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Romito I, Giannarini G, Rossanese M, Mucciardi G, Simonato A, Ficarra V. Incidence of Rectal Injury After Radical Prostatectomy: A Systematic Review and Meta-analysis. EUR UROL SUPPL 2023; 52:85-99. [PMID: 37213241 PMCID: PMC10192923 DOI: 10.1016/j.euros.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 05/23/2023] Open
Abstract
Context Rectal injury (RI) is a dreaded complication after radical prostatectomy (RP), increasing the risk of early postoperative complications, such as bleeding and severe infection/sepsis, and late sequelae, such as a rectourethral fistula (RUF). Considering its traditionally low incidence, uncertainty remains as to predisposing risk factors and management. Objective To examine the incidence of RI after RP in contemporary series and to propose a pragmatic algorithm for its management. Evidence acquisition A systematic literature search was performed using the Medline and Scopus databases. Studies reporting data on RI incidence were selected. Subgroup analyses were conducted to assess the differential incidence by age, surgical approach, salvage RP after radiation therapy, and previous benign prostatic hyperplasia (BPH)-related surgery. Evidence synthesis Eighty-eight, mostly retrospective noncomparative, studies were selected. The meta-analysis obtained a pooled RI incidence of 0.58% (95% confidence interval [CI] 0.46-0.73) in contemporary series with significant across-study heterogeneity (I2 = 100%, p < 0.00001). The highest RI incidence was found in patients undergoing open RP (1.25%; 95% CI 0.66-2.38) and laparoscopic RP (1.25%; 95% CI 0.75-2.08) followed by perineal RP (0.19%; 95% CI 0-276.95) and robotic RP (0.08%; 95% CI 0.02-0.31). Age ≥60 yr (0.56%; 95% CI 0.37-06) and salvage RP after radiation therapy (6.01%; 95% CI 3.99-9.05), but not previous BPH-related surgery (4.08%, 95% CI 0.92-18.20), were also associated with an increased RI incidence. Intraoperative versus postoperative RI detection was associated with a significantly decreased risk of severe postoperative complications (such as sepsis and bleeding) and subsequent formation of a RUF. Conclusions RI is a rare, but potentially devastating, complication following RP. RI incidence was higher in patients ≥60 yr of age, and in those who underwent open/laparoscopic approach or salvage RP after radiation therapy. Intraoperative RI detection and repair apparently constitute the single most critical step to significantly decrease the risk of major postoperative complications and subsequent RUF formation. Conversely, intraoperatively undetected RI can lead more often to severe infective complications and RUF, the management of which remains poorly standardised and requires complex procedures. Patient summary Accidental rectum tear is a rare, but potentially devastating, complication in men undergoing prostate removal for cancer. It occurs more often in patients aged 60 yr or older as well as in those who underwent prostate removal via an open/laparoscopic approach and/or prostate removal after radiation therapy for recurrent disease. Prompt identification and repair of this condition during the initial operation are the key to reduce further complications such as the formation of an abnormal opening between the rectum and the urinary tract.
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Affiliation(s)
- Ilaria Romito
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Marta Rossanese
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Giuseppe Mucciardi
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Urology Section, University of Palermo, Palermo, Italy
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section, University of Messina, Messina, Italy
- Corresponding author. Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, Via Consolare Valeria 1, IT-98125 Messina, Italy. Tel. +390902217027.
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Blank F, Meyer M, Wang H, Abbas H, Tayebi S, Hsu WW, Sidana A. Salvage Radical Prostatectomy after Primary Focal Ablative Therapy: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:2727. [PMID: 37345064 DOI: 10.3390/cancers15102727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/08/2023] [Accepted: 05/10/2023] [Indexed: 06/23/2023] Open
Abstract
CONTEXT Focal therapy (FT) has been gaining popularity as a treatment option for localized intermediate-risk prostate cancer (PCa) due to the associated lower morbidity compared to whole-gland treatment. However, there is an increased risk of local cancer recurrence requiring subsequent treatment in a small proportion of patients. OBJECTIVE To conduct a systematic review and meta-analysis to better describe and analyze patient postoperative, oncologic, and functional outcomes for those who underwent salvage radical prostatectomy (sRP) to manage their primary FT failure. EVIDENCE ACQUISITION A systematic review was completed using three databases (PubMed, Embase, and CINAHL) from October to December 2021 to identify data on outcomes in patients who received sRP for cancer recurrence after prior focal treatment. EVIDENCE SYNTHESIS 12 articles (482 patients) were included. Median time to sRP was 24 months. Median follow-up time was 27 months. A meta-analysis revealed a postoperative complication rate of 15% (95% CI: 0.09, 0.24), with 4.6% meeting criteria for a major complication Clavien (CG) grade ≥3. Severe GU toxicity was seen in 3.6% of the patients, and no patients had severe GI toxicity. Positive surgical margins (PSM) were found in 27% (95% CI: 0.19, 0.37). Biochemical recurrence (BCR) after sRP occurred in 23% (95% CI: 0.17, 0.30), indicating a BCR-free probability of 77% at 2 years. Continence (pad-free) and potency (ability to have penetrative sex) were maintained in 67% (95% CI: 0.53, 0.78) and 37% (95% CI: 0.18, 0.62) at 12 months, respectively. CONCLUSION Our evidence shows acceptable complication rates and oncologic outcomes; however, with suboptimal functional outcomes for patients undergoing sRP for recurrent PCa after prior FT. Inferior outcomes were observed for salvage treatment compared to primary radical prostatectomy (pRP). More high-quality studies are needed to better characterize outcomes after this sequence of PCa treatments. PATIENT SUMMARY We looked at treatment outcomes and toxicity for men treated with sRP for prior FT failure. We conclude that these patients will have significant detriment to genitourinary function, with outcomes being worse than those for pRP patients.
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Affiliation(s)
- Fernando Blank
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Meredith Meyer
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Hannah Wang
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Hasan Abbas
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Shima Tayebi
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
| | - Wei-Wen Hsu
- Division of Biostatistics and Bioinformatics, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Abhinav Sidana
- Division of Urology, Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH 45267, USA
- University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
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Maestroni U, Tafuri A, Dinale F, Campobasso D, Antonelli A, Ziglioli F. Oncologic outcome of salvage high-intensity focused ultrasound (HIFU) in radiorecurrent prostate cancer. A systematic review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021191. [PMID: 34487074 PMCID: PMC8477121 DOI: 10.23750/abm.v92i3.11475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 01/08/2023]
Abstract
INTRODUCTION External Beam Radiation Therapy (EBRT) is one of the option available for the treatment of clinically localized prostate cancer. In patients with radiorecurrent localized prostate cancer, Androgen Deprivation Therapy (ADT) is one of the most common therapeutic strategies. However, in the last decades, other salvage treatment options have been investigated, such as brachytherapy, cryoablation and High Intensity Focused Ultrasound (Hifu). MATERIAL AND METHODS The oncologic outcome of Hifu in a salvage setting after EBRT failure was investigated. We reviewed the literature from 2005 to 2020 in order to report the oncologic outcome of the technique. RESULTS A total of 1241 patients were analyzed, with a mean age of 68.6 years and a PSA value of 5.87 ng/mL before treatment. Mean follow-up was 24.3 months after treatment, ranging from 3 to 168 months. CONCLUSION Our review of the literature revealed that salvage Hifu is effective in the treatment of radiorecurrent clinically localized prostate cancer, with an overall survival of 85.2% at 5 years.
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Nathan A, Fricker M, De Groote R, Arora A, Phuah Y, Flora K, Patel S, Kasivisvanathan V, Sridhar A, Shaw G, Kelly J, Briggs T, Rajan P, Sooriakumaran P, Nathan S. Salvage Versus Primary Robot-assisted Radical Prostatectomy: A Propensity-matched Comparative Effectiveness Study from a High-volume Tertiary Centre. EUR UROL SUPPL 2021; 27:43-52. [PMID: 33997823 PMCID: PMC8090976 DOI: 10.1016/j.euros.2021.03.003] [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] [Indexed: 11/29/2022] Open
Abstract
Background Salvage robot-assisted radical prostatectomy (sRARP) is a potential treatment option for locally recurrent prostate cancer (PCa) after nonsurgical primary treatment. There are minimal data comparing outcomes between propensity-matched sRARP and primary robot-assisted radical prostatectomy (RARP). Objective The primary objective is to compare perioperative, oncological, and functional outcomes of sRARP with primary RARP, and the secondary is to compare outcomes between sRARP after whole and focal gland therapy. Design, setting, and participants A 1:1 propensity-matched comparison was carried out of 135 sRARP cases with primary RARP cases from a cohort of 3852 consecutive patients from a high-volume tertiary centre. Outcome measurements and statistical analysis Perioperative, oncological, and functional outcomes including complication rates, positive surgical margins, biochemical recurrence (BCR), continence, and erectile dysfunction (ED) were retrospectively collected. Results and limitations There were no significant differences in patient characteristics between sRARP and primary RARP groups. In the salvage and primary groups, median (interquartile range) follow-up periods were 521 (304–951) and 638 (394–951) d, grade III–V Clavien-Dindo complication rates were 1.5% and 0% (p = 0.310), BCR rates were 31.9% and 14.1% (p < 0.001) at the last follow-up, pad-free continence rates were 78.8% and 84.3% at 2 yr (p = 0.337), and ED rates were 94.8% and 76.3% (p < 0.001), respectively. Comparing the whole and focal gland groups, BCR rates were 36.7% and 29.1% (p = 0.687) at follow-up, pad-free continence rates were 53.1% and 89.3% at 2 yr (p < 0.001), and ED rates were 98% and 93% (p = 0.214), respectively. Conclusions Salvage RARP has similar perioperative outcomes to primary RARP with inferior potency rates. Post–focal therapy sRARP has similar recurrence and continence rates to primary RARP. Post–whole gland therapy, complication, and recurrence rates are higher, and there is a higher risk of urinary incontinence. Patient summary We report the largest propensity-matched comparison of salvage robot-assisted radical prostatectomy (RARP) after focal and whole gland therapy. Salvage RARP is a feasible procedure for the treatment of locally recurrent prostate cancer in high-volume centres; however, patients should be counselled appropriately as to the different outcomes.
