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Jeong H, Choo MS, Cho MC, Son H, Yoo S. Prediction of surgical margin status and location after radical prostatectomy using positive biopsy sites on 12-core standard prostate biopsy. Sci Rep 2022; 12:4066. [PMID: 35260742 PMCID: PMC8904446 DOI: 10.1038/s41598-022-08022-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 02/23/2022] [Indexed: 12/24/2022] Open
Abstract
We evaluated the surgical margin status after radical prostatectomy according to sites positive for prostate cancer on standard 12-core transrectal ultrasound-guided prostate biopsy. Among patients who underwent radical prostatectomy at Boramae Medical Center, 520 patients with preoperative prostate-specific antigen (PSA) level < 20 ng/mL and locally confined prostate cancer on preoperative magnetic resonance imaging, treated with nerve-sparing radical prostatectomy, were included in the analysis. The surgical margin was positive for cancer in 166 (31.9% of the total) patients. The preoperative PSA level (9.3 vs. 8.0, ng/mL p = 0.001) and number of positive cores on 12-core prostate biopsy (4.1 vs. 3.4, p = 0.003) were significantly higher in patients with positive surgical margins. Moreover, the biopsy Gleason grade was higher in patients with positive surgical margins (p = 0.001). However, the pathologic Gleason grade and tumor volume were equivalent between the 2 groups. On multivariate analysis, the detection of prostate cancer on anterior lateral biopsy was associated with an increased rate of positive surgical margins (hazard ratio [HR]: 1.781, p = 0.008) after adjusting for other variables. Anterior lateral (HR: 1.919, p = 0.020), basal lateral (HR: 9.176, p < 0.001), basal medial (HR: 3.302, p = 0.031), and mid lateral (HR: 2.501, p = 0.044) biopsies were associated with positive apical, posterior, basal, and lateral surgical margins, respectively, after adjusting for other variables. The sites of prostate cancer on standard 12-core prostate biopsy could be useful for predicting surgical margin positivity after radical prostatectomy. In other words, clinicians should consider the sites of prostate cancer on prostate biopsy to reduce margin positivity after radical prostatectomy.
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Affiliation(s)
- Hyeon Jeong
- Department of Urology, Seoul National University Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Min Soo Choo
- Department of Urology, Seoul National University Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Min Chul Cho
- Department of Urology, Seoul National University Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Hwancheol Son
- Department of Urology, Seoul National University Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea
| | - Sangjun Yoo
- Department of Urology, Seoul National University Boramae Medical Center, Sindaebang 2(i)-dong, Dongjak-gu, Seoul, 07061, Korea.
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2
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Khanolkar RA, Quon H, Thind K, Sia M, Roumeliotis M, Husain S, McGeachy P, Meyer T, Martell K. Excessive waitlists and delays to treatment with low-dose-rate brachytherapy predict an increased risk of recurrence and metastases in intermediate-risk prostatic carcinoma. Clin Transl Radiat Oncol 2021; 30:38-42. [PMID: 34307912 PMCID: PMC8283023 DOI: 10.1016/j.ctro.2021.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
Resource constraints have led to prolonged wait-times for prostate brachytherapy. Increased wait times predict a significant increase in recurrence and metastases. Better resource planning is needed to reduce management delays & improve outcomes.
Purpose It has previously been shown that increased wait times for prostatectomy are associated with poorer outcomes in intermediate-risk prostatic carcinoma (PCa). However, the impact of wait times on PCa outcomes following low-dose-rate brachytherapy (LDR-BT) are unknown. Methods and Materials We retrospectively reviewed 466 intermediate-risk PCa patients that underwent LDR-BT at a single comprehensive cancer center between 2003 and 2016. Wait times were defined as the time from biopsy to LDR-BT. The association of wait times with outcomes was evaluated using Cox and Fine-Gray regression in both univariate and multivariate models. Results Median (interquartile range) follow-up and wait time for all patients were 8.1 (6.3–10.4) years and 5.1 (3.9–6.9) months, respectively. Among NCCN unfavourable intermediate-risk (UIR) patients (n = 170; 36%), increased wait times predicted both a greater cumulative incidence of recurrence [MHR = 1.01/month of wait time (95% CI: 1.00–1.03); P = 0.044] and metastases [MHR = 1.04/month of wait time (95% CI: 1.02–1.06); P < 0.001] in multivariate modeling. In NCCN favourable intermediate-risk (FIR) patients, there was no significant association between wait time and recurrence or metastases risk. Among all intermediate-risk patients, wait time was associated with an increase in the incidence of metastases [MHR = 1.03/month of wait time (95% CI: 1.02–1.05); P < 0.001], but not recurrence in multivariate models. There was no association between wait time and overall survival in the UIR, FIR, or all intermediate-risk cohorts. Conclusions Resource constraints within this center’s public healthcare system have contributed to waitlists exceeding 5-months in length. This study finds that patients with UIR PCa experience a 1% increase in the risk of recurrence and 4% increase in the risk of metastases with each additional month of delay in definitive disease management. Preventing such extended management delays in LDR-BT may improve disease-related outcomes in patients with PCa.
