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Tian Y, Mao Y, Tang Z, Hu M. Current Controversy and Developments Regarding the Cytoreductive Prostatectomy for Oligometastatic Prostate Cancer. Technol Cancer Res Treat 2023; 22:15330338231216011. [PMID: 38105493 PMCID: PMC10729631 DOI: 10.1177/15330338231216011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 09/29/2023] [Accepted: 11/06/2023] [Indexed: 12/19/2023] Open
Abstract
Oligometastatic prostate cancer is a term that is most often used to refer to limited sites of disseminated tumor growth following primary radical prostatectomy (RP) or radiotherapy (RT), while de novo oligometastatic is a term that is used to refer to prostate tumors that have disseminated to limited sites before definitive treatment. In patients with de novo oligometastatic prostate cancer, treatment planning must thus consider the need to manage the primary tumor and the associated distant lesions. Traditionally, resectioning primary metastatic tumors is not thought to offer significant benefits to affected patients while increasing their risk of surgery-related complications. Recent clinical evidence indicates that patients undergoing cytoreductive prostatectomy (CRP) may observe substantial enhancements in overall survival rates while not experiencing a noticeable decline in their quality of life. Nevertheless, based on the current body of evidence, it is deemed inadequate to justify revising clinical guidelines. Consequently, it is not advisable to propose CRP for patients with oligometastatic prostate cancer. The present review was compiled to summarize available data regarding the indications, functional outcomes, and oncological outcomes associated with cytoreductive radical prostatectomy to provide a robust and objective foundation that can be used to better assess the value of this interventional strategy from a clinical perspective.
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Affiliation(s)
- Yuan Tian
- Maoming People's Hospital, Maoming, Guangdong, China
- The First School of Clinical Medicine, Southern Medical University, Gaungzhou, China
| | - Yifeng Mao
- The Second Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Zhizhong Tang
- Maoming People's Hospital, Maoming, Guangdong, China
| | - Mingqiu Hu
- Maoming People's Hospital, Maoming, Guangdong, China
- The First School of Clinical Medicine, Southern Medical University, Gaungzhou, China
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2
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Lee DB, Kim JY, Song WH, Nam JK, Lee HJ, Kim TU, Park SW. The Impact of the Percent of Residual Prostate-Specific Antigen on Metastasis-Free Survival in Patients with Persistent Prostate-Specific Antigen after Radical Prostatectomy. World J Mens Health 2023; 41:227-235. [PMID: 36047076 PMCID: PMC9826909 DOI: 10.5534/wjmh.220066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/12/2022] [Accepted: 07/16/2022] [Indexed: 01/21/2023] Open
Abstract
PURPOSE Persistent levels of prostate-specific antigen (PSA) is a poor prognostic factor for recurrence after radical prostatectomy (RP). We investigated the impact of the percentage of residual PSA (%rPSA) [(post-/preoperative PSA)×100], representing a biochemical residual tumor, and the first postoperative PSA (fPSA) level on metastasis-free survival (MFS) in men with persistent levels of PSA after RP. MATERIALS AND METHODS We retrospectively identified male patients within a single tertiary referral hospital database who harbored persistent (≥0.1 ng/mL) vs. undetectable (<0.1 ng/mL) PSA levels 4 to 8 weeks after RP. Kaplan-Meier analyses and Cox regression models were used to test the effect of persistent PSA levels, the fPSA level, and %rPSA on MFS. RESULTS Of 1,205 patients, 178 patients with persistent PSA levels were enrolled. Seven-year MFS rates were 60.5% vs. 84.3% (p<0.001) for patients with a %rPSA ≥6% and <6%, respectively. Multivariable Cox regression models of the overall cohort revealed that persistent PSA levels (hazard ratio [HR], 3.94; p=0.010), extracapsular extension (HR, 4.17; 95% confidence interval [CI], 1.06-16.41; p=0.041), and pathological Gleason grade group (pGGG) (HR, 3.69; 95% CI, 1.32-10.27; p=0.013) were independent predictors of metastasis. Multivariable Cox regression models in men with persistent PSA levels revealed that the %rPSA (HR, 8.92; 95% CI, 1.74-45.71; p=0.009) and pGGG 4-5 (HR, 4.13; 95% CI, 1.22-13.96; p=0.022) were independent predictors of distant metastasis, but not the fPSA level after surgery. CONCLUSIONS Persistent levels of PSA were associated with worse MFS after RP. In men with persistent PSA levels after RP, the %rPSA is a valuable predictor of MFS unlike the fPSA level.
