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Sankarapillai J, Krishnan S, Ramamoorthy T, Sudarshan KL, Mathur P. Descriptive epidemiology of prostate cancer in India, 2012-2019: Insights from the National Cancer Registry Programme. Indian J Urol 2024; 40:167-173. [PMID: 39100620 PMCID: PMC11296585 DOI: 10.4103/iju.iju_27_24] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/24/2024] [Accepted: 05/22/2024] [Indexed: 08/06/2024] Open
Abstract
Purpose This study describes the epidemiology, clinical extent at diagnosis, and treatment modalities for prostate cancer in India. Methodology This study is a secondary analysis of primary prostate cancer data sourced from the National Cancer Registry Programme. Data from population-based cancer registry for the period 2012-2016 were used to estimate the incidence rates, including crude incidence rate (CR), age-adjusted incidence rate (AAR), age-specific rate, and cumulative risk. Trends in the AAR were assessed using join-point regression. Hospital-Based Cancer Registry data from 2012 to 2019 were used to describe the clinical extent of the cancer at diagnosis and the treatment modalities. Results The incidence of prostate cancers was higher in urban registries such as Delhi, Kamrup Urban, and Mumbai (AAR of 11.8 per 100,000, 10.9 per 100,000, and 9.7 per 100,000, respectively). Prostate cancer incidence showed a rise after the age of 50, with a notable acceleration after age 64. The overall annual percentage change for prostate cancer incidence from 1982 to 2016 was 2.6. Around 43.0% of all prostate cancers were diagnosed at the distant metastatic stage. Surgery and radiotherapy, either as standalone treatments or in combination with other modalities, contributed to the treatment of 78.5% of localized cancer, 74.2% of locoregional cancer, and 57.2% of distant metastatic stage of prostate cancer. Conclusion There is heterogeneity in the incidence of prostate cancer, as evidenced by urban registries. Additionally, there is a need for downstaging the disease, without risking overdiagnosis.
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Affiliation(s)
- Jayasankar Sankarapillai
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Sathishkumar Krishnan
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | - Thilagavathi Ramamoorthy
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
| | | | - Prashant Mathur
- National Centre for Disease Informatics and Research, Indian Council of Medical Research, Bengaluru, Karnataka, India
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Sivaraman A, Ramasamy V, Aarthy P, Sankar V, Sivaraman PB. Safety and feasibility of freehand transperineal prostate biopsy under local anesthesia: Our initial experience. Indian J Urol 2022; 38:34-41. [PMID: 35136293 PMCID: PMC8796764 DOI: 10.4103/iju.iju_222_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 10/15/2021] [Accepted: 12/06/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION With the emergence of multidrug-resistant organisms causing urosepsis after transrectal biopsy of prostate, the need for an alternative approach has increased. We assessed the safety and feasibility of transrectal ultrasound (TRUS) guided free-hand transperineal prostate biopsy under local anesthesia (LA) for suspected prostate cancer. MATERIALS AND METHODS This prospective study was conducted from July 2019 to December 2020 in which patients with elevated prostate-specific antigen (PSA) and/or abnormal digital rectal examination underwent magnetic resonance imaging-TRUS cognitive fusion transperineal prostate biopsy (target and systematic) using coaxial needle. Demographic, perioperative, and outcome data of 50 consecutive patients were analyzed. RESULTS The mean age of the patients was 69.6 ± 7.61 years, median PSA 13.55 ng/mL (4.17-672) and prostate size 45cc (16-520). Prostate Imaging-Reporting and Data System (PIRADS) 2, 3, 4, and 5 lesions were found in 2, 12, 12, and 24 patients, respectively. Average procedure duration was 20 min (15-40 min) and number of cores ranged from 12 to 38 (median 20). Forty out of fifty (40/50) patients experienced only mild pain with visual analog scale ≤2. Histopathological examination showed adenocarcinoma, benign prostatic hyperplasia, and chronic prostatitis in 41, 5, and 4 patients respectively with 82% cancer detection rate (CDR). Over 95% of cases showed clinically significant cancer (International Society of Urological Pathology class ≥ 2) and 91.7% of patients with PIRADS score 4/5 and 66.7% with PIRADS score 3 had malignancy. Three patients developed complications (two hematuria, one urinary retention), both were managed conservatively and none had urosepsis. CONCLUSIONS Free-hand transperineal prostate biopsy by coaxial needle technique under LA is safe and feasible with good tolerability, high CDR, and minimal complications particularly reduced urosepsis.
