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Ditonno F, Bologna E, Licari LC, Franco A, Cannoletta D, Checcucci E, Veccia A, Bertolo R, Crivellaro S, Porpiglia F, De Nunzio C, Antonelli A, Autorino R. Neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during robot-assisted radical prostatectomy: a systematic review and meta-analysis of comparative studies. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00891-3. [PMID: 39232095 DOI: 10.1038/s41391-024-00891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 08/20/2024] [Accepted: 08/28/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND To compare surgical, pathological, and functional outcomes of patients undergoing NeuroSAFE-guided RARP vs. RARP alone. METHODS In February 2024, a literature search and assessment was conducted through PubMed®, Scopus®, and Web of Science™, to retrieve data of men with PCa (P) undergoing RARP with NeuroSAFE (I) versus RARP without NeuroSAFE (C) to evaluate surgical, pathological, oncological, and functional outcomes (O), across retrospective and/or prospective comparative studies (Studies). Surgical (operative time [OT], number of nerve-sparing [NS] RARP, number of secondary resections after NeuroSAFE), pathological (PSM), oncological (biochemical recurrence [BCR]), and functional (postoperative continence and sexual function recovery) outcomes were analyzed, using weighted mean difference (WMD) for continuous variables and odd ratio (OR) for dichotomous variables. RESULTS Overall, seven studies met the inclusion criteria (one randomized clinical trial, one prospective non-randomized trial and five retrospective studies) and were eligible for SR and MA. A total of 4,207 patients were included in the MA, with 2247 patients (53%) undergoing RARP with the addition of NeuroSAFE, and 1 960 (47%) receiving RARP alone. The addition of NeuroSAFE enhanced the likelihood of receiving a nerve-sparing (NS) RARP (OR 5.49, 95% CI 2.48-12.12, I2 = 72%). In the NeuroSAFE cohort, a statistically significant reduction in the likelihood of PSM at final pathology (OR 0.55, 95% CI 0.39-0.79, I2 = 73%) was observed. Similarly, a reduced likelihood of BCR favoring the NeuroSAFE was obtained (OR 0.47, 95% CI 0.35-0.62, I2 = 0%). At 12-month postoperatively, NeuroSAFE led to a significantly higher likelihood of being pad-free (OR 2.01, 95% CI 1.25-3.25, I2 = 0%), and of erectile function recovery (OR 3.50, 95% CI 2.34-5.23, I2 = 0%). CONCLUSION Available evidence suggests that NeuroSAFE might represent a histologically based approach to NVB preservation, broadening the indications of NS RARP, reducing the likelihood of PSM and subsequent BCR. In addition, it might translate into better functional postoperative outcomes. However, the current body of evidence is mostly derived from non-randomized studies with a high risk of bias.
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Affiliation(s)
- Francesco Ditonno
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Eugenio Bologna
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, ''Sapienza'' University, Rome, Italy
| | - Leslie Claire Licari
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Unit of Urology, Department of Maternal-Child and Urological Sciences, Policlinico Umberto I Hospital, ''Sapienza'' University, Rome, Italy
| | - Antonio Franco
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Donato Cannoletta
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Alessandro Veccia
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Bertolo
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, IL, USA
| | - Francesco Porpiglia
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Autorino
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
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Martini A, Wever L, Soeterik TFW, Rakauskas A, Fankhauser CD, Grogg JB, Checcucci E, Amparore D, Haiquel L, Rodriguez-Sanchez L, Ploussard G, Qiang P, Affentranger A, Marquis A, Marra G, Ettala O, Zattoni F, Falagario UG, De Angelis M, Kesch C, Apfelbeck M, Al-Hammouri T, Kretschmer A, Kasivisvanathan V, Preisser F, Lefebvre E, Olivier J, Radtke JP, Carrieri G, Moro FD, Boström P, Jambor I, Gontero P, Chiu PK, John H, Macek P, Porpiglia F, Hermanns T, van den Bergh RCN, van Basten JPA, Gandaglia G, Valerio M. An updated model for predicting side-specific extraprostatic extension in the era of MRI-targeted biopsy. Prostate Cancer Prostatic Dis 2024; 27:520-524. [PMID: 38182804 DOI: 10.1038/s41391-023-00776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/26/2023] [Accepted: 12/01/2023] [Indexed: 01/07/2024]
Abstract
PURPOSE Accurate prediction of extraprostatic extension (EPE) is pivotal for surgical planning. Herein, we aimed to provide an updated model for predicting EPE among patients diagnosed with MRI-targeted biopsy. MATERIALS AND METHODS We analyzed a multi-institutional dataset of men with clinically localized prostate cancer diagnosed by MRI-targeted biopsy and subsequently underwent prostatectomy. To develop a side-specific predictive model, we considered the prostatic lobes separately. A multivariable logistic regression analysis was fitted to predict side-specific EPE. The decision curve analysis was used to evaluate the net clinical benefit. Finally, a regression tree was employed to identify three risk categories to assist urologists in selecting candidates for nerve-sparing, incremental nerve sparing and non-nerve-sparing surgery. RESULTS Overall, data from 3169 hemi-prostates were considered, after the exclusion of prostatic lobes with no biopsy-documented tumor. EPE was present on final pathology in 1,094 (34%) cases. Among these, MRI was able to predict EPE correctly in 568 (52%) cases. A model including PSA, maximum diameter of the index lesion, presence of EPE on MRI, highest ISUP grade in the ipsilateral hemi-prostate, and percentage of positive cores in the ipsilateral hemi-prostate achieved an AUC of 81% after internal validation. Overall, 566, 577, and 2,026 observations fell in the low-, intermediate- and high-risk groups for EPE, as identified by the regression tree. The EPE rate across the groups was: 5.1%, 14.9%, and 48% for the low-, intermediate- and high-risk group, respectively. CONCLUSION In this study we present an update of the first side-specific MRI-based nomogram for the prediction of extraprostatic extension together with updated risk categories to help clinicians in deciding on the best approach to nerve-preservation.
