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Sun X, Liu M, Zhao Y, Leng K, Zhang H. Evaluation of cystoprostatectomy on patients with prostate cancer extending to bladder: a retrospective study from single center. BMC Urol 2022; 22:118. [PMID: 35902854 PMCID: PMC9330683 DOI: 10.1186/s12894-022-01068-7] [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] [Accepted: 07/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background This is an exploratory research of cystoprostatectomy (CP) in treating prostate cancer (PCa) extending to the bladder, which aimed to evaluate the effects of CP on survival outcomes and improving quality of life (QoL) in these patients. Methods A total of 27 PCa patients extending to the bladder were subjected to CP and followed up at regular intervals in our center. Prostate cancer-specific survival (PCSS) and prostate-specific antigen recurrence-free survival (PFS) were assessed by Kaplan–Meier analysis. Multivariate Cox regression was performed to evaluate clinical characteristics predicting survivals. QoL and pelvic symptoms were also evaluated. Results Median PCSS was not reached over the period of follow-up. 5-year PCSS rate was 82.1%. Median PFS was 66.0 months. 5-year PFS rate was 58.5%. Multivariate analysis showed Gleason score (≥ 8) (hazard ratio (HR) 2.55, 95% confidence interval (CI) 1.28–4.04, p = 0.033), positive local lymph node status (HR 3.52, 95% CI 1.57–7.38, p = 0.006) and bladder muscle-invasion (HR 4.75, 95% CI 1.37–7.53, p < 0.001) were independent predictors of worse PCSS. The number of patients suffering pelvic symptoms was significantly decreased, and QoL scores were significantly down-regulated after surgeries. Conclusion CP offered effective and durable palliation in patients of locally advanced prostate cancer with invasion of the bladder, providing better QoL and relieving local symptoms.
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Affiliation(s)
- Xiaoliang Sun
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Min Liu
- Department of Oncologic Chemotherapy, Shandong Second Provincial General Hospital, Jinan, 250022, Shandong, China
| | - Yong Zhao
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Kang Leng
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China
| | - Haiyang Zhang
- Department of Urology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong, China. .,Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California, San Francisco, CA, 94143, USA.
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2
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Oncolytic Adenovirus with SPAG9 shRNA Driven by DD3 Promoter Improved the Efficacy of Docetaxil for Prostate Cancer. JOURNAL OF ONCOLOGY 2022; 2022:7918067. [PMID: 35535313 PMCID: PMC9078851 DOI: 10.1155/2022/7918067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/12/2022] [Accepted: 03/17/2022] [Indexed: 11/20/2022]
Abstract
Prostate cancer (PCa) is a common malignant tumor of the male urinary system and ranks the second in the causes of tumor-related deaths. Differential display code 3 (DD3) is a noncoding gene that is specifically expressed in PCa. High expression of sperm-associated antigen 9 (SPAG9) is closely related to tumorigenesis of PCa, and SPAG9 is a therapeutic target for PCa. In this study, a new oncolytic adenovirus DD3-ZD55-SPAG9 was constructed by using DD3 promoter to enhance the efficacy and safety of adenovirus. The combined use of DD3-ZD55-SPAG9 and docetaxel showed that DD3-ZD55-SPAG9 significantly improved the anti-tumor efficacy of docetaxel in PCa both in vitro and in vivo. The mechanism was related to the induction of tumor cell apoptosis and the inhibition of tumor cell invasion. In conclusion, DD3-ZD55-SPAG9 combined with docetaxel is an effective strategy for PCa therapy.