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Affiliation(s)
- Ananthakrishnan Sivaraman
- Department of Urology, Uro-Oncology and Robotic Surgery, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India
| | - Vasantharaja Ramasamy
- Department of Urology, Uro-Oncology and Robotic Surgery, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India
| | - P. Aarthy
- Department of Urology, Uro-Oncology and Robotic Surgery, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India
| | - Vinoth Sankar
- Department of Urology, Uro-Oncology and Robotic Surgery, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India
| | - P. B. Sivaraman
- Department of Urology, Uro-Oncology and Robotic Surgery, Chennai Urology and Robotics Institute, Chennai, Tamil Nadu, India
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Kumar A, Yadav S, Krishnappa RS, Gautam G, Raghavan N, Bakshi G, Prakash G, Ahluwalia P, Tamankar A, Surekha S, Kumar N, Kumar S, Mallya A, Saini G, Singhal M, Mavuduru R, Nayak B, Singh P, Jaipuria J, Kumar V, Rawal SK, Gupta NP. The Urological Society of India guidelines for the evaluation and management of prostate cancer (executive summary). Indian J Urol 2022; 38:252-257. [PMID: 36568450 PMCID: PMC9787438 DOI: 10.4103/iju.iju_232_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 08/09/2022] [Indexed: 12/27/2022] Open
Affiliation(s)
- Anup Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India,
E-mail:
| | - Siddharth Yadav
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | | - Gagan Gautam
- Department of Urology, Max Super Specialty Hospital, Bengaluru, Karnataka, India
| | | | - Ganesh Bakshi
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Gagan Prakash
- Department of Urology, Tata Memorial Hospital, Mumbai, India
| | - Puneet Ahluwalia
- Department of Urology, Max Super Speciality Hospital, Gaziabad, India
| | - Ashwin Tamankar
- Department of Urology, Apollo Hospital, Navi Mumbai, Maharashtra, India
| | - Sanjoy Surekha
- Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Luckhnow, India
| | - Niraj Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sandeep Kumar
- Department of Urology and Renal Transplant, Vardhaman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Ashwin Mallya
- Department of Urology, Sir Ganga Ram Hospital, New Delhi, India
| | - Gagan Saini
- Department of Radiation Oncology, Fortis Internation Oncology Center, Noida, Uttar Pradesh, India
| | - Manish Singhal
- Department of Medical Oncology, Apollo Hospital, New Delhi, India
| | - Ravimohan Mavuduru
- Department of Urology, Post Graduate Institute of Medical Sciences, Chandigarh, India
| | - Brusabhanu Nayak
- Department of Urology, All Indian Institute of Medical Sciences, New Delhi, India
| | - Prabhjot Singh
- Department of Urology, All Indian Institute of Medical Sciences, New Delhi, India
| | - Jiten Jaipuria
- Departmetn of Urology, Rajiv Gandhi Cancer Institute and Cancer Center, Noida, Uttar Pradesh, India
| | - Vijoy Kumar
- Department of Urology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sudhir K Rawal
- Departmetn of Urology, Rajiv Gandhi Cancer Institute and Cancer Center, Noida, Uttar Pradesh, India
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Does prior transurethral resection of prostate affect the functional and oncological outcomes of robot-assisted radical prostatectomy? A matched-pair analysis. J Robot Surg 2021; 16:1091-1097. [PMID: 34839463 DOI: 10.1007/s11701-021-01339-9] [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: 09/19/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
Robot-assisted radical prostatectomy (RARP) is challenging in men with prior history of transurethral resection of the prostate (TURP). Few studies analyze this peculiar group of patients, and hence we sought to investigate the outcome of RARP in post-TURP men. We interrogated our prospectively maintained database containing 643 patients who underwent RARP from January 2012 to December 2020. We matched 36 men with prior history of TURP consecutively to 72 men without prior TURP. The groups were matched for age, body mass index (BMI), Charlson comorbidity index (CCI), serum PSA, International Society of Urological Pathology (ISUP) grade groups and clinical stage. Men with prior history of stricture surgeries, pelvic radiation, ablative laser procedures, Urolift and Rezum were excluded from the study. Fisher's Exact test/Chi-square was used for the comparison of categorical variables. Mann-Whitney test (Independent group/Unpaired data) and Wilcoxon sign rank test (for paired data) were employed to analyze continuous variables. The complication rates, median day of drain removal and length of hospital stay were similar between the groups. The TURP group required bladder neck reconstruction twice as often as the non-TURP group (58.3% versus 29.1%, p = 0.0035) and a longer duration of postoperative catheterization (10 versus 8 days, p = 0.0005). The rate of positive surgical margins was higher in the TURP group (30.5% versus 25%, p = 0.5414), albeit statistically insignificant. Biochemical recurrence (BCR) at one year (48.8% versus 60%, p = 0.0644) and zero pad/one safety-pad continence rates at one, three, six and twelve months were also not significantly different (14.3%, 35.4%, 59.2%, 81.6% for non TURP group versus 9.1%, 28.6%, 53.6%, 76.0% for TURP group). On multivariate analysis, prior TURP was not associated with a higher risk of BCR, margin positivity or incontinence. The oncological and functional outcomes of RARP post-TURP are comparable to men without prior TURP.