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Affiliation(s)
- Alberto Martini
- Department of Urology, La Croix du Sud Hospital, Toulouse, France.
| | - Lieke Wever
- St. Antonius ziekenhuis, Nieuwegein, the Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - Arnas Rakauskas
- Department of Urology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Josias Bastian Grogg
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | | | - Luciano Haiquel
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | | | - Peng Qiang
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Alessandro Marquis
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Giancarlo Marra
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Otto Ettala
- Department of Urology, Turku University, Turku, Finland
| | - Fabio Zattoni
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | | | - Mario De Angelis
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Claudia Kesch
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Tarek Al-Hammouri
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Veeru Kasivisvanathan
- Department of Urology, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt, Germany
| | | | | | - Jan Philipp Radtke
- Department of Urology, University Hospital Essen, Essen, Germany
- German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | | | - Fabrizio Dal Moro
- Urology Unit, Academical Medical Centre Hospital, Udine, Italy
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy
| | - Peter Boström
- Department of Urology, Turku University, Turku, Finland
| | - Ivan Jambor
- Department of Urology, Turku University, Turku, Finland
| | - Paolo Gontero
- Department of Urology, San Giovanni Battista Hospital, University of Turin, Turin, Italy
| | - Peter K Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Thomas Hermanns
- Department of Urology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Jean-Paul A van Basten
- St. Antonius ziekenhuis, Nieuwegein, the Netherlands
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Massimo Valerio
- Department of Urology, Geneva University Hospital, Geneva, Switzerland.
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de Roode LM, de Boer LL, Da Silva Guimaraes M, van Leeuwen PJ, van der Poel HG, Dashtbozorg B, Ruers TJ. Feasibility of Diffuse Reflection Spectroscopy for Intraoperative Margin Assessment During Prostatectomy. EUR UROL SUPPL 2024; 67:62-68. [PMID: 39229364 PMCID: PMC11369370 DOI: 10.1016/j.euros.2024.07.112] [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: 07/16/2024] [Indexed: 09/05/2024] Open
Abstract
Background and objective A positive surgical margin (PSM) occurs in up to 32% of patients undergoing robot-assisted radical prostatectomy (RARP). Diffuse reflectance spectroscopy (DRS), which measures tissue composition according to its optical properties, can potentially be used for real-time PSM detection during RARP. Our objective was to assess the feasibility of DRS in distinguishing prostate cancer from benign tissue in RARP specimens. Methods In a single-center prospective study, DRS measurements were taken ex vivo for RARP specimens from 59 patients with biopsy-proven prostate carcinoma. Discriminating features from the DRS spectra were used to create a machine learning-based classification algorithm. The data were split patient-wise into training (70%) and testing (30%) sets, with ten iterations to ensure algorithm robustness. The average sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve (AUC) from ten classification iterations were calculated. Key findings and limitations We collected 542 DRS measurements, of which 53% were tumor and 47% were healthy-tissue measurements. Twenty discriminating features from the DRS spectra were used as the input for a support vector machine model. This model achieved average sensitivity of 89%, specificity of 82%, accuracy of 85%, and AUC of 0.91 for the test set. Limitations include the binary label input for classification. Conclusions and clinical implications DRS can potentially discriminate prostate cancer from benign tissue. Before implementing the technique in clinical practice, further research is needed to assess its performance on heterogeneous tissue volumes and measurements from the prostate surface. Patient summary We looked at the ability of a technique called diffuse reflectance spectroscopy to guide surgeons in discriminating prostate cancer tissue from benign prostate tissue in real time during prostate cancer surgery. Our study showed promising results in an experimental setting. Future research will focus on bringing this technique to clinical practice.
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Affiliation(s)
- Lotte M. de Roode
- Department of Nanobiophysics, University of Twente, Enschede, The Netherlands
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Lisanne L. de Boer
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Marcos Da Silva Guimaraes
- Molecular Pathology & Biobanking, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Pim J. van Leeuwen
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G. van der Poel
- Department of Urology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
- Department of Urology, Amsterdam University Medical Centers, VU University, Amsterdam, The Netherlands
| | - Behdad Dashtbozorg
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Theo J.M. Ruers
- Department of Nanobiophysics, University of Twente, Enschede, The Netherlands
- Image-Guided Surgery, Department of Surgery, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Mannas MP, Deng FM, Ion-Margineanu A, Freudiger C, Jones D, Hoskoppal D, Melamed J, Wysock J, Orringer DA, Taneja SS. Intraoperative margin assessment with near real time pathology during partial gland ablation of prostate cancer: A feasibility study. Urol Oncol 2024:S1078-1439(24)00533-7. [PMID: 39129081 DOI: 10.1016/j.urolonc.2024.06.023] [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: 04/26/2024] [Revised: 05/27/2024] [Accepted: 06/20/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND In-field or in-margin recurrence after partial gland cryosurgical ablation (PGCA) of prostate cancer (PCa) remains a limitation of the paradigm. Stimulated Raman histology (SRH) is a novel microscopic technique allowing real time, label-free, high-resolution microscopic images of unprocessed, un-sectioned tissue which can be interpreted by humans or artificial intelligence (AI). We evaluated surgical team and AI interpretation of SRH for real-time pathologic feedback in the planning and treatment of PCa with PGCA. METHODS About 12 participants underwent prostate mapping biopsies during PGCA of their PCa between January and June 2022. Prostate biopsies were immediately scanned in a SRH microscope at 20 microns depth using 2 Raman shifts to create SRH images which were interpreted by the surgical team intraoperatively to guide PGCA, and retrospectively assessed by AI. The cores were then processed, hematoxylin and eosin stained as per normal pathologic protocols and used for ground truth pathologic assessment. RESULTS Surgical team interpretation of SRH intraoperatively revealed 98.1% accuracy, 100% sensitivity, 97.3% specificity for identification of PCa, while AI showed a 97.9% accuracy, 100% sensitivity and 97.5% specificity for identification of clinically significant PCa. 3 participants' PGCA treatments were modified after SRH visualized PCa adjacent to an expected MRI predicted tumor margin or at an untreated cryosurgical margin. CONCLUSION SRH allows for accurate rapid identification of PCa in PB by a surgical team interpretation or AI. PCa tumor mapping and margin assessment during PGCA appears to be feasible and accurate. Further studies evaluating impact on clinical outcomes are warranted.
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Affiliation(s)
- Miles P Mannas
- Dept. of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada; Vancouver Prostate Centre, University of British Columbia, Vancouver, British Columbia, Canada; Dept. of Urology, NYU Langone Health, New York, NY.
| | | | | | | | - Derek Jones
- Dept. of Pathology, NYU Langone Health, New York, NY
| | | | | | - James Wysock
- Dept. of Urology, NYU Langone Health, New York, NY
| | | | - Samir S Taneja
- Dept. of Urology, NYU Langone Health, New York, NY; Dept. of Radiology, NYU Langone Health, New York, NY; Dept. of Biomedical Engineering, NYU Langone Health, New York, NY
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Dinneen E, Almeida-Magana R, Al-Hammouri T, Fernandes I, Mayor N, Mendes L, Winkler M, Silvanto A, Haider A, Freeman A, Shaw G. Intraoperative margin assessment during radical prostatectomy: is microscopy frozen in time or ready for digital defrost? Histopathology 2024. [PMID: 39104212 DOI: 10.1111/his.15290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
Intraoperative frozen section (IFS) is used with the intention to improve functional and oncological outcomes for patients undergoing radical prostatectomy (RP). High resource requirements of IFS techniques such as NeuroSAFE may preclude widespread adoption, even if there are benefits to patients. Recent advances in fresh-tissue microscopic digital imaging technologies may offer an attractive alternative, and there is a growing body of evidence regarding these technologies. In this narrative review, we discuss some of the familiar limitations of IFS and compare these to the attractive counterpoints of modern digital imaging technologies such as the speed and ease of image generation, the locality of equipment within (or near) the operating room, the ability to maintain tissue integrity, and digital transfer of images. Confocal laser microscopy (CLM) is the modality most frequently reported in the literature for margin assessment during RP. We discuss several imitations and obstacles to widespread dissemination of digital imaging technologies. Among these, we consider how the 'en-face' margin perspective will challenge urologists and pathologists to understand afresh the meaning of positive margin significance. As a part of this, discussions on how to describe, categorize, react to, and evaluate these technologies are needed to improve patient outcomes. Limitations of this review include its narrative structure and that the evidence base in this field is relatively immature but developing at pace.
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Affiliation(s)
- Eoin Dinneen
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Ricardo Almeida-Magana
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Tarek Al-Hammouri
- Division of Surgery & Interventional Science, University College London, London, UK
- Centre for Medical Imaging, University College London, London, UK
| | - Iona Fernandes
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Nikhil Mayor
- Department of Urology, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
- Imperial Prostate, Division of Surgery, Imperial College London, London, UK
| | - Larissa Mendes
- Department of Histopathology, University College Hospital London, London, UK
| | - Mathias Winkler
- Department of Urology, Imperial College NHS Healthcare Trust, Charing Cross Hospital, London, UK
- Imperial Prostate, Division of Surgery, Imperial College London, London, UK
| | - Anna Silvanto
- Department of Histopathology, University College Hospital London, London, UK
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, London, UK
| | - Greg Shaw
- Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
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Ambrosini F, Preisser F, Tilki D, Heinzer H, Salomon G, Michl U, Steuber T, Maurer T, Chun FKH, Budäus L, Pose RM, Terrone C, Schlomm T, Tennstedt P, Huland H, Graefen M, Haese A. Nerve-sparing radical prostatectomy using the neurovascular structure-adjacent frozen-section examination (NeuroSAFE): results after 20 years of experience. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00851-x. [PMID: 38862777 DOI: 10.1038/s41391-024-00851-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 05/13/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVES To evaluate the long-term oncological outcomes and functional results of the neurovascular structure-adjacent frozen-section examination (NeuroSAFE) during nerve-sparing (NS) radical prostatectomy (RP). MATERIALS AND METHODS A 10-yr survival analysis on 11069 RPs performed with or without the NeuroSAFE, between January 2002 to June 2011 was carried out. In the NeuroSAFE cohort, the neurovascular structure-adjacent prostatic margins are removed and stained for cryo-sectioning during RP. In case of a PSM, partial or full removal of the neurovascular bundle was performed. The impact of NeuroSAFE on biochemical recurrence-free survival (BFS), salvage radiation therapy-free survival, metastasis-free survival, and prostate cancer-specific survival at 10 years was analyzed. 1-year (1-yr) erectile function (EF), 1-yr, and 2-yr continence rates were assessed in propensity score-based matched cohorts. RESULTS Median follow-up was 121 (IQR: 73, 156) months. No differences in BFS between NeuroSAFE and non-NeuroSAFE were recorded (10-yr BFS: NeuroSAFE vs non-Neurosafe, pT2: 81% vs 84%, p = 0.06; pT3a: 58% vs. 63%, p = 0.6; ≥pT3b: 22% vs. 27%, p = 0.99). No differences were found between the two groups in terms of sRFS (pT2: p = 0.1; pT3a: p = 0.4; ≥pT3b: p = 0.4) (Fig. 1B, Table 2), and MTS (pT2: p = 0.3; pT3a: p = 0.6; ≥pT3b: p = 0.9). The NeuroSAFE-navigated patients reported a better 1-yr EF than non-NeuroSAFE (68% vs. 58%, p = 0.02) and no differences in 1-yr and 2-yr continence rates (92.4% vs. 91.8%, and 93.4% vs. 93%, respectively). The main limitation is the retrospective study design. CONCLUSIONS While the NeuroSAFE approach did not show significant improvements in long-term oncologic or continence outcomes, it did provide an opportunity for a higher proportion of patients to improve postoperative functional results, possibly through increased nerve-sparing procedures.