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3
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Fang K, Song P, Zhang J, Yang L, Liu P, Lu N, Dong Q. The Impact of Palliative Transurethral Resection of the Prostate on the Prognosis of Patients With Bladder Outlet Obstruction and Metastatic Prostate Cancer: A Population-Matched Study. Front Surg 2021; 8:726534. [PMID: 34778357 PMCID: PMC8586220 DOI: 10.3389/fsurg.2021.726534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: This study aimed to evaluate the survival outcomes of patients with bladder outlet obstruction (BOO) and metastatic prostate cancer (mPCa) after having a palliative transurethral resection of the prostate (pTURP) surgery. Methods: We identified patients with mPCa between 2004 and 2016 in the Surveillance, Epidemiology, and End Results (SEER) database. Patients who received pTURP and non-surgical therapy were identified. A propensity-score matching was introduced to balance the covariate. Kaplan-Meier analysis and COX regression were conducted to evaluate the overall survival (OS) and cancer-specific survival (CSS) outcomes. Results: A total of 36,003 patients were identified; 2,823 of them were in the pTURP group and 33,180 were in the non-surgical group. The survival curves of the overall cohort showed that the pTURP group was associated with worse outcomes in both OS (HR: 1.12, 95% CI: 1.07-1.18, p < 0.001) and CSS (HR: 1.08, 95% CI: 1.02-1.15, p = 0.004) compared with the non-surgical group. The mean survival time in the overall cohort of the pTURP group was shorter than the non-surgical group in both OS [35.13 ± 1.53 vs. 40.44 ± 0.59 months] and CSS [48.8 ± 1.27 vs. 55.92 ± 0.43 months]. In the matched cohort, the pTURP group had significantly lower survival curves for both OS (HR: 1.25, 95% CI: 1.16-1.35, p < 0.001) and CSS (HR: 1.23, 95% CI: 1.12-1.35, p < 0.001) than the non-surgical group. pTURP significantly reduced the survival months of the patients (36.49 ± 0.94 vs. 45.52 ± 1.23 months in OS and 50.1 ± 1.49 vs. 61.28 ± 1.74 months in CSS). In the multivariate COX analysis, pTURP increased the risk of overall mortality (HR: 1.19, 95% CI: 1.09-1.31, p < 0.001) and cancer-specific mortality CSS (HR: 1.23, 95% CI: 1.14-1.33, p < 0.001) compared with the non-surgical group. Conclusions: For mPCa patients with BOO, pTURP could reduce OS and CSS while relieving the obstruction.
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Affiliation(s)
- Kun Fang
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Pan Song
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Jiahe Zhang
- The Second Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Luchen Yang
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China
| | - Peiwen Liu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Ni Lu
- The First Clinical Medical College of Lanzhou University, Lanzhou, China
| | - Qiang Dong
- Department of Urology, West China Hospital of Sichuan University, Chengdu, China,*Correspondence: Qiang Dong
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4
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Kanzelmeyer S, Bludau M, Pfister DJKP, Heidenreich A. [Pelvic exenteration in patients with locally advanced, symptomatic castration-resistant prostate cancer]. Urologe A 2021; 61:167-172. [PMID: 34424358 PMCID: PMC8831235 DOI: 10.1007/s00120-021-01619-0] [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: 07/13/2021] [Indexed: 10/24/2022]
Abstract
GOAL The retrospective evaluation of clinical outcomes after palliative pelvic exenteration (PPE) in patients with subvesical and supravesical complications due to symptomatic locally advanced castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS In all, 84 patients with locally advanced and symptomatic CRPC underwent radical cystoprostatectomy (n = 71, 83.3%) or anterior and posterior exenteration (n = 13, 16.7%). Local staging was done via pelvic MRI (magnetic resonance imaging), cystoscopy, and rectoscopy. Systemic staging was performed by computed tomography of the thorax, abdomen pelvis, and skeletal scintigraphy. Perioperative complications were evaluated using the Clavien-Dindo classification. The primary study objective was symptom-free survival defined as absence of lower or upper urinary tract symptoms and absence of endoluminal or percutaneous intervention. RESULTS After a median follow-up of 43.5 (3-139) months, symptom-free survival at 1 and 3 years was 95.2% and 86.7%, respectively. In all, 86.7% of patients remained symptom-free for their remaining lifetime with respect to local symptoms. Overall survival at 1 and 3 years was 92.9% and 54.7%, respectively. Clavien-Dindo grade 2, 3, and 4 complications occurred in 19 (22.6%), 7 (8.3%), and 3 (3.6%) patients, respectively. CONCLUSION With adequate patient selection, PPE is possible with a low complication rate and results in significant symptom relief in the lower or upper genitourinary tract in about 90% of patients, of whom more than 80% remain symptom-free for the remainder of their lives. Prerequisites for favorable surgical outcomes are patient selection, an interdisciplinary approach, and appropriate surgical expertise.