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Affiliation(s)
| | - Harvey Quon
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Kundan Thind
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Michael Sia
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Michael Roumeliotis
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Siraj Husain
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Philip McGeachy
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Tyler Meyer
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
| | - Kevin Martell
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Alberta Health Services, Calgary, AB, Canada
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3
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Effects of Delayed Radical Prostatectomy and Active Surveillance on Localised Prostate Cancer-A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13133274. [PMID: 34208888 PMCID: PMC8268689 DOI: 10.3390/cancers13133274] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary We reviewed the evidence available for postponing or delaying cancer surgery for localised prostate cancer. Watchful waiting is an acceptable option in low-risk patients. Evidence is uncertain in postponing surgery, but conservative estimates suggest delays of over 5 months, 4 months, and 30 days for low-, intermediate-, and high-risk patients, respectively, can lead to worse survival outcomes. Neoadjuvant therapy can shrink the tumours prior to surgery and can be a useful adjunct in delaying surgery for, at the most, 3 months. Abstract External factors, such as the coronavirus disease 2019 (COVID-19), can lead to cancellations and backlogs of cancer surgeries. The effects of these delays are unclear. This study summarised the evidence surrounding expectant management, delay radical prostatectomy (RP), and neoadjuvant hormone therapy (NHT) compared to immediate RP. MEDLINE and EMBASE was searched for randomised controlled trials (RCTs) and non-randomised controlled studies pertaining to the review question. Risks of biases (RoB) were evaluated using the RoB 2.0 tool and the Newcastle–Ottawa Scale. A total of 57 studies were included. Meta-analysis of four RCTs found overall survival and cancer-specific survival were significantly worsened amongst intermediate-risk patients undergoing active monitoring, observation, or watchful waiting but not in low- and high-risk patients. Evidence from 33 observational studies comparing delayed RP and immediate RP is contradictory. However, conservative estimates of delays over 5 months, 4 months, and 30 days for low-risk, intermediate-risk, and high-risk patients, respectively, have been associated with significantly worse pathological and oncological outcomes in individual studies. In 11 RCTs, a 3-month course of NHT has been shown to improve pathological outcomes in most patients, but its effect on oncological outcomes is apparently limited.
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4
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Laukhtina E, Sari Motlagh R, Mori K, Quhal F, Schuettfort VM, Mostafaei H, Katayama S, Grossmann NC, Ploussard G, Karakiewicz PI, Briganti A, Abufaraj M, Enikeev D, Pradere B, Shariat SF. Oncologic impact of delaying radical prostatectomy in men with intermediate- and high-risk prostate cancer: a systematic review. World J Urol 2021; 39:4085-4099. [PMID: 34047825 PMCID: PMC8160557 DOI: 10.1007/s00345-021-03703-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE To summarize the available evidence on the survival and pathologic outcomes after deferred radical prostatectomy (RP) in men with intermediate- and high-risk prostate cancer (PCa). METHODS The PubMed database and Web of Science were searched in November 2020 according to the PRISMA statement. Studies were deemed eligible if they reported the survival and pathologic outcomes of patients treated with deferred RP for intermediate- and high-risk PCa compared to the control group including those patients treated with RP without delay. RESULTS Overall, nineteen studies met our eligibility criteria. We found a significant heterogeneity across the studies in terms of definitions for delay and outcomes, as well as in patients' baseline clinicopathologic features. According to the currently available literature, deferred RP does not seem to affect oncological survival outcomes, such as prostate cancer-specific mortality and metastasis-free survival, in patients with intermediate- or high-risk PCa. However, the impact of deferred RP on biochemical recurrence rates remains controversial. There is no clear association of deferring RP with any of the features of aggressive disease such as pathologic upgrading, upstaging, positive surgical margins, extracapsular extension, seminal vesicle invasion, and lymph node invasion. Deferred RP was not associated with the need for secondary treatments. CONCLUSIONS Owing to the different definitions of a delayed RP, it is hard to make a consensus regarding the safe delay time. However, the current data suggest that deferring RP in patients with intermediate- and high-risk PCa for at least around 3 months is generally safe, as it does not lead to adverse pathologic outcomes, biochemical recurrence, the need for secondary therapy, or worse oncological survival outcomes.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Reza Sari Motlagh
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Men's Health and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Keiichiro Mori
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Fahad Quhal
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Victor M Schuettfort
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hadi Mostafaei
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Satoshi Katayama
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Nico C Grossmann
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Department of Urology, University Hospital Zurich, Zurich, Switzerland
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, Toulouse, France
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montreal Health Center, Montreal, Canada
| | - Alberto Briganti
- Department of Urology, Vita Salute San Raffaele University, Milan, Italy
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia. .,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. .,Department of Urology, Weill Cornell Medical College, New York, NY, USA. .,Department of Urology, University of Texas Southwestern, Dallas, TX, USA. .,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic. .,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria. .,European Association of Urology Research Foundation, Arnhem, Netherlands.
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5
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Piazza P, Bianchi L, Giampaoli M, Droghetti M, Casablanca C, Ercolino A, Beretta C, Recenti D, Balestrazzi E, Puliatti S, Rosiello G, Amato M, Romagnoli D, D'Agostino D, Gaudiano C, Golfieri R, Porreca A, Mottrie A, Schiavina R. Short Time Delay Between Previous Prostate Biopsy for Prostate Cancer Assessment and Holmium Laser Enucleation of the Prostate Correlates with Worse Perioperative Outcomes. Eur Urol Focus 2021; 8:563-571. [PMID: 33858812 DOI: 10.1016/j.euf.2021.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/08/2021] [Accepted: 04/04/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND No data are available regarding the impact of time between a previous transrectal prostate biopsy (PB) and holmium laser enucleation of the prostate (HoLEP) on perioperative outcomes. OBJECTIVE To evaluate the impact of time from PB to HoLEP on perioperative outcomes. DESIGN, SETTING, AND PARTICIPANTS A total of 172 consecutive patients treated with HoLEP within 12 mo of a single previous transrectal PB at two tertiary centers were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients were stratified into two groups according to the median time from PB to HoLEP (namely, ≤6 and >6 mo). The primary outcome was intraoperative complications. Multivariate logistic regressions were used to identify the predictors of intraoperative complications. Linear regressions were used to test the association between the time from PB to HoLEP and intraoperative complications, enucleation efficiency, and enucleation time. RESULTS AND LIMITATIONS In total, 93 (54%) and 79 (46%) patients had PB ≤ 6 and >6 mo before HoLEP, respectively. Patients in PB ≤ 6 mo group experienced higher rates of intraoperative complications than those in PB > 6 mo group (14% vs 2.6%, p = 0.04). At multivariable analysis, time between PB and HoLEP was an independent predictor of intraoperative complications (odds ratio: 0.74; 95% confidence interval: 0.6-0.9; p = 0.006). Finally, the risk of intraoperative complications reduced by 1.5%, efficiency of enucleation increased by 4.1%, and enucleation time reduced by 1.7 min for each month passed from PB to HoLEP (all p ≤ 0.006). Selection of patients with only one previous PB represents the main limitation. CONCLUSIONS The time from PB to HoLEP of ≤6 mo is associated with a higher risk of intraoperative complications, lower enucleation efficacy, and longer enucleation time. PATIENT SUMMARY Patients with a prostate biopsy (PB) ≤6 mo before holmium laser enucleation of the prostate (HoLEP) had significantly worse outcomes than those with a PB > 6 mo before HoLEP.
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Affiliation(s)
- Pietro Piazza
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy; ORSI Academy, Melle, Belgium
| | - Lorenzo Bianchi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy.
| | - Marco Giampaoli
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Matteo Droghetti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Casablanca
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Amelio Ercolino
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Carlo Beretta
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Dario Recenti
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Eleonora Balestrazzi
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
| | - Stefano Puliatti
- ORSI Academy, Melle, Belgium; Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Rosiello
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Amato
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | | | | | - Caterina Gaudiano
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Rita Golfieri
- Università degli Studi di Bologna, Bologna, Italy; Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Porreca
- Department of Urology, Veneto Institute of Oncology IOV - IRCCS, 35128 Padua, Italy
| | | | - Riccardo Schiavina
- Division of Urology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy; Università degli Studi di Bologna, Bologna, Italy
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6
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Guo Z, Gu C, Li S, Gan S, Li Y, Xiang S, Gong L, Wang S. Periodontal disease and the risk of prostate cancer: a meta-analysis of cohort studies. Int Braz J Urol 2021; 47:1120-1130. [PMID: 33650836 PMCID: PMC8486441 DOI: 10.1590/s1677-5538.ibju.2020.0333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/19/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Periodontal disease is reportedly associated with the risk of various systemic diseases, including pancreatic and lung cancers. However, its association with prostate cancer remains inconclusive. Herein, we explored the association of periodontal disease with the risk of prostate cancer through a meta-analysis. Materials and Methods: MEDLINE, Embase, Web of Sciences and Cochrane Library databases were searched for eligible publications up to April 2020. Multivariate adjusted risk estimates with corresponding 95% confidence intervals (CIs) were extracted and calculated using random- or fixed-effect models. Results: Nine cohort studies involving 3.353 prostate cancer cases with 440.911 participants were identified and included in the meta-analysis. We found that periodontal disease significantly increased the risk of prostate cancer by 1.40-fold (hazard ratio [HR]=1.40, 95% CI: 1.16-1.70; P=0.001; I2=76.1%) compared with normal condition. Interestingly, the risk of developing prostate cancer was not significant in patients treated with periodontal therapy (HR=1.22, 95% CI: 0.86-1.73; P=0.272; I2=65.2%). The results of subgroup analyses were also consistent and significant when stratified by study design and follow-up period, whereas conflicting results were observed in periodontal disease ascertainment stratification. These findings were robust as indicated by sensitivity analyses. Conclusions: Periodontal disease was associated with the increased risk of prostate cancer, whereas no significant association was observed in patients treated with periodontal therapy. Hence, the awareness and importance for maintaining oral health should be improved, and the underlying mechanisms linking periodontal disease and prostate cancer should be fully explored in future research.
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Affiliation(s)
- Zhenlang Guo
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chiming Gu
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Siyi Li
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Shu Gan
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuan Li
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Songtao Xiang
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Leiliang Gong
- Department of mechanical engineering, National University of Singapore, Kent Ridge, Singapore
| | - Shusheng Wang
- Department of Urology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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7
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Gacci M, Greco I, Artibani W, Bassi P, Bertoni F, Bracarda S, Briganti A, Carmignani G, Carmignani L, Conti GN, Corvò R, DE Nunzio C, Fusco F, Graziotti P, Maggi S, Magrini SM, Mirone V, Montironi R, Muto G, Noale M, Pecoraro S, Porreca A, Ricardi U, Russi E, Salonia A, Simonato A, Serni S, Tubaro A, Zagonel V, Crepaldi G. The waiting time for prostate cancer treatment in Italy: analysis from the PROS-IT CNR Study. Minerva Urol Nephrol 2020; 74:38-48. [PMID: 33200896 DOI: 10.23736/s2724-6051.20.03925-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer (PCa) is the second most common neoplasm in male patients. To date, there's no certain indication about the maximum waiting time (WT) acceptable for treatment beginning and the impact on oncological and functional outcomes has not been well established. METHODS Data from the National Research Council PCa monitoring multicenter project in Italy (Pros-IT CNR) were prospectively collected and analyzed. WT was defined as the time from the bioptical diagnosis of PCa to the first treatment received. Patients were divided in two groups, using a time frame of 90 days. Quality of life was measured through the Italian version of the University of California Los Angeles-Prostate Cancer Index (UCLA-PCI) and of the Short-Form Health Survey (SF-12). The occurrence of upgrading, upstaging, presence of lymph node metastasis and positive surgical margins at the final histopathological diagnosis, and PSA at 12 months follow-up were evaluated. RESULTS The overall median WT was 93 days. The logistic multivariable model confirmed that age, being resident in Southern regions of Italy and T staging at diagnosis were significantly associated with a WT>90 days. At 6 months from diagnosis the mean SF-12 score for the emotional-psychological component was significantly lower in WT≥90 days group (P=0.0428). Among patients treated with surgical approach, no significant differences in oncological outcomes were found in the two groups. CONCLUSIONS In our study age, clinical T stage and provenance from Southern regions of Italy are associated with a WT>90 days. WT might have no impact on functional and oncological outcome.