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Affiliation(s)
- Arjun Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | | | - Ruben De Groote
- Department of Urology, Onze Lieve Vrouw Hospital Aalst, Aalst, Belgium
| | - Amandeep Arora
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | | | | | | | - Veeru Kasivisvanathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,University College London, London, UK
| | - Ashwin Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Greg Shaw
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - John Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim Briggs
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Prabhakar Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Barts Cancer Institute, CR-UK Barts Centre, Queen Mary University of London, London, UK
| | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.,Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Senthil Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
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Outcomes and toxicities of re-irradiation for prostate cancer: A systematic review on behalf of the Re-Irradiation Working Group of the Italian Association of Radiotherapy and Clinical Oncology (AIRO). Cancer Treat Rev 2021; 95:102176. [PMID: 33743409 DOI: 10.1016/j.ctrv.2021.102176] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
AIMS The best therapeutic approach for local relapses of previously irradiated prostate cancer (PC) is still not defined. Re-irradiation (Re-I) could offer a chance of cure for highly selected patients, although high quality evidences are lacking. The aim of our study is to provide a literature review on efficacy and safety of Re-I. METHODS Only studies where Re-I field overlaps with previous radiotherapy were considered. To determine 2 and 4 years overall mortality (OM), 2 and 4 years biochemical failure (BF) and pooled acute and late G ≥ 3 toxicities rate, a meta-analysis over single arm study was performed. RESULTS Thirty-eight studies with 1194 patients were included. Median follow-up from Re-I was 30 months (10-94 months). Brachytherapy (BRT) was the most used Re-I technique (27 studies), followed by Stereotactic Body Radiotherapy (SBRT) (9) and External Beam Radiation Therapy (EBRT) (2). Re-I prescription doses ranged from 19 Gy in single HDR fraction to 145 Gy (interstitial BRT). The pooled 2 and 4 years OM rates were 2.1% (95%CI:1.1-3.7%, P < 0.001) and 12.5% (95%CI:8.1-19.5%; P < 0.001). The pooled 2 years BF rate was 24% (95% CI: 19.1-30.2%, P < 0.001). The pooled 4 years BF was 35.6% (95% CI: 28.7-44.3%, P < 0.001). The pooled result of G ≥ 3 acute toxicity was 1.4% (95%CI: 0.7-3%, P < 0.001). One hundred and three G ≥ 3 late adverse events were reported, with a pooled result of G ≥ 3 late toxicity of 8.7% (95%CI: 5.8-13%, P < 0.001). CONCLUSIONS Re-I of local failures from PC showed promising OM and biochemical control rates with a safe toxicity profile.
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Surcel C, Mirvald C, Tsaur I, Borgmann H, Heidegger I, Labanaris AP, Sinescu I, Tilki D, Ploussard G, Briganti A, Montorsi F, Mathieu R, Valerio M, Jinga V, Badescu D, Radavoi D, van den Bergh RCN, Gandaglia G, Kretschmer A. Contemporary role of palliative cystoprostatectomy or pelvic exenteration in advanced symptomatic prostate cancer. World J Urol 2020; 39:2483-2490. [PMID: 33135127 DOI: 10.1007/s00345-020-03493-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 10/10/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To access the feasibility of palliative cystoprostatectomy/pelvic exenteration in patients with bladder/rectal invasion due to prostate cancer (PC). PATIENTS AND METHODS Twenty-five men with cT4 PC were retrospectively identified in the institutional databases of six tertiary referral centers in the last decade. Local invasion was documented by CT or MRI scans and was confirmed by urethrocystoscopy. Oncological therapies, local symptoms, previous local treatments, time from diagnosis to intervention and type of surgical procedure were recorded. Patients were divided into groups: ADT group (12 pts) and 13 pts without any history of previous local/systemic treatments for PCa (nonADT groups). Perioperative complications were classified using the Clavien-Dindo system. Overall survival (OS) was defined as the time from surgery to death from any cause. A Cox regression analysis, stratified for ISUP score and previous hormonal treatment (ADT) was also performed for survival analysis. RESULTS Ileal conduit was the main urinary diversion in both cohorts. For the entire cohort, complication rate was 44%. No significant differences regarding perioperative complications and complication severity between both subgroups were observed (p = 0.2). Median follow-up was 15 months (range 3-41) for the entire cohort with a median survival of 15 months (95% CI 10.1-19.9). In Cox regression analysis stratified for ISUP score, no statistically significant differences in OS in patients with and without previous ADT before cystectomy or exenteration were observed (HR 3.26, 95% CI 0.62-17.23, p = 0.164). CONCLUSION Palliative cystoprostatectomy and pelvic exenteration represent viable treatment options associated with acceptable morbidity and good short-term survival outcome.
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Affiliation(s)
- C Surcel
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
| | - C Mirvald
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. .,Department of Urology, Fundeni Clinical Institute, Bucharest, Romania.
| | - I Tsaur
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - H Borgmann
- Department of Urology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Isabel Heidegger
- Department of Urology, Medical University Innsbruck, Innsbruck, Austria
| | - A P Labanaris
- Department of Urology, Interbalkan Medical Center, Thessaloniki, Greece
| | - I Sinescu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,Department of Urology, Fundeni Clinical Institute, Bucharest, Romania
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - G Ploussard
- Department of Urology, La Croix du Sud Hospital, Toulouse, France
| | - A Briganti
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - F Montorsi
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - R Mathieu
- Department of Urology, CHU Rennes, Rennes, France
| | - M Valerio
- Department of Urology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - V Jinga
- Urology Department, 'Prof. Dr. Th. Burghele' Clinical Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - D Badescu
- Urology Department, 'Prof. Dr. Th. Burghele' Clinical Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - D Radavoi
- Urology Department, 'Prof. Dr. Th. Burghele' Clinical Hospital, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - R C N van den Bergh
- Unit of Urology/Division of Oncology, St Antonius Hospital, Utrecht, Netherlands
| | - G Gandaglia
- Department of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - A Kretschmer
- Department of Urology, Ludwig-Maximilians University of Munich, Munich, Germany
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Keady C, Hechtl D, Joyce M. When the bowel meets the bladder: Optimal management of colorectal pathology with urological involvement. World J Gastrointest Surg 2020; 12:208-225. [PMID: 32551027 PMCID: PMC7289647 DOI: 10.4240/wjgs.v12.i5.208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/10/2020] [Accepted: 05/13/2020] [Indexed: 02/07/2023] Open
Abstract
Fistulae between the gastrointestinal and urinary systems are rare but becoming increasingly more common in current surgical practice. They are a heterogeneous group of pathological entities that are uncommon complications of both benign and malignant processes. As the incidence of complicated diverticular disease and colorectal malignancy increases, so too does the extent of fistulous connections between the gastrointestinal and urinary systems. These complex problems will be more common as a factor of an aging population with increased life expectancy. Diverticular disease is the most commonly encountered aetiology, accounting for up to 80% of cases, followed by colorectal malignancy in up to 20%. A high index of suspicion is required in order to make the diagnosis, with ever improving imaging techniques playing an important role in the diagnostic algorithm. Management strategies vary, with most surgeons now advocating for a single-stage approach to enterovesical fistulae, particularly in the elective setting. Concomitant bladder management techniques are also disputed. Traditionally, open techniques were the standard; however, increased experience and advances in surgical technology have contributed to refined and improved laparoscopic management. Unfortunately, due to the relative rarity of these entities, no randomised studies have been performed to ascertain the most appropriate management strategy. Rectourinary fistulae have dramatically increased in incidence with advances in the non-operative management of prostate cancer. With radiotherapy being a major contributing factor in the development of these complex fistulae, optimum surgical approach and exposure has changed accordingly to optimise their management. Conservative management in the form of diversion therapy is effective in temporising the situation and allowing for the diversion of faecal contents if there is associated soiling, macerated tissues or associated co-morbidities. One may plan for definitive surgical intervention at a later stage. Less contaminated cases with no fibrosis may proceed directly to definitive surgery if the appropriate expertise is available. An abdominal approach with direct repair and omentum interposition between the repaired tissues has been well described. In low lying fistulae, a transperineal approach with the patient in a prone-jack knife position provides optimum exposure and allows for the use of interposition muscle grafts. According to recent literature, it offers a high success rate in complex cases.
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Affiliation(s)
- Conor Keady
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
| | - Daniel Hechtl
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
| | - Myles Joyce
- Department of Colorectal Surgery, Galway University Hospital, Galway H91 YR71, Ireland
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Woodrum DA, Kawashima A, Gorny KR, Mynderse LA. Magnetic Resonance-Guided Prostate Ablation. Semin Intervent Radiol 2019; 36:351-366. [PMID: 31798208 PMCID: PMC6887527 DOI: 10.1055/s-0039-1697001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In 2019, the American Cancer Society (ACS) estimates that 174,650 new cases of prostate cancer will be diagnosed and 31,620 will die due to the prostate cancer in the United States. Prostate cancer is often managed with aggressive curative intent standard therapies including radiotherapy or surgery. Regardless of how expertly done, these standard therapies often bring significant risk and morbidity to the patient's quality of life with potential impact on sexual, urinary, and bowel functions. Additionally, improved screening programs, using prostatic-specific antigen and transrectal ultrasound-guided systematic biopsy, have identified increasing numbers of low-risk, low-grade "localized" prostate cancer. The potential, localized, and indolent nature of many prostate cancers presents a difficult decision of when to intervene, especially within the context of the possible comorbidities of aggressive standard treatments. Active surveillance has been increasingly instituted to balance cancer control versus treatment side effects; however, many patients are not comfortable with this option. Although active debate continues on the suitability of either focal or regional therapy for the low- or intermediate-risk prostate cancer patients, no large consensus has been achieved on the adequate management approach. Some of the largest unresolved issues are prostate cancer multifocality, limitations of current biopsy strategies, suboptimal staging by accepted imaging modalities, less than robust prediction models for indolent prostate cancers, and safety and efficiency of the established curative therapies following focal therapy for prostate cancer. In spite of these restrictions, focal therapy continues to confront the current paradigm of therapy for low- and even intermediate-risk disease. It has been proposed that early detection and proper characterization may play a role in preventing the development of metastatic disease. There is level-1 evidence supporting detection and subsequent aggressive treatment of intermediate- and high-risk prostate cancer. Therefore, accurate assessment of cancer risk (i.e., grade and stage) using imaging and targeted biopsy is critical. Advances in prostate imaging with MRI and PET are changing the workup for these patients, and advances in MR-guided biopsy and therapy are propelling prostate treatment solutions forward faster than ever.
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9
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Devos B, Al Hajj Obeid W, Andrianne C, Diamand R, Peltier A, Everaerts W, Van Poppel H, Van Velthoven R, Joniau S. Salvage high-intensity focused ultrasound versus salvage radical prostatectomy for radiation-recurrent prostate cancer: a comparative study of oncological, functional, and toxicity outcomes. World J Urol 2019; 37:1507-1515. [PMID: 30666400 DOI: 10.1007/s00345-019-02640-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 01/11/2019] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To compare oncological, functional, and toxicity outcomes of patients with radiation-recurrent prostate cancer (PCa) after external beam radiation therapy (EBRT) or brachytherapy (BT) treated with salvage high-intensity focused ultrasound (S-HIFU) or salvage radical prostatectomy (S-RP). METHODS This retrospective study compared 52 patients with radiation-recurrent PCa after EBRT or BT treated with S-HIFU (n = 27) or S-RP (n = 25) between 1998 and 2016. We estimated overall survival (OS), cancer-specific survival (CSS), and metastasis-free survival (MFS) at 5 years. Incontinence after local salvage therapy (LST) was scored according to the number of pads used per day. Complications were graded according to the Clavien-Dindo classification. RESULTS Both groups were similar for pre-LST tumor features, however, no S-HIFU patients received BT and S-RP patients were younger and healthier. Median follow-up was 45 months for S-HIFU and 43 months for S-RP. No significant differences were found in estimated 5-year OS (80.9% vs. 61.9%, p = 0.24), 5-year CSS (84.0% vs. 74.0%, p = 0.36), and 5-year MFS (60.3% vs. 55.2%, p = 0.55) for S-HIFU vs. S-RP, respectively. We observed a significant difference in pad-dependent status at 12 months (22.2% vs. 56.0%, p = 0.01) and in the number of Clavien ≥ III complications [9 (7/27 patients) vs. 16 (12/25 patients), p = 0.027] in favor of S-HIFU vs. S-RP, respectively. CONCLUSION S-HIFU and S-RP could both be considered valuable LST options for patients with radiation-recurrent nonmetastatic PCa with sufficient life expectancy. S-RP is associated with more pad-dependent patients at 12 months.
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Affiliation(s)
| | - Walid Al Hajj Obeid
- Department of Urology, Saint George Hospital University Medical Center, Beirut, Lebanon
- Department of Urology, Jules Bordet Institute, Brussels, Belgium
| | - Colin Andrianne
- Department of Urology, Jules Bordet Institute, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, Jules Bordet Institute, Brussels, Belgium
| | | | - Wouter Everaerts
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Hein Van Poppel
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | | | - Steven Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
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10
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Miszczyk L, Stąpór-Fudzińska M, Miszczyk M, Maciejewski B, Tukiendorf A. Salvage CyberKnife-Based Reirradiation of Patients With Recurrent Prostate Cancer: The Single-Center Experience. Technol Cancer Res Treat 2018; 17:1533033818785496. [PMID: 29983098 PMCID: PMC6048607 DOI: 10.1177/1533033818785496] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate CyberKnife-based radioablation as a salvage
treatment for prostate cancer postirradiation relapses based on a group of patients
disqualified from available conventional methods of salvage treatment. Thirty-eight
patients were treated with a fraction dose varying from 5.5 to 10 Gy (median 7.35) to a
total dose of 18 to 36.25 Gy (median 36.25). In all, 55.3% of patients had androgen
deprivation therapy during this time. Nine patients had oligometastases in the salvage
time. The follow-up varied from 1.6 to 46.4 months (mean 19.7, median 14.4). In all, 92.6%
to 97.4% of patients had no gastrointestinal acute adverse effects; no effects higher than
G1 were noted. There were particular (up to 4.8%) G2 late gastrointestinal effects. The
percentage without genitourinary acute effects varied from 59.1% to 78.9%; 3.7% had G3
toxicity. G3 late genitourinary toxicity appeared 3 times, the maximal percentage being
12.5% (24 months after salvage treatment). The nadir of prostate-specific antigen median
was 0.24 ng/mL (9 months after treatment). Twelve (31.6%) patients failed in the timeline
of 6 to 42 months after salvage treatment (mean 18.7, median 16.5)—5 due to dissemination.
In 2 cases, progression in existing metastases was identified. Five (13.2%) patients had
biochemical failure without additional metastases (local relapses); hence, local control
was 86.8%. The failure risk is strongly influenced by initial disease stage and presalvage
prostate-specific antigen concentration. The obtained results permit us to conclude that
such a treatment could be an effective and safe option for prostate cancer postirradiation
relapse salvage treatment.
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Affiliation(s)
- Leszek Miszczyk
- 1 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | | | | | - Bogusław Maciejewski
- 1 Radiotherapy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Andrzej Tukiendorf
- 3 Epidemioloy Department, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice Branch, Gliwice, Poland
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11
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Martini A, Gandaglia G, Nicita G, Montorsi F. A Novel Classification Proposal for Rectourethral Fistulas After Primary Treatment of Prostate Cancer. Eur Urol Oncol 2018; 1:510-511. [PMID: 31158096 DOI: 10.1016/j.euo.2018.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 08/31/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Alberto Martini
- Department of Urology, University Vita Salute, San Raffaele Hospital, Milan, Italy.
| | - Giorgio Gandaglia
- Department of Urology, University Vita Salute, San Raffaele Hospital, Milan, Italy
| | - Giulio Nicita
- Department of Urology, University of Florence, Florence, Italy
| | - Francesco Montorsi
- Department of Urology, University Vita Salute, San Raffaele Hospital, Milan, Italy
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12
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da Silva RD, Kim FJ. Prostate Cancer - Local Treatment after Radiorecurrence: Salvage Cryoablation. Int Braz J Urol 2018; 44:435-439. [PMID: 29792652 PMCID: PMC5996813 DOI: 10.1590/s1677-5538.ibju.2018.03.05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Rodrigo Donalisio da Silva
- Division of Urology, Denver Health Medical Center, Denver, CO, USA.,Division of Urology, University of Colorado Denver, Denver, CO, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center, Denver, CO, USA.,Division of Urology, University of Colorado Denver, Denver, CO, USA
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13
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Bandini M, Gandaglia G, Fossati N, Montorsi F, Briganti A. Anastomotic leaks and catheter time after salvage robot-assisted radical prostatectomy. Transl Androl Urol 2018; 7:S141-S143. [PMID: 29644184 PMCID: PMC5881216 DOI: 10.21037/tau.2017.03.86] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Marco Bandini
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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14
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Nunes-Silva I, Barret E, Srougi V, Baghdadi M, Capogrosso P, Garcia-Barreras S, Kanso S, Tourinho-Barbosa R, Carneiro A, Sanchez-Salas R, Rozet F, Galiano M, Cathelineau X. Effect of Prior Focal Therapy on Perioperative, Oncologic and Functional Outcomes of Salvage Robotic Assisted Radical Prostatectomy. J Urol 2017; 198:1069-1076. [DOI: 10.1016/j.juro.2017.05.071] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Igor Nunes-Silva
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Arnaldo Vieira de Carvalho Cancer Institute, São Paulo, Brazil
| | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Victor Srougi
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mohammed Baghdadi
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Paolo Capogrosso
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Unit of Urology, Division of Experimental Oncology, URI, IRCCS Ospedale San Raffaele Università Vita-Salute San Raffaele, Milan, Italy
| | - Silvia Garcia-Barreras
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Solange Kanso
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Ariê Carneiro
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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15
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Woodrum D, Kawashima A, Gorny K, Mynderse L. Prostate cancer: state of the art imaging and focal treatment. Clin Radiol 2017; 72:665-679. [DOI: 10.1016/j.crad.2017.02.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/26/2017] [Accepted: 02/07/2017] [Indexed: 10/19/2022]
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16
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Georgiou PS, Jaros J, Payne H, Allen C, Shah TT, Ahmed HU, Gibson E, Barratt D, Treeby BE. Beam distortion due to gold fiducial markers during salvage high-intensity focused ultrasound in the prostate. Med Phys 2016; 44:679-693. [PMID: 28032342 DOI: 10.1002/mp.12044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/21/2016] [Accepted: 11/17/2016] [Indexed: 11/07/2022] Open
Abstract
PURPOSE High intensity focused ultrasound (HIFU) provides a non-invasive salvage treatment option for patients with recurrence after external beam radiation therapy (EBRT). As part of EBRT the prostate is frequently implanted with permanent fiducial markers. To date, the impact of these markers on subsequent HIFU treatment is unknown. The objective of this work was to systematically investigate, using computational simulations, how these fiducial markers affect the delivery of HIFU treatment. METHODS A series of simulations was performed modelling the propagation of ultrasound pressure waves in the prostate with a single spherical or cylindrical gold marker at different positions and orientations. For each marker configuration, a set of metrics (spatial-peak temporal-average intensity, focus shift, focal volume) was evaluated to quantify the distortion introduced at the focus. An analytical model was also developed describing the marker effect on the intensity at the focus. The model was used to examine the marker's impact in a clinical setting through case studies. RESULTS The simulations show that the presence of the marker in the pre-focal region causes reflections which induce a decrease in the focal intensity and focal volume, and a shift of the maximum pressure point away from the transducer's focus. These effects depend on the shape and orientation of the marker and become more pronounced as its distance from the transducer's focus decreases, with the distortion introduced by the marker greatly increasing when placed within 5 mm of the focus. The analytical model approximates the marker's effect and can be used as an alternative method to the computationally intensive and time consuming simulations for quickly estimating the intensity at the focus. A retrospective review of a small patient cohort selected for focal HIFU after failed EBRT indicates that the presence of the marker may affect HIFU treatment delivery. CONCLUSIONS The distortion introduced by the marker to the HIFU beam when positioned close to the focus may result in an undertreated region beyond the marker due to less energy arriving at the focus, and an overtreated region due to reflections. Further work is necessary to investigate whether the results presented here justify the revision of the patient selection criteria or the markers' placement protocol.
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Affiliation(s)
- P S Georgiou
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - J Jaros
- Faculty of Information Technology, Brno University of Technology, Brno, Czech Republic
| | - H Payne
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK.,Department of Oncology, University College London Hospitals, London, UK
| | - C Allen
- Department of Oncology, University College London Hospitals, London, UK
| | - T T Shah
- Division of Surgery and Interventional Science, University College London, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, London, UK
| | - E Gibson
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - D Barratt
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
| | - B E Treeby
- Department of Medical Physics and Biomedical Engineering, University College London, London, UK
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17
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Peters M, Piena MA, Steuten LM, van der Voort van Zyp JR, Moerland MA, van Vulpen M. Comparative cost-effectiveness of focal and total salvage 125I brachytherapy for recurrent prostate cancer after primary radiotherapy. J Contemp Brachytherapy 2016; 8:484-491. [PMID: 28115953 PMCID: PMC5241382 DOI: 10.5114/jcb.2016.64808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 12/06/2016] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Focal salvage (FS) iodine 125 (125I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study estimates the incremental cost per quality-adjusted life year (QALY) of FS compared to TS. MATERIAL AND METHODS A decision analytic Markov model was developed, which compares costs and QALYs associated with FS and TS. A 3-year time horizon was adopted with six month cycles, with a hospital perspective on costs. Probabilities for genitourinary (GU) and gastrointestinal (GI) toxicity and their impact on health-related quality of life (SF-36) were derived from clinical studies in the University Medical Center Utrecht (UMCU). Probabilistic sensitivity analysis, using 10,000 Monte Carlo simulations, was performed to quantify the joint decision uncertainty up to the recommended maximum willingness-to-pay threshold of €80,000/QALY. RESULTS Focal salvage dominates TS as it results in less severe toxicity and lower treatment costs. Decision uncertainty is small, with a 97-100% probability for FS to be cost-effective compared to TS (€0-€80,000/QALY). Half of the difference in costs between FS and TS was explained by higher treatment costs of TS, the other half by higher incidence of severe toxicity. One-way sensitivity analyses show that model outcomes are most sensitive to utilities and probabilities for severe toxicity. CONCLUSIONS Focal salvage 125I brachytherapy dominates TS, as it has lower treatment costs and leads to less toxicity in our center. Larger comparative studies with longer follow-up are necessary to assess the exact influence on (biochemical disease free) survival and toxicity.
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Affiliation(s)
- Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
- Both authors contributed equally to this research
| | - Marjanne A. Piena
- University of Twente, Enschede, The Netherlands
- Both authors contributed equally to this research
| | | | | | - Marinus A. Moerland
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
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18
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Rutenberg MS, Meister M, Amin PP, Hussain A, Naslund MJ, Kwok Y. Salvage external beam radiotherapy for locally recurrent prostate cancer after definitive brachytherapy. Brachytherapy 2016; 15:722-729. [DOI: 10.1016/j.brachy.2016.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/29/2016] [Accepted: 08/05/2016] [Indexed: 11/30/2022]
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19
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Yamada Y, Okihara K, Iwata T, Masui K, Kamoi K, Yamada K, Miki T. Salvage brachytherapy for locally recurrent prostate cancer after external beam radiotherapy. Asian J Androl 2016; 17:899-903. [PMID: 26112477 PMCID: PMC4814964 DOI: 10.4103/1008-682x.151391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
External beam radiotherapy (EBRT) is a standard treatment for prostate cancer. Despite the development of novel radiotherapy techniques such as intensity-modulated conformal radiotherapy, the risk of local recurrence after EBRT has not been obviated. Various local treatment options (including salvage prostatectomy, brachytherapy, cryotherapy, and high-intensity focused ultrasound [HIFU]) have been employed in cases of local recurrence after primary EBRT. Brachytherapy is the first-line treatment for low-risk and selected intermediate-risk prostate tumors. However, few studies have examined the use of brachytherapy to treat post-EBRT recurrent prostate cancer. The purpose of this paper is to analyze the current state of our knowledge about the effects of salvage brachytherapy in patients who develop locally recurrent prostate cancer after primary EBRT. This article also introduces our novel permanent brachytherapy salvage method.
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Affiliation(s)
| | - Koji Okihara
- Department of Urology, Kyoto Prefectural University of Medicine, Kyoto, Japan
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20
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Minimally Invasive Salvage Prostatectomy After Primary Radiation or Ablation Treatment. Urology 2016; 94:111-6. [DOI: 10.1016/j.urology.2016.04.040] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 04/03/2016] [Accepted: 04/26/2016] [Indexed: 11/17/2022]
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21
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Shah TT, Peters M, Kanthabalan A, McCartan N, Fatola Y, van der Voort van Zyp J, van Vulpen M, Freeman A, Moore CM, Arya M, Emberton M, Ahmed HU. PSA nadir as a predictive factor for biochemical disease-free survival and overall survival following whole-gland salvage HIFU following radiotherapy failure. Prostate Cancer Prostatic Dis 2016; 19:311-6. [PMID: 27431499 PMCID: PMC4983180 DOI: 10.1038/pcan.2016.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/14/2016] [Accepted: 03/20/2016] [Indexed: 12/03/2022]
Abstract
Background: Treatment options for radio-recurrent prostate cancer are either androgen-deprivation therapy or salvage prostatectomy. Whole-gland high-intensity focussed ultrasound (HIFU) might have a role in this setting. Methods: An independent HIFU registry collated consecutive cases of HIFU. Between 2005 and 2012, we identified 50 men who underwent whole-gland HIFU following histological confirmation of localised disease following prior external beam radiotherapy (2005–2012). No upper threshold was applied for risk category, PSA or Gleason grade either at presentation or at the time of failure. Progression was defined as a composite with biochemical failure (Phoenix criteria (PSA>nadir+2 ng ml−1)), start of systemic therapies or metastases. Results: Median age (interquartile range (IQR)), pretreatment PSA (IQR) and Gleason score (range) were 68 years (64–72), 5.9 ng ml−1 (2.2–11.3) and 7 (6–9), respectively. Median follow-up was 64 months (49–84). In all, 24/50 (48%) avoided androgen-deprivation therapies. Also, a total of 28/50 (56%) achieved a PSA nadir <0.5 ng ml−1, 15/50 (30%) had a nadir ⩾0.5 ng ml−1 and 7/50 (14%) did not nadir (PSA non-responders). Actuarial 1, 3 and 5-year progression-free survival (PFS) was 72, 40 and 31%, respectively. Actuarial 1, 3 and 5-year overall survival (OS) was 100, 94 and 87%, respectively. When comparing patients with PSA nadir <0.5 ng ml−1, nadir ⩾0.5 and non-responders, a statistically significant difference in PFS was seen (P<0.0001). Three-year PFS in each group was 57, 20 and 0%, respectively. Five-year OS was 96, 100 and 38%, respectively. Early in the learning curve, between 2005 and 2007, 3/50 (6%) developed a fistula. Intervention for bladder outlet obstruction was needed in 27/50 (54%). Patient-reported outcome measure questionnaires showed incontinence (any pad-use) as 8/26 (31%). Conclusions: In our series of high-risk patients, in whom 30–50% may have micro-metastases, disease control rates were promising in PSA responders, however, with significant morbidity. Additionally, post-HIFU PSA nadir appears to be an important predictor for both progression and survival. Further research on focal salvage ablation in order to reduce toxicity while retaining disease control rates is required.
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Affiliation(s)
- T T Shah
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, Whittington Hospital NHS Trust, London, UK
| | - M Peters
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Kanthabalan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - N McCartan
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - Y Fatola
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - J van der Voort van Zyp
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M van Vulpen
- Department of Radiation Oncology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Freeman
- Department of Histopathology, UCLH NHS Foundation Trust, London, UK
| | - C M Moore
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK.,NIHR UCLH/UCL Comprehensive Biomedical Research Centre, London, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, UCL, London, UK.,Department of Urology, UCLH NHS Foundation Trust, London, UK
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22
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Minimally Invasive Transanal Repair of Rectourethral Fistulas. Eur Urol 2016; 71:133-138. [PMID: 27339834 DOI: 10.1016/j.eururo.2016.06.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Rectourethral fistulas (RUFs) represent an uncommon complication of pelvic surgery, especially radical prostatectomy. To date there is no standardised treatment for managing RUFs. This represents a challenge for surgeons, mainly because of the potential recurrence risk. OBJECTIVE To describe our minimally invasive transanal repair (MITAR) of RUFs and to assess its safety and outcomes. DESIGN, SETTING, AND PARTICIPANTS We retrospectively evaluated 12 patients who underwent MITAR of RUF at our centre from October 2008 to December 2014. Exclusion criteria were a fistula diameter greater than 1.5cm, sepsis, and/or faecaluria. SURGICAL PROCEDURE After fistula identification through cystoscopy and 5F-catheter positioning within the fistula, MITAR is performed using laparoscopic instruments introduced through Parks' anal retractor. The fibrotic margins of the fistula are carefully dissected by a lozenge incision of the rectal wall, parallel to the rectal axis. Under the healthy flap of the rectal wall the urothelium is located and the fistulous tract is sutured with interrupted stitches. After a leakage test of the bladder, the rectal wall is sutured with interrupted stitches. Electrocoagulation is never used during this procedure. MEASUREMENTS Fistula closure, postoperative complications, and recurrence. RESULTS AND LIMITATIONS Median follow-up was 21 (range, 12-74) mo. Median operative time was 58 (range, 50-70) min. Median hospital stay was 1.5 (range, 1-4) d. Early surgical complications occurred in one patient (8.3%). Recurrence did not occur in any of the cases. Limitations included retrospective analysis, small case load, and lack of experience with radiation-induced fustulas. CONCLUSIONS MITAR is a safe, effective, and reproducible procedure. Its advantages are low morbidity and quick recovery, and no need for a colostomy. PATIENT SUMMARY We studied the treatment of rectourethral fistulas. Our technique, transanally performed using laparoscopic instruments, was found to be safe, feasible, and effective, with limited risk of complications.
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23
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Kovac E, ElShafei A, Tay KJ, Mendez M, Polascik TJ, Jones JS. Five-Year Biochemical Progression-Free Survival Following Salvage Whole-Gland Prostate Cryoablation: Defining Success with Nadir Prostate-Specific Antigen. J Endourol 2016; 30:624-31. [DOI: 10.1089/end.2015.0719] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Evan Kovac
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed ElShafei
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
- Urology Department, Medical School, Cairo University, Giza, Egypt
| | - Kae Jack Tay
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Melissa Mendez
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - Thomas J. Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina
| | - J. Stephen Jones
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio
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24
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Focal salvage therapy for local prostate cancer recurrences after primary radiotherapy: a comprehensive review. World J Urol 2016; 34:1521-1531. [PMID: 27012712 PMCID: PMC5063906 DOI: 10.1007/s00345-016-1811-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2015] [Accepted: 03/11/2016] [Indexed: 11/16/2022] Open
Abstract
Background/Aim Patients with locally recurrent prostate cancer after primary radiotherapy can be eligible for salvage treatment. Whole-gland salvage techniques carry a high risk of toxicity. A focal salvage approach might reduce the risk of adverse events while maintaining cancer control in carefully selected patients. The aim of this review was to evaluate current literature to assess whether focal salvage leads to a comparable or favourable recurrence rate and less toxicity compared to whole-gland salvage. Methods A literature search was performed using PubMed, Embase and the Cochrane Library. A total of 3015 articles were screened and assessed for quality. Eight papers [on focal cryoablation (n = 3), brachytherapy (n = 3) and high-intensity focused ultrasound (n = 2)] were used to report outcomes. Results One-, 2-, 3- and 5-year biochemical disease-free survival (BDFS) ranges for focal salvage are, respectively, 69–100, 49–100, 50–91 and 46.5–54.5 %. Severe genitourinary, gastrointestinal and sexual function toxicity rates are 0–33.3 %. One study directly compares focal to whole-gland salvage cryotherapy, showing 5-year BDFS of, respectively, 54.4 and 86.5 % with lower toxicity rates for focal salvage patients. Conclusion Provisional data suggest that BDFS rates of focal salvage are in line with those of whole-gland approaches. There is evidence that focal salvage could decrease severe toxicity and preserve erectile function. Electronic supplementary material The online version of this article (doi:10.1007/s00345-016-1811-9) contains supplementary material, which is available to authorized users.
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25
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Rectal dose constraints for salvage iodine-125 prostate brachytherapy. Brachytherapy 2016; 15:85-93. [DOI: 10.1016/j.brachy.2015.10.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/19/2015] [Accepted: 10/22/2015] [Indexed: 11/17/2022]
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Peters M, van der Voort van Zyp J, Hoekstra C, Westendorp H, van de Pol S, Moerland M, Maenhout M, Kattevilder R, van Vulpen M. Urethral and bladder dosimetry of total and focal salvage Iodine-125 prostate brachytherapy: Late toxicity and dose constraints. Radiother Oncol 2015; 117:262-9. [DOI: 10.1016/j.radonc.2015.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/22/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
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Magnetic Resonance–Guided Thermal Therapy for Localized and Recurrent Prostate Cancer. Magn Reson Imaging Clin N Am 2015; 23:607-19. [DOI: 10.1016/j.mric.2015.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Salomon L, Ploussard G, Hennequin C, Richaud P, Soulié M. Traitements complémentaires de la chirurgie du cancer de la prostate et chirurgie de la récidive. Prog Urol 2015; 25:1086-107. [DOI: 10.1016/j.purol.2015.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/06/2015] [Indexed: 10/22/2022]
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van den Bos W, Muller BG, de Bruin DM, de Castro Abreu AL, Chaussy C, Coleman JA, Finelli A, Gill IS, Gross ME, Jenniskens SF, Kahmann F, Laguna-Pes MP, Rastinehad AR, Simmons LA, Sulser T, Villers A, Ward JF, de la Rosette JJ. Salvage ablative therapy in prostate cancer: International multidisciplinary consensus on trial design. Urol Oncol 2015; 33:495.e1-7. [DOI: 10.1016/j.urolonc.2015.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 11/26/2022]
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Philippou Y, Parker RA, Volanis D, Gnanapragasam VJ. Comparative Oncologic and Toxicity Outcomes of Salvage Radical Prostatectomy Versus Nonsurgical Therapies for Radiorecurrent Prostate Cancer: A Meta-Regression Analysis. Eur Urol Focus 2015; 2:158-171. [PMID: 28723532 DOI: 10.1016/j.euf.2015.09.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 08/20/2015] [Accepted: 09/08/2015] [Indexed: 01/20/2023]
Abstract
CONTEXT In the absence of randomised controlled trials comparing the oncologic, toxicity, and functional outcomes of salvage radical prostatectomy (SRP), salvage high-intensity focused ultrasound (SHIFU), salvage brachytherapy (SBT), and salvage cryotherapy (SCT), controversy exists as to the optimal salvage modality in radiorecurrent prostate cancer. OBJECTIVE We carried out a meta-regression analysis to determine whether there is a difference in oncologic, toxicity, and functional outcomes using data from original publications of salvage modalities in the postradiation setting. EVIDENCE ACQUISITION We performed a systematic review of PubMed/Medline citations according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. We included 63 articles in the analysis (25 on SRP, 8 on SHIFU, 16 on SCT, 14 on SBT). EVIDENCE SYNTHESIS Median values of the following variables were extracted from each study: patient age, length of follow-up, prostate-specific antigen (PSA) before radiotherapy (RT), PSA before salvage therapy, Gleason score before RT, and time interval between RT and salvage therapy. Functional, toxicity, and oncologic outcomes were measured according to rates of impotence, incontinence, fistula formation, urethral strictures, and biochemical recurrence. Meta-regression adjusting for confounders found no significant difference in oncologic outcomes between SRP and nonsurgical salvage modalities. SBT, SCT, and SHIFU appeared to have better continence outcomes than SRP. No significant difference in toxicity outcomes between modalities was found, although limitations such as reporting, selection, and publication bias and between-study heterogeneity must also be considered with these conclusions. CONCLUSIONS Oncologic outcomes are comparable for SRP and all three nonsurgical salvage modalities. We found no significant differences in toxicity outcomes among modalities; however, SRP appears to be associated with worse rates of urinary incontinence than SBT, SCT, and SHIFU. PATIENT SUMMARY We performed a meta-regression analysis to compare oncologic, functional, and toxicity outcomes between salvage radical prostatectomy and nonsurgical salvage modalities. Oncologic and toxicity outcomes appear to be similar; however, all nonsurgical salvage modalities may be associated with better continence outcomes.