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Affiliation(s)
- Dan Bee Lee
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Yeon Kim
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Won Hoon Song
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jong Kil Nam
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Hyun Jung Lee
- Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Tae Un Kim
- Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sung-Woo Park
- Department of Urology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
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3
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Milonas D, Laenen A, Venclovas Z, Jarusevicius L, Devos G, Joniau S. Benefits of early salvage therapy on oncological outcomes in high-risk prostate cancer with persistent PSA after radical prostatectomy. Clin Transl Oncol 2021; 24:371-378. [PMID: 34453699 DOI: 10.1007/s12094-021-02700-y] [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: 06/12/2021] [Accepted: 08/18/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patients with prostate-specific antigen (PSA) persistence are at the increased risk of disease progression. The aim of our study was to evaluate the impact of early salvage therapy on oncological outcomes in patients with persistent PSA after radical prostatectomy (RP). METHODS Within a single tertiary centre database, we identified men with persistent (≥ 0.1 ng/ml) versus undetectable (< 0.1 ng/ml) PSA 4-8 weeks after RP for high-risk prostate cancer (HRPCa). The cumulative incidence function was used to estimate cancer-specific survival (CSS) and clinical progression-free survival (CPFS). The Kaplan-Meier method was used to estimate overall survival (OS). The effects on oncological outcomes of salvage radiotherapy (SRT) ± androgen deprivation therapy (ADT) vs. ADT monotherapy were tested in the subgroup of patients with persistent PSA. RESULTS Of 414 consecutive patients who underwent RP for HRPC, 125 (30.2%) had persistent PSA. Estimated 10-year CPFS, CSS and OS for men with persistent vs. undetectable PSA were 63.8% vs. 93.5%, 78.5% vs. 98.3% and 54% vs. 83.2% (all p < 0.0001), respectively. In men with persistent PSA, ADT alone was associated with higher risk (hazard ratio (HR) for worse CSS (HR 3.9, p = 0.005) and OS (HR 4.7, p < 0.0001) but not for CP (HR 1.6, p = 0.2) when compared with SRT ± ADT. CONCLUSION In patients who underwent RP for HRPCa, persistent PSA was associated with poor oncological outcomes. Early SRT ± ADT resulted in significantly improved CSS and OS in men with persistent PSA comparing with early androgen deprivation monotherapy.
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Affiliation(s)
- D Milonas
- Medical Academy, Department of Urology, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307, Kaunas, Lithuania. .,Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - A Laenen
- Leuven Biostatistics and Statistical Bioinformatics Center, KU Leuven, Oude Markt 13, 3000, Leuven, Belgium
| | - Z Venclovas
- Medical Academy, Department of Urology, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307, Kaunas, Lithuania
| | - L Jarusevicius
- Medical Academy, Department of Oncology and Hematology, Lithuanian University of Health Sciences, A. Mickeviciaus 9, 44307, Kaunas, Lithuania
| | - G Devos
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - S Joniau
- Department of Urology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
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Milonas D, Venclovas Z, Sasnauskas G, Ruzgas T. The Significance of Prostate Specific Antigen Persistence in Prostate Cancer Risk Groups on Long-Term Oncological Outcomes. Cancers (Basel) 2021; 13:cancers13102453. [PMID: 34070052 PMCID: PMC8158093 DOI: 10.3390/cancers13102453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 05/14/2021] [Accepted: 05/15/2021] [Indexed: 12/02/2022] Open
Abstract
Simple Summary The current prostate cancer guidelines recommend performing the first prostate-specific antigen measurement at three months after radical prostatectomy. However, at an earlier measurement, persistence (≥0.1 ng/mL) of this biomarker could be found in up to 30% of cases, depending on the prostate cancer risk factors. Recent reports have demonstrated an increasing interest in prostate-specific antigen persistence as a possible additional predictor of disease progression and cancer-specific survival. However, the data remain scant, with weak evidence. We assessed the relationship between prostate-specific antigen persistence and long-term oncological outcomes within prostate cancer risk groups. We found that persistence of this biomarker could be used as an independent predictor of worse long-term outcomes in high-risk prostate cancer patients, while in intermediate-risk patients, this parameter significantly predicts only biochemical recurrence and has no impact on the outcomes in low-risk patients. Abstract Objective: To assess the significance of prostate-specific antigen (PSA) persistence at the first measurement after radical prostatectomy (RP) on long-term outcomes in different prostate cancer risk groups. Methods: Persistent PSA was defined as ≥0.1 ng/mL at 4–8 weeks after RP. Patients were stratified into low-, intermediate- and high-risk groups, according to the preoperative PSA, pathological stage, grade group and lymph nodes status. The ten-year cumulative incidence of biochemical recurrence (BCR), metastases, cancer-specific mortality (CSM) and overall mortality (OM) were calculated in patients with undetectable and persistent PSA in different PCa-risk groups. Multivariate regression analyses depicted the significance of PSA persistence on each study endpoint. Results: Of all 1225 men, in 246 (20.1%), PSA persistence was detected. These men had an increased risk of BCR (hazard ratio (HR) 4.2, p < 0.0001), metastases (HR: 2.7, p = 0.002), CRM (HR: 5.5, p = 0.002) and OM (HR: 1.8, p = 0.01) compared to the men with undetectable PSA. The same significance of PSA persistence on each study endpoint was found in the high-risk group (HR: 2.5 to 6.2, p = 0.02 to p < 0.0001). In the intermediate-risk group, PSA persistence was found as a predictor of BCR (HR: 3.9, p < 0.0001), while, in the low-risk group, PSA persistence was not detected as a significant predictor of outcomes after RP. Conclusions: Persistent PSA could be used as an independent predictor of worse long-term outcomes in high-risk PCa patients, while, in intermediate-risk patients, this parameter significantly predicts only biochemical recurrence and has no impact on the outcomes in low-risk PCa patients.
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Affiliation(s)
- Daimantas Milonas
- Medical Academy, Department of Urology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (Z.V.); (G.S.)
- Correspondence:
| | - Zilvinas Venclovas
- Medical Academy, Department of Urology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (Z.V.); (G.S.)
| | - Gustas Sasnauskas
- Medical Academy, Department of Urology, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania; (Z.V.); (G.S.)
| | - Tomas Ruzgas
- Department of Applied Mathematics, Kaunas University of Technology, 44249 Kaunas, Lithuania;
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5
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Haidl F, Al-Monajjed R. [Prostate cancer: surgical complications]. Aktuelle Urol 2020; 51:469-474. [PMID: 32557447 DOI: 10.1055/a-1185-8179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Radical prostatectomy (RP), performed as an open, laparoscopic or robotic procedure, remains the "gold standard" for patients with localised prostate cancer who can be cured with surgery and have a life expectancy of at least 10 years. Today, RP is also used as a first-line treatment for locally advanced prostate cancer, possibly in a multimodal setting with adjuvant radiation/hormonal therapy. The increasing experience of surgeons, better knowledge of anatomy and refinements of surgical techniques have greatly improved oncological and functional outcomes. In our article we would like to give an overview of the complications associated with this surgical procedure.
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Affiliation(s)
- Friederike Haidl
- Universitätsklinikum Köln, Urologie, Uro-Onkologie, spezielle urologische und Roboter-assistierte Chirurgie, Köln
| | - Rouvier Al-Monajjed
- Heinrich-Heine Universität Düsseldorf, Klinik für Urologie und Kinderurologie, Universitätsklinikum, Düsseldorf
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Preisser F, Gandaglia G, Arad F, Karakiewicz PI, Bandini M, Pompe RS, Montorsi F, Graefen M, Huland H, Briganti A, Tilki D. Association of neurovascular bundle preservation with oncological outcomes in patients with high-risk prostate cancer. Prostate Cancer Prostatic Dis 2020; 24:193-201. [PMID: 32814844 DOI: 10.1038/s41391-020-00266-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/22/2020] [Accepted: 08/06/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate the oncologic safety of neurovascular bundles (NVB) preservation at radical prostatectomy (RP) in patients with high-risk and/or locally advanced prostate cancer (PCa). MATERIAL AND METHODS Within a two-institutional high-volume center database we identified patients who harbored high-risk PCa at RP (2000-2017). Only patients with D'Amico high-risk PCa were included. Kaplan-Meier and multivariable Cox regression models tested the effect of NVB preservation on biochemical recurrence (BCR), metastasis and overall survival (OS). Subgroup analyses focused on patients with clinical stage T3 and/or biopsy ISUP grade 5 and pathologic stage T3. RESULTS Of 4351 patients with D'Amico high-risk, 35.7% vs. 38.0% vs. 26.3% underwent bilateral vs. unilateral vs. no NVB preservation, respectively. At 120 months after RP BCR-free, metastasis-free survival and OS rates were 62.2% vs. 44.3% vs. 27.1% (p < 0.001), 83.7% vs. 66.7% vs. 60.3% (p < 0.001), and 91.8% vs. 87.5% vs. 72.3% (p < 0.001) for bilateral vs. unilateral vs. no NVB preservation, respectively. In multivariable Cox regression models, bilateral and unilateral compared to no NVB preservation did not increase the risk for BCR, metastasis or death in the entire cohort and in subgroups with clinical stage T3 and/or biopsy ISUP grade 5, as well as pathologic stage T3. CONCLUSIONS NVB preservation was not associated with worse oncological outcome in patients with high-risk and/or locally advanced PCa and may be offered to well-selected patients who are at risk of harboring nonorgan-confined PCa.
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Affiliation(s)
- Felix Preisser
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Farid Arad
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
| | - Marco Bandini
- Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Raisa S Pompe
- Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI; IRCCS Ospedale San Raffaele, Milan, Italy
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg Eppendorf, Hamburg, Germany. .,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
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7
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Preisser F, Chun FK, Pompe RS, Heinze A, Salomon G, Graefen M, Huland H, Tilki D. Persistent Prostate-Specific Antigen After Radical Prostatectomy and Its Impact on Oncologic Outcomes. Eur Urol 2019; 76:106-114. [DOI: 10.1016/j.eururo.2019.01.048] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 01/31/2019] [Indexed: 01/25/2023]
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8
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Heidenreich A, Fossati N, Pfister D, Suardi N, Montorsi F, Shariat S, Grubmüller B, Gandaglia G, Briganti A, Karnes RJ. Cytoreductive Radical Prostatectomy in Men with Prostate Cancer and Skeletal Metastases. Eur Urol Oncol 2018; 1:46-53. [PMID: 31100228 DOI: 10.1016/j.euo.2018.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 03/03/2018] [Accepted: 03/14/2018] [Indexed: 01/23/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) represents the standard treatment for hormone-naïve prostate cancer with systemic metastases (mPCA). The role of radical prostatectomy (RP) in this setting is unclear. OBJECTIVE To evaluate the oncological and functional outcomes of men with mPCA who underwent cytoreductive RP (CRP). DESIGN, SETTING, AND PARTICIPANTS Retrospective, multi-institutional study of 113 patients with biopsy-proven mPCA who fulfilled the following selection criteria: (1) completely resectable PCA; (2) osseous metastases; (3) absence of gross retroperitoneal lymph node metastases; (4) absence of bulky pelvic lymph node metastases >3cm; (5) no or minimal visceral metastases; (6) Eastern Cooperative Oncology Group performance status of 0-1; and (7) written informed consent. INTERVENTION CRP with extended pelvic lymphadenectomy. Eighty patients (70.8%) received neoadjuvant ADT and 91 (86.5%) adjuvant ADT and/or radiation therapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cancer-specific survival, overall survival (OS), biochemical relapse-free survival (BRFS), and clinical relapse-free survival (CRFS) were evaluated using descriptive statistical analyses, the Kaplan-Meier method, and univariate and multivariate analyses. Treatment-associated complications were analysed according to the Clavien-Dindo classification. RESULTS AND LIMITATIONS The mean patient age was 61 yr (range 42-69). The mean follow-up was 53.6 mo (range 13-96, median 45.7). The 3-yr and 5-yr OS was 99 (87.6%) and 90 (79.6%), respectively, and the mean CRFS was 72.3 mo. Preoperative prostate-specific antigen (PSA)<1.0ng/ml and PSA below the median of 8.0ng/ml were significantly associated with BRFS (p<0.0004). Pathohistology revealed viable PCA in all cases: 16 (14.2%) had pT4a, 21 (18.6%) had pT2a-c, and 76 (67.3%) had pT3a/b PCA. Positive lymph nodes were identified in 61.6% and positive surgical margins in 36.8% of the patients. Eleven men (9.7%) experienced Clavien Dindo grade IIIa-b complications. Low-volume disease, neoadjuvant ADT, and preoperative PSA were significantly associated with a lower risk of surgery-related complications (p<0.05). No, mild (1-2 pads/d), and severe incontinence (>2 pads/d) was observed in 68.1%, 17.7%, and 14.1%, respectively. Limitations of the study are the retrospective nature and potential patient selection bias. CONCLUSIONS CRP results in 5-yr OS of 80%, a low rate of significant complications, and good functional outcome in well-selected patients. CRP might be an individualised treatment option in the multimodal management of mPCA. PATIENT SUMMARY We assessed oncological and functional outcomes associated with cytoreductive radical prostatectomy (CRP) in select men with prostate cancer and osseous metastases. We found that CRP might be associated with long overall and relapse-free survival in well-selected patients. CRP could become an additional treatment option in the multimodal therapy of metastatic prostate cancer; it should be performed in a clinical protocol setting and does not represent a standard therapeutic option.
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany; Department of Urology, University of Vienna, Vienna, Austria.
| | - Nicola Fossati
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - David Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Reconstructive Urology, University of Cologne, Cologne, Germany
| | - Nazareno Suardi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | | | | | - Giorgio Gandaglia
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Alberto Briganti
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
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9
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Abstract
Prostate cancer is the most common male malignant tumor in Germany, which thus places growing demands on differentiated imaging and risk-adapted therapeutic approaches. Multiparametric MRI (mpMRI) of the prostate enables reliable detection of clinically significant cancers and is currently the leading imaging modality for the detection, characterization, and local staging of prostate cancer. According to the German S3 guideline, mpMRI of the prostate is currently primarily recommended in patients with previous negative TRUS biopsies and persisting tumor suspicion. The serial use of mpMRI in the pretherapeutic setting can support individual therapy planning of patients with locally advanced prostate cancer in the near future.
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10
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Liu XJ, Liu L, Chang K, Ye DW, Zheng YF, Yao XD. Risk factors of perioperative complications in patients undergoing radical retropubic prostatectomy: A ten-year experience. ACTA ACUST UNITED AC 2017; 37:379-383. [PMID: 28585137 DOI: 10.1007/s11596-017-1743-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 05/02/2017] [Indexed: 11/27/2022]
Abstract
Radical retropubic prostatectomy (RRP) has been one of the most effective treatments for prostate cancer. This study is designed to identify the related predictive risk factors for complications in patients following RRP. Between 2000 and 2012 in Department of Urology, Fudan University Shanghai Cancer Center, 421 cases undergoing RRP for localized prostate cancer by one surgeon were included in this retrospective analysis. We reviewed various risk factors that were correlated with perioperative complications, including patient characteristics [age, body mass index (BMI), co-morbidities], clinical findings (preoperative PSA level, Gleason score, clinical stage, pathological grade), and surgeon's own clinical practice. Charlson comorbidity index (CCI) was used to explain comorbidities. The total rate of perioperative complications was 23.2% (98/421). There were 45/421 (10.7%), 28/421 (6.6%), 24/421 (5.7%) and 1/421 (0.2%) in grade I, II, III, IV respectively, and 323/421 (76.8%) cases had none of these complications. Statistical analysis of multiple potential risk factors revealed that BMI >30 (P=0.014), Charlson score ≥1 (P<0.001) and surgical experience (P=0.0252) were predictors of perioperative complications. Age, PSA level, Gleason score, TNM stage, operation time, blood loss, and blood transfusion were not correlated with perioperative complications (P>0.05). It was concluded that patients' own factors and surgeons' technical factors are related with an increased risk of development of perioperative complications following radical prostatectomy. Knowing these predictors can both favor risk stratification of patients undergoing RRP and help surgeons make treatment decisions.
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Affiliation(s)
- Xiao-Jun Liu
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Liang Liu
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China.,Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Kun Chang
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Ding-Wei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yong-Fa Zheng
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, China.
| | - Xu-Dong Yao
- Department of Urology, The Tenth People's Hospital Affiliated to Tongji University, Tongji University, Shanghai, 200032, China.
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11
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Abstract
Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.
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Affiliation(s)
- A Heidenreich
- Klinik für Urologie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
| | - D Böhmer
- Klinik für Radioonkologie und Strahlentherapie, Charité Campus Benjamin Franklin, Berlin, Deutschland
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12
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Mathieu R, Korn SM, Bensalah K, Kramer G, Shariat SF. Cytoreductive radical prostatectomy in metastatic prostate cancer: Does it really make sense? World J Urol 2016; 35:567-577. [PMID: 27502935 DOI: 10.1007/s00345-016-1906-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 07/22/2016] [Indexed: 01/06/2023] Open
Abstract
PURPOSE Surgical removal of the primary tumor in metastatic prostate cancer (mPCa) is becoming a hotly debated issue. The purpose of this review was to summarize the current knowledge on cytoreductive radical prostatectomy (cRP) in this setting. MATERIALS AND METHODS We performed a non-systematic Medline/PubMed literature search of articles published in the field between January 2000 and April 2015. RESULTS Cytoreductive surgery has demonstrated its benefit in various malignancies with a solid biological rationale to justify its assessment in mPCa. cRP appears as a safe and feasible procedure in expert hands and well-selected patients. A growing body of evidence suggests a survival benefit for patients undergoing cRP as a part of a multimodal approach compared to those treated with systemic treatment alone. Nevertheless, little is known about the best clinical and tumor characteristics for the selection of patients most likely to benefit from cRP. The current literature is based on retrospective studies with small cohorts and limited follow-up or large uncontrolled population-based studies. CONCLUSIONS Data from various other malignancies together with the biological rationale and preliminary results in PCa suggest that cytoreductive surgery may be an option in some mPCa patients. The lack of randomized controlled trials and the low level of evidence in the current literature preclude any firms conclusion on the benefit of cRP in mPCa. Ongoing phase II and future phase III studies are mandatory to define the exact role of cRP in mPCa and to identify the patients who are most likely to benefit from cRP.
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Affiliation(s)
- Romain Mathieu
- Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria.,Department of Urology, Rennes University Hospital, Rennes, France
| | - Stephan M Korn
- Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria
| | - Karim Bensalah
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Gero Kramer
- Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, General Hospital, Medical University Vienna, Vienna, Austria. .,Department of Urology, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA. .,Department of Urology, Weill Cornell Medical College, New York, NY, USA.
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Jo SY, Chang JC, Bae HG, Oh JS, Heo J, Hwang JC. A Morphometric Study of the Obturator Nerve around the Obturator Foramen. J Korean Neurosurg Soc 2016; 59:282-6. [PMID: 27226861 PMCID: PMC4877552 DOI: 10.3340/jkns.2016.59.3.282] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 11/11/2015] [Accepted: 02/26/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Obturator neuropathy is a rare condition. Many neurosurgeons are unfamiliar with the obturator nerve anatomy. The purpose of this study was to define obturator nerve landmarks around the obturator foramen. METHODS Fourteen cadavers were studied bilaterally to measure the distances from the nerve root to relevant anatomical landmarks near the obturator nerve, including the anterior superior iliac spine (ASIS), the pubic tubercle, the inguinal ligament, the femoral artery, and the adductor longus. RESULTS The obturator nerve exits the obturator foramen and travels infero-medially between the adductors longus and brevis. The median distances from the obturator nerve exit zone (ONEZ) to the ASIS and pubic tubercle were 114 mm and 30 mm, respectively. The median horizontal and vertical distances between the pubic tubercle and the ONEZ were 17 mm and 27 mm, respectively. The shortest median distance from the ONEZ to the inguinal ligament was 19 mm. The median inguinal ligament lengths from the ASIS and the median pubic tubercle to the shortest point were 103 mm and 24 mm, respectively. The median obturator nerve lengths between the ONEZ and the adductor longus and femoral artery were 41 mm and 28 mm, respectively. CONCLUSION The obturator nerve exits the foramen 17 mm and 27 mm on the horizontal and sagittal planes, respectively, from the pubic tubercle below the pectineus muscle. The shallowest area is approximately one-fifth medially from the inguinal ligament. This study will help improve the accuracy of obturator nerve surgeries to better establish therapeutic plans and decrease complications.
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Affiliation(s)
- Se Yeong Jo
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Jae Chil Chang
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Hack Gun Bae
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Jae-Sang Oh
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Juneyoung Heo
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
| | - Jae Chan Hwang
- Department of Neurosurgery, Soonchunhyang University Gumi Hospital, Gumi, Korea
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Recovery of Baseline Erectile Function in Men Following Radical Prostatectomy for High-Risk Prostate Cancer: A Prospective Analysis Using Validated Measures. J Sex Med 2016; 13:435-43. [DOI: 10.1016/j.jsxm.2016.01.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 01/09/2016] [Accepted: 01/12/2016] [Indexed: 11/19/2022]
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15
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Tang V, Murphy DG, Moon D. Management of Locally Advanced (Nonmetastatic) Prostate Cancer. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00051-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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16
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Faria EF, Chapin BF, Muller RL, Machado RD, Reis RB, Matin SF. Radical Prostatectomy for Locally Advanced Prostate Cancer: Current Status. Urology 2015; 86:10-5. [DOI: 10.1016/j.urology.2015.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/11/2015] [Accepted: 03/16/2015] [Indexed: 11/26/2022]
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17