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Affiliation(s)
- Saskia Kanzelmeyer
- Klinik und Poliklinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Mark Bludau
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinikum Köln, Köln, Deutschland
| | - David Johannes Karl Paul Pfister
- Klinik und Poliklinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Axel Heidenreich
- Klinik und Poliklinik für Urologie, Uro-Onkologie, spezielle urologische und roboter-assistierte Chirurgie, Universitätsklinikum Köln, Kerpener Str. 62, 50937, Köln, Deutschland. .,Klinik für Urologie, Medizinische Universität Wien, Wien, Österreich.
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Marra G, Calleris G, Alessio P, Oderda M, Palou J, Joniau S, Piechaud T, Smelzo S, Morlacco A, Sharma V, Tilki D, Van der Poel H, Veerman H, Karnes RJ, Gontero P. Outcomes of Salvage Radical Prostatectomy for M0 Castration-resistant Recurrent Prostate Cancer: A Reasonable Option in the Era of New Antiandrogen Therapies? Eur Urol Focus 2021; 7:807-811. [DOI: 10.1016/j.euf.2020.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/16/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022]
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6
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The cost of metastatic prostate cancer using time-driven activity-based costing. Int J Technol Assess Health Care 2021; 37:e60. [PMID: 33896428 DOI: 10.1017/s0266462321000271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To estimate the cost of metastatic prostate cancer (mPC) treatment using the time-driven activity-based costing (TDABC) method from the perspective of a philanthropic hospital in the Brazilian public health system (PHS) and to identify determinants of costs. METHODS We used data from patients who received docetaxel chemotherapy in the Brazilian PHS from September 2012 to May 2017. Direct medical costs were estimated with the TDABC microcosting method, taking into account the multiple departments and services the patients interacted with during their oncological treatment. RESULTS The median overall survival of the forty-three patient sample was 1.8 years (95% CI 1.45-2.30), and the total cost of the sample was BRL 917.005 (USD 250,878). The median monthly cost per patient was BRL 20.201 (USD 5,526). The end-of-life cost per patient using the TDABC method was BRL 5.151 (USD 1,409). Patients who had received previous treatment at the center registered the lowest cost for hospitalizations and exams, suggesting an opportunity to better manage healthcare resources. CONCLUSIONS This is the first study on the economic burden of mPC in the Brazilian PHS using the TDABC costing evaluation method. Accurate cost information obtained with the TDABC can be helpful in guiding disease management to guarantee better use of ever-scarcer resources.
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7
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Bhanvadia RR, Khouri RK, Ashbrook C, Woldu SL, Margulis V, Raj GV, Bagrodia A. Safety, Efficacy, and Impact on Quality of Life of Palliative Robotic Cystectomy for Advanced Prostate Cancer. Clin Genitourin Cancer 2020; 19:e129-e134. [PMID: 33246846 DOI: 10.1016/j.clgc.2020.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/13/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Raj R Bhanvadia
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Roger K Khouri
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Caleb Ashbrook
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Solomon L Woldu
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Vitaly Margulis
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Ganesh V Raj
- Department of Urology, University of Texas Southwestern, Dallas, TX
| | - Aditya Bagrodia
- Department of Urology, University of Texas Southwestern, Dallas, TX.
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8
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Anttinen M, Mäkelä P, Nurminen P, Yli-Pietilä E, Suomi V, Sainio T, Saunavaara J, Taimen P, Blanco Sequeiros R, Boström PJ. Palliative MRI-guided transurethral ultrasound ablation for symptomatic locally advanced prostate cancer. Scand J Urol 2020; 54:481-486. [PMID: 32897169 DOI: 10.1080/21681805.2020.1814857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE Locally advanced prostate cancer can cause bladder outlet obstruction, gross hematuria and frequent hospitalization. While these complications are commonly treated by palliative transurethral resection of the prostate, the improvement is often insufficient. The purpose of this study was to evaluate the safety and feasibility of MRI-guided transurethral ultrasound ablation as an alternative palliative treatment option (pTULSA) for men suffering from symptomatic locally advanced prostate cancer. METHODS This prospective, phase one study included 10 men in need of palliative surgical intervention due to urinary retention and gross hematuria caused by locally advanced prostate cancer. Patients were followed for 1 year at 3-month intervals. Time without catheter, time without hematuria, reduction in hospitalization time, and adverse events were measured. RESULTS Ten patients with locally advanced prostate cancer were enrolled, all having continuous catheterization due to urinary retention and nine had gross hematuria before treatment. At 1 week post-pTULSA five patients were catheter-free. At last follow-up catheter-free and gross hematuria-free rates were 70% and 100%, respectively. Average hospitalization time from local complications reduced from 7.3 to 1.4 days in the 6 months before and after pTULSA. No > Grade 2 treatment related adverse events were reported, with all five being urinary tract infections. CONCLUSIONS pTULSA appears safe and feasible for palliative ablation of locally advanced prostate cancer. The therapy seems to accomplish long-term hematuria control, can relieve bladder outlet obstruction in selected patients, and seems to reduce the burden of hospitalization due to local complications. Trial Registration Number: NCT03350529.
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Affiliation(s)
- Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pietari Mäkelä
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pertti Nurminen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Eemil Yli-Pietilä
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Visa Suomi
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Teija Sainio
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Pekka Taimen
- Institute of Biomedicine and Department of Pathology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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9
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Heidenreich A, Bludau M, Bruns C, Nestler T, Porres D, Pfister DJKP. Pelvic exenteration surgery in patients with locally advanced castration-naïve and castration-resistant, symptomatic prostate cancer. BJU Int 2020; 126:342-349. [PMID: 32320130 DOI: 10.1111/bju.15088] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 01/15/2023]
Abstract
OBJECTIVES To evaluate retrospectively the surgical, symptomatic and oncological outcomes of pelvic exenteration surgery (PES) in men with significant intrapelvic complications of locally advanced castration-sensitive (CSPC) and castration-resistant prostate cancer (CRPC). PATIENTS AND METHODS A total of 103 patients with locally advanced progressive and symptomatic CSPC or CRPC underwent PES (radical cystoprostatectomy, n = 71 [68.9%]; radical prostatectomy with continent vesicostomy, n = 9 [8.7%]; total exenteration, n = 23 [22.3%]). All patients underwent local staging via magnetic resonance imaging, cystoscopy and rectoscopy. Systemic staging was carried out with chest, abdominal and pelvic computed tomography scans and bone scans. Peri-operative complications were assessed according to Clavien-Dindo classification. Symptom-free and overall survival were evaluated using the Kaplan-Meier method. Statistical tests were two-tailed with a P value <0.05 taken to indicate statistical significance. RESULTS After a median (range) follow-up of 36.5 (3-123) months, the symptom-free survival rate at 1 and 3 years was 89.2% (n = 89) and 64.1% (n = 66), respectively. The median symptom-free survival was 27.9 months. A total of 78.6% of the patients were symptom-free during their remaining lifetime. The overall survival rate at 1 and 3 years was 92.2% and 43.7%, respectively, and the median overall survival was 33.6 months. Clavien-Dindo grades 2, 3 and 4 complications developed in 31 (30.6%), 12 (11.6%) and eight patients (8.1%), respectively. CONCLUSION Pelvic exenteration surgery is technically feasible in well-selected patients, resulting in symptom relief in >90% of patients, covering 80% of their remaining lifetime.
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Affiliation(s)
- Axel Heidenreich
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urological Surgery, University Hospital Cologne, Cologne, Germany.,Department of Urology, Medical University Vienna, Vienna, Austria
| | - Mark Bludau
- Department of Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Christiane Bruns
- Department of Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Tim Nestler
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urological Surgery, University Hospital Cologne, Cologne, Germany
| | - Daniel Porres
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urological Surgery, University Hospital Cologne, Cologne, Germany
| | - David Johannes Karl Paul Pfister
- Department of Urology, Uro-Oncology, Robot-Assisted and Specialized Urological Surgery, University Hospital Cologne, Cologne, Germany
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10
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Leufgens F, Berneking V, Vögeli TA, Kirschner-Hermanns R, Eble MJ, Pinkawa M. Quality of Life Changes >10 Years After Postoperative Radiation Therapy After Radical Prostatectomy for Prostate Cancer. Int J Radiat Oncol Biol Phys 2019; 105:382-388. [PMID: 31201895 DOI: 10.1016/j.ijrobp.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/20/2019] [Accepted: 06/01/2019] [Indexed: 02/09/2023]
Abstract
PURPOSE To analyze long-term quality-of-life (QoL) changes related to postoperative radiation therapy (RT) after radical prostatectomy. METHODS AND MATERIALS Patients who received postoperative 3-dimensional conformal RT in the years 2003 to 2008 with 1.8 to 2.0 Gy fractions up to 66.0 to 66.6 Gy (n = 181) were surveyed using the Expanded Prostate Cancer Index Composite questionnaire before the beginning of RT (A); on the last day (B); and 2 months (C), 1 to 3 years (D), 6 to 9 years (E), and 10 to 13 years (F) after RT. RESULTS Mean urinary bother, urinary incontinence bother, and bowel bother score changes (in relation to baseline at time A) of 13, 14, and 7 and 14, 15, and 7 were found at times E and F, respectively (P < .01 for all comparisons). Sexual function scores decreased 6 and 8 points on average (P < .01). Patient age at the time of RT had a considerable impact on urinary bother and urinary incontinence bother, with increasing differences over time when comparing patients aged <68 versus ≥68 years: 0 versus 7 and 0 versus 7 points at time D and 8 versus 23 and 6 versus 35 points at time F, respectively. Patients who did not respond to RT with a decreasing prostate-specific antigen level had greater urinary and urinary incontinence bother and bowel bother score changes >10 years after treatment (25 vs 12; P = .04, 36 vs 10; P = .03, and 20 vs 5; P = .07, respectively). A higher rectal dose was associated with greater acute and long-term bowel bother score decrease. No correlation was found between the dose to the bladder and QoL changes. CONCLUSIONS In contrast to early evaluations in the first years, significantly decreasing QoL in the urinary, bowel, and sexual domains was found >5 years after RT. Aging is likely to be a major factor. Younger patients who responded to the treatment had the most favorable long-term QoL results. As 3-dimensional conformal RT was used in this study, intensity modulated concepts could result in improved outcomes.
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Affiliation(s)
| | - Vanessa Berneking
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany
| | | | | | - Michael J Eble
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany
| | - Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany; Department of Radiation Oncology, MediClin Robert Janker Klinik, Bonn, Germany.
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11
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New F, Deverill S, Somani BK. Role of percutaneous nephrostomy in end of life prostate cancer patients: a systematic review of the literature. Cent European J Urol 2018; 71:404-409. [PMID: 30680234 PMCID: PMC6338820 DOI: 10.5173/ceju.2018.1780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/15/2018] [Accepted: 11/17/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction Prostate cancer is the most common cancer amongst men in the UK. Treatments for malignant ureteric obstruction consist of percutaneous nephrostomy, ureteric stent insertion, or occasionally other forms of urinary diversion. Our aim was to look at the outcomes of percutaneous nephrostomy (PCN) in patients with advanced prostate cancer and to look at the impact on patient's general health, quality of life, life expectancy and complications after PCN insertion. Material and methods A systematic review of the literature was done for all prospective English language articles on PCN in patients with prostate cancer using PubMed, MEDLINE, EMBASE, Scopus, CINAHL, Cochrane library, Clinicaltrials.gov, Google Scholar and individual urological journals from inception to August 2017. While studies involving prostate cancer patients were included, studies on all other mixed pelvic malignancies were excluded. Results Seven articles met the inclusion criteria. There were 184 patients, with a mean age of 70 years (range: 51–94 years). PCN was performed for ureteric obstruction due to advanced prostate cancer, patients underwent unilateral (n = 66) or bilateral PCN (n = 118) with conversion to an antegrade stent in 25 patients. Their post-PCN survival varied between 4–31 months and this was longer if they were hormone naïve or showed a good recovery in their renal function. Although the complication rates were low (1–3%), patients spend a high proportion of their lives in the hospital. Conclusions PCNs should only be pursued after thoughtful counselling regarding further treatment options and prognosis as these patients with advanced malignancies seem to have reduced survival duration and spend a significant amount of time in hospital.