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Affiliation(s)
- Yiannis Philippou
- Department of Surgery, Basildon and Thurrock University Hospital, Essex, UK
| | - Richard A Parker
- Health Services Research Unit University of Edinburgh, Edinburgh, UK
| | - Dimitrios Volanis
- Department of Urology, Addenbrooke's University Hospital, Cambridge, UK
| | - Vincent J Gnanapragasam
- Department of Urology, Addenbrooke's University Hospital, Cambridge, UK; Academic Urology Group, Department of Surgery and Oncology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
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Kanthabalan A, Shah T, Arya M, Punwani S, Bomanji J, Haroon A, Illing RO, Latifoltojar A, Freeman A, Jameson C, van der Meulen J, Charman S, Emberton M, Ahmed HU. The FORECAST study - Focal recurrent assessment and salvage treatment for radiorecurrent prostate cancer. Contemp Clin Trials 2015; 44:175-186. [PMID: 26184343 DOI: 10.1016/j.cct.2015.07.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/29/2015] [Accepted: 07/03/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND One-third of men may experience biochemical failure by 8years following radical radiotherapy for localised prostate cancer. Over 90% of men are started on androgen deprivation therapy (ADT) which is non-curative and confers systemic side-effects. Focal salvage therapy (FST) limits collateral tissue damage and may improve therapeutic ratios. In order to deliver FST, distant disease must be ruled-out and intra-prostatic disease must be accurately detected, localised and characterised. AIM FORECAST - Focal Recurrent Assessment and Salvage Treatment - is a study designed to evaluate a novel imaging-based diagnostic and therapeutic complex intervention pathway for men who fail radiotherapy. METHODS Men with biochemical failure following radical prostate radiotherapy, prior to salvage therapy will be recruited. They will undergo whole-body multi-parametric MRI (WB-MRI), choline PET/CT, bone-scan and pelvic-mpMRI and then MRI transperineal-targeted biopsies (MRI-TB) and Transperineal Template Prostate Mapping Biopsy (TPM). Those suitable for FST will undergo either high intensity focused ultrasound (HIFU) or cryotherapy. RESULTS Primary outcome measures: a) the accuracy of WB-MRI to detect distant metastatic disease; b) accuracy of prostate mpMRI in local detection of radiorecurrent prostate cancer; c) detection accuracy of MRI-TB; and d) rate of urinary incontinence following FST. CONCLUSION Focal salvage therapy may confer lower rates of morbidity whilst retaining disease control. In order to deliver FST, intra- and extra-prostatic disease must be detected early and localised accurately. Novel diagnostic techniques including WB-MRI and MRI-TB may improve the detection of distant and local disease whilst reducing healthcare burdens compared with current imaging and biopsy strategies.
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Affiliation(s)
- A Kanthabalan
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK.
| | - T Shah
- Division of Surgery and Interventional Science, University College London, UK
| | - M Arya
- Department of Urology, UCLH NHS Foundation Trust, UK
| | - S Punwani
- Department of Radiology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK
| | - J Bomanji
- Institute of Nuclear Medicine, UCLH NHS Foundation Trust, UK
| | - A Haroon
- Centre for Medical Imaging and Computing, University College London, UK
| | - R O Illing
- Department of Radiology, UCLH NHS Foundation Trust, UK
| | - A Latifoltojar
- Department of Urology, UCLH NHS Foundation Trust, UK; Centre for Medical Imaging, Division of Medicine, University College London, UK
| | - A Freeman
- Department of Pathology, UCLH NHS Foundation Trust, UK
| | - C Jameson
- Department of Pathology, UCLH NHS Foundation Trust, UK
| | | | - S Charman
- London School of Hygiene and Tropical Medicine, London, UK
| | - M Emberton
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College London, UK; Department of Urology, UCLH NHS Foundation Trust, UK
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Lim C, Malone SC, Avruch L, Breau RH, Flood TA, Lim M, Morash C, Quon JS, Walsh C, Schieda N. Pictorial review. Magnetic resonance for radiotherapy management and treatment planning in prostatic carcinoma. Br J Radiol 2015; 88:20150507. [PMID: 26279086 DOI: 10.1259/bjr.20150507] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
MRI has an important role for radiotherapy (RT) treatment planning in prostate cancer (PCa) providing accurate visualization of the dominant intraprostatic lesion (DIL) and locoregional anatomy, assessment of local staging and depiction of implanted devices. MRI enables the radiation oncologist to optimize RT planning by better defining target tumour volumes (thereby increasing local tumour control), as well as decreasing morbidity (by minimizing the dose to adjacent normal structures). Using MRI, radiation oncologists can define the DIL for delivery of boost doses of RT using a variety of techniques including: stereotactic body radiotherapy, intensity-modulated radiotherapy, proton RT or brachytherapy to improve tumour control. Radiologists require a familiarity with the different RT methods used to treat PCa, as well as an understanding of the advantages and disadvantages of the various MR pulse sequences available for RT planning in order to provide an optimal multidisciplinary RT treatment approach to PCa. Understanding the expected post-RT appearance of the prostate and typical characteristics of local tumour recurrence is also important because MRI is rapidly becoming an integral component for diagnosis, image-guided histological sampling and treatment planning in the setting of biochemical failure after RT or surgery.
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Affiliation(s)
- Christopher Lim
- 1 Department of Medical Imaging The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Shawn C Malone
- 2 Department of Radiation Oncology, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Leonard Avruch
- 1 Department of Medical Imaging The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Rodney H Breau
- 3 Department of Surgery, Division of Urology, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Trevor A Flood
- 4 Department of Anatomical Pathology, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Megan Lim
- 5 Faculty of Medicine, The University of Saskatchewan, Saskatoon, SK, Canada
| | - Christopher Morash
- 3 Department of Surgery, Division of Urology, The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Jeff S Quon
- 1 Department of Medical Imaging The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Cynthia Walsh
- 1 Department of Medical Imaging The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
| | - Nicola Schieda
- 1 Department of Medical Imaging The Ottawa Hospital, The University of Ottawa, Ottawa, ON, Canada
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Shah TT, Ahmed H, Kanthabalan A, Lau B, Ghei M, Maraj B, Arya M. Focal cryotherapy of localized prostate cancer: a systematic review of the literature. Expert Rev Anticancer Ther 2015; 14:1337-47. [PMID: 25367324 DOI: 10.1586/14737140.2014.965687] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Radical/whole gland treatment for prostate cancer has significant side-effects. Therefore focal treatments such as cryotherapy have been used to treat localized lesions whilst aiming to provide adequate cancer control with minimal side-effects. We performed a systematic review of Pubmed/Medline and Cochrane databases' to yield 9 papers for primary focal prostate cryotherapy and 2 papers for focal salvage treatment (radio-recurrent). The results of 1582 primary patients showed biochemical disease-free survival between 71-93% at 9-70 months follow-up. Incontinence rates were 0-3.6% and ED 0-42%. Recto-urethral fistula occurred in only 2 patients. Salvage focal cryotherapy had biochemical disease-free survival of 50-68% at 3 years. ED occurred in 60-71%. Focal cryotherapy appears to be an effective treatment for primary localized prostate cancer and compares favorably to radical/whole gland treatments in medium-term oncological outcomes and side-effects. Although more studies are needed it is also effective for radio-recurrent cancer with a low complications rates.
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Affiliation(s)
- Taimur Tariq Shah
- Division of Surgery and Interventional Science, University College London, London, UK
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Baust JG, Bischof JC, Jiang-Hughes S, Polascik TJ, Rukstalis DB, Gage AA, Baust JM. Re-purposing cryoablation: a combinatorial 'therapy' for the destruction of tissue. Prostate Cancer Prostatic Dis 2015; 18:87-95. [PMID: 25622539 DOI: 10.1038/pcan.2014.54] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/18/2014] [Accepted: 12/10/2014] [Indexed: 11/09/2022]
Abstract
It is now recognized that the tumor microenvironment creates a protective neo-tissue that isolates the tumor from the various defense strategies of the body. Evidence demonstrates that, with successive therapeutic attempts, cancer cells acquire resistance to individual treatment modalities. For example, exposure to cytotoxic drugs results in the survival of approximately 20-30% of the cancer cells as only dividing cells succumb to each toxic exposure. With follow-up treatments, each additional dose results in tumor-associated fibroblasts secreting surface-protective proteins, which enhance cancer cell resistance. Similar outcomes are reported following radiotherapy. These defensive strategies are indicative of evolved capabilities of cancer to assure successful tumor growth through well-established anti-tumor-protective adaptations. As such, successful cancer management requires the activation of multiple cellular 'kill switches' to prevent initiation of diverse protective adaptations. Thermal therapies are unique treatment modalities typically applied as monotherapies (without repetition) thereby denying cancer cells the opportunity to express defensive mutations. Further, the destructive mechanisms of action involved with cryoablation (CA) include both physical and molecular insults resulting in the disruption of multiple defensive strategies that are not cell cycle dependent and adds a damaging structural (physical) element. This review discusses the application and clinical outcomes of CA with an emphasis on the mechanisms of cell death induced by structural, metabolic, vascular and immune processes. The induction of diverse cell death cascades, resulting in the activation of apoptosis and necrosis, allows CA to be characterized as a combinatorial treatment modality. Our understanding of these mechanisms now supports adjunctive therapies that can augment cell death pathways.
