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Yuan P, Wang S, Sun X, Xu H, Ye Z, Chen Z. Quality of life among patients after cystoprostatectomy as the treatment for locally advanced prostate cancer with bladder invasion. Aging Male 2020; 23:847-853. [PMID: 31012363 DOI: 10.1080/13685538.2019.1604653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
PURPOSE This study aimed to evaluate the changes of patients' quality of life (QoL) after cystoprostatectomy as a treatment for locally advanced prostate cancer (LAPC) with the bladder invasion and to determine risk factors for postoperative poor QoL. MATERIALS AND METHODS Between Jan 2012 and December 2015, 27 patients who received cystoprostatectomy for LAPC with the bladder invasion were retrospectively included. QoL was assessed with the functional assessment of cancer therapy-prostate (FACT-P) questionnaire scores. Determinants for postoperative poor QoL were investigated using univariate and multivariate regression analysis. RESULTS Three-year overall survival, biochemical progression-free survival, and clinical progress-free survival were 88.89%, 62.96% and 77.78%, respectively. Preoperative symptoms of hematuria, urinary frequency, and dysuria were well alleviated after cystoprostatectomy. Moreover, FACT-P questionnaire scores at 6 months and 1 year after cystoprostatectomy were significantly higher than preoperative scores. Univariate and multivariable analysis (p < .05) showed that postoperative complication was the independent risk factor for the loss of postoperative QoL. CONCLUSIONS Patients' QoL can be improved after cystoprostatectomy as the treatment for LAPC with the bladder invasion, which is associated with ameliorative urinary symptoms after the surgery. Besides, surgical complication is identified to be a risk factor for postoperative poor QoL.
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Affiliation(s)
- Peng Yuan
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xifeng Sun
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Hua Xu
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
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Bhanvadia RR, Khouri RK, Ashbrook C, Woldu SL, Margulis V, Raj GV, Bagrodia A. Safety, Efficacy, and Impact on Quality of Life of Palliative Robotic Cystectomy for Advanced Prostate Cancer. Clin Genitourin Cancer 2020; 19:e129-e134. [PMID: 33246846 DOI: 10.1016/j.clgc.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/13/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Roger K Khouri
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Caleb Ashbrook
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Ganesh V Raj
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern, Dallas, TX.
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Surcel C, Mirvald C, Tsaur I, Borgmann H, Heidegger I, Labanaris AP, Sinescu I, Tilki D, Ploussard G, Briganti A, Montorsi F, Mathieu R, Valerio M, Jinga V, Badescu D, Radavoi D, van den Bergh RCN, Gandaglia G, Kretschmer A. Contemporary role of palliative cystoprostatectomy or pelvic exenteration in advanced symptomatic prostate cancer. World J Urol 2020; 39:2483-2490. [PMID: 33135127 DOI: 10.1007/s00345-020-03493-5] [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: 07/14/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To access the feasibility of palliative cystoprostatectomy/pelvic exenteration in patients with bladder/rectal invasion due to prostate cancer (PC). PATIENTS AND METHODS Twenty-five men with cT4 PC were retrospectively identified in the institutional databases of six tertiary referral centers in the last decade. Local invasion was documented by CT or MRI scans and was confirmed by urethrocystoscopy. Oncological therapies, local symptoms, previous local treatments, time from diagnosis to intervention and type of surgical procedure were recorded. Patients were divided into groups: ADT group (12 pts) and 13 pts without any history of previous local/systemic treatments for PCa (nonADT groups). Perioperative complications were classified using the Clavien-Dindo system. Overall survival (OS) was defined as the time from surgery to death from any cause. A Cox regression analysis, stratified for ISUP score and previous hormonal treatment (ADT) was also performed for survival analysis. RESULTS Ileal conduit was the main urinary diversion in both cohorts. For the entire cohort, complication rate was 44%. No significant differences regarding perioperative complications and complication severity between both subgroups were observed (p = 0.2). Median follow-up was 15 months (range 3-41) for the entire cohort with a median survival of 15 months (95% CI 10.1-19.9). In Cox regression analysis stratified for ISUP score, no statistically significant differences in OS in patients with and without previous ADT before cystectomy or exenteration were observed (HR 3.26, 95% CI 0.62-17.23, p = 0.164). CONCLUSION Palliative cystoprostatectomy and pelvic exenteration represent viable treatment options associated with acceptable morbidity and good short-term survival outcome.
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Affiliation(s)
- C Surcel
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
| | - C Mirvald
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. .,Department of Urology, Fundeni Clinical Institute, Bucharest, Romania.
