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Suartz CV, Cordeiro MD, de Carvalho PA, Gallucci FP, Ribeiro‐Filho LA, Cardili L, Sivaraman A, Audenet F, Mota JM, Nahas WC. Scoring system for prediction of overall survival in patients with renal cell carcinoma T3aN0M0. BJUI Compass 2024; 5:289-296. [PMID: 38371207 PMCID: PMC10869657 DOI: 10.1002/bco2.309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/27/2023] [Accepted: 10/24/2023] [Indexed: 02/20/2024] Open
Abstract
Objective We aim to create a new score to predict postoperative overall survival in patients with nonmetastatic T3aN0 renal cell carcinoma. Methods We reviewed the clinical data of adult patients who underwent radical nephrectomy for renal cell carcinoma between December 2007 and January 2022 in a single tertiary oncological institution. Clinical characