Laparoscopic and robotic radical prostatectomy

Label-free high-resolution imaging of prostate glands and cavernous nerves using coherent anti-Stokes Raman scattering microscopy

A custom built coherent anti-Stokes Raman scattering (CARS) microscope was used to image prostatic glands and nerve structures from 17 patients undergoing radical prostatectomy. Imaging of glandular and nerve structures showed distinctive cellular features that correlated to histological stains. Segmentation of cell nucleus was performed to establish a cell feature-based model to separate normal glands from cancer glands. In this study, we use a single parameter, average cell neighbor distance based on CARS imaging, to characterize normal and cancerous glandular structures. By combining CARS with our novel classification model, we are able to characterize prostate glandular and nerve structures in a manner that potentially enables real-time, intra-operative assessment of surgical margins and neurovascular bundles. As such, this method could potentially improve outcomes following radical prostatectomy.

A case-controlled study of total laparoscopic radical hysterectomy with pelvic lymphadenectomy versus radical abdominal hysterectomy in a fellowship training program

To determine whether total laparoscopic radical hysterectomy (TLRH) is a feasible alternative to an abdominal radical hysterectomy (ARH) in a gynecologic oncology fellowship training program. We prospectively collected cases of all of the patients with cervical cancer treated with TLRH and pelvic lymphadenectomy by our division from 2000 to 2006. All of the patients from the TLRH group were matched 1:1 with the patients who had ARH during the same period based on stage, age, histological subtype, and nodal status. Thirty patients were treated with TLRH with a mean age of 48.3 years (range, 29–78 years). The mean pelvic lymph node count was 31 (range, 10–61) in the TLRH group versus 21.8 (range, 8–42) (P < 0.01) in the ARH group. Mean estimated blood loss was 200 cc (range, 100–600 cc) in the TLRH with no transfusions compared to 520 cc in the ARH group (P < 0.01), in which five patients required transfusions. Mean operating time was 318.5 min (range, 200–464 min) compared to 242.5 min in the ARH group (P < 0.01), and mean hospital stay was 3.8 days (range, 2–11 days) compared to 5.6 days in the ARH group (P < 0.01). All TLRH cases were completed laparoscopically. All patients in the TLRH group are disease free at the time of this report. In conclusion, it is feasible to incorporate TLRH training into the surgical curriculum of gynecologic oncology fellows without increasing perioperative morbidity. Standardization of TLRH technique and consistent guidance by experienced faculty is imperative.

Surgery Versus Implant for Early Prostate Cancer: Results From a Single Institution, 1992–2005

PURPOSE

The aim of this study was to compare the biochemical disease-free survival rates for radical prostatectomy versus transperineal ultrasound-guided prostate implant for patients with early prostate cancer treated at a single institution from 1992 through 2005.

MATERIALS AND METHODS

The charts of 741 patients with early prostate cancer (350 implant and 391 surgery) treated from 1992 through 2005 were retrospectively reviewed. Surgery patients were treated by members of the academic Urology Section at Yale University School of Medicine. Implant patients were treated by a combined team from the Urology Section and the Department of Therapeutic Radiology at Yale Medical School. For the 350 implant patients, 35% were treated with iodine-125 and 65% with palladium-103. Of the implant patients 92% were treated with an implant alone and 8% with combined external beam radiation therapy plus an implant and 25% received short-term hormone therapy to downsize the prostate before the implant. Both surgery and implant patients were analyzed based on a group with favorable cancers (clinical stage T1c or T2, prostate-specific antigen <10, and Gleason score <7), an intermediate group (any 1 factor increased compared with the favorable group), and a poor group (any 2 factors increased compared with the favorable group). The follow-up time varied from 12 to 120 months with a mean/median follow-up time of 44 months/42 months for implant patients and 42 months/40 months for surgery patients. Prostate-specific antigen recurrence for surgery was defined as any detectable prostate-specific antigen after surgery. Prostate-specific antigen recurrence for implant was defined as the prostate-specific antigen nadir plus 2 ng/mL after implant. The biochemical disease-free survival rates were calculated using the life-table method.

RESULTS

The 5-year biochemical disease-free survival rates for radical prostatectomy versus implant were identical for the favorable group (93% versus 92%), intermediate group (70% versus 70%), and poor group (50% versus 52%) patients.

CONCLUSIONS

From 1992 through 2005, implant therapy produced equivalent 5-year biochemical disease-free survival rates compared with surgery in patients with early prostate cancer treated at a single institution.