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Robot-assisted radical prostatectomy in indian men of age 75 years and above: a propensity score-matched analysis. J Robot Surg 2021; 16:799-806. [PMID: 34455530 DOI: 10.1007/s11701-021-01301-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Older men undergoing robot-assisted radical prostatectomy (RARP) have been thought to have worse perioperative, functional and oncological outcomes than younger men. However, there is a dearth of matched studies on this subject in the currently available literature. Our study is a matched pair analysis of perioperative, oncological and functional outcomes of RARP in men < 75 years of age versus ≥ 75 years (62 in each group). There was no statistically significant difference in complications, length of stay, pathological stage, positive surgical margins (PSM) and nodal involvement. Older men were less likely to undergo nerve sparing in our study (8.0 vs 75.8% p = 0.01). Potency rates were too low to be compared. The 1-year continence rates, time to continence and the proportion of men with biochemical recurrence (BCR) were similar between the groups. Men ≥ 75 years developed BCR much earlier than < 75 years (30 versus 78 months p = 0.07). However, this was not statistically significant. Age ≥ 75 years was associated with a statistically insignificant 53.5% rise in the risk of BCR. It was also not associated with any increased risk of postoperative complications or PSM. RARP is a safe procedure in senior adults. The oncological and functional outcomes of RARP in senior adults are similar to younger men.
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Forster LR, Jelley C, Breeze CE, Singh R, Chahal R, Addla SK. Prostate cancer in the British Asian population: A case-control study. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820969574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives: To study demographic and disease variables at presentation, diagnosis and treatment of prostate cancer in British South Asian (SA) men and compare with their Caucasian counterparts. Methods: A retrospective review of prostate cancer cases between 2010 and 2015 identified patients of SA descent who were matched for age, residential location and year of diagnosis with two Caucasian patients. Disease characteristics, treatment and short-term outcomes were recorded and compared. Results: A total of 1274 patients were diagnosed, of which 50 (3.9%) were SA. SA patients had less screen-detected prostate cancer (12% versus 31%, p=0.02), more co-morbidity and more high-risk disease (57% versus 37%, p=0.03). Active surveillance was the preferred treatment option (32%) with 2% having surgery compared with 22% ( p=0.003) from the Caucasian cohort. Logistic regression showed these disparities to be related to the different presentations. Conclusion: SA men with prostate cancer are less likely to be diagnosed following asymptomatic screening and the majority have high-risk disease at presentation. These differences lead to SA men preferring active surveillance to radical surgery. Given the increasing British Asian population, the findings demonstrate a need for research and public health interventions to better understand and address the differences noted between these groups.
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Affiliation(s)
- Luke R Forster
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Clare Jelley
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Royal Berkshire Hospital, Reading, UK
| | | | - Rajindra Singh
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Rohit Chahal
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Sanjai K Addla
- Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
- Apollo Cancer Institute, Apollo Health City, Hyderabad, India
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Singh S, Patil S, Tamhankar AS, Ahluwalia P, Gautam G. Low-risk prostate cancer in India: Is active surveillance a valid treatment option? Indian J Urol 2020; 36:184-190. [PMID: 33082633 PMCID: PMC7531380 DOI: 10.4103/iju.iju_37_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/08/2020] [Accepted: 05/03/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction and Objective: Carcinoma prostate is considered highly aggressive in Asian countries such as India. This raises an argument whether active surveillance (AS) gives a false sense of security as opposed to upfront radical prostatectomy (RP) in Indian males with low-risk prostate cancer (PCa). We analyzed our prospectively maintained robot-assisted RP (RARP) database to address this question. Materials and Methods: Five hundred and sixty-seven men underwent RARP by a single surgical team from September 2013 to September 2019. Of these, 46 (8.1%) were low risk considering the National Comprehensive Cancer Network criteria. Gleason grade group and stage were compared before and after surgery to ascertain the incidence of upgrading and upstaging. Preoperative clinical and pathological characteristics were analyzed for association with the probability of upstaging and upgrading. Results: The mean age was 60.8 ± 6.8 years. Average prostate-specific antigen level was 6.7 ± 2.0 ng/mL. 40 (86.9%) patients had a T1 stage disease and 6 (13%) patients were clinically in T2a stage. A total of 25 (54.3%) cases were either upstaged or upgraded, 19 (41.3%) showed no change, and the remaining 2 (4.3%) had no malignancy on the final RP specimen. Upstaging occurred in 8 (17.4%) cases: 5 (10.9%) to pT3a and 3 (6.5%) to pT3b. Upgrading occurred in 23 (50%) cases: 19 (41.3%) to Grade 2; 3 (6.5%) to Grade 3; and 1 (2.2%) to Grade 4. Conclusions: There is a 50% likelihood of upstaging or upgrading in Indian males with low-risk PCa eligible for AS. Decision to proceed with AS should be taken carefully.
