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Roach E, Hutten R, Johnson S, Suneja G, Tward J, Petereit D, Gaffney D. The impact of a positive COVID-19 test on timeliness of radiation in patients receiving brachytherapy. Brachytherapy 2024; 23:360-367. [PMID: 38395662 DOI: 10.1016/j.brachy.2024.01.006] [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: 10/22/2023] [Revised: 01/09/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Delays in initiating and completing brachytherapy may have adverse oncologic outcomes for patients with cervical, uterine, and prostate cancer. The impact of the COVID-19 pandemic on brachytherapy in the United States has not been well-characterized. OBJECTIVES We aim to evaluate how a positive COVID-19 test affected timeliness of treatment for patients undergoing brachytherapy for cervical, uterine, and prostate cancer. METHODS We queried the National Cancer Database to identify patients diagnosed with cervical, uterine, and prostate cancer in 2019 and 2020 who received brachytherapy in their treatment. Patients who tested positive for COVID-19 between cancer diagnosis and start of radiation were compared to those who did not test positive for COVID-19. Time in days from cancer diagnosis to initiation of radiation was compared using two-sample t-tests with p < 0.05 signifying significant differences. RESULTS We identified 38,341 patients with cervical (n = 6,925), uterine (n = 18,587), and prostate cancer (n = 12,829). Rates of COVID-19 positivity were cervical cancer (n = 135; 2%), uterine cancer (n = 236; 1.3%), and prostate cancer (n = 141; 1%). Of those, 35% of cervical, 49% of uterine, and 43% of prostate cancer patients tested positive between their cancer diagnosis and initiation of radiation. Median days to radiation was significantly longer in these patients: 78 versus 51 for cervical cancer (p < 0.01), 150 versus 104 for uterine cancer (p < 0.01), and 154 versus 124 for prostate cancer (p < 0.01). CONCLUSIONS For patients with cervical, uterine, and prostate cancer diagnosed between 2019-2020, testing positive for COVID-19 after their cancer diagnosis was associated with a delay to initiation of radiation by 4-7 weeks.
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Affiliation(s)
- Eric Roach
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
| | - Ryan Hutten
- Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, WI
| | - Skyler Johnson
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Gita Suneja
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | - Jonathan Tward
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
| | | | - David Gaffney
- Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT
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Hikita K, Honda M, Shimizu R, Teraoka S, Kimura Y, Yumioka T, Tsounapi P, Iwamoto H, Morizane S, Takenaka A. The influence of the long duration from biopsy to surgery on biochemical recurrence after robot-assisted radical prostatectomy in Japanese patients. Asian J Surg 2021; 45:2179-2184. [PMID: 34810115 DOI: 10.1016/j.asjsur.2021.10.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 10/14/2021] [Accepted: 10/27/2021] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVE We evaluated the impact of the duration between the biopsy and surgery on the biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). METHODS We retrospectively evaluated 302 patients who underwent RARP in our institution from April 2010 to December 2017. Patients were categorized into 2 groups, an interval between biopsy and surgery of 180 days or less (Group A) and longer than 180 days (Group B). Factors retrospectively analyzed for the BCR for the interval between the biopsy and RARP included patient's characteristics, intraoperative and postoperative results. The Kaplan-Meier method and Cox proportional hazards regression model were used to evaluate the predictors of BCR. RESULTS The median follow-up was 42 months, with 24 patients developing BCR at a mean of 13.5 months after RARP. There was no difference in the rate of BCR in Group A and Group B. Multivariate analysis showed that BMI (<23.5 kg/m2, p = 0.034), worst GS of the biopsy (≥8, p = 0.007), and without lymph node dissection (p = 0.034) were significant predictors of BCR. Analysis of the interval from the biopsy showed that there was no significant difference between Group A and Group B, when tested according to the NCCN risk stratification (low risk: p = 0.871, intermediate risk: p = 0.205, high risk: p = 0.287). CONCLUSION The preoperative predictors of BCR included BMI (<23.5 kg/m2) and worst GS of the biopsy, and without lymph node dissection. A long duration from biopsy to RARP did not influence the probability of BCR, even in patients considered to be at a high risk.
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Affiliation(s)
- Katsuya Hikita
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan.
| | - Masashi Honda
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Ryutaro Shimizu
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Shogo Teraoka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Yuske Kimura
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Tetsuya Yumioka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Panagiota Tsounapi
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Hideto Iwamoto
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Shuichi Morizane
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
| | - Atsushi Takenaka
- Division of Urology, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishicho, Yonago, Japan
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Effects of Delayed Radical Prostatectomy and Active Surveillance on Localised Prostate Cancer-A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13133274. [PMID: 34208888 PMCID: PMC8268689 DOI: 10.3390/cancers13133274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary We reviewed the evidence available for postponing or delaying cancer surgery for localised prostate cancer. Watchful waiting is an acceptable option in low-risk patients. Evidence is uncertain in postponing surgery, but conservative estimates suggest delays of over 5 months, 4 months, and 30 days for low-, intermediate-, and high-risk patients, respectively, can lead to worse survival outcomes. Neoadjuvant therapy can shrink the tumours prior to surgery and can be a useful adjunct in delaying surgery for, at the most, 3 months. Abstract External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle–Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited.
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Mungovan SF, Carlsson SV, Gass GC, Graham PL, Sandhu JS, Akin O, Scardino PT, Eastham JA, Patel MI. Preoperative exercise interventions to optimize continence outcomes following radical prostatectomy. Nat Rev Urol 2021; 18:259-281. [PMID: 33833445 PMCID: PMC8030653 DOI: 10.1038/s41585-021-00445-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 01/31/2023]
Abstract
Urinary incontinence is a common and predictable consequence among men with localized prostate cancer who have undergone radical prostatectomy. Despite advances in the surgical technique, urinary continence recovery time remains variable. A range of surgical and patient-related risk factors contributing to urinary incontinence after radical prostatectomy have been described, including age, BMI, membranous urethral length and urethral sphincter insufficiency. Physical activity interventions incorporating aerobic exercise, resistance training and pelvic floor muscle training programmes can positively influence the return to continence in men after radical prostatectomy. Traditional approaches to improving urinary continence after radical prostatectomy have typically focused on interventions delivered during the postoperative period (rehabilitation). However, the limited efficacy of these postoperative approaches has led to a shift from the traditional reactive model of care to more comprehensive interventions incorporating exercise-based programmes that begin in the preoperative period (prehabilitation) and continue after surgery. Comprehensive prehabilitation interventions include appropriately prescribed aerobic exercise, resistance training and specific pelvic floor muscle instruction and exercise training programmes. Transperineal ultrasonography is a non-invasive and validated method for the visualization of the action of the pelvic floor musculature, providing real-time visual biofeedback to the patient during specific pelvic floor muscle instruction and training. Importantly, the waiting time before surgery can be used for the delivery of comprehensive prehabilitation exercise-based interventions to increase patient preparedness in the lead-up to surgery and optimize continence and health-related quality-of-life outcomes following radical prostatectomy.
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Affiliation(s)
- Sean F Mungovan
- Westmead Private Physiotherapy Services, Westmead Private Hospital, Westmead, New South Wales, Australia.
- The Clinical Research Institute, Westmead, New South Wales, Australia.
- Department of Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Victoria, Australia.
| | - Sigrid V Carlsson
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Institute of Clinical Sciences, Department of Urology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Gregory C Gass
- The Clinical Research Institute, Westmead, New South Wales, Australia
- Physical Therapy Program, University of Jamestown, Fargo, ND, USA
| | - Petra L Graham
- Department of Mathematics and Statistics, Macquarie University, Macquarie Park, New South Wales, Australia
| | - Jaspreet S Sandhu
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Oguz Akin
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter T Scardino
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James A Eastham
- Urology Service at the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Manish I Patel
- Specialty of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Department of Urology, Westmead Hospital, Westmead, New South Wales, Australia
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Detti B, Ingrosso G, Becherini C, Lancia A, Olmetto E, Alì E, Marani S, Teriaca MA, Francolini G, Sardaro A, Aristei C, Filippi AR, Sanguineti G, Livi L. Management of prostate cancer radiotherapy during the COVID-19 pandemic: A necessary paradigm change. Cancer Treat Res Commun 2021; 27:100331. [PMID: 33581491 PMCID: PMC7864785 DOI: 10.1016/j.ctarc.2021.100331] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 11/13/2020] [Accepted: 12/02/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To adapt the management of prostate malignancy in response to the COVID-19 pandemic. METHODS In according to the recommendations of the European Association of Urology, we have developed practical additional document on the treatment of prostate cancer. RESULTS Low-Risk Group Watchful Waiting should be offered to patients >75 years old, with a limited life expectancy and unfit for local treatment. In Active Surveillance (AS) patients re-biopsy, PSA evaluation and visits should be deferred for up to 6 months, preferring non-invasive multiparametric-MRI. The active treatment should be delayed for 6-12 months. Intermediate-Risk Group AS should be offered in favorable-risk patients. Short-course neoadjuvant androgen deprivation therapy (ADT) combined with ultra-hypo-fractionation radiotherapy should be used in unfavorable-risk patients. High-Risk Group Neoadjuvant ADT combined with moderate hypofractionation should be preferred. Whole-pelvis irradiation should be offered to patients with positive lymph nodes in locally advanced setting. ADT should be initiated if PSA doubling time is < 12 months in radio-recurrent patients, as well as in low priority/low volume of metastatic hormone sensitive prostate cancer. If radiotherapy cannot be delayed, hypo-fractionated regimens should be preferred. In high priority class metastatic disease, treatment with androgen receptor-targeted agents should be offered. When palliative radiotherapy for painful bone metastasis is required, single fraction of 8 Gy should be offered. CONCLUSIONS In Covid-19 Era, the challenge should concern a correct management of the oncologic patient, reducing the risk of spreading the virus without worsening tumor prognosis.
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Affiliation(s)
- Beatrice Detti
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
| | - Gianluca Ingrosso
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Carlotta Becherini
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Andrea Lancia
- Radiation Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Emanuela Olmetto
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Emanuele Alì
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | - Simona Marani
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Giulio Francolini
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Angela Sardaro
- Diagnostic Imaging and Radiotherapy Section, Department of Interdisciplinary Medicine, University Aldo Moro, Bari, Italy
| | - Cynthia Aristei
- Radiation Oncology Section, Department of Surgical and Biomedical Science, University of Perugia and Perugia General Hospital, Perugia, Italy
| | | | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenzo Livi
- RadiationOncology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
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Hathout L, Ennis RD, Mattes MD, Wagman RT, Grann A, Jabbour SK, Singh R, Yue NJ, Haffty BG, Vergalasova I. The Impact of COVID-19 on Brachytherapy During the Pandemic: A Rutgers-Robert Wood Johnson Barnabas Health Multisite Experience. Adv Radiat Oncol 2021; 6:100600. [PMID: 33163697 PMCID: PMC7605726 DOI: 10.1016/j.adro.2020.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/01/2020] [Accepted: 10/13/2020] [Indexed: 12/19/2022] Open
Abstract
PURPOSE This study aimed to evaluate whether the coronavirus disease of 2019 (COVID-19) pandemic resulted in treatment delays in patients scheduled for or undergoing brachytherapy. METHODS AND MATERIALS A retrospective cohort study was conducted across 4 affiliated sites after local institutional review board approval. The eligibility criteria were defined as all patients with cancer whose treatment plan included brachytherapy during the COVID-19 pandemic from February 24, 2020 to June 30, 2020. Treatment delays, cancellations, alterations of fractionation regimens, and treatment paradigm changes were evaluated. RESULTS A total of 47 patients were eligible for the analysis. Median patient age at the time of treatment was 62 years (interquartile range, 56-70 years). Endometrial, cervical, and prostate cancers were the most common sites included in this analysis. Three patients (6.4%) with cervical cancer were diagnosed with COVID-19 during the course of their treatment. Interruptions of external beam radiation therapy (EBRT), cancellations of EBRT, cancellations of brachytherapy, and treatment delays due to COVID occurred in 5 (10.6%), 3 (6.4%), 8 (17%), and 9 (19%) patients, respectively. The mean and median number of days delayed for patients who experienced treatment interruptions were 16.3 days (standard deviation: 13.9 days) and 14 days (interquartile range, 5.75-23.75 days), respectively. For patients with cervical cancer, the mean and median overall treatment times defined as the time from the start of EBRT to the end of brachytherapy were 56 and 49 days, respectively. CONCLUSIONS Despite the challenges the health care system faced during the pandemic, most patients with cancer were safely treated with minor treatment delays and interruptions. Long-term follow up is needed to assess the impact of COVID-19 and treatment interruptions on oncologic outcomes.
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Affiliation(s)
- Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Ronald D. Ennis
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Malcolm D. Mattes
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Newark, New Jersey
| | - Raquel T. Wagman
- Department of Radiation Oncology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Alison Grann
- Department of Radiation Oncology, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Salma K. Jabbour
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Rachana Singh
- Department of Radiation Oncology, Robert Wood Johnson University Hospital, Hamilton, New Jersey
| | - Ning J. Yue
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Bruce G. Haffty
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Mian BM, Siddiqui S, Ahmad AE. Management of urologic cancers during the pandemic and potential impact of treatment deferrals on outcomes. Urol Oncol 2020; 39:258-267. [PMID: 33129674 PMCID: PMC7598541 DOI: 10.1016/j.urolonc.2020.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 10/05/2020] [Accepted: 10/17/2020] [Indexed: 01/03/2023]
Abstract
The COVID-19 pandemic-related constraints on healthcare access have raised concerns about adverse outcomes from delayed treatment, including the risk of cancer progression and other complications. Further, concerns were raised about a potentially significant backlog of patients in need of cancer care due to the pandemic-related delays in healthcare, further exacerbating any potential adverse outcomes. Delayed access to surgery is particularly relevant to urologic oncology since one-third of new cancers in men (20% overall) arise from the genitourinary (GU) tract and surgery is often the primary treatment. Herein, we summarize the prepandemic literature on deferred surgery for GU cancers and risk of disease progression. The aforementioned data on delayed surgery were gathered in the context of systemic delays present in certain healthcare systems, or occasionally, due to planned deferral in suboptimal surgical candidates. These data provide indirect, but sufficient insight to develop triage schemas for prioritization of uro-oncological cases. Herein, we outline the extent to which the pandemic-related triage guidelines had influenced urologic practice in various regions. To study the adverse outcomes in the pandemic-era, a survey of urologic oncologists was conducted regarding modifications in their initial management of urologic cancers and any delay-related adverse outcomes. While the adverse effects directly from COVID-19 related delays will become apparent in the coming years, the results showing short-term outcomes are quite instructive. Since cancer care was assigned a higher priority at most centers, this strategy may have avoided significant delays in care and limited the anticipated negative impact of pandemic-related constraints.
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Affiliation(s)
- Badar M Mian
- Division of Urology, Albany Medical Center, Albany NY.
| | - Sana Siddiqui
- Division of Urology, Albany Medical Center, Albany NY
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8
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Impact of surgical wait times during summer months on the oncological outcomes following robotic-assisted radical prostatectomy: 10 years' experience from a large Canadian academic center. World J Urol 2020; 39:2913-2919. [PMID: 33106941 DOI: 10.1007/s00345-020-03496-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/13/2020] [Indexed: 10/23/2022] Open
Abstract
PURPOSE Most Canadian hospitals face significant reductions in operating room access during the summer. We sought to assess the impact of longer wait times on the oncological outcomes of localized prostate cancer patients following robotic-assisted radical prostatectomy (RARP). METHODS We conducted a retrospective review of a prospectively maintained RARP database in two high-volume academic centers, between 2010 and 2019. Assessed outcomes included the difference between post-biopsy UCSF-CAPRA and post-surgical CAPRA-S scores, Gleason score upgrade and biochemical recurrence rates (BCR). Multivariable regression analyses (MVA) were used to evaluate the effect of wait times. RESULTS A total of 1057 men were included for analysis. Consistent over a 10 year period, summer months had the lowest surgical volumes despite above average booking volumes. The lowest surgical volume occurred during the month of July (7.1 cases on average), which was 35% less than the cohort average. The longest average wait times occurred for patients booked in June (93 ± 69 days, p < 0.001). On MVA, patients booked in June had significantly more chance of having an increase in CAPRA score [HR (95% CI) 1.64 (1.02-2.63); p = 0.04] and in CAPRA risk group [HR (95% CI) 1.82 (1.04-3.19); p = 0.03]. Cohort analysis showed fair correlation between CAPRA-score difference and wait time (Pearson correlation: r = - 0.062; p = 0.044). CONCLUSION Our cohort results demonstrate that conventional RARP wait times are significantly and consistently prolonged during summer months over the past 10 years, with worse post-RARP oncological outcomes in terms of CAPRA scores. Other compensatory mechanisms to sustain consistent yearly operative output should be considered.
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9
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Katims AB, Razdan S, Eilender BM, Wiklund P, Tewari AK, Kyprianou N, Badani KK, Mehrazin R. Urologic oncology practice during COVID-19 pandemic: A systematic review on what can be deferrable vs. nondeferrable. Urol Oncol 2020; 38:783-792. [PMID: 32703636 PMCID: PMC7318929 DOI: 10.1016/j.urolonc.2020.06.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE To provide a review of high-risk urologic cancers and the feasibility of delaying surgery without impacting oncologic or mortality outcomes. MATERIALS AND METHODS A thorough literature review was performed using PubMed and Google Scholar to identify articles pertaining to surgical delay and genitourinary oncology. We reviewed all relevant articles pertaining to kidney, upper tract urothelial cell, bladder, prostate, penile, and testicular cancer in regard to diagnostic, surgical, or treatment delay. RESULTS The majority of urologic cancers rely on surgery as primary treatment. Treatment of unfavorable intermediate or high-risk prostate cancer, can likely be delayed for 3 to 6 months without affecting oncologic outcomes. Muscle-invasive bladder cancer and testicular cancer can be treated initially with chemotherapy. Surgical management of T3 renal masses, high-grade upper tract urothelial carcinoma, and penile cancer should not be delayed. CONCLUSION The majority of urologic oncologic surgeries can be safely deferred without impacting long-term cancer specific or overall survival. Notable exceptions are muscle-invasive bladder cancer, high-grade upper tract urothelial cell, large renal masses, testicular and penile cancer. Joint decision making among providers and patients should be encouraged. Clinicians must manage emotional anxiety and stress when decisions around treatment delays are necessary as a result of a pandemic.
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Affiliation(s)
- Andrew B Katims
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Shirin Razdan
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Benjamin M Eilender
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Peter Wiklund
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashutosh K Tewari
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Natasha Kyprianou
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ketan K Badani
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Reza Mehrazin
- Department of Urology, Division of Urologic Oncology, Icahn School of Medicine at Mount Sinai, New York, NY.