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Affiliation(s)
- Mauro Gacci
- Department of Urology, University of Florence, Florence, Italy -
| | - Isabella Greco
- Department of Urology, University of Florence, Florence, Italy
| | - Walter Artibani
- Urologic Clinic, Department of Oncological and Surgical Sciences, AOU Integrata and University of Verona, Verona, Italy
| | | | - Filippo Bertoni
- Italian Association for Radiation Oncology (AIRO), Milan, Italy
| | | | - Alberto Briganti
- Department of Urology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Luca Carmignani
- Department of Urology, San Donato Policlinic Hospital, Milan, Italy
| | | | - Renzo Corvò
- Department of Radiation Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Cosimo DE Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Ferdinando Fusco
- Department of Urology, University of Naples Federico II, Naples, Italy
| | | | - Stefania Maggi
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
| | - Stefano M Magrini
- Radiation Oncology Unit, Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Vincenzo Mirone
- Department of Urology, University of Naples Federico II, Naples, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of Marche, Ancona, Italy
| | - Giovanni Muto
- Department of Urology, Humanitas, Gradenigo Hospital, Turin, Italy
| | - Marianna Noale
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
| | | | - Angelo Porreca
- Department of Urology, Abano Terme General Hospital, Padua, Italy
| | - Umberto Ricardi
- Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy
| | - Elvio Russi
- Radiation Unit, San Croce e Carle Hospital, Cuneo, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology (URI), IRCCS San Raffaele Hospital, Milan, Italy
| | - Alchiede Simonato
- Section of Urology, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, Palermo, Italy
| | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Andrea Tubaro
- Department of Urology, Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | - Vittorina Zagonel
- Oncology Unit, Veneto Institute of Oncology (IOV-IRCCS), Padua, Italy
| | - Gaetano Crepaldi
- Institute of Neuroscience, National Research Council (CNR), Padua, Italy
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8
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Engl T, Mandel P, Hoeh B, Preisser F, Wenzel M, Humke C, Welte M, Köllermann J, Wild P, Deuker M, Kluth LA, Roos FC, Chun FKH, Becker A. Impact of "Time-From-Biopsy-to-Prostatectomy" on Adverse Oncological Results in Patients With Intermediate and High-Risk Prostate Cancer. Front Surg 2020; 7:561853. [PMID: 33102515 PMCID: PMC7545071 DOI: 10.3389/fsurg.2020.561853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/21/2020] [Indexed: 01/12/2023] Open
Abstract
Objective: Many patients with localized prostate cancer (PCa) do not immediately undergo radical prostatectomy (RP) after biopsy confirmation. The aim of this study was to investigate the influence of “time-from-biopsy-to- prostatectomy” on adverse pathological outcomes. Materials and Methods: Between January 2014 and December 2019, 437 patients with intermediate- and high risk PCa who underwent RP were retrospectively identified within our prospective institutional database. For the aim of our study, we focused on patients with intermediate- (n = 285) and high-risk (n = 151) PCa using D'Amico risk stratification. Endpoints were adverse pathological outcomes and proportion of nerve-sparing procedures after RP stratified by “time-from-biopsy-to-prostatectomy”: ≤3 months vs. >3 and < 6 months. Medians and interquartile ranges (IQR) were reported for continuously coded variables. The chi-square test examined the statistical significance of the differences in proportions while the Kruskal-Wallis test was used to examine differences in medians. Multivariable (ordered) logistic regressions, analyzing the impact of time between diagnosis and prostatectomy, were separately run for all relevant outcome variables (ISUP specimen, margin status, pathological stage, pathological nodal status, LVI, perineural invasion, nerve-sparing). Results: We observed no difference between patients undergoing RP ≤3 months vs. >3 and <6 months after diagnosis for the following oncological endpoints: pT-stage, ISUP grading, probability of a positive surgical margin, probability of lymph node invasion (LNI), lymphovascular invasion (LVI), and perineural invasion (pn) in patients with intermediate- and high-risk PCa. Likewise, the rates of nerve sparing procedures were 84.3 vs. 87.4% (p = 0.778) and 61.0% vs. 78.8% (p = 0.211), for intermediate- and high-risk PCa patients undergoing surgery after ≤3 months vs. >3 and <6 months, respectively. In multivariable adjusted analyses, a time to surgery >3 months did not significantly worsen any of the outcome variables in patients with intermediate- or high-risk PCa (all p > 0.05). Conclusion: A “time-from-biopsy-to-prostatectomy” of >3 and <6 months is neither associated with adverse pathological outcomes nor poorer chances of nerve sparing RP in intermediate- and high-risk PCa patients.
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Affiliation(s)
- Tobias Engl
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.,Urogate Associates, Frankfurt am Main, Germany
| | - Philipp Mandel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany.,Urogate Associates, Frankfurt am Main, Germany
| | - Felix Preisser
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Mike Wenzel
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Clara Humke
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Maria Welte
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Jens Köllermann
- Department of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Peter Wild
- Department of Pathology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Marina Deuker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Frederik C Roos
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Frankfurt am Main, Germany
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9
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Diamand R, Ploussard G, Roumiguié M, Oderda M, Benamran D, Fiard G, Peltier A, Simone G, Van Damme J, Malavaud B, Iselin C, Descotes JL, Roche JB, Quackels T, Roumeguère T, Albisinni S. Timing and delay of radical prostatectomy do not lead to adverse oncologic outcomes: results from a large European cohort at the times of COVID-19 pandemic. World J Urol 2020; 39:1789-1796. [PMID: 32776243 PMCID: PMC7416303 DOI: 10.1007/s00345-020-03402-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/03/2020] [Indexed: 11/03/2022] Open
Abstract
PURPOSE The current COVID-19 pandemic is transforming our urologic practice and most urologic societies recommend to defer any surgical treatment for prostate cancer (PCa) patients. It is unclear whether a delay between diagnosis and surgical management (i.e., surgical delay) may have a detrimental effect on oncologic outcomes of PCa patients. The aim of the study was to assess the impact of surgical delay on oncologic outcomes. METHODS Data of 926 men undergoing radical prostatectomy across Europe for intermediate and high-risk PCa according to EAU classification were identified. Multivariable analysis using binary logistic regression and Cox proportional hazard model tested association between surgical delay and upgrading on final pathology, lymph-node invasion (LNI), pathological locally advanced disease (pT3-4 and/or pN1), need for adjuvant therapy, and biochemical recurrence. Kaplan-Meier analysis was used to estimate BCR-free survival after surgery as a function of surgical delay using a 3 month cut-off. RESULTS Median follow-up and surgical delay were 26 months (IQR 10-40) and 3 months (IQR 2-5), respectively. We did not find any significant association between surgical delay and oncologic outcomes when adjusted to pre- and post-operative variables. The lack of such association was observed across EAU risk categories. CONCLUSION Delay of several months did not appear to adversely impact oncologic results for intermediate and high-risk PCa, and support an attitude of deferring surgery in line with the current recommendation of urologic societies.
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Affiliation(s)
- Romain Diamand
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium.