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Affiliation(s)
- Shanky Singh
- Department of Urology, AIIMS, Rishikesh, Uttarakhand, India
| | - Saurabh Patil
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
| | | | - Puneet Ahluwalia
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
| | - Gagan Gautam
- Department of Urooncology, Max Institute of Cancer Care, New Delhi, India
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Abdollah F, Arora S, Jindal T, Gild P, Sood A, Yuvaraja TB, Ahlawat RK, Gupta NP, Bhandari M, Menon M. Utilization of pelvic lymph node dissection in patients undergoing robot-assisted radical prostatectomy in India versus the United States - A Vattikuti Collective Quality Initiative database analysis. Indian J Cancer 2018; 54:421-425. [PMID: 29469070 DOI: 10.4103/ijc.ijc_227_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The utilization and extent of pelvic lymph node dissection (PLND) varies depending on the disease and practice patterns. AIMS This study compares practice patterns in utilization of PLND between Indian and United States (US) practices. SETTINGS AND DESIGN We focused on 415 patients (204 India; 211 US) prostate cancer patients treated with robot-assisted radical prostatectomy, between 2015 and 2016, within the Vattikuti Collective Quality Initiative database. SUBJECTS AND METHODS Utilization of PLND and number of nodes removed were evaluated for the entire cohort, and after stratifying for Country of treatment and D'Amico risk groups. Logistic regression tested the relationship between PLND and country of treatment, after adjusting for disease risk. RESULTS Indian patients had a higher risk distribution (D'Amico high-risk 53.4% in India vs. 27% in the US; P< 0.001) compared to their US counterparts. Overall, 193/204 (94.6%) Indian patients underwent PLND versus 181/211 (85.8%) US patients (P = 0.003). When stratified based on disease risk, PLND was performed more frequently in Indian patients with low-risk disease (81.0% vs. 41.4%,P= 0.008), but not in those with intermediate and high-risk disease. On multivariable analysis, Indian patients had a 2.57-fold higher probability of undergoing PLND than their US counterparts (P = 0.02). The analysis of the number of lymph nodes removed showed similar trends. CONCLUSIONS Indian patients are more likely to undergo PLND than US patients. This is, especially true for patients with low-risk disease, who are unlikely to benefit from this procedure. Efforts should focus on optimizing the utilization of PLND, and deliver it only when there is clinical indication.
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Affiliation(s)
- F Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - S Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - T Jindal
- Department of Urology and Kidney Transplant, Fortis Escorts Kidney and Urology Institute, New Delhi, India
| | - P Gild
- Department of Urology, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - A Sood
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - T B Yuvaraja
- Department of Urology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India
| | - R K Ahlawat
- Department of Urology and Kidney Transplant, Fortis Escorts Kidney and Urology Institute, New Delhi, India
| | - N P Gupta
- Department of Urology, Medanta Kidney and Urology Institute, Gurgaon, Haryana, India
| | - M Bhandari
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - M Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
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Preoperative Predictors of Extraprostatic Extension of Prostate Cancer (pT3a) in a Contemporary Indian Cohort. Indian J Surg Oncol 2017; 8:331-336. [DOI: 10.1007/s13193-017-0671-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 05/30/2017] [Indexed: 10/19/2022] Open
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Abstract
Introduction: The incidence of prostate cancer has shown significant variation across the globe. Though the prevalence and characteristics of this disease have been extensively studied in many countries, data regarding the true incidence of prostate cancer in India is limited. Materials and Methods: MEDLINE publications from 1990 to 2014 were searched and reviewed and compiled to assess the demographic profile of prostate cancer in India and characteristics unique to this disease in India. Results: The limited data available on prostate cancer showed significant differences in incidence, precipitating factors, and disease characteristics of prostate cancer in India. Conclusions: Since India would be having more number of cases of prostate cancer than most others in the years to come, adequate population-based data regarding the demography and disease characteristics of this disease are of paramount importance in this country.
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Somford D, Hamoen E, Fütterer J, van Basten J, Hulsbergen-van de Kaa C, Vreuls W, van Oort I, Vergunst H, Kiemeney L, Barentsz J, Witjes J. The Predictive Value of Endorectal 3 Tesla Multiparametric Magnetic Resonance Imaging for Extraprostatic Extension in Patients with Low, Intermediate and High Risk Prostate Cancer. J Urol 2013; 190:1728-34. [DOI: 10.1016/j.juro.2013.05.021] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
Affiliation(s)
- D.M. Somford
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - E.H. Hamoen
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.J. Fütterer
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.P. van Basten
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | | | - W. Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - I.M. van Oort
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - H. Vergunst
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - L.A. Kiemeney
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.O. Barentsz
- Department of Radiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J.A. Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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