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Affiliation(s)
- Francesca New
- University Hospital Southampton NHS Trust, Department of Urology, Southampton, United Kingdom
| | - Sally Deverill
- University Hospital Southampton NHS Trust, Department of Urology, Southampton, United Kingdom
| | - Bhaskar K Somani
- University Hospital Southampton NHS Trust, Department of Urology, Southampton, United Kingdom.,University of Southampton, Department of PCPS, United Kingdom
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12
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Pelletier J, Cyr SJ, Julien AS, Fradet Y, Lacombe L, Toren P. Contemporary outcomes of palliative transurethral resection of the prostate in patients with locally advanced prostate cancer. Urol Oncol 2018; 36:363.e7-363.e11. [DOI: 10.1016/j.urolonc.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 03/19/2018] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
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13
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Reichard CA, Gregg JR, Achim MF, Aparicio AM, Pettaway CA, Pisters LL, Ward JF, Davis JW, Chapin BF. Radical Prostatectomy in Metastatic Castration-resistant Prostate Cancer: Feasibility, Safety, and Quality of Life Outcomes. Eur Urol 2018; 74:140-143. [PMID: 29656854 DOI: 10.1016/j.eururo.2018.03.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022]
Abstract
Ongoing prospective studies are evaluating treatment of the primary tumor in men with de novo metastatic prostate cancer (PCa). One potential benefit is prevention of morbidity from local progression. Thus, local therapy may be best applied selectively to men with local progression once resistance to first-line therapies has occurred. Here, we gather support for the hypothesis that radical prostatectomy (RP) is safe and preserves quality of life (QOL) when applied in men with metastatic castration-resistant PCa (mCRPC). We analyzed 14 patients who underwent RP in the setting of mCRPC from 2008 to 2016. Median time from mCRPC to RP was 5.1 mo (interquartile range [IQR] 1.4-12.0). Median preoperative and <3 mo postoperative Expanded Prostate Cancer Index Composite urinary function QOL scores were 84 (IQR 70-95) and 78 (IQR 62-81), respectively. There were one Clavien Grade III, three Grade II, and one Grade I complications postoperatively. In these patients with mCRPC, RP was feasible with limited minor complications. PATIENT SUMMARY We report on a select group of men with metastatic castration-resistant prostate cancer who had prostatectomy. Prostatectomy is highly investigational in this setting and should not be used outside of a clinical trial other than for symptom relief.
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Affiliation(s)
- Chad A Reichard
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Justin R Gregg
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Mary F Achim
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Ana M Aparicio
- Department of GU Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Curtis A Pettaway
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Louis L Pisters
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - John F Ward
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - John W Davis
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Brian F Chapin
- Department of Urology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA.
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Palliative Radical (Cysto-)prostatectomy for Locally Advanced, Symptomatic Castration-resistant Prostate Cancer. Eur Urol Focus 2016; 2:478-479. [DOI: 10.1016/j.euf.2016.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/17/2016] [Indexed: 12/11/2022]
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15
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Heidenreich A. New Developments in the Management of Prostate Cancer. Oncol Res Treat 2015; 38:628. [DOI: 10.1159/000442269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 11/09/2015] [Indexed: 11/19/2022]
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