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Affiliation(s)
- Francesca Ambrosini
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hans Heinzer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Salomon
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe Michl
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Steuber
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias Maurer
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Lars Budäus
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Randi M Pose
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Carlo Terrone
- IRCCS Ospedale Policlinico San Martino, Genova, Italia
| | - Thorsten Schlomm
- Department of Urology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Pierre Tennstedt
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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Almeida-Magana R, Au M, Al-Hammouri T, Dinneen K, Haider A, Freeman A, Shaw G. Improving fluorescence confocal microscopy for margin assessment during robot-assisted radical prostatectomy: The LaserSAFE technique. BJU Int 2024; 133:677-679. [PMID: 38009389 DOI: 10.1111/bju.16239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Affiliation(s)
- Ricardo Almeida-Magana
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Matthew Au
- Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Tarek Al-Hammouri
- Division of Surgery and Interventional Sciences, University College London, London, UK
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Kate Dinneen
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aiman Haider
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Alex Freeman
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Greg Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
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8
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Diamand R, Roche JB, Lacetera V, Simone G, Windisch O, Benamran D, Fourcade A, Fournier G, Fiard G, Ploussard G, Roumeguère T, Peltier A, Albisinni S. Predicting contralateral extraprostatic extension in unilateral high-risk prostate cancer: a multicentric external validation study. World J Urol 2024; 42:247. [PMID: 38647728 DOI: 10.1007/s00345-024-04966-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE Accurate prediction of extraprostatic extension (EPE) is crucial for decision-making in radical prostatectomy (RP), especially in nerve-sparing strategies. Martini et al. introduced a three-tier algorithm for predicting contralateral EPE in unilateral high-risk prostate cancer (PCa). The aim of the study is to externally validate this model in a multicentric European cohort of patients. METHODS The data from 208 unilateral high-risk PCa patients diagnosed through magnetic resonance imaging (MRI)-targeted and systematic biopsies, treated with RP between January 2016 and November 2021 at eight referral centers were collected. The evaluation of model performance involved measures such as discrimination (AUC), calibration, and decision-curve analysis (DCA) following TRIPOD guidelines. In addition, a comparison was made with two established multivariable logistic regression models predicting the risk of side specific EPE for assessment purposes. RESULTS Overall, 38%, 48%, and 14% of patients were categorized as low, intermediate, and high-risk groups according to Martini et al.'s model, respectively. At final pathology, EPE on the contralateral prostatic lobe occurred in 6.3%, 12%, and 34% of patients in the respective risk groups. The algorithm demonstrated acceptable discrimination (AUC 0.68), comparable to other multivariable logistic regression models (p = 0.3), adequate calibration and the highest net benefit in DCA. The limitations include the modest sample size, retrospective design, and lack of central revision. CONCLUSION Our findings endorse the algorithm's commendable performance, supporting its utility in guiding treatment decisions for unilateral high-risk PCa patients.
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Affiliation(s)
- Romain Diamand
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium.
| | | | - Vito Lacetera
- Department of Urology, Azienda Ospedaliera Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Giuseppe Simone
- Department of Urology, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Olivier Windisch
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Alexandre Fourcade
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Georges Fournier
- Department of Urology, Hôpital Cavale Blanche, CHRU Brest, Brest, France
| | - Gaelle Fiard
- Department of Urology, Grenoble Alpes University Hospital, Université Grenoble Alpes, CNRS, Grenoble INP, TIMC, Grenoble, France
| | | | - Thierry Roumeguère
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
| | - Alexandre Peltier
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
| | - Simone Albisinni
- Department of Urology, Jules Bordet Institute-Erasme Hospital, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Rue Meylemeersch 90, 1070, Brussels, Belgium
- Urology Unit, Department of Surgical Sciences, Tor Vergata University, Rome, Italy
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9
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Meenderink JJL, Kroon LJ, van der Slot MA, Venderbos LDF, van Leenders GJLH, Roobol MJ, Busstra MB. Lymphoceles after pelvic lymph node dissection during robot-assisted radical prostatectomy. Transl Androl Urol 2023; 12:1622-1630. [PMID: 38106676 PMCID: PMC10719774 DOI: 10.21037/tau-23-416] [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: 07/31/2023] [Accepted: 11/03/2023] [Indexed: 12/19/2023] Open
Abstract
Background Lymphoceles, lymph fluid-filled collections within the body lacking epithelial lining, are a common complication after pelvic lymph node dissection (PLND) during robot-assisted radical prostatectomy (RARP). In this study, we investigate the incidence of imaging confirmed symptomatic lymphoceles (SLC) in a centralized high-volume operating centre and assess predictive factors and treatment. Methods We retrospectively analysed the incidence, risk factors and treatment of a consecutive series of patients who underwent PLND during RARP between September 2018 and January 2021 in a specialised operation clinic. We compared baseline patients' characteristics and pathological data between men who developed an SLC and those who did not. A multivariable model for the occurrence of an SLC was created using predetermined, clinically relevant variables to investigate predictive factors. Results We analysed the records of 404 patients. The median follow-up length was 29 months. A total of 30 (7.4%) patients with an SLC were identified. The median time until SLC presentation was 12 weeks [interquartile range (IQR), 4-31 weeks], one-third of SLCs presented after 180 days. Percutaneous drainage was performed in 17 patients (57%). On multivariable analysis, only body mass index (BMI) significantly increased the odds of an SLC [per 5 odds ratio (OR) =1.7; 95% confidence interval (CI): 1.0-3.0, P=0.04]. Conclusions SLCs present significant consequences, as more than half of patients with an SLC were treated with percutaneous drainage. Many patients presented later than the centralized surgeons' postoperative follow-up, a drawback of centralized care. An increased BMI was a significant predictor for SLC.
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Affiliation(s)
- Jonas J. L. Meenderink
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Lisa J. Kroon
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands
- Department of Pathology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Margaretha A. van der Slot
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands
| | - Lionne D. F. Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | | | - Monique J. Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Martijn B. Busstra
- Department of Urology, Erasmus MC Cancer Institute, Erasmus MC, Rotterdam, The Netherlands
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands
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10
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Leitsmann C, Uhlig A, Bremmer F, Mohr MN, Trojan L, Leitsmann M, Reichert M. Impact of multiparametric magnetic resonance imaging targeted biopsy on functional outcomes in patients following robot-assisted laparoscopic radical prostatectomy. Front Surg 2023; 10:1305365. [PMID: 38053718 PMCID: PMC10694190 DOI: 10.3389/fsurg.2023.1305365] [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: 10/01/2023] [Accepted: 11/07/2023] [Indexed: 12/07/2023] Open
Abstract
Introduction Multiparametric magnetic resonance imaging guided prostate biopsy (mpMRI PBx) leads to a higher rate of successful nerve-sparing in robot-assisted laparoscopic prostatectomy (ns-RALP) for prostate cancer (PCa). This study aimed to evaluate the impact of mpMRI PBx compared to standard ultrasound-guided PBx on functional outcomes focusing on erectile function in patients following ns-RALP. Material and methods All RALPs performed between 01/2016 and 06/2021 were retrospectively stratified according to (attempted) ns vs. non ns RALPs and were then categorized based on the PBx technique (mpMRI PBx vs. standard PBx). We compared RALP outcomes such as pathological tumor stage, rates of secondary nerve resection (SNR) and positive surgical margin status (PSM). Furthermore, we explored the association between PBx-technique and patient-reported outcomes assessed 12 months after RALP using the prospectively collected 26-item Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. Chi-square tests and logistic regression analysis were conducted. Results A total of 849 RALPs included 517 (61%) procedures with (attempted) ns. Among these, 37.5% were diagnosed via preoperative mpMRI PBx. Patients with a preoperative standard PBx had a 57% higher association of PSM (p = 0.030) compared to patients with mpMRI PBx and a 24% higher risk of erectile dysfunction (ED) 12 months post RALP (p = 0.025). When ns was attempted, we observed a significantly higher rate of SNR in patients who underwent a standard PBx compared to those who received a mpMRI PBx (50.8% vs. 26.7%, p < 0.001) prior RALP. In comparison, upgrading occurred more often in the standard PBx group (50% vs. 40% mpMRI PBx, p = 0.008). Conclusion The combination of mpMRI PBx for PCa diagnosis followed by ns-RALP resulted in significantly fewer cases of SNR, better oncological outcomes and reduced incidence of ED 1 year after surgery. This included fewer PSM and a lower rate of postoperative tumor upgrading.
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Affiliation(s)
- Conrad Leitsmann
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Annemarie Uhlig
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Felix Bremmer
- Department of Pathology, University Medical Center Goettingen, Goettingen, Germany
| | - Mirjam Naomi Mohr
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | - Lutz Trojan
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
| | | | - Mathias Reichert
- Department of Urology, University Medical Center Goettingen, Goettingen, Germany
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11
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Wu X, Wong CHM, Gandaglia G, Chiu PKF. Urinary continence in high-risk prostate cancer after robot-assisted radical prostatectomy. Curr Opin Urol 2023; 33:482-487. [PMID: 37646515 DOI: 10.1097/mou.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW Urinary incontinence is common postoperative complication following robot-assisted radical prostatectomy (RARP) in patients with prostate cancer (PCa). Despite the increasing adoption of RARP in the treatment of high-risk PCa (HRPC), concerns persist regarding the adequacy of reported continence outcomes in this subgroup. This review aims to illuminate the state of continence recovery in HRPC patients post-RARP. RECENT FINDINGS Urinary continence (UC) recovery rates in HRPC was reported to be lower than the intermediate/low-risk counterparts from 6 to 24 months post-RARP. Predictive models showed that age, obesity, race, disease status, and surgical approaches represent predictors of continence recovery. Special techniques like NeuroSAFE technique and Retzius-Sparing approach also play a role in reducing incontinence also in the high-risk scenario. SUMMARY RARP for HRPC appears to be associated with worse continence compared with other risk groups. A multimodality approach for prediction and prevention of incontinence after RARP is vital. Further research into this area is necessary to enhance continence recovery outcomes in HRPC patients undergoing RARP.