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Affiliation(s)
- J G Baust
- 1] Institute of Biomedical Technology, State University of New York at Binghamton, Binghamton, NY, USA [2] Department of Biological Sciences, Binghamton University, Binghamton, NY, USA
| | - J C Bischof
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - S Jiang-Hughes
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN, USA
| | - T J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - D B Rukstalis
- Department of Urology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - A A Gage
- Department of Surgery, State University of New York at Buffalo, Medical School, Buffalo, NY, USA
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Anderson KM, Gallegos M, Higuchi TT, Flynn BJ. Evaluation and Management of Rectourethral Fistulas After Prostate Cancer Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-015-0297-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Stone NN, Unger P, Crawford ED, Stock RG. Diagnosis and management of local recurrence after low-dose-rate brachytherapy. Brachytherapy 2015; 14:124-30. [DOI: 10.1016/j.brachy.2014.08.046] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 08/05/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
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Abstract
PURPOSE OF REVIEW Widespread prostate-specific antigen screening has led to an increase in prostate cancer diagnoses in Asian populations, reflecting changes in socioeconomic status and epidemiological features in these countries. In this setting, the present review explores opportunities for target focal therapy in Japan. RECENT FINDINGS Our review examines several topics relating to focal therapy in Asia, and discusses the current status of prostate cancer diagnosis and treatment in that region. First, we summarize the prevalence of prostate cancer in Asian populations. Second, we examine prostate cancer diagnosis and treatment options such as mapping biopsy and MRI fusion biopsy in Japan. Third, we review treatment strategies for localized prostate cancer, especially robotic-assisted surgery, active surveillance, and high-intensity focused ultrasound. Lastly, we discuss the potential for focal therapy in Japan. SUMMARY The number of localized prostate cancer patients is expected to increase in Asia. Accordingly, the need for precise diagnosis in terms of localization of prostate cancer foci will also expand. MRI fusion target biopsies are being performed in Asia, particularly in some Japanese academic institutions, but as pilot studies. In recent years, an increase in robotic-assisted surgery in East Asia has yielded new options in prostate cancer treatment. Although active surveillance is a practical choice for low-risk prostate cancer in some Asian countries, focal therapy is expected to see increasing interest as another alternative in Japan.
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Gnanapragasam VJ, Payne H, Syndikus I, Kynaston H, Johnstone T. Primary radical therapy selection in high-risk non-metastatic prostate cancer. Clin Oncol (R Coll Radiol) 2014; 27:136-44. [PMID: 25441052 DOI: 10.1016/j.clon.2014.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 10/02/2014] [Accepted: 10/07/2014] [Indexed: 10/24/2022]
Abstract
As the incidence of prostate cancer rises, the detection and management of men with high-risk non-metastatic prostate cancer is becoming increasingly important. The benefits of radical treatment have been clearly shown in this group from a number of publications. The current mainstays of treatment are radical prostatectomy (with selective use of adjuvant radiation) and radical radiotherapy with concurrent androgen deprivation. The outcomes from these two approaches seem to be remarkably similar and are considered equally valid options for primary treatment. The choice of therapy is critically dependent on a number of factors, but ultimately left to the decision of the patients with advice from clinicians. Clinicians themselves, however, are known to be biased towards their particular skill set and experiences. Attempts at randomised comparisons between these two modalities have so far failed and are confounded by patient-clinician bias, the continual advances in therapy as well as the long natural history of the disease. In the lack of level 1 comparable evidence, this article explores the existing literature as to the key factors that should be considered in radical treatment selection for high-risk prostate cancer. These factors include disease aggressiveness, comorbidity and life expectancy, functional outcomes and the consequences of therapy failure with regards to salvage treatment. We propose that these factors may be useful in developing a decision guide for rationale radical therapy selection in the light of two apparently equally effective treatments. Ultimately, however, there is an urgent need for added clinical and biological markers that can provide a more precise approach to therapy selection.
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Affiliation(s)
- V J Gnanapragasam
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK; Translational Prostate Cancer Group, Hutchison/MRC Research Centre, University of Cambridge, Cambridge, UK.
| | - H Payne
- Department of Oncology, University College London, London, UK
| | | | - H Kynaston
- Department of Urology, University Hospital of Wales, Cardiff, UK
| | - T Johnstone
- Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK
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Soulié M, Salomon L. Traitements de rattrapage après irradiation prostatique : place de l’urologue. Cancer Radiother 2014; 18:535-9. [DOI: 10.1016/j.canrad.2014.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 06/26/2014] [Accepted: 06/29/2014] [Indexed: 11/15/2022]
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Robotic radical prostatectomy in patients with previous prostate surgery and radiotherapy. Prostate Cancer 2014; 2014:367675. [PMID: 25120933 PMCID: PMC4120925 DOI: 10.1155/2014/367675] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 06/23/2014] [Accepted: 06/23/2014] [Indexed: 01/22/2023] Open
Abstract
Herein, we will review the available literature about robot-assisted radical prostatectomy in patients who have undergone prostate surgery or radiotherapy. Current data about this topic consists of small case series with limited follow-up. Despite being technically demanding, robot-assisted radical prostatectomy (RARP) can be considered feasible in either setting. Prostate surgery or prostatic irradiation should not be considered as a contraindication for robot-assisted radical prostatectomy. Nevertheless, patient counseling about the possible complications and the need for reintervention is of extreme importance in this patient population. Early oncologic and functional results of RARP performed in case of radiorecurrent prostate cancer look promising. Regarding postprostate surgery RARP, some series have reported comparable results, while some have demonstrated more inferior outcomes than those of naive cases. In order to assess the exact functional and oncologic outcome of RARP in patients with previous prostate surgery and radiotherapy, studies enrolling higher number of patients and providing longer follow-up data are needed.
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Peters M, Maenhout M, van der Voort van Zyp JRN, Moerland MA, Moman MR, Steuten LMG, van Deursen MJH, van Vulpen M. Focal salvage iodine-125 brachytherapy for prostate cancer recurrences after primary radiotherapy: a retrospective study regarding toxicity, biochemical outcome and quality of life. Radiother Oncol 2014; 112:77-82. [PMID: 24998704 DOI: 10.1016/j.radonc.2014.06.013] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 06/16/2014] [Accepted: 06/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Whole-gland salvage for recurrent prostate cancer (PCa) shows high failure and toxicity rates. Early and adequate localization of recurrences enables focal salvage, thereby potentially improving functional outcomes, while maintaining cancer control. MATERIALS AND METHODS Retrospective analysis yielded 20 focal salvage I125 brachytherapy patients for locally recurrent PCa after primary radiotherapy. Tumor was defined by multiparametric MRI and correspondence with transrectal biopsies. Dose data were obtained intra-operatively. The tumor was prescribed ⩾144 Gy. Toxicity was scored by the Common Terminology Criteria for Adverse Events version 4 (CTCAE-4). Biochemical failure (BF) was defined using the Phoenix criteria (PSA-nadir + 2.0 ng/ml). Quality of life (QoL) was measured by SF-36 Health Survey and European Organization of Research and Treatment of Cancer (EORTC) C30+3 and PR25 questionnaires. RESULTS With a median follow-up of 36 months (range 10-45), six patients experienced BF, of which three had no initial response. Grade 3 genitourinary (GU) toxicity occurred in one patient (a urethral stricture). The five previously potent patients retained erectile function. QoL remained decreased with regard to urinary symptoms. CONCLUSION Focal salvage I125 brachytherapy showed one grade 3 GU toxicity in the 20 treated patients. Biochemical response and QoL were acceptable.
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Affiliation(s)
- Max Peters
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
| | - Metha Maenhout
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands.
| | | | - Marinus A Moerland
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
| | - Maaike R Moman
- Department of Radiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Lotte M G Steuten
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | | | - Marco van Vulpen
- Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands
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Friedlander DF, Gu X, Prasad SM, Lipsitz SR, Nguyen PL, Trinh QD, Sun M, Hu JC. Population-based comparative effectiveness of salvage radical prostatectomy vs cryotherapy. Urology 2014; 83:653-7. [PMID: 24581527 DOI: 10.1016/j.urology.2013.11.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 11/04/2013] [Accepted: 11/18/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To characterize population-based practice patterns, disease-specific and overall mortality, and cost associated with salvage cryotherapy (SCT) vs salvage radical prostatectomy (SRP). METHODS We retrospectively identified 440 men who failed primary radiation therapy and subsequently underwent SCT (n = 341, 77.5%) or SRP (n = 99, 22.5%) between 1992 and 2009 from Surveillance, Epidemiology, and End Results-Medicare linked data. Propensity score analyses were used to compare overall and prostate cancer-specific mortality and associated Medicare expenditures for SRP vs SCT. RESULTS Men undergoing SCT were more likely to be white (P <.001), less likely to be high school graduates (P = .008), and experienced shorter median time from diagnosis to salvage therapy (44.1 vs 60.1, P <.001) and from primary radiotherapy to salvage therapy (38.7 vs 55.8 months, P <.001). In adjusted analyses, overall mortality was higher (21.6 vs 6.1 deaths/100 person years, P <.001) for SRP vs SCT. There was a trend for higher prostate cancer-specific death rates with SRP vs SCT (6.5 vs 1.4 deaths/100 person years, P = .061). Medicare expenditures for SRP vs SCT were more than 2-fold higher ($19,543 vs $8,088, P <.001). CONCLUSION SRP vs SCT is associated with higher overall mortality and greater health care expenditures. However, longer follow-up is needed to assess long-term functional outcomes and cancer control.