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10
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Engl T, Mandel P, Hoeh B, Preisser F, Wenzel M, Humke C, Welte M, Köllermann J, Wild P, Deuker M, Kluth LA, Roos FC, Chun FKH, Becker A. Impact of "Time-From-Biopsy-to-Prostatectomy" on Adverse Oncological Results in Patients With Intermediate and High-Risk Prostate Cancer. Front Surg 2020; 7:561853. [PMID: 33102515 PMCID: PMC7545071 DOI: 10.3389/fsurg.2020.561853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/21/2020] [Indexed: 01/12/2023] Open
Abstract
Objective: Many patients with localized prostate cancer (PCa) do not immediately undergo radical prostatectomy (RP) after biopsy confirmation. The aim of this study was to investigate the influence of “time-from-biopsy-to- prostatectomy” on adverse pathological outcomes. Materials and Methods: Between January 2014 and December 2019, 437 patients with intermediate- and high risk PCa who underwent RP were retrospectively identified within our prospective institutional database. For the aim of our study, we focused on patients with intermediate- (n = 285) and high-risk (n = 151) PCa using D'Amico risk stratification. Endpoints were adverse pathological outcomes and proportion of nerve-sparing procedures after RP stratified by “time-from-biopsy-to-prostatectomy”: ≤3 months vs. >3 and < 6 months. Medians and interquartile ranges (IQR) were reported for continuously coded variables. The chi-square test examined the statistical significance of the differences in proportions while the Kruskal-Wallis test was used to examine differences in medians. Multivariable (ordered) logistic regressions, analyzing the impact of time between diagnosis and prostatectomy, were separately run for all relevant outcome variables (ISUP specimen, margin status, pathological stage, pathological nodal status, LVI, perineural invasion, nerve-sparing). Results: We observed no difference between patients undergoing RP ≤3 months vs. >3 and <6 months after diagnosis for the following oncological endpoints: pT-stage, ISUP grading, probability of a positive surgical margin, probability of lymph node invasion (LNI), lymphovascular invasion (LVI), and perineural invasion (pn) in patients with intermediate- and high-risk PCa. Likewise, the rates of nerve sparing procedures were 84.3 vs. 87.4% (p = 0.778) and 61.0% vs. 78.8% (p = 0.211), for intermediate- and high-risk PCa patients undergoing surgery after ≤3 months vs. >3 and <6 months, respectively. In multivariable adjusted analyses, a time to surgery >3 months did not significantly worsen any of the outcome variables in patients with intermediate- or high-risk PCa (all p > 0.05). Conclusion: A “time-from-biopsy-to-prostatectomy” of >3 and <6 months is neither associated with adverse pathological outcomes nor poorer chances of nerve sparing RP in intermediate- and high-risk PCa patients.
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Affiliation(s)
- Tobias Engl
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.,Urogate Associates, Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.,Urogate Associates, Frankfurt am Main, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maria Welte
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jens Köllermann
- Department of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Wild
- Department of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marina Deuker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
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11
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Abstract
PURPOSE OF REVIEW The novel coronavirus-2019 disease (COVID-19) pandemic has had devastating consequences on healthcare systems globally. The effect this has on urologists and the patients they care for is not fully understood and presents the challenge of prioritizing the most urgent cases. We aim to review the impact on urology services and evaluate strategies to minimize disruption. RECENT FINDINGS Various healthcare systems have been forced to postpone treatment for many urological conditions as resources are dedicated to the treatment of COVID-19. Training has been postponed as staff are reallocated to areas of need. Face-to-face contact is largely minimized and innovative, virtual communication methods are used in the outpatient setting and multidisciplinary team meetings. Surgical practice is changing because of the risks posed by COVID-19 and procedures can be prioritized in a nonurgent, low priority, high priority or emergency category. SUMMARY Although the COVID-19 pandemic will inevitably affect urological services, steps can be taken to mitigate the impact and prioritize the patients most in need of urgent care. Similarly, in future; simulation, e-learning and webinars will allow interaction to share, discuss and debate focused training and education.
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Affiliation(s)
- Thomas Hughes
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Hui Ching Ho
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Shahrokh Francois Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
- Department of Urology, Weill Cornell Medical College, New York, New York
- Department of Urology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Bhaskar Kumar Somani
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- University of Southampton, Southampton, UK
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12
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Williams VM, Kahn JM, Harkenrider MM, Chino J, Chen J, Fang LC, Dunn EF, Fields E, Mayadev JS, Rengan R, Petereit D, Dyer BA. COVID-19 impact on timing of brachytherapy treatment and strategies for risk mitigation. Brachytherapy 2020; 19:401-411. [PMID: 32359937 PMCID: PMC7172676 DOI: 10.1016/j.brachy.2020.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 04/10/2020] [Accepted: 04/10/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE The purpose of this study was to highlight the importance of timely brachytherapy treatment for patients with gynecologic, breast, and prostate malignancies, and provide a framework for brachytherapy clinical practice and management in response to the COVID-19 pandemic. METHODS AND MATERIALS We review amassing evidence to help guide the management and timing of brachytherapy for gynecologic, breast, and prostate cancers. Where concrete data could not be found, peer-reviewed expert opinion is provided. RESULTS There may be a significant negative impact on oncologic outcomes for patients with gynecologic malignancies who have a delay in the timely completion of therapy. Delay of prostate or breast cancer treatment may also impact oncologic outcomes. If a treatment delay is expected, endocrine therapy may be an appropriate temporizing measure before delivery of radiation therapy. The use of shorter brachytherapy fractionation schedules will help minimize patient exposure and conserve resources. CONCLUSIONS Brachytherapy remains a critical treatment for patients and may shorten treatment time and exposure for some. Reduced patient exposure and resource utilization is important during COVID-19. Every effort should be made to ensure timely brachytherapy delivery for patients with gynecologic malignancies, and endocrine therapy may help temporize treatment delays for breast and prostate cancer patients. Physicians should continue to follow developing institutional, state, and federal guidelines/recommendations as challenges in delivering care during COVID-19 will continue to evolve.
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Affiliation(s)
| | - Jenna M Kahn
- Department of Radiation Oncology, Oregon Health & Science University, Portland, OR
| | | | - Junzo Chino
- Department of Radiation Oncology, Duke University, Durham, VA
| | - Jonathan Chen
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - L Christine Fang
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Emily F Dunn
- Department of Radiation Oncology, Willamette Valley Cancer Institute and Research Center, Eugene, OR
| | - Emma Fields
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA
| | - Jyoti S Mayadev
- Department of Radiation Medicine and Applied Sciences, University of California San Diego, La Jolla, CA
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington, Seattle, WA
| | - Daniel Petereit
- Department of Radiation Oncology, Monument Health Cancer Care Institute, Rapid City, SD
| | - Brandon A Dyer
- Department of Radiation Oncology, University of Washington, Seattle, WA.
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13
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Kokorovic A, So AI, Hotte SJ, Black PC, Danielson B, Emmenegger U, Finelli A, Niazi T, Pouliot F, Shayegan B, Sridhar S, Vigneault E, Loblaw A, Rendon RA. A Canadian framework for managing prostate cancer during the COVID-19 pandemic: Recommendations from the Canadian Urologic Oncology Group and the Canadian Urological Association. Can Urol Assoc J 2020; 14:163-168. [PMID: 32374715 PMCID: PMC7654681 DOI: 10.5489/cuaj.6667] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Andrea Kokorovic
- The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Alan I So
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Brita Danielson
- Department of Oncology, Division of Radiation Oncology, University of Alberta, Edmonton, AB, Canada
| | - Urban Emmenegger
- Department of Medical Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Antonio Finelli
- Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Tamim Niazi
- Department of Oncology, Division of Radiation Oncology, McGill University, Montreal QC, Canada
| | - Frederic Pouliot
- Division of Urology, Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Bobby Shayegan
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Srikala Sridhar
- Division of Hematology and Medical Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Eric Vigneault
- Department of Radiation Oncology, CHUQ, Université Laval, Quebec City, QC, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
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14
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Sean Ong XR, Condon B, Bagguley D, Lawrentschuk N, Azad A, Murphy D. Safety first: evidence for delay of radical prostatectomy without use of androgen deprivation therapy during COVID-19. Future Oncol 2020; 16:1409-1411. [PMID: 32407145 PMCID: PMC7226924 DOI: 10.2217/fon-2020-0388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Xuan Rui Sean Ong
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Benjamin Condon
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Dominic Bagguley
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Nathan Lawrentschuk
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia.,EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Health, Victoria, Australia
| | - Arun Azad
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
| | - Declan Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Parkville, Victoria, Australia
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15
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Shah P, Kim FJ, Mian BM. Genitourinary cancer management during a severe pandemic: Utility of rapid communication tools and evidence-based guidelines. BJUI COMPASS 2020; 1:45-59. [PMID: 32537615 PMCID: PMC7280667 DOI: 10.1002/bco2.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/06/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To determine the usefulness of social media for rapid communication with experts to discuss strategies for prioritization and safety of deferred treatment for urologic malignancies during COVID-19 pandemic, and to determine whether the discourse and recommendations made through discussions on social media (Twitter) were consistent with the current peer-reviewed literature regarding the safety of delayed treatment. METHODS We reviewed and compiled the responses to our questions on Twitter regarding the management and safety of deferred treatment in the setting of COVID-19 related constraints on non-urgent care. We chronicled the guidance published on this subject by various health authorities and professional organizations. Further, we analyzed peerreviewed literature on the safety of deferred treatment (surgery or systemic therapy) to make made evidence-based recommendations. RESULTS Due to the rapidly changing information about epidemiology and infectious characteristics of COVID-19, the health authorities and professional societies guidance required frequent revisions which by design take days or weeks to produce. Several active discussions on Twitter provided real-time updates on the changing landscape of the restrictions being placed on non-urgent care. For separate discussion threads on prostate cancer and bladder cancer, dozens of specialists with expertise in treating urologic cancers could be engaged in providing their expert opinions as well as share evidence to support their recommendations. Our analysis of published studies addressing the safety and extent to which delayed cancer care does not compromise oncological outcome revealed that most prostate cancer care and certain aspects of the bladder and kidney cancer care can be safely deferred for 2-6 months. Urothelial bladder cancer and advanced kidney cancer require a higher priority for timely surgical care. We did not find evidence to support the idea of using nonsurgical therapies, such as hormone therapy for prostate cancer or chemotherapy for bladder cancer for safer deferment of previously planned surgery. We noted that the comments and recommendations made by the participants in the Twitter discussions were generally consistent with our evidence-based recommendations for safely postponing cancer care for certain types of urologic cancers. CONCLUSION The use of social media platforms, such as Twitter, where the comments and recommendations are subject to review and critique by other specialists is not only feasible but quite useful in addressing the situations requiring urgent resolution, often supported by published evidence. In circumstances such as natural disasters, this may be a preferable approach than the traditional expert panels due to its ability to harness the collective intellect to available experts to provide responses and solutions in real-time. These real-time communications via Twitter provided sound guidance which was readily available to the public and participants, and was generally in concordance with the peerreviewed data on safety of deferred treatment.
