Ramzi Leyh-Bannurah
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Mykyta Kachanov
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dirk Beyersdorff
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Felix Preisser
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Derya Tilki
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lars Budäus
- Martini-Klinik, Prostate Cancer Center Hamburg-Eppendorf, Hamburg, Germany.
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12
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Abstract
PURPOSE OF REVIEW Prostate cancer (PCa) remains a significant public health burden, with multiple points for decision-making at all stages of the disease. Given the amount and variety of data that may influence disease management, prediction models have been published to assist clinicians and patients in making decisions about the best next course of action at many disease states. We sought to review the most important studies related to PCa prediction models since 2016 and evaluate their impact upon the evolving field of risk modeling in PCa. RECENT FINDINGS There has been a significant amount of work published in the past year concerning risk modeling in PCa at all stages of disease, ranging from screening to predicting survival with metastatic disease. The majority of recent publications focus upon the addition of a new biomarker to prediction models or upon validating previously published prediction models. In particular, MRI has been the topic of a number of more recent studies. SUMMARY Prediction modeling in PCa currently compares the area under the receiver operating curve between models with and without the biomarker of interest to predict the outcome of interest in multiple disease states, ranging from diagnosis to prediction of survival with metastatic disease. Future work should provide additional information regarding clinical impact and measures of prediction confidence.
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13
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Sierra PS, Damodaran S, Jarrard D. Clinical and pathologic factors predicting reclassification in active surveillance cohorts. Int Braz J Urol 2018; 44:440-451. [PMID: 29368876 PMCID: PMC5996796 DOI: 10.1590/s1677-5538.ibju.2017.0320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/12/2017] [Indexed: 01/28/2023] Open
Abstract
The incidence of small, lower risk well-differentiated prostate cancer is increasing and almost half of the patients with this diagnosis are candidates for initial conservative management in an attempt to avoid overtreatment and morbidity associated with surgery or radiation. A proportion of patients labeled as low risk, candidates for Active Surveillance (AS), harbor aggressive disease and would benefit from definitive treatment. The focus of this review is to identify clinicopathologic features that may help identify these less optimal AS candidates. A systematic Medline/PubMed Review was performed in January 2017 according to PRISMA guidelines; 83 articles were selected for full text review according to their relevance and after applying limits described. For patients meeting AS criteria including Gleason Score 6, several factors can assist in predicting those patients that are at higher risk for reclassification including higher PSA density, bilateral cancer, African American race, small prostate volume and low testosterone. Nomograms combining these features improve risk stratification. Clinical and pathologic features provide a significant amount of information for risk stratification (>70%) for patients considering active surveillance. Higher risk patient subgroups can benefit from further evaluation or consideration of treatment. Recommendations will continue to evolve as data from longer term AS cohorts matures.
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Affiliation(s)
| | - Shivashankar Damodaran
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - David Jarrard
- Department of Urology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- University of Wisconsin Carbone Cancer Center, Madison, WI, USA
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14
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Glaser ZA, Gordetsky JB, Porter KK, Varambally S, Rais-Bahrami S. Prostate Cancer Imaging and Biomarkers Guiding Safe Selection of Active Surveillance. Front Oncol 2017; 7:256. [PMID: 29164056 PMCID: PMC5670116 DOI: 10.3389/fonc.2017.00256] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 10/12/2017] [Indexed: 01/04/2023] Open
Abstract
Background Active surveillance (AS) is a widely adopted strategy to monitor men with low-risk, localized prostate cancer (PCa). Current AS inclusion criteria may misclassify as many as one in four patients. The advent of multiparametric magnetic resonance imaging (mpMRI) and novel PCa biomarkers may offer improved risk stratification. We performed a review of recently published literature to characterize emerging evidence in support of these novel modalities. Methods An English literature search was conducted on PubMed for available original investigations on localized PCa, AS, imaging, and biomarkers published within the past 3 years. Our Boolean criteria included the following terms: PCa, AS, imaging, biomarker, genetic, genomic, prospective, retrospective, and comparative. The bibliographies and diagnostic modalities of the identified studies were used to expand our search. Results Our review identified 222 original studies. Our expanded search yielded 244 studies. Among these, 70 met our inclusion criteria. Evidence suggests mpMRI offers improved detection of clinically significant PCa, and MRI-fusion technology enhances the sensitivity of surveillance biopsies. Multiple studies demonstrate the promise of commercially available screening assays for prediction of AS failure, and several novel biomarkers show promise in this setting. Conclusion In the era of AS for men with low-risk PCa, improved strategies for proper stratification are needed. mpMRI has dramatically enhanced the detection of clinically significant PCa. The advent of novel biomarkers for prediction of aggressive disease and AS failure has shown some initial promise, but further validation is warranted.
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Affiliation(s)
- Zachary A Glaser
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Jennifer B Gordetsky
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Kristin K Porter
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, United States.,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, United States
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15
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Audenet F, Rozet F, Resche-Rigon M, Bernard R, Ingels A, Prapotnich D, Sanchez-Salas R, Galiano M, Barret E, Cathelineau X. Grade Group Underestimation in Prostate Biopsy: Predictive Factors and Outcomes in Candidates for Active Surveillance. Clin Genitourin Cancer 2017; 15:e907-e913. [PMID: 28522288 DOI: 10.1016/j.clgc.2017.04.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/04/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We intended to analyze the outcomes and predictive factors for underestimating the prostate cancer (PCa) grade group (GG) from prostate biopsies in a large monocentric cohort of patients treated by minimally invasive radical prostatectomy (RP). MATERIALS AND METHODS Using a monocentric prospectively maintained database, we included 3062 patients who underwent minimally invasive RP between 2006 and 2013. We explored clinicopathologic features and outcomes associated with a GG upgrade from biopsy to RP. Multivariate logistic regression was used to develop and validate a nomogram to predict upgrading for GG1. RESULTS Biopsy GG was upgraded after RP in 51.5% of cases. Patients upgraded from GG1 to GG2 or GG3 after RP had a longer time to biochemical recurrence than those with GG2 or GG3 respectively, on both biopsy and RP, but a shorter time to biochemical recurrence than those who remained GG1 after RP (P < .0001). In multivariate analyses, variables predicting upgrading for GG1 PCa were age (P = .0014), abnormal digital rectal examination (P < .0001), prostate-specific antigen density (P < .0001), percentage of positive cores (P < .0001), and body mass index (P = .037). A nomogram was generated and validated internally. CONCLUSIONS Biopsy grading system is misleading in approximately 50% of cases. Upgrading GG from biopsy to RP may have consequences on clinical outcomes. A nomogram using clinicopathologic features could aid the probability of needing to upgrade GG1 patients at their initial evaluation.
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Affiliation(s)
- François Audenet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.
| | - Matthieu Resche-Rigon
- Department of Biostatistics, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Rémy Bernard
- Department of Biostatistics, Hôpital Saint Louis, Université Paris Diderot, Paris, France
| | - Alexandre Ingels
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Dominique Prapotnich
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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