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Affiliation(s)
| | - Xiangmei Gu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Sandip M Prasad
- Department of Urology, Medical University of South Carolina, Charleston, SC; Section of Urology, Ralph A. Johnson VA Medical Center, Charleston, SC
| | - Stuart R Lipsitz
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Boston, MA
| | - Quoc-Dien Trinh
- Division of Urologic Surgery, Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA
| | - Maxine Sun
- Department of Public Health, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada
| | - Jim C Hu
- Department of Urology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA.
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44
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Song W, Jung US, Suh YS, Jang HJ, Sung HH, Jeon HG, Jeong BC, Seo SI, Jeon SS, Choi HY, Lee HM. High-intensity focused ultrasound as salvage therapy for patients with recurrent prostate cancer after radiotherapy. Korean J Urol 2014; 55:91-6. [PMID: 24578803 PMCID: PMC3935076 DOI: 10.4111/kju.2014.55.2.91] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/01/2013] [Indexed: 11/18/2022] Open
Abstract
Purpose To evaluate the oncologic outcomes and postoperative complications of high-intensity focused ultrasound (HIFU) as a salvage therapy after external-beam radiotherapy (EBRT) failure in patients with prostate cancer. Materials and Methods Between February 2002 and August 2010, we retrospectively reviewed the medical records of all patients who underwent salvage HIFU for transrectal ultrasound-guided, biopsy-proven locally recurred prostate cancer after EBRT failure (by ASTRO definition: prostate-specific antigen [PSA] failure after three consecutive PSA increases after a nadir, with the date of failure as the point halfway between the nadir date and the first increase or any increase great enough to provoke initiation of therapy). All patients underwent prostate magnetic resonance imaging and bone scintigraphy and had no evidence of distant metastasis. Biochemical recurrence (BCR) was defined according to the Stuttgart definition (PSA nadir plus 1.2 ng/mL). Results A total of 13 patients with a median age of 68 years (range, 60-76 years) were included. The median pre-EBRT PSA was 21.12 ng/mL, the pre-HIFU PSA was 4.63 ng/mL, and the period of salvage HIFU after EBRT was 32.7 months. The median follow-up after salvage HIFU was 44.5 months. The overall BCR-free rate was 53.8%. In the univariate analysis, predictive factors for BCR after salvage HIFU were higher pre-EBRT PSA (p=0.037), pre-HIFU PSA (p=0.015), and short time to nadir (p=0.036). In the multivariate analysis, there were no significant predictive factors for BCR. The complication rate requiring intervention was 38.5%. Conclusions Salvage HIFU for prostate cancer provides effective oncologic outcomes for local recurrence after EBRT failure. However, salvage HIFU had a relatively high rate of complications.
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Affiliation(s)
- Wan Song
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - U Seok Jung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Seok Suh
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Jun Jang
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Han Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Bjerklund Johansen TE, Witzsch U, Greene D. Salvage treatment in prostate cancer: a clinical approach. Expert Rev Anticancer Ther 2014; 13:613-23. [DOI: 10.1586/era.13.35] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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46
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Role of focal salvage ablative therapy in localised radiorecurrent prostate cancer. World J Urol 2013; 31:1361-8. [DOI: 10.1007/s00345-013-1100-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 05/10/2013] [Indexed: 10/26/2022] Open
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Neal RE, Smith RL, Kavnoudias H, Rosenfeldt F, Ou R, Mclean CA, Davalos RV, Thomson KR. The effects of metallic implants on electroporation therapies: feasibility of irreversible electroporation for brachytherapy salvage. Cardiovasc Intervent Radiol 2013; 36:1638-1645. [PMID: 23942593 DOI: 10.1007/s00270-013-0704-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 07/03/2013] [Indexed: 12/18/2022]
Abstract
PURPOSE Electroporation-based therapies deliver brief electric pulses into a targeted volume to destabilize cellular membranes. Nonthermal irreversible electroporation (IRE) provides focal ablation with effects dependent on the electric field distribution, which changes in heterogeneous environments. It should be determined if highly conductive metallic implants in targeted regions, such as radiotherapy brachytherapy seeds in prostate tissue, will alter treatment outcomes. Theoretical and experimental models determine the impact of prostate brachytherapy seeds on IRE treatments. MATERIALS AND METHODS This study delivered IRE pulses in nonanimal, as well as in ex vivo and in vivo tissue, with and in the absence of expired radiotherapy seeds. Electrical current was measured and lesion dimensions were examined macroscopically and with magnetic resonance imaging. Finite-element treatment simulations predicted the effects of brachytherapy seeds in the targeted region on electrical current, electric field, and temperature distributions. RESULTS There was no significant difference in electrical behavior in tissue containing a grid of expired radiotherapy seeds relative to those without seeds for nonanimal, ex vivo, and in vivo experiments (all p > 0.1). Numerical simulations predict no significant alteration of electric field or thermal effects (all p > 0.1). Histology showed cellular necrosis in the region near the electrodes and seeds within the ablation region; however, there were no seeds beyond the ablation margins. CONCLUSION This study suggests that electroporation therapies can be implemented in regions containing small metallic implants without significant changes to electrical and thermal effects relative to use in tissue without the implants. This supports the ability to use IRE as a salvage therapy option for brachytherapy.
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Affiliation(s)
- Robert E Neal
- Radiology Research Unit, Department of Radiology, The Alfred Hospital, 1st Floor Philip Block, 55 Commercial Road, Melbourne, VIC, 3004, Australia.
| | - Ryan L Smith
- William Buckland Radiotherapy Centre, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Helen Kavnoudias
- Radiology Research Unit, Department of Radiology, The Alfred Hospital, 1st Floor Philip Block, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Franklin Rosenfeldt
- Department of Surgery, Monash University, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Ruchong Ou
- Department of Surgery, Monash University, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Catriona A Mclean
- Department of Anatomical Pathology, The Alfred Hospital, 55 Commercial Road, Melbourne, VIC, 3004, Australia
| | - Rafael V Davalos
- School of Biomedical Engineering and Sciences, Virginia Tech, 329 ICTAS Building, Stranger St. (MC 0298), Blacksburg, VA, 24061, USA
| | - Kenneth R Thomson
- Radiology Research Unit, Department of Radiology, The Alfred Hospital, 1st Floor Philip Block, 55 Commercial Road, Melbourne, VIC, 3004, Australia
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Parekh A, Graham PL, Nguyen PL. Cancer Control and Complications of Salvage Local Therapy After Failure of Radiotherapy for Prostate Cancer: A Systematic Review. Semin Radiat Oncol 2013; 23:222-34. [DOI: 10.1016/j.semradonc.2013.01.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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49
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Mohammed A, Miller S, Douglas-Moore J, Miller M. Cryotherapy and its applications in the management of urologic malignancies: a review of its use in prostate and renal cancers. Urol Oncol 2013; 32:39.e19-27. [PMID: 23790537 DOI: 10.1016/j.urolonc.2013.04.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/14/2013] [Accepted: 04/14/2013] [Indexed: 10/26/2022]
Abstract
Cryotherapy has been established as an ablative modality for the treatment of a wide range of malignancies. Being minimally invasive, it is associated with less morbidity than conventional extirpative surgical procedures. In recent years, it has been used with success for treating two of the common urologic malignancies, that is, prostate and renal cancer. In this review, we highlight the role of cryotherapy as a treatment modality, the proposed destructive mechanisms of action and the risks of its use in the management of prostate and renal malignancy.
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Kaplan JR, Kowalczyk KJ, Borza T, Gu X, Lipsitz SR, Nguyen PL, Friedlander DF, Trinh QD, Hu JC. Patterns of care and outcomes of radiotherapy for lymph node positivity after radical prostatectomy. BJU Int 2013; 111:1208-14. [DOI: 10.1111/bju.12079] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Joshua R. Kaplan
- Division of Urologic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston; MA
| | | | - Tudor Borza
- Division of Urologic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston; MA
| | - Xiangmei Gu
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School
| | - Stuart R. Lipsitz
- Center for Surgery and Public Health; Brigham and Women's Hospital; Harvard Medical School
| | - Paul L. Nguyen
- Department of Radiation Oncology; Lank Center for Genitourinary Oncology; Dana Farber Cancer Institute; Boston; MA
| | | | - Quoc-Dien Trinh
- Vattikuti Urology Institute; Henry Ford Health System; Detroit; MI
| | - Jim C. Hu
- Department of Urology; David Geffen School of Medicine at UCLA; Los Angeles; CA; USA
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