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Affiliation(s)
- P. Shah
- Department of UrologyMayo ClinicRochesterMNUSA
| | - F. J. Kim
- Division of UrologyUniversity of ColoradoDenverCOUSA
| | - B. M. Mian
- Division of UrologyAlbany Medical CenterAlbanyNYUSA
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16
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Westerman ME, Sharma V, Bailey GC, Boorjian SA, Frank I, Gettman MT, Thompson RH, Tollefson MK, Karnes RJ. Impact of time from biopsy to surgery on complications, functional and oncologic outcomes following radical prostatectomy. Int Braz J Urol 2019; 45:468-477. [PMID: 30676305 PMCID: PMC6786103 DOI: 10.1590/s1677-5538.ibju.2018.0196] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 09/27/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction: To determine the impact of time from biopsy to surgery on outcomes following radical prostatectomy (RP) as the optimal interval between prostate biopsy and RP is unknown. Material and methods: We identified 7, 350 men who underwent RP at our institution between 1994 and 2012 and had a prostate biopsy within one year of surgery. Patients were grouped into five time intervals for analysis: ≤ 3 weeks, 4-6 weeks, 7-12 weeks, 12-26 weeks, and > 26 weeks. Oncologic outcomes were stratified by NCCN disease risk for comparison. The associations of time interval with clinicopathologic features and survival were evaluated using multivariate logistic and Cox regression analyses. Results: Median time from biopsy to surgery was 61 days (IQR 37, 84). Median follow-up after RP was 7.1 years (IQR 4.2, 11.7) while the overall perioperative complication rate was 19.7% (1,448/7,350). Adjusting for pre-operative variables, men waiting 12-26 weeks until RP had the highest likelihood of nerve sparing (OR: 1.45, p = 0.02) while those in the 4-6 week group had higher overall complications (OR: 1.33, p = 0.01). High risk men waiting more than 6 months had higher rates of biochemical recurrence (HR: 3.38, p = 0.05). Limitations include the retrospective design. Conclusions: Surgery in the 4-6 week time period after biopsy is associated with higher complications. There appears to be increased biochemical recurrence rates in delaying RP after biopsy, for men with both low and high risk disease.
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Affiliation(s)
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | - George C Bailey
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, Minnesota, USA
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17
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Patel P, Sun R, Shiff B, Trpkov K, Gotto GT. The effect of time from biopsy to radical prostatectomy on adverse pathologic outcomes. Res Rep Urol 2019; 11:53-60. [PMID: 30881945 PMCID: PMC6410755 DOI: 10.2147/rru.s187950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the impact of time between prostate cancer diagnosis on biopsy and definitive intervention with radical prostatectomy (RP) in regard to adverse pathologic outcomes using a large multi-surgeon database. Materials and methods We retrospectively reviewed 2,728 patients who underwent RP between 2005 and 2014. Patients were stratified according to biopsy Grade Group (GG). Pathologic outcomes were evaluated for patients with <2 months between biopsy and surgery and then at monthly intervals of up to 6 months. Adverse pathological outcomes were defined as Gleason upgrading from biopsy, the presence of extraprostatic extension (EPE, pT3a) or seminal vesicle invasion (SVI, pT3b), positive surgical margins, and lymph node positivity. The chi-squared test was used for statistical analysis. Results In total 2,310 patients met the inclusion criteria. Median time from biopsy to surgery was 83 days (range: 61–109 days). No difference was observed for patients in any risk category regarding the adverse pathologic outcomes, including GG upgrade from biopsy to prostatectomy, presence of EPE, SVI, positive surgical margins, and positive lymph node involvement, with delays of up to 6 months between biopsy and RP. Surgical margins were positive in 25% of cases with pT2 disease and 50.2% of cases with pT3 and greater disease. EPE and SVI were present in 24.5% and 7.5% of specimens, respectively. Conclusion Surgical delays of up to 6 months following prostate biopsy were not associated with an increased risk of GG upgrading, EPE, SVI, positive surgical margins, or lymph node involvement.
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Affiliation(s)
- Premal Patel
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada,
| | - Ryan Sun
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada,
| | - Benjamin Shiff
- Section of Urology, University of Manitoba, Winnipeg, MB, Canada,
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
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18
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Gupta N, Bivalacqua TJ, Han M, Gorin MA, Challacombe BJ, Partin AW, Mamawala MK. Evaluating the impact of length of time from diagnosis to surgery in patients with unfavourable intermediate-risk to very-high-risk clinically localised prostate cancer. BJU Int 2019; 124:268-274. [PMID: 30570825 DOI: 10.1111/bju.14659] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate the impact of length of time from diagnostic biopsy to radical prostatectomy (RP) on oncological outcomes amongst men diagnosed with unfavourable intermediate- to very-high-risk clinically localised prostate cancer. PATIENTS AND METHODS We performed a retrospective review of men with a diagnosis of grade group (GG) ≥3 prostate cancer on biopsy, who underwent RP within 6 months of diagnosis, at our institution between 2005 and 2018. We assessed patient demographics, pre-biopsy disease characteristics, and receipt of neoadjuvant therapy. We categorised time between biopsy and RP into two intervals: <3 and 3-6 months. For each GG, we compared receipt of adjuvant therapy, pathological outcomes at RP (positive surgical margin [PSM], extraprostatic extension [EPE], seminal vesicle invasion [SVI], and lymph node involvement [LNI]), risk of 2- and 5-year biochemical recurrence-free survival (BCRFS), and 2-, 5-, and 10-year metastasis-free survival (MFS) between patients who underwent RP at <3 vs 3-6 months after diagnosis. RESULTS Amongst 2303 men who met the study inclusion criteria, 1244 (54%) had GG 3, 608 (26%) had GG 4, and 451 (20%) had GG 5 disease. In all, 72% underwent RP at <3 months after diagnosis. For each diagnostic GG, there was no significant difference in rates of adjuvant therapy, PSM, EPE, SVI, or LNI in men who had RP at <3 vs 3-6 months after diagnosis. In all, 1568 men had follow-up after RP of >1 year. For each diagnostic GG, there was no significant difference in 2- and 5-year BCRFS between patients who had RP at <3 vs 3-6 months after diagnosis (GG 3: 78% vs 83% and 69% vs 66%, respectively, P = 0.6; GG 4: 68% vs 74% and 51% vs 57%, respectively, P = 0.4; GG 5: 58% vs 74% and 48% vs 54%, respectively, P = 0.2). Similarly, for each diagnostic GG, there was no significant difference in 2-, 5-, and 10-year MFS between patients who had RP at <3 vs 3-6 months after diagnosis, although we were not able to calculate 10-year MFS for patients with GG 5 disease due to limited follow-up in that group (GG 3: 98%, 92%, and 84% vs 97%, 95%, and 91%, respectively, P = 0.4; GG 4: 97%, 90%, and 72% vs 94%, 91%, and 81%, respectively, P = 0.8; GG 5: 89% and 81% vs 91% and 71%, respectively, P = 0.9). CONCLUSIONS Waiting for RP up to 6 months after diagnosis is not associated with adverse outcomes amongst patients with unfavourable intermediate- to very-high-risk prostate cancer.
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Affiliation(s)
- Natasha Gupta
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Trinity J Bivalacqua
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Misop Han
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael A Gorin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ben J Challacombe
- Department of Urology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Alan W Partin
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Mufaddal K Mamawala
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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19
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Meunier ME, Neuzillet Y, Radulescu C, Cherbonnier C, Hervé JM, Rouanne M, Molinié V, Lebret T. [Does the delay from prostate biopsy to radical prostatectomy influence the risk of biochemical recurrence?]. Prog Urol 2018; 28:475-481. [PMID: 29907495 DOI: 10.1016/j.purol.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 03/19/2018] [Accepted: 05/15/2018] [Indexed: 10/14/2022]
Abstract
INTRODUCTION The influence of the delay between prostate biopsy and radical prostatectomy for patients with localized prostate cancer is controversial. The objective of this study was to establish a time limit between prostate biopsy and radical prostatectomy beyond which the risks of upgradging and biochemical recurrence (BCR) are increased. MATERIAL AND METHODS Between January 2013 and January 2017, a retrospective analysis of the clinical, biological and histological data of 513 patients treated with radical prostatectomy for localized prostate cancer was performed in a single center. The primary endpoint was the assessment of the risk of BCR by the difference between post-biopsy USCF-CAPRA and post-surgical CAPRA-S scores. The secondary endpoint was the evaluation of the upgrading by the difference between the Gleason score on biopsy and on surgical specimen. The risks of BCR and upgrading were compared by Student test according to different delays between prostate biopsy and radical prostatectomy. The shortest delays for which a significant difference was found were reported. RESULTS In this study, 513 patients were included. The median age at the time of the biopsy was 65 years (IQR: 60-69). The median preoperative PSA was 7.30ng/mL (IQR: 5.60-9.94). The median time between biopsy and surgery was 108 days (IQR: 86-141). For the entire cohort, the risk of BCR was significantly higher above a threshold of 90 days (P=0.039). No threshold was found for Gleason 6(3+3) patients. A 90-day threshold was found for Gleason 7(3+4) patients (P=0.038). Gleason patients≥8 had more upgrading beyond a 60-day threshold (P=0.040). CONCLUSION Our study showed that after a 3 months delay, the risk of BCR was significantly higher for localized prostate cancer. It seemed possible to extend this period for low-risk patients, whereas it seemed necessary to keep it for intermediate-risks and to reduce it to 2 months for high-risks. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- M E Meunier
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France
| | - Y Neuzillet
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France.
| | - C Radulescu
- Service d'anatomopathologie, hôpital Foch, 92151 Suresnes, France
| | - C Cherbonnier
- Service d'anatomopathologie, hôpital Foch, 92151 Suresnes, France
| | - J-M Hervé
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France
| | - M Rouanne
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
| | - V Molinié
- Service d'anatomopathologie, centre hospitalier de Martinique, 93232 Le Lamentin, France
| | - T Lebret
- Service d'urologie et de transplantation rénale, hôpital Foch, 92151 Suresnes, France; UFR des sciences de la santé Simone-Veil, université de Versailles-Saint-Quentin-en-Yvelines, 40, rue Worth, 92150 Suresnes, France
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20
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Inoue LYT, Lin DW, Newcomb LF, Leonardson AS, Ankerst D, Gulati R, Carter HB, Trock BJ, Carroll PR, Cooperberg MR, Cowan JE, Klotz LH, Mamedov A, Penson DF, Etzioni R. Comparative Analysis of Biopsy Upgrading in Four Prostate Cancer Active Surveillance Cohorts. Ann Intern Med 2018; 168:1-9. [PMID: 29181514 PMCID: PMC5752581 DOI: 10.7326/m17-0548] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Active surveillance (AS) is increasingly accepted for managing low-risk prostate cancer, yet there is no consensus about implementation. This lack of consensus is due in part to uncertainty about risks for disease progression, which have not been systematically compared or integrated across AS studies with variable surveillance protocols and dropout to active treatment. OBJECTIVE To compare risks for upgrading from a Gleason score (GS) of 6 or less to 7 or more across AS studies after accounting for differences in surveillance intervals and competing treatments and to evaluate tradeoffs of more versus less frequent biopsies. DESIGN Joint statistical model of longitudinal prostate-specific antigen (PSA) levels and risks for biopsy upgrading. SETTING Johns Hopkins University (JHU); Canary Prostate Active Surveillance Study (PASS); University of California, San Francisco (UCSF); and University of Toronto (UT) AS studies. PATIENTS 2576 men aged 40 to 80 years with a GS between 2 and 6 and clinical stage T1 or T2 prostate cancer enrolled between 1995 and 2014. MEASUREMENTS PSA levels and biopsy GSs. RESULTS After variable surveillance intervals and competing treatments were accounted for, estimated risks for biopsy upgrading were similar in the PASS and UT studies but higher in UCSF and lower in JHU studies. All cohorts had a delay of 3 to 5 months in detecting upgrading with biennial biopsies starting after a first confirmatory biopsy versus annual biopsies. LIMITATION The model does not account for possible misclassification of biopsy GS. CONCLUSION Men in different AS studies have different risks for biopsy upgrading after variable surveillance protocols and competing treatments are accounted for. Despite these differences, the consequences of more versus less frequent biopsies seem to be similar across cohorts. Biennial biopsies seem to be an acceptable alternative to annual biopsies. PRIMARY FUNDING SOURCE National Cancer Institute.
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Affiliation(s)
- Lurdes Y T Inoue
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Daniel W Lin
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Lisa F Newcomb
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Amy S Leonardson
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Donna Ankerst
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Roman Gulati
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - H Ballentine Carter
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Bruce J Trock
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Peter R Carroll
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Matthew R Cooperberg
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Janet E Cowan
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Laurence H Klotz
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Alexandre Mamedov
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - David F Penson
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
| | - Ruth Etzioni
- From University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington; Technical University of Munich, Garching, Germany; The James Buchanan Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland; University of California, San Francisco, San Francisco, California; University of Toronto, Toronto, Ontario, Canada; and Vanderbilt University, Nashville, Tennessee
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21
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Zanaty M, Alnazari M, Lawson K, Azizi M, Rajih E, Alenizi A, Hueber PA, Meskawi M, Lebacle C, Lebeau T, Benayoun S, Karakiewicz PI, El-Hakim A, Zorn KC. Does surgical delay for radical prostatectomy affect patient pathological outcome? A retrospective analysis from a Canadian cohort. Can Urol Assoc J 2017; 11:265-269. [PMID: 28798829 DOI: 10.5489/cuaj.4149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We sought to assess the impact of surgical wait time (SWT) to robot-assisted radical prostatectomy (RARP) on final pathological outcome. METHODS A retrospective review of RARP patient records operated between 2006 and 2015 was conducted. SWT was defined as period from prostate biopsy to surgery. Primary outcome was the impact on postoperative Cancer of the Prostate Risk Assessment (CAPRA-S) score. Patients were stratified according to D'Amico risk categories. Univariate analysis (UVA) and multivariable (MVA) analysis with a generalized linear model was used to evaluate the effect of SWT and other predictive factors on pathological outcome in individual risk group and on the overall sample. RESULTS A total of 835 patients were eligible for analysis. Mean SWT was significantly different between the three D'Amico groups, with mean SWT of 180.22 days (95% confidence interval [CI] 169.03; 191.41), 159.14 days (95% CI 152.38; 165.90), and 138.96 days (95% CI 124.60; 153.33) for low-, intermediate-, and high-risk groups, respectively (p<0.001). After stratification by D'Amico risk group, no significant association was observed between SWT and CAPRA-S score in the three risk categories on UVA and MVA. Predictors of higher CAPRA-S score in the multivariable model in the overall cohort were: older age (p=0.014), biopsy Gleason score (p<0.001), percentage of positive cores (p<0.001), and clinical stage (p<0.001). CONCLUSIONS In the present study evaluating SWT for RARP in a Canadian socialized system, increased delay for surgery does not appear to impact the pathological outcome. Further studies are required to evaluate the impact of wait time on biochemical recurrence-free survival, cancer-specific survival, and overall survival.
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Affiliation(s)
- Marc Zanaty
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Mansour Alnazari
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Kelsey Lawson
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Mounsif Azizi
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Emad Rajih
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Abdullah Alenizi
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Pierre-Alain Hueber
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Malek Meskawi
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Cedric Lebacle
- Department of Urology, CHU Mondor, Assistance Publique des Hôpitaux de Paris, Université Paris-Est, Créteil, France
| | - Thierry Lebeau
- Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Serge Benayoun
- Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Pierre I Karakiewicz
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada
| | - Assaad El-Hakim
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
| | - Kevin C Zorn
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Montréal (CHUM), Montreal, QC, Canada.,Division of Robotic Urology, Department of Surgery, Hôpital du Sacré Coeur de Montréal, Montreal, QC, Canada
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22
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Fossati N, Rossi MS, Cucchiara V, Gandaglia G, Dell'Oglio P, Moschini M, Suardi N, Dehò F, Montorsi F, Schiavina R, Mottrie A, Briganti A. Evaluating the effect of time from prostate cancer diagnosis to radical prostatectomy on cancer control: Can surgery be postponed safely? Urol Oncol 2016; 35:150.e9-150.e15. [PMID: 27986374 DOI: 10.1016/j.urolonc.2016.11.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/12/2016] [Accepted: 11/15/2016] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To test the prognostic role of treatment delay in patients affected by prostate cancer (PCa). MATERIALS AND METHODS The study included 2,653 patients treated with radical prostatectomy (RP) at a single institution between 2006 and 2011. The evaluated outcomes were biochemical recurrence (BCR) and clinical recurrence (CR). Multivariable Cox regression analysis was used to test the association between time from diagnosis to RP and oncological outcomes. Nonparametric curve fitting methods were used to graphically explore the relationship between time from diagnosis to RP and oncological outcomes. Sensitivity analyses were repeated in the subgroups of low-, intermediate-, and high-risk patients. RESULTS At median follow-up of 56 months (interquartile range: 26, 92), 283 patients experienced BCR, and 84 patients developed CR. Median time from PCa diagnosis to surgery was 2.8 months (interquartile range: 1.6, 4.7). At multivariable Cox regression analysis, time from biopsy to RP was significantly associated with an increased risk of BCR (hazard ratio = 1.02, P = 0.0005) and CR (hazard ratio = 1.03, P = 0.0002). Using Nonparametric curve fitting methods, a significant increased risk of BCR and CR after approximately 18 months was observed. However, when sensitivity analyses were repeated according to risk groups, this effect was maintained in high-risk patients only, and such time interval was reduced to 12 months. CONCLUSIONS Despite the overall trend on higher rate of cancer relapse after RP, the effect of treatment delay from biopsy to RP was significantly evident in high-risk patients only. Even in high-risk patients surgical treatment can be postponed safely, but not beyond the 12-month landmark.
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Affiliation(s)
- Nicola Fossati
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; OLV Ziekenhuis, Department of Urology, Aalst, Belgium; ORSI Academy, Melle, Belgium.
| | - Martina Sofia Rossi
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vito Cucchiara
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paolo Dell'Oglio
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Moschini
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nazareno Suardi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Alexandre Mottrie
- OLV Ziekenhuis, Department of Urology, Aalst, Belgium; ORSI Academy, Melle, Belgium
| | - Alberto Briganti
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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23
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Radhakrishnan A, Grande D, Mitra N, Bekelman J, Stillson C, Pollack CE. Second opinions from urologists for prostate cancer: Who gets them, why, and their link to treatment. Cancer 2016; 123:1027-1034. [PMID: 28263389 DOI: 10.1002/cncr.30412] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND Cancer patients are encouraged to obtain second opinions before starting treatment. Little is known about men with localized prostate cancer who seek second opinions, the reasons why, and the association with treatment and quality of care. METHODS We surveyed men who were diagnosed with localized prostate cancer in the greater Philadelphia area from 2012 to 2014. Men were asked if they obtained a second opinion from a urologist, and the reasons why. We used multivariable logistic regression models to evaluate the relationship between second opinions and definitive prostate cancer treatment and perceived quality of care. RESULTS A total of 2386 men responded to the survey (adjusted response rate, 51.1%). After applying exclusion criteria, the final analytic cohort included 2365 respondents. Of these, 40% obtained second opinions, most commonly because they wanted more information about their cancer (50.8%) and wanted to be seen by the best doctor (46.3%). Overall, obtaining second opinions was not associated with definitive treatment or perceived quality of cancer care. Men who sought second opinions because they were dissatisfied with their initial urologist were less likely to receive definitive treatment (odds ratio, 0.49; 95% confidence interval, 0.32-0.73), and men who wanted more information about treatment were less likely to report excellent quality of cancer care (odds ratio, 0.70; 95% confidence interval, 0.49-0.99) compared with men who did not receive a second opinion. CONCLUSIONS Although a large proportion of men with localized prostate cancer obtained a second opinion, the reasons for doing so were not associated with treatment choice or perceived quality of cancer care. Future study is needed to determine when second opinions contribute to increasing the value of cancer care. Cancer 2017;123:1027-34. © 2016 American Cancer Society.