| | | | | | - Marco Oderda
- Urology Department, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Daniel Benamran
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Gaelle Fiard
- Urology Department, CHU de Grenoble, Grenoble, France.,Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Giuseppe Simone
- Urology Department, IRCCS "Regina Elena" National Cancer Institute, Rome, Italy
| | - Julien Van Damme
- Urology Department, University Clinics Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Bernard Malavaud
- Urology Department, Institut Universitaire du Cancer Toulouse-Oncopole, Toulouse, France
| | - Christophe Iselin
- Urology Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jean-Luc Descotes
- Urology Department, CHU de Grenoble, Grenoble, France.,Grenoble Alpes University, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | | | - Thierry Quackels
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Thierry Roumeguère
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
| | - Simone Albisinni
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Route de Lennik 808, 1070, Brussels, Belgium
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10
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Wallis CJD, Novara G, Marandino L, Bex A, Kamat AM, Karnes RJ, Morgan TM, Mottet N, Gillessen S, Bossi A, Roupret M, Powles T, Necchi A, Catto JWF, Klaassen Z. Risks from Deferring Treatment for Genitourinary Cancers: A Collaborative Review to Aid Triage and Management During the COVID-19 Pandemic. Eur Urol 2020; 78:29-42. [PMID: 32414626 PMCID: PMC7196384 DOI: 10.1016/j.eururo.2020.04.063] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
Abstract
Context The coronavirus disease 2019 (COVID-19) pandemic is leading to delays in the treatment of many urologic cancers. Objective To provide a contemporary picture of the risks from delayed treatment for urologic cancers to assist with triage. Evidence acquisition A collaborative review using literature published as of April 2, 2020. Evidence synthesis Patients with low-grade non–muscle-invasive bladder cancer are unlikely to suffer from a 3–6-month delay. Patients with muscle-invasive bladder cancer are at risk of disease progression, with radical cystectomy delays beyond 12 wk from diagnosis or completion of neoadjuvant chemotherapy. Prioritization of these patients for surgery or management with radiochemotherapy is encouraged. Active surveillance should be used for low-risk prostate cancer (PCa). Treatment of most patients with intermediate- and high-risk PCa can be deferred 3–6 mo without change in outcomes. The same may be true for cancers with the highest risk of progression. With radiotherapy, neoadjuvant androgen deprivation therapy (ADT) is the standard of care. For surgery, although the added value of neoadjuvant ADT is questionable, it may be considered if a patient is interested in such an approach. Intervention may be safely deferred for T1/T2 renal masses, while locally advanced renal tumors (≥T3) should be treated expeditiously. Patients with metastatic renal cancer may consider vascular endothelial growth factor targeted therapy over immunotherapy. Risks for delay in the treatment of upper tract urothelial cancer depend on grade and stage. For patients with high-grade disease, delays of 12 wk in nephroureterectomy are not associated with adverse survival outcomes. Expert guidance recommends expedient local treatment of testis cancer. In penile cancer, adverse outcomes have been observed with delays of ≥3 mo before inguinal lymphadenectomy. Limitations include a paucity of data and methodologic variations for many cancers. Conclusions Patients and clinicians should consider the oncologic risk of delayed cancer intervention versus the risks of COVID-19 to the patient, treating health care professionals, and the health care system. Patient summary The coronavirus disease 2019 pandemic has led to delays in the treatment of patients with urologic malignancies. Based on a review of the literature, patients with high-grade urothelial carcinoma, advanced kidney cancer, testicular cancer, and penile cancer should be prioritized for treatment during these challenging times.
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Affiliation(s)
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology-Urology Clinic, University of Padua, Padua, Italy
| | - Laura Marandino
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Axel Bex
- Royal Free London NHS Foundation Trust, UCL Division of Surgery and Interventional Science, London, UK
| | - Ashish M Kamat
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Todd M Morgan
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Nicolas Mottet
- Department of Urology, University hospital Nord, St Etienne, France
| | - Silke Gillessen
- Department of Medical Oncology, Istituto Oncologico della Svizzera Italiana, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Alberto Bossi
- Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France
| | - Morgan Roupret
- Urology, GRC n°5, PREDICTIVE ONCO-URO, AP-HP, Pitié Salpetriere Hospital, Sorbonne University, Paris, France; European Section of Onco Urology, EAU
| | - Thomas Powles
- Barts Cancer Center, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - James W F Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK.
| | - Zachary Klaassen
- Department of Surgery, Division of Urology, Augusta University-Medical College of Georgia, Augusta, GA, USA; Georgia Cancer Center, Augusta, GA, USA.
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11
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Diniz ALL. Editorial Comment: Acute prostatitis after prostate biopsy under ciprofloxacin prophylaxis with or without ornidazole and pre-biopsy enema: analysis of 3.479 prostate biopsy cases. Int Braz J Urol 2019; 46:67-69. [PMID: 31851460 PMCID: PMC6968898 DOI: 10.1590/s1677-5538.ibju.2019.0257.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Andre Luiz Lima Diniz
- Instituto Nacional do Câncer - INCA, Rio de Janeiro, RJ, Brasil, Brasil.,Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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12
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Favorito LA. The multiparametric prostate resonance imaging with the prostate imaging-reporting and data system (PI-RADS): the state of art of prostate cancer diagnosis. Int Braz J Urol 2019; 45:422-423. [PMID: 31149788 PMCID: PMC6786123 DOI: 10.1590/s1677-5538.ibju.2019.03.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Luciano Alves Favorito
- Univ. Estadual do Rio de Janeiro – UERJ, Brasil; Hospital Federal da Lagoa, Brasil; , Brasil
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