| | - I Tsaur
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - H Borgmann
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - A P Labanaris
- Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece
| | - I Sinescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - G Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, France
| | - A Briganti
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Montorsi
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - R Mathieu
- Department of Urology, CHU Rennes, Rennes, France
| | - M Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - V Jinga
- Urology Department, 'Prof. Dr. Th. Burghele' Clinical Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - D Badescu
- Urology Department, 'Prof. Dr. Th. Burghele' Clinical Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - D Radavoi
- Urology Department, 'Prof. Dr. Th. Burghele' Clinical Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - R C N van den Bergh
- Unit of Urology/Division of Oncology, St Antonius Hospital, Utrecht, Netherlands
| | - G Gandaglia
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - A Kretschmer
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany
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Yuan P, Wang S, Liu X, Wang X, Ye Z, Chen Z. The role of cystoprostatectomy in management of locally advanced prostate cancer: a systematic review. World J Surg Oncol 2020; 18:14. [PMID: 31959170 PMCID: PMC6971978 DOI: 10.1186/s12957-020-1791-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/14/2020] [Indexed: 12/26/2022] Open
Abstract
Background The role of cystoprostatectomy for the treatment of locally advanced prostate cancer (LAPC) was evaluated by a comprehensive review of contemporary literatures. Methods A systematic search of English language literatures using PubMed, EMBASE, Web of Science, and Cochrane library, from 1990 to 2018, was performed. Two independent authors reviewed abstracts as well as full-text articles and extracted data from the selected manuscripts. Results After the literature research, seven articles with a total of 211 patients were identified. Both 120 cases who received cystoprostatectomy for the primary treatment of LAPC and 91 cases for the salvage surgery after local recurrence were finally included. Overall incidence of positive surgical margins ranged from 25 to 78%. The incidence of major complications caused by the surgery during the follow-up time was limited. It had been reported that among LAPC patients who received cystoprostatectomy combined with adjuvant therapies, 5-year cancer-specific survival rate and 5-year biochemical progression-free survival was up to 87.1% and 62.2%. Moreover, symptoms such as hematuria and other urination dysfunctions, as well as patients’ quality of life were significantly improved after cystoprostatectomy in LAPC patients with the bladder invasion. Conclusions Cystoprostatectomy can serve as an alternative to the surgical step of multimodal therapy for highly selected LAPC patients with the bladder invasion, which may improve patients’ symptoms and related quality of life. Therefore, cystoprostatectomy as an option for the treatment of LAPC with the bladder invasion may be feasible and safe with considerable survival outcomes.
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Affiliation(s)
- Peng Yuan
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Shen Wang
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xiao Liu
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Xinguang Wang
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Zhangqun Ye
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiqiang Chen
- Department of Urology, Tongji Hospital, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, China.
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Kim AH, Konety B, Chen Z, Schumacher F, Kutikov A, Smaldone M, Abouassaly R, Khanna A, Kim SP. Comparative Effectiveness of Local and Systemic Therapy for T4 Prostate Cancer. Urology 2018; 120:173-179. [PMID: 29990574 DOI: 10.1016/j.urology.2018.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/08/2018] [Accepted: 06/27/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the comparative effectiveness of local vs systemic therapy among patients diagnosed with nonmetastatic clinical T4 prostate cancer. METHODS Using the National Cancer Database men with clinical T4N0-1M0 prostate cancer from 2004 to 2013 were identified. Local therapy was defined as radiation (RT with androgen deprivation therapy [ADT]), surgery (radical prostatectomy with ADT), or combined radiation plus surgery (radical prostatectomy plus RT with ADT). Systemic therapy was defined as ADT or chemotherapy alone. The primary outcome of overall survival was estimated using the Kaplan-Meier method. Factors associated with overall survival were determined by Cox proportional hazards models. RESULTS A total of 1914 patients were included in our analysis, 1559 received local therapy and 355 received systemic therapy. Median 5-year survival for local vs systemic therapy was 41.5 and 28.2 months, respectively. On multivariable analysis, local therapy was associated with increased overall survival compared to systemic therapy (hazard ratio [HR] = 0.52; 95% confidence interval [CI] 0.44-0.62, P < .001). Comparing local therapy treatment modalities, both radiation (HR = 0.44; 95% CI 0.36-0.53, P < .001) and surgery (HR = 0.67; 95% CI 0.55-0.82, P < .001) were associated with increased overall survival compared to systemic therapy. Among those receiving local therapy, more patients were treated with radiation (n = 709/1559 or 45.5%) compared to surgery (n = 560/1559 or 35.9%) or combined radiation plus surgery (n = 290/1559 or 18.6%) with 5-year overall survival by treatment type being 61%, 51.4%, and 62.2%, respectively. CONCLUSION Local therapy for clinical T4 prostate cancer is associated with improved overall survival. Due to the retrospective, nonrandomized nature of the study design, a clinical trial is needed to better define the efficacy of local therapy in this high-risk patient population.
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Affiliation(s)
- Albert H Kim
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH
| | - Badrinath Konety
- Masonic Cancer Center, Department of Urology, University of Minnesota Health System, Minneapolis, MN
| | - Zhengyi Chen
- Center for Community Health Integration (CHI), Case Western Reserve University School of Medicine, Cleveland, OH
| | - Fredrick Schumacher
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH; Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Alexander Kutikov
- Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA
| | - Marc Smaldone
- Louis Stokes Veterans Affairs Medical Center, Department of Urology, Cleveland, OH
| | - Robert Abouassaly
- Louis Stokes Veterans Affairs Medical Center, Department of Urology, Cleveland, OH; Cleveland Clinic Foundation, Department of Urology, Cleveland, OH
| | - Abhinav Khanna
- Cleveland Clinic Foundation, Department of Urology, Cleveland, OH
| | - Simon P Kim
- University Hospitals Cleveland Medical Center, Urology Institute, Cleveland, OH; Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH.
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Stratton K. Cystectomy for cT4 prostate cancer: the most radical treatment. BJU Int 2017; 120:E6-E7. [PMID: 29105992 DOI: 10.1111/bju.13853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Stratton
- Department of Urology, University of Oklahoma College of Medicine, Oklahoma, OK, USA
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