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Affiliation(s)
- Archana Radhakrishnan
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland
| | - David Grande
- Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nandita Mitra
- Department of Biostatistics and Epidemiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Bekelman
- Department of Radiation Oncology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christian Stillson
- Division of General Internal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Craig Evan Pollack
- Division of General Internal Medicine, Johns Hopkins University, Baltimore, Maryland.,Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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24
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Jo JK, Oh JJ, Lee S, Jeong SJ, Hong SK, Byun SS, Lee SE. Can robot-assisted laparoscopic radical prostatectomy (RALP) be performed very soon after biopsy? World J Urol 2016; 35:605-612. [PMID: 27480545 DOI: 10.1007/s00345-016-1893-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 07/08/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE To identify the perioperative and oncological impact of different intervals between biopsy and robot-assisted laparoscopic radical prostatectomy (RALP) for localized prostate cancer. METHODS All consecutive patients with localized prostate cancer who underwent RALP with primary curative intent in January 2008-July 2014 in a large tertiary hospital were enrolled in this retrospective cohort study. The patients were divided into groups according to whether the biopsy-RALP interval was ≤2, ≤4, ≤6, or >6 weeks. Estimated blood loss and operating room time were surrogates for surgical difficulty. Surgical margin status and continence at the 1 year were surrogates for surgical efficacy. Biochemical recurrence (BCR) was defined as two consecutive postoperative prostate serum antigen values of ≥0.2 ng/ml. RESULTS Of the 1446 enrolled patients, the biopsy-RALP interval was ≤2, ≤4, ≤6, and >6 weeks in 145 (10 %), 728 (50.3 %), 1124 (77.7 %), and 322 (22.3 %) patients, respectively. The >6 week group had a significantly longer mean operation time than the ≤2, ≤4, and ≤6 week groups. The groups did not differ significantly in terms of estimated blood loss or surgical margin status. Kaplan-Meier analysis showed that interval did not significantly affect postoperative BCR-free survival. Multivariable Cox proportional hazards model analysis showed that interval duration was not an independent predictor of BCR (≤2 vs. >2 weeks, HR = 0.859, p = 0.474; ≤4 vs. >4 weeks, HR = 1.029, p = 0.842; ≤6 vs. >6 weeks, HR = 0.84, p = 0.368). CONCLUSION Performing RALP within 2, 4, or 6 weeks of biopsy does not appear to adversely influence surgical difficulty or efficacy or oncological outcomes.
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Affiliation(s)
- Jung Ki Jo
- Department of Urology, Hanynag University College of Medicine, Seoul, Korea
| | - Jong Jin Oh
- Department of Urology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Sangchul Lee
- Department of Urology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Seong Jin Jeong
- Department of Urology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Sung Kyu Hong
- Department of Urology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Seok-Soo Byun
- Department of Urology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea
| | - Sang Eun Lee
- Department of Urology, Seoul National University Bundang Hospital, 82, Gumi-ro, 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.
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25
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Berg WT, Danzig MR, Pak JS, Korets R, RoyChoudhury A, Hruby G, Benson MC, McKiernan JM, Badani KK. Delay from biopsy to radical prostatectomy influences the rate of adverse pathologic outcomes. Prostate 2015; 75:1085-91. [PMID: 25809289 DOI: 10.1002/pros.22992] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/13/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND We sought to determine maximum wait times between biopsy diagnosis and surgery for localized prostate cancer, beyond which the rate of adverse pathologic outcomes is increased. METHODS We retrospectively reviewed 4,610 patients undergoing radical prostatectomy between 1990 and 2011. Patients were stratified by biopsy Gleason score and PSA value. For each stratification, χ2 analysis was used to determine the smallest 15-day multiple of surgical delay (e.g., 15, 30, 45…180 days) for which adverse pathologic outcomes were significantly more likely after the time interval than before. Adverse outcomes were defined as positive surgical margins, upgrading from biopsy, upstaging, seminal vesicle invasion, or positive lymph nodes. RESULTS Two thousand two hundred twelve patients met inclusion criteria. Median delay was 64 days (mean 76, SD 47). One thousand six hundred seventy-five (75.7%), 537 (24.3%), and 60 (2.7%) patients had delays of <=90, >90, and >180 days, respectively. Twenty-six percent were upgraded on final pathology and 23% were upstaged. The positive surgical margin rate was 24.2% and the positive lymph node rate was 1.1%. Significant increases in the proportion of adverse pathological outcomes were found beyond 75 days in the overall cohort (P = 0.03), 150 days for patients with Gleason <=6, and PSA 0-10 (P = 0.038), 60 days for patients with Gleason 7 and PSA >20 (P = 0.032), and 30 days for patients with Gleason 8-10 and PSA 11-20 (0.041). CONCLUSION In low-risk disease, there is a considerable but not unlimited surgical delay which will not adversely impact the rate of adverse pathologic features found. In higher risk disease, this time period is considerably shorter.
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Affiliation(s)
- William T Berg
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Matthew R Danzig
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Jamie S Pak
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ruslan Korets
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Arindam RoyChoudhury
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Gregory Hruby
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Mitchell C Benson
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - James M McKiernan
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
| | - Ketan K Badani
- Department of Urology, Herbert Irving Cancer Center, Columbia University College of Physicians and Surgeons, New York, New York
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26
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Eroglu M, Doluoglu OG, Sarici H, Telli O, Ozgur BC, Bozkurt S. Does the time from biopsy to radical prostatectomy affect Gleason score upgrading in patients with clinical t1c prostate cancer? Korean J Urol 2014; 55:395-9. [PMID: 24955224 PMCID: PMC4064048 DOI: 10.4111/kju.2014.55.6.395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/26/2013] [Indexed: 11/18/2022] Open
Abstract
PURPOSE It is debated whether treatment delay worsens oncologic results in localized prostate cancer (PCa). Few studies have focused on the role of a delay between the time of biopsy and the time of surgery. Thus, we aimed to investigate the effect of the time period between biopsy and surgery on Gleason score upgrading (GSU). MATERIALS AND METHODS A total of 290 patients who underwent radical retropubic prostatectomy in Ankara Training and Research Hospital were included in the study. The biopsy Gleason score, age, total prostate-specific antigen (PSA) value, prostate volumes, and PSA density (PSAD) were analyzed in all patients. The patients were divided into two groups: patients with GSU (group 1) and patients without GSU (group 2). Variables having a p-value of ≤0.05 in the univariate analysis were selected and then evaluated by use of multivariate logistic regression models. Results were considered significant at p<0.05. RESULTS GSU occurred in 121 of 290 patients (41.7%). The mean age of the patients was 66.0±7.2 years in group 1 and 65.05±5.60 years in group 2 (p=0.18). The mean PSA values of groups 1 and 2 were 8.6±4.1 and 8.8±4.3 ng/dL, respectively. The mean prostate volumes of groups 1 and 2 were 43.8±14.1 and 59.5±29.8 mL, respectively. The PSAD of group 1 was significantly higher than that of group 2 (0.20 vs. 0.17, p=0.003). The mean time to surgery was shorter in group 2 (group 1, 52.2±22.6 days; group 2, 45.3±15.5 days; p=0.004). According to the logistic regression, time from biopsy to surgery is important in the prediction of GSU. CONCLUSIONS We suggest that the time period between biopsy and surgery is a significant factor that affects GSU in patients with clinically localized PCa.
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Affiliation(s)
- Muzaffer Eroglu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | | | - Hasmet Sarici
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Onur Telli
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Berat Cem Ozgur
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - Selen Bozkurt
- Department of Biostatistics and Medical Informatics, Akdeniz University Faculty of Medicine, Antalya, Turkey
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27
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Barocas DA, Grubb R, Black A, Penson DF, Fowke JH, Andriole G, Crawford ED. Association between race and follow-up diagnostic care after a positive prostate cancer screening test in the prostate, lung, colorectal, and ovarian cancer screening trial. Cancer 2013; 119:2223-9. [PMID: 23559420 DOI: 10.1002/cncr.28042] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 12/12/2012] [Accepted: 12/18/2012] [Indexed: 11/12/2022]
Abstract
BACKGROUND Follow-through of a positive screening test is necessary to reap the potential benefits of cancer screening. Racial variation in follow-through diagnostic care may underlie a proportion of the known disparity in prostate cancer mortality. The authors used data from the screening arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) cancer screening trial to determine whether race is associated with the use of follow-up diagnostic testing after a positive initial screening evaluation. METHODS Men who had a prostate-specific antigen (PSA) level >4 ng/mL at any time during the study were included. The proportion of men who underwent follow-up evaluation with a repeat PSA, a prostate biopsy, or either test within 9 months was determined, and the authors tested for differences in follow-through according to race using mixed-effects multivariate models with a random effect for accrual site to account for clustering. Models were stratified according to age (<65 years and ≥65 years). RESULTS Among 6294 men who had a PSA elevation during the study period, 70% underwent a repeat PSA or prostate biopsy within 9 months. Non-Hispanic black men aged <65 years had 45% lower odds of undergoing a repeat PSA test or prostate biopsy compared with non-Hispanic white men (odds ratio, 0.55; 95% confidence interval, 0.37-0.82), whereas there was no racial difference in follow-through among older men. CONCLUSIONS The current results suggest that limitations in access to care among non-Hispanic black men under the age of Medicare eligibility may underlie the paradoxically low use of follow-through diagnostic care among non-Hispanic black men in the United States.