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Froehner M, Wirth MP. Locally advanced prostate cancer: optimal therapy in older patients. Drugs Aging 2014; 30:959-67. [PMID: 24097331 DOI: 10.1007/s40266-013-0123-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is no standard treatment for locally advanced prostate cancer. Even the definition is still unclear. Locally advanced disease may refer to over-staged well-curable tumors as well as to advanced and probably incurable cancers. Similar uncertainties are present regarding the definition of 'old' in this context. Conservatively treated locally advanced prostate cancer is associated with poor survival outcome. With the increasing life expectancy, in the absence of curative treatment, even patients in their ninth decade of life may later suffer from symptoms of aggressive prostate cancer and are at a high risk of death from prostate cancer that might be prevented at least in part by early intervention. On the other hand, functional results after prostate cancer treatment are worse in elderly patients. In this article we discuss aspects of the management of locally advanced prostate cancer in the elderly with special focus on the recommendation of current clinical guidelines.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Fetscherstrasse 74, 01304, Dresden, Germany,
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18
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Tosco L, Van Poppel H. Prostate cancer: The role of local therapy for metastatic prostate cancer. Nat Rev Urol 2014; 11:134-5. [PMID: 24567085 DOI: 10.1038/nrurol.2014.33] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Lorenzo Tosco
- University Hospitals Leuven, Urology, Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium
| | - Hendrik Van Poppel
- University Hospitals Leuven, Urology, Department of Development and Regeneration, Herestraat 49, Leuven 3000, Belgium
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19
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Min BD, Kim WT, Cho BS, Kim YJ, Yun SJ, Lee SC, Kim WJ. Usefulness of a combined approach of t1-weighted, t2-weighted, dynamic contrast-enhanced, and diffusion-weighted imaging in prostate cancer. Korean J Urol 2012; 53:830-5. [PMID: 23301126 PMCID: PMC3531635 DOI: 10.4111/kju.2012.53.12.830] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/20/2012] [Indexed: 11/18/2022] Open
Abstract
Purpose We evaluated the value of a combined approach of T1-weighted (T1W) imaging, T2-weighted (T2W) imaging, dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), and diffusion-weighted imaging (DWI) for the detection of prostate cancer and extracapsular extension (ECE) in patients with prostate cancer by using pathologic data after radical prostatectomy. Materials and Methods From April 2009 to December 2011, 126 patients who underwent radical prostatectomy and prostate MRI for prostate cancer were analyzed retrospectively. The MRI findings were compared with the pathologic findings of the radical prostatectomy specimens in each patient. The sensitivity, specificity, and accuracy of the detection of prostate cancer and extracapsular extension were analyzed. Results The prostate cancer detection rate by use of T1W and T2W imaging, DCE-MRI, and their combination was 65.1%, 69.0%, and 80.2%, respectively (p=0.023). The detection rate using T1W and T2W imaging, DCE-MRI, DWI, and their combination was 57.7%, 65.4%, 67.3%, and 80.8%, respectively (p=0.086). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of combination MRI (T1W, T2W, and DCE-MRI) for ECE were 46.4%, 91.4%, 83.9%, and 68.1%, respectively. The sensitivity of combination MRI (T1W, T2W, and DCE-MRI) for ECE tended to increase as the prostate-specific antigen level rose (p=0.010). The sensitivity, specificity, PPV, and NPV of combination MRI (T1W, T2W, DCE-MRI, and DWI) for ECE were 65.0%, 87.5%, 76.5%, and 80.0%, respectively. Conclusions A combined approach of T1W, T2W, and DCE-MRI with DWI demonstrated an accurate detection rate of prostate cancer. Also, combination approaches showed a high specificity for predicting ECE, although sensitivity was relatively lower. Therefore, these methods are reliable for predicting prostate cancer. However, a new protocol is necessary to enhance the sensitivity for predicting ECE.
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Affiliation(s)
- Byung Dal Min
- Department of Urology, Chungbuk National University College of Medicine, Cheongju, Korea
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Thurairaja R, Koupparis A. The role of surgery in high-risk localised prostate cancer. BJU Int 2012; 110:E1-2. [PMID: 22691024 DOI: 10.1111/j.1464-410x.2012.11303_2.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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