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Affiliation(s)
- Xiaobo Wu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Chris Ho-Ming Wong
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Gianfranco Soldera Prostate Cancer Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Peter Ka-Fung Chiu
- SH Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Shatin, Hong Kong
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12
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Franco A, Ditonno F, Manfredi C, Johnson AD, Mamgain A, Feldman-Schultz O, Feng CL, Pellegrino AA, Mir MC, Porpiglia F, Crivellaro S, De Nunzio C, Chow AK, Autorino R. Robot-assisted Surgery in the Field of Urology: The Most Pioneering Approaches 2015-2023. Res Rep Urol 2023; 15:453-470. [PMID: 37842031 PMCID: PMC10575039 DOI: 10.2147/rru.s386025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 09/30/2023] [Indexed: 10/17/2023] Open
Abstract
Robot-assisted surgery has emerged as a transformative technology, revolutionizing surgical approaches and techniques that decades ago could barely be imagined. The field of urology has taken charge in pioneering a new era of minimally invasive surgery with the ascent of robotic systems which offer enhanced visualization, precision, dexterity, and enabling surgeons to perform intricate maneuvers with improved accuracy. This has led to improved surgical outcomes, including reduced blood loss, lower complication rates, and faster patient recovery. The aim of our review is to present an evidence-based critical analysis on the most pioneering robotic urologic approaches described over the last eight years (2015-2023).
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Affiliation(s)
- Antonio Franco
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Francesco Ditonno
- Department of Urology, Rush University, Chicago, IL, USA
- Department of Urology, University of Verona, Verona, Italy
| | - Celeste Manfredi
- Department of Urology, Rush University, Chicago, IL, USA
- Urology Unit, “Luigi Vanvitelli” University, Naples, Italy
| | | | | | | | - Carol L Feng
- Department of Urology, Rush University, Chicago, IL, USA
| | - Antony A Pellegrino
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
- Unit of Urology/Division of Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Carmen Mir
- Department of Urology, Hospital Universitario La Ribera, Valencia, Spain
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy
| | - Simone Crivellaro
- Department of Urology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Cosimo De Nunzio
- Department of Urology, Sant’Andrea Hospital, Sapienza University, Rome, Italy
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13
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Köseoğlu E, Kulaç İ, Armutlu A, Gürses B, Seymen H, Vural M, Aykanat İC, Tarım K, Sarıkaya AF, Kılıç M, Baydar DE, Demirkol MO, Balbay MD, Kordan Y, Canda AE, Esen T. Intraoperative Frozen Section via Neurosafe During Robotic Radical Prostatectomy in the Era of Preoperative Risk Stratifications and Primary Staging With mpMRI and PSMA-PET CT: Is There a Perfect Candidate? Clin Genitourin Cancer 2023; 21:602-611. [PMID: 37451883 DOI: 10.1016/j.clgc.2023.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/01/2023] [Accepted: 06/25/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We aimed to analyze the effect of preoperative risk assessment including Ga-68 PSMA PET and multiparametric magnetic resonance imaging (mpMRI) on nerve sparing practices, positive surgical margin (PSM) rates and oncological outcomes based on a comparison between patients underwent RARP with and without Neurosafe (NS). METHODS Patients underwent RARP with NS (RARP-NS) or without (RARP-only) NS retrospectively evaluated. Suspicion for extracapsular extension on mpMRI and/or Ga-68 PSMA PET was recorded as i(imaging)T3. NS was performed according to the Martini-Klinik technique. PSM at preserved bundle side were called PSM at region of interest (ROI) while the others were elsewhere. RESULTS A total of 208 patients (90 in RARP-NS, 118 in RARP-only groups) were included. Preoperatively the RARP-only group showed significantly higher mean PSA (p = .01) and PIRADS 5 (p = .002) findings and had more D'Amico high risk (DAHR) patients (p = .08). The overall PSM rates for pT2 versus pT3 disease were 7.5% versus 21.6 and 15.6% versus 55% in RARP-NS and RARP-only groups, respectively. NS resulted in more bilaterally preserved bundles (81.1% vs. 66.3%) and less PSM at the ROI (3.3% vs. 23.4%) than RARP-only group. NS outperformed RARP-only in all clinical settings had its highest differential benefit in more bilateral nerve sparing and less PSM at ROI in patients with both DAHR and iT3 disease. BCR rates were 2.2% and 2.5% for RARP-NS and RARP only groups, respectively (p = .4). One patient in RARP-NS and 9 in RARP-only groups had PSA persistence (p = .02). CONCLUSION RARP-NS led to more preserved bundles with less PSM. It was especially useful in DAHR patients with preoperative extracapsular extension suspicion in imaging simultaneously.
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Affiliation(s)
- Ersin Köseoğlu
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey.
| | - İbrahim Kulaç
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Ayşe Armutlu
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Bengi Gürses
- Department of Radiology, Koç University School of Medicine, Istanbul, Turkey
| | - Hülya Seymen
- Department of Nuclear Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Metin Vural
- Radiology Clinic, VKF American Hospital, Istanbul, Turkey
| | | | - Kayhan Tarım
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | | - Mert Kılıç
- Urology Clinic, VKF American Hospital, Istanbul, Turkey
| | - Dilek Ertoy Baydar
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Mehmet Onur Demirkol
- Department of Nuclear Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Mevlana Derya Balbay
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey; Urology Clinic, VKF American Hospital, Istanbul, Turkey
| | - Yakup Kordan
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey
| | | | - Tarık Esen
- Department of Urology, Koç University School of Medicine, Istanbul, Turkey; Urology Clinic, VKF American Hospital, Istanbul, Turkey
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14
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Cano Garcia C, Wenzel M, Koll F, Zatik A, Köllermann J, Graefen M, Tilki D, Karakiewicz PI, Kluth LA, Chun FKH, Mandel P, Hoeh B. Differences in long-term continence rates between prostate cancer patients with extraprostatic vs. organ-confined disease undergoing robotic-assisted radical prostatectomy: An observational studys. Clinics (Sao Paulo) 2023; 78:100284. [PMID: 37783172 PMCID: PMC10551827 DOI: 10.1016/j.clinsp.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 10/04/2023] Open
Abstract
OBJECTIVES Within the tertiary-case database, the authors tested for differences in long-term continence rates (≥ 12 months) between prostate cancer patients with extraprostatic vs. organ-confined disease who underwent Robotic-Assisted Radical Prostatectomy (RARP). METHOD In the institutional tertiary-care database the authors identified prostate cancer patients who underwent RARP between 01/2014 and 01/2021. The cohort was divided into two groups based on tumor extension in the final RARP specimen: patients with extraprostatic (pT3/4) vs. organ-confined (pT2) disease. Additionally, the authors conducted subgroup analyses within both the extraprostatic and organ-confined disease groups to compare continence rates before and after the implementation of the new surgical technique, which included Full Functional-Length Urethra preservation (FFLU) and Neurovascular Structure-Adjacent Frozen-Section Examination (NeuroSAFE). Multivariable logistic regression models addressing long-term continence were used. RESULTS Overall, the authors identified 201 study patients of whom 75 (37 %) exhibited extraprostatic and 126 (63 %) organ-confined disease. There was no significant difference in long-term continence rates between patients with extraprostatic and organ-confined disease (77 vs. 83 %; p = 0.3). Following the implementation of FFLU+ NeuroSAFE, there was an overall improvement in continence from 67 % to 89 % (Δ = 22 %; p < 0.001). No difference in the magnitude of improved continence rates between extraprostatic vs. organ-confined disease was observed (Δ = 22 % vs. Δ = 20 %). In multivariable logistic regression models, no difference between extraprostatic vs. organ-confined disease in long-term continence was observed (Odds Ratio: 0.91; p = 0.85). CONCLUSION In this tertiary-based institutional study, patients with extraprostatic and organ-confined prostate cancer exhibited comparable long-term continence rates.
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Affiliation(s)
- Cristina Cano Garcia
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany; Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.
| | - Mike Wenzel
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany
| | - Florestan Koll
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany
| | - Agnes Zatik
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany
| | - Jens Köllermann
- Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Luis A Kluth
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany
| | - Felix K H Chun
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany
| | - Philipp Mandel
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany
| | - Benedikt Hoeh
- Goethe University Frankfurt, University Hospital Frankfurt, Department of Urology, Germany
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15
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van der Slot MA, Remmers S, van Leenders GJLH, Busstra MB, Gan M, Klaver S, Rietbergen JBW, den Bakker MA, Kweldam CF, Bangma CH, Roobol MJ, Venderbos LDF. Urinary Incontinence and Sexual Function After the Introduction of NeuroSAFE in Radical Prostatectomy for Prostate Cancer. Eur Urol Focus 2023; 9:824-831. [PMID: 37032279 DOI: 10.1016/j.euf.2023.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/28/2023] [Accepted: 03/28/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Nerve-sparing (NS) radical prostatectomy (RP) results in better functional outcomes. Intraoperative neurovascular structure-adjacent frozen section examination (NeuroSAFE) significantly increases the frequency of NS surgery. The effect of NeuroSAFE on postoperative erectile function (EF) and continence is not yet clear. OBJECTIVE To describe EF and continence outcomes for men undergoing RP with the NeuroSAFE technique. DESIGN, SETTING, AND PARTICIPANTS Between September 2018 and February 2021, 1034 men underwent robot-assisted RP. Data for patient-reported outcomes were collected via validated questionnaires. INTERVENTION NeuroSAFE technique for RP. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Continence was assessed using the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) or Expanded Prostate Cancer Index Composite short form (EPIC-26) and defined as use of 0-1 pads/d. EF was evaluated using EPIC-26 or the International Index of Erectile Function short form (IIEF-5), with data converted according to the Vertosick method and categorized. Descriptive statistics were used to asses and describe tumor characteristics and continence and EF outcomes. RESULTS AND LIMITATIONS Of the 1034 men who underwent RP after introduction of the NeuroSAFE technique, 63% and 60% completed a preoperative and at least one postoperative questionnaire on continence and EF, respectively. Of the men who underwent unilateral or bilateral NS surgery, use of 0-1 pads/d was reported by 93% after 1 yr and 96% after 2 yr; the corresponding rates for men who underwent non-NS surgery were 86% and 78%. Overall, use of 0-1 pads/d was reported by 92% of the men at 1 yr and by 94% at 2 yr after RP. Men in the NS group had a good or intermediate Vertosick score after RP more often than the non-NS group. Overall, 44% of the men had a good or intermediate Vertosick score at 1 and 2 yr after RP. CONCLUSIONS After introduction of the NeuroSAFE technique, the continence rate was 92% at 1 yr and 94% at 2 yr after RP. The NS group had a greater percentage of men with an intermediate or good Vertosick score and a higher continence rate after RP in comparison to the non-NS group. PATIENT SUMMARY Our study shows that after introduction of the NeuroSAFE technique during removal of the prostate, the continence rate among patients was 92% at 1 year and 94% at 2 years after surgery. Some 44% of the men had a good or intermediate score for erectile function 1 and 2 years after surgery.