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Affiliation(s)
- Daniel A Barocas
- Department of Urologic Surgery, Vanderbilt University, Nashville, Tennessee 37232, USA. dan.barocasVC vanderbilt.edu
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28
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van den Bergh RCN, Albertsen PC, Bangma CH, Freedland SJ, Graefen M, Vickers A, van der Poel HG. Timing of curative treatment for prostate cancer: a systematic review. Eur Urol 2013; 64:204-15. [PMID: 23453419 DOI: 10.1016/j.eururo.2013.02.024] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
CONTEXT Delaying definitive therapy unfavourably affects outcomes in many malignancies. Diagnostic, psychological, and logistical reasons but also active surveillance (AS) strategies can lead to treatment delay, an increase in the interval between the diagnosis and treatment of prostate cancer (PCa). OBJECTIVE To review and summarise the current literature on the impact of treatment delay on PCa oncologic outcomes. EVIDENCE ACQUISITION A comprehensive search of PubMed and Embase databases until 30 September 2012 was performed. Studies comparing pathologic, biochemical recurrence (BCR), and mortality outcomes between patients receiving direct and delayed curative treatment were included. Studies presenting single-arm results following AS were excluded. EVIDENCE SYNTHESIS Seventeen studies were included: 13 on radical prostatectomy, 3 on radiation therapy, and 1 combined both. A total of 34 517 PCa patients receiving radical local therapy between 1981 and 2009 were described. Some studies included low-risk PCa only; others included a wider spectrum of disease. Four studies found a significant effect of treatment delay on outcomes in multivariate analysis. Two included low-risk patients only, but it was unknown whether AS was applied or repeat biopsy triggered active therapy during AS. The two other studies found a negative effect on BCR rates of 2.5-9 mo delay in higher risk patients (respectively defined as any with T ≥ 2b, prostate-specific antigen >10, Gleason score >6, >34-50% positive cores; or D'Amico intermediate risk-group). All studies were retrospective and nonrandomised. Reasons for delay were not always clear, and time-to-event analyses may be subject to bias. CONCLUSIONS Treatment delay of several months or even years does not appear to affect outcomes of men with low-risk PCa. Limited data suggest treatment delay may have an impact on men with non-low-risk PCa. Most AS protocols suggest a confirmatory biopsy to avoid delaying treatment in those who harbour higher risk disease that was initially misclassified.
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Affiliation(s)
- Roderick C N van den Bergh
- University Medical Centre Utrecht, Utrecht, The Netherlands; Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Socioeconomic and Clinical Factors Influence the Interval Between Positive Prostate Biopsy and Radical Prostatectomy. Urology 2012; 80:1027-32. [DOI: 10.1016/j.urology.2012.01.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 12/12/2011] [Accepted: 01/06/2012] [Indexed: 11/21/2022]
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Radical Prostatectomy for Low-Risk Prostate Cancer Following Initial Active Surveillance: Results From a Prospective Observational Study. Eur Urol 2012; 62:195-200. [DOI: 10.1016/j.eururo.2012.02.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2011] [Accepted: 02/05/2012] [Indexed: 11/22/2022]
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[Complications and nerve preservation in prostatectomy according to the time interval from diagnostic biopsy]. Actas Urol Esp 2012; 36:178-85. [PMID: 21742416 DOI: 10.1016/j.acuro.2011.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 05/20/2011] [Accepted: 05/22/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To summarize the available evidence on complications and bilateral nerve preservation in radical prostatectomy in patients according to the time interval from diagnostic biopsy (more or less than six weeks). MATERIAL AND METHODS Relevant studies were identified by using structured and specific search strategies for each of the databases consulted, without limitations. The methodological quality of each of the studies included was evaluated and the data were extracted independently. RESULTS For open radical prostatectomy, two of the studies concluded that a time interval of less than 4 or 6 weeks between prostate biopsy and surgery had no influence on the postsurgical complications rate or on nerve preservation during surgery. For laparoscopic robotic-assisted radical prostatectomy, the study included concluded that performing this type of intervention in an interval of less than 4 or 6 weeks after diagnostic biopsy was associated with a higher risk of postsurgical complications. However, all these studies had major methodological limitations. CONCLUSIONS The time interval between diagnostic biopsy and open surgery has no influence on the complications rate or nerve preservations. In contrast, an interval of less than 4 weeks between diagnostic biopsy and laparoscopic surgery is associated with a higher risk of surgical complications.
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Korets R, Seager CM, Pitman MS, Hruby GW, Benson MC, McKiernan JM. Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis. BJU Int 2011; 110:211-6. [PMID: 22093486 DOI: 10.1111/j.1464-410x.2011.10666.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Study Type - Therapy (case series). Level of Evidence 4. What's known on the subject? and What does the study add? For patients electing surgical treatment, the question of the effect of surgical delay on clinical outcomes in prostate cancer is controversial. In this study we examined the effect of delay from diagnosis to surgery on outcomes in men with localized prostate cancer and found no association between time to surgery and risk of biochemical recurrence, even for patients with longer delays and high-risk disease. Men with localized prostate cancer can be reassured that reasonable delays in treatment will not influence disease outcomes. OBJECTIVE • To examine the effect of time from last positive biopsy to surgery on clinical outcomes in men with localized prostate cancer undergoing radical prostatectomy (RP). PATIENTS AND METHODS • We conducted a retrospective review of 2739 men who underwent RP between 1990 and 2009 at our institution. • Clinical and pathological features were compared between men undergoing RP ≤ 60, 61-90 and >90 days from the time of prostate biopsy. • A Cox proportional hazards model was used to analyse the association between clinical features and surgical delay with biochemical progression. Biochemical recurrence (BCR)-free rates were assessed using the Kaplan-Meier method. RESULTS • Of the 1568 men meeting the inclusion criteria, 1098 (70%), 303 (19.3%) and 167 (10.7%) had a delay of ≤ 60, 61-90 and >90 days, respectively, between biopsy and RP. A delay of >60 days was not associated with adverse pathological findings at surgery. • The 5-year survival rate was similar among the three groups (78-85%, P= 0.11). • In a multivariate Cox model, men with higher PSA levels, clinical stages, Gleason sums, and those of African-American race were all at higher risk for developing BCR. • A delay to surgery of >60 days was not associated with worse biochemical outcomes in a univariate and multivariate model. CONCLUSIONS • A delay of >60 days is not associated with adverse pathological outcomes in men with localized prostate cancer, nor does it correlate with worse BCR-free survival. • Patients can be assured that delaying treatment while considering therapeutic options will not adversely affect their outcomes.
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Affiliation(s)
- Ruslan Korets
- Department of Urology, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA
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Kim IS, Na W, Nam JS, Oh JJ, Jeong CW, Hong SK, Byun SS, Lee SE. Interval from Prostate Biopsy to Robot-Assisted Laparoscopic Radical Prostatectomy (RALP): Effects on Surgical Difficulties. Korean J Urol 2011; 52:664-8. [PMID: 22087359 PMCID: PMC3212659 DOI: 10.4111/kju.2011.52.10.664] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 08/11/2011] [Indexed: 11/29/2022] Open
Abstract
Purpose Traditionally, an interval of 4 to 6 weeks has been recommended after prostate biopsy before open radical prostatectomy. However, such an interval is not explicitly specified in robot-assisted laparoscopic radical prostatectomy (RALP). This study was designed to determine whether the interval from prostate biopsy to RALP affects surgical difficulties. Materials and Methods Between January 2008 and May 2009, a total of 237 men underwent
RALP in our institution. The interval from biopsy to RALP was categorized as follows: ≤ 2 weeks, >2 to ≤ 4 weeks, >4 to ≤ 6 weeks, >6 to ≤ 8 weeks, and >8 weeks. Multivariate analysis was used to identify whether the interval from prostate biopsy to RALP was an independent predictor of operative time, estimated blood loss (EBL), margin positivity, continence, and potency. Results Among the 5 groups, there were no significant differences in age, body mass index (BMI), preoperative serum prostate-specific antigen (PSA), prostate volume, or preoperative International Index of Erectile Dysfunction-5 score (all p>0.05). In the multivariate analysis, operative time was significantly associated with prostate volume. EBL was associated with prostate volume and BMI. Margin positivity was associated with preoperative serum PSA, prostate volume, and biopsy Gleason score. Postoperative continence and potency were significantly associated with age. However, in univariate and multivariate analyses, the interval from biopsy to RALP was not significantly associated with operative time, EBL, margin positivity, postoperative continence, or potency (all p>0.05). Conclusions Our data suggest that the interval from prostate biopsy to RALP is not related to surgical difficulties.
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Affiliation(s)
- In Sung Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, Korea
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Stevens C, Bondy SJ, Loblaw DA. Wait times in prostate cancer diagnosis and radiation treatment. Can Urol Assoc J 2010; 4:243-8. [PMID: 20694099 PMCID: PMC2910767 DOI: 10.5489/cuaj.09122] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Wait times for cancer diagnosis and treatment are a significant concern for Canadians. Men with prostate cancer experience longer waiting times for diagnosis and treatment than those observed for other cancers. Longer waits are associated with both patient and family psychosocial distress and may be associated with worse prognosis. METHODS Men referred for treatment of prostate cancer at a single Canadian cancer centre were interviewed. The intervals from suspicion to definitive therapy were calculated, factors associated with delays along this pathway were identified, and common causes of delay identified by patients were described. RESULTS A total of 41 consecutive patients participated. The median interval from suspicion to the first fraction of radiotherapy for all patients was 247 days (interquartile range [IQR] 168-367 d). The median diagnostic interval was 53 days (IQR 28-166 d). The median treatment interval was 127 days (IQR 100-180 d). Patients under 70 years old and patients with INTERPRETATION In this study, 12% and 0% of patients met Canadian Strategy for Cancer Control and Canadian Association of Radiation Oncologists wait time recommendations, respectively. A large component of wait time is patient driven. Alternate strategies should be developed and measured to shorten the intervals between the suspicion and treatment of prostate cancer.
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Affiliation(s)
- Christiaan Stevens
- Fellow, Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, ON
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Choi H, Ko YH, Kang SG, Kang SH, Park HS, Cheon J, Patel VR. Biopsy related prostate status does not affect on the clinicopathological outcome of robotic assisted laparoscopic radical prostatectomy. Cancer Res Treat 2009; 41:205-10. [PMID: 20057965 DOI: 10.4143/crt.2009.41.4.205] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/28/2009] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To determine whether the biopsy core number and time interval between prostate biopsy and radical prostatectomy affect the operative and oncologic outcome of robot assisted laparoscopic radical prostatectomy (RALP). MATERIALS AND METHODS From January 2008 to April 2009, a single surgeon performed 72 RALPs after an initial learning period of 30 cases. The relationship between time from biopsy to prostatectomy and biopsy core number with operative time and estimated blood loss (EBL) were initially evaluated with a linear regression model. These patients were classified into groups according to whether the interval from biopsy to RALP was within four weeks or not, and whether there were less than or greater than 10 core specimens removed. RESULTS RALP was performed in 34 patients within four weeks of biopsy, and in 38 patients more than 4 weeks after biopsy. According to the number of core specimens removed, less than 10 cores were performed in 10 patients, and more than 10 cores were performed in 62 patients. Using an interval of 4 weeks as the cutoff point, early surgery was associated with longer operating time (232.6 vs 208.8 min) and increased estimated blood loss (305.1 vs 276.9 mL). For cases with more than 10 biopsy cores, there was a slight increase in operative time (229.2 vs 210.3 min). None of these differences were statistically significant by multivariate analysis. CONCLUSION Our data suggests that there is no reason to delay RALP to more than 4 weeks after prostate biopsy. It also revealed that the number of biopsy cores (up to 14) did not influence operative outcome. Thus, RALP is a feasible procedure regardless of the biopsy related prostate state.
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Affiliation(s)
- Hoon Choi
- Department of Urology, MIS & Robotic Urologic Surgery Center, Korea University School of Medicine, Seoul, Korea
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Martin GL, Nunez RN, Humphreys MD, Martin AD, Ferrigni RG, Andrews PE, Castle EP. Interval from prostate biopsy to robot-assisted radical prostatectomy: effects on perioperative outcomes. BJU Int 2009; 104:1734-7. [DOI: 10.1111/j.1464-410x.2009.08685.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Alonso AR, Blanco AG, Fernández SP, Díaz SP, Martín CB, Cuerpo Pérez MA. Influencia de la demora quirúrgica en los hallazgos patológicos y el pronóstico de los pacientes con cáncer de próstata. Actas Urol Esp 2009. [DOI: 10.1016/s0210-4806(09)73183-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Neoadjuvant androgen deprivation for prostate volume reduction: the optimal duration in prostate cancer radiotherapy. Urol Oncol 2009; 29:52-7. [PMID: 19523856 DOI: 10.1016/j.urolonc.2009.03.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 03/30/2009] [Accepted: 03/31/2009] [Indexed: 11/23/2022]
Abstract
OBJECTIVES For locally advanced prostate cancer, the results of radiotherapy are improved by combination with androgen deprivation therapy. Volume reduction achieved with neoadjuvant hormonal treatment can facilitate dose escalation without increasing the toxicity. The optimal duration of hormonal treatment, however, is unknown. The endpoint of this study is the optimal duration of androgen deprivation for prostate volume reduction in a cohort of patients scheduled for external beam radiotherapy. PATIENTS AND METHODS Twenty patients scheduled for external beam radiotherapy with cT2-3No/xMo prostate cancer were treated with a luteinizing hormone releasing hormone agonist (busereline) and nonsteroidal anti-androgen (nilutamide) for 9 months consecutively. Repeated CT scan examination was performed 3-monthly to measure prostate volumes until the start of radiation therapy. The analysis of volume reduction was performed with the Wilcoxon signed ranks test. RESULTS The baseline median prostate volume for the cohort of patients was 82 cc (95% CI: 61-104 cc) with a median volume reduction of 31% (95% CI: 26%-35%) (P < 0.0001) after 3 months of androgen deprivation. Between 3 and 6 months, a median volume reduction of 9% (95% CI: 4%-14%) (P < 0.0001) was observed. The effect was more pronounced in large prostates (>60 cc) than in small prostates (≤60 cc). In the total cohort of patients no significant volume reduction occurred between 6 and 9 months of maximal androgen blockade (MAB). CONCLUSIONS In this study, we have shown that the most significant prostate volume reduction is achieved after 3 months of MAB with a maximum reduction after 6 months. Therefore, the optimal duration of neoadjuvant androgen deprivation to reduce prostate volume before prostate cancer radiotherapy is 6 months. In small prostates 3 months of hormonal treatment may be enough for maximal volume reduction.
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[Early biochemical failure after radical prostatectomy for prostate cancer. Impact factors?]. Actas Urol Esp 2008; 32:406-10. [PMID: 18540261 DOI: 10.1016/s0210-4806(08)73854-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
UNLABELLED Does delay from biopsy to surgery have any influence? OBJECTIVES To determine wether WT may impact on the EBF (before one year) alter RRP in our series, and to study other factors that may impact on this issue. MATERIAL AND METHODS We study 310 RRP. Inclusion criteria are: one year follow up, no hormonal manipulation neither previous radiotherapy. Patients are divide in two groups attending WT. Group A < 90 days (n: 148), Group B > 90 days (n: 162). We study EBF (2 or more PSA determinations >= 0.2 ng/ml), and the impact of previous PSA, biopsy Gleason, Gleason of the specimen (G), pT stage (pT), and WT. T of Student or W of Wilcoxon are used to determine the homogeneity of the two groups. Chi Square of Pearson to compare the two group's EBF and pT attending to WT and EBF attending to pT. U of Mann Whitney is used to study EBF attending to G. Multivariate logistic regresion (LR) is used to study the impact of the variables on EBF. RESULTS There are no differences between the two groups in age (p<0.129), PSA (p<0.479), biopsy's Gleason (p<0.913). There are no differences in EBF nor in pT attending to WT. Significant statystical differences are founded in EBF attending to pT and G. T3 tumors have more chance of recurrence than T2. EBF is more frecuent as G increases. In logistic regresion of the global serie, independent variables for progression are: Previous PSA and pT. Nor biopsy's Gleason nor specimen's Gleason, nor WT, impact on the EBF. CONCLUSIONS Biopsy Gleason and WT do not impact on EBF. WT do not impact on pT. In our serie differences on EBF are lead by previous PSA and pT. Also Gleason of the especimen seems to impact on EBF, but in lower proportion, with no significance in multivariate analysis.
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The role for intramuscular testosterone injection in the gel era. CURRENT SEXUAL HEALTH REPORTS 2007. [DOI: 10.1007/s11930-007-0014-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Eggener SE, Yossepowitch O, Serio AM, Vickers AJ, Scardino PT, Eastham JA. Radical prostatectomy shortly after prostate biopsy does not affect operative difficulty or efficacy. Urology 2007; 69:1128-33. [PMID: 17572200 DOI: 10.1016/j.urology.2007.01.089] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2006] [Revised: 12/04/2006] [Accepted: 01/26/2007] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To examine whether radical prostatectomy (RP) conducted before 4 or 6 weeks after prostate biopsy is associated with surgical difficulty or efficacy. Many urologists recommend an interval of at least 4 to 6 weeks between prostate biopsy and RP. METHODS Using our surgical database, we identified 2996 men undergoing open RP and compared the outcomes after surgery stratified by the interval from biopsy, analyzed as a dichotomous variable with cutpoints of either 4 or 6 weeks. The estimated blood loss and operating room time were considered surrogates for surgical difficulty, and surgical margin status and postoperative urinary and erectile function surrogates for surgical efficacy. We used regression models to assess whether the time to RP affected these surgical outcomes after controlling for the surgeon, surgeon experience, and various clinical and pathologic disease features. RESULTS The interval between biopsy and RP was 4 weeks or less for 168 men (6%) and 6 weeks or less for 416 men (14%). Using an interval of 4 weeks or less or 6 weeks or less, multivariate mixed effects regression analyses did not show a significant association between early surgery and operating room time, estimated blood loss, surgical margin status, urinary continence, or erectile function (all P > or = 0.18). Our results were sufficiently precise to exclude an important effect of early surgery. CONCLUSIONS The results of our study have shown that performing radical prostatectomy shortly after prostate biopsy, within 4 to 6 weeks, does not adversely influence surgical difficulty or efficacy.
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Affiliation(s)
- Scott E Eggener
- Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
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Yassin AA, Saad F. Treatment of sexual dysfunction of hypogonadal patients with long-acting testosterone undecanoate (Nebido®). World J Urol 2006; 24:639-44. [PMID: 17048032 DOI: 10.1007/s00345-006-0120-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Recently, testosterone undecanoate (TU), a new parenteral testosterone (T) preparation has been introduced. Two of its distinctive features are (a) its prolonged action: after two initial loading injections 6 weeks apart, usually only one injection every 12 weeks is needed (b) over the full interval between two injections, plasma T levels are in the physiological range. New research presents convincing evidence that T has profound effects on tissues of the penis involved in the mechanism of erection and that testosterone deficiency impairs the anatomical and physiological substrate of erectile capacity, which is, at least, in part reversible upon androgen therapy. Our studies with TU demonstrated that venous leakage could be corrected with T treatment in a number of patients. We further could show that sexual functions, in a substantial number of elderly men, can be restored with treatment with T only. So, these results argue for determination of T levels in elderly men with sexual problems. If the levels are subnormal, T treatment is warranted.
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Affiliation(s)
- Aksam A Yassin
- Clinic of Urology/Andrology, Segeberger Kliniken, Norderstedt-Hamburg, Germany.
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