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Affiliation(s)
- Margaretha A van der Slot
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands; Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands
| | - Martijn B Busstra
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands
| | - Melanie Gan
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Sjoerd Klaver
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
| | - John B W Rietbergen
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Michael A den Bakker
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Charlotte F Kweldam
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Pathology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Chris H Bangma
- Anser Prostate Operation Clinic, Rotterdam, The Netherlands; Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands
| | - Lionne D F Venderbos
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, The Netherlands.
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16
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van der Slot MA, Remmers S, Kweldam CF, den Bakker MA, Nieboer D, Busstra MB, Gan M, Klaver S, Rietbergen JBW, van Leenders GJLH. Biopsy prostate cancer perineural invasion and tumour load are associated with positive posterolateral margins at radical prostatectomy: implications for planning of nerve-sparing surgery. Histopathology 2023; 83:348-356. [PMID: 37140551 DOI: 10.1111/his.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 05/05/2023]
Abstract
AIMS Radical prostatectomy (RP) for prostate cancer is frequently complicated by erectile dysfunction and urinary incontinence. However, sparing of the nerve bundles adjacent to the posterolateral sides of the prostate reduces the number of complications at the risk of positive surgical margins. Preoperative selection of men eligible for safe, nerve-sparing surgery is therefore needed. Our aim was to identify pathological factors associated with positive posterolateral surgical margins in men undergoing bilateral nerve-sparing RP. METHODS AND RESULTS Prostate cancer patients undergoing RP with standardised intra-operative surgical margin assessment according to the NeuroSAFE technique were included. Preoperative biopsies were reviewed for grade group (GG), cribriform and/or intraductal carcinoma (CR/IDC), perineural invasion (PNI), cumulative tumour length and extraprostatic extension (EPE). Of 624 included patients, 573 (91.8%) received NeuroSAFE bilaterally and 51 (8.2%) unilaterally, resulting in a total of 1197 intraoperative posterolateral surgical margin assessments. Side-specific biopsy findings were correlated to ipsilateral NeuroSAFE outcome. Higher biopsy GG, CR/IDC, PNI, EPE, number of positive biopsies and cumulative tumour length were all associated with positive posterolateral margins. In multivariable bivariate logistic regression, ipsilateral PNI [odds ratio (OR) = 2.98, 95% confidence interval (CI) = 1.62-5.48; P < 0.001] and percentage of positive cores (OR = 1.18, 95% CI = 1.08-1.29; P < 0.001) were significant predictors for a positive posterolateral margin, while GG and CR/IDC were not. CONCLUSIONS Ipsilateral PNI and percentage of positive cores were significant predictors for a positive posterolateral surgical margin at RP. Biopsy PNI and tumour volume can therefore support clinical decision-making on the level of nerve-sparing surgery in prostate cancer patients.
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Affiliation(s)
- Margaretha A van der Slot
- Anser Prostate Operation Clinic, Rotterdam, the Netherlands
- Department of Pathology, Maasstad Hospital, Rotterdam, the Netherlands
- Department of Urology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Charlotte F Kweldam
- Anser Prostate Operation Clinic, Rotterdam, the Netherlands
- Department of Pathology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Michael A den Bakker
- Anser Prostate Operation Clinic, Rotterdam, the Netherlands
- Department of Pathology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Daan Nieboer
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Martijn B Busstra
- Anser Prostate Operation Clinic, Rotterdam, the Netherlands
- Department of Urology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
| | - Melanie Gan
- Anser Prostate Operation Clinic, Rotterdam, the Netherlands
- Department of Urology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Sjoerd Klaver
- Anser Prostate Operation Clinic, Rotterdam, the Netherlands
- Department of Urology, Maasstad Hospital, Rotterdam, the Netherlands
| | - John B W Rietbergen
- Anser Prostate Operation Clinic, Rotterdam, the Netherlands
- Department of Urology, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Geert J L H van Leenders
- Department of Pathology, Erasmus MC Cancer Institute, University Medical Centre, Rotterdam, the Netherlands
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17
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Vis AN, Nieuwenhuijzen JA, Veerman H, Roeleveld T, Wit E, van der Sluis TM, van der Poel HG, van Leeuwen PJ. NeuroSAFE remains an investigational, debatable, laborious (expensive) procedure. BJU Int 2023; 131:131-132. [PMID: 36546721 DOI: 10.1111/bju.15868] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- André N Vis
- Department of Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands
| | - Jakko A Nieuwenhuijzen
- Department of Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands
| | - Hans Veerman
- Department of Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands
| | - Ton Roeleveld
- Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands.,Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Esther Wit
- Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands
| | - Tim M van der Sluis
- Department of Urology, Amsterdam UMC, Location VUmc, Amsterdam, the Netherlands.,Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands
| | - Henk G van der Poel
- Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands
| | - Pim J van Leeuwen
- Department of Urology, NKI/AVL, Amsterdam, The Netherlands.,Prostate Cancer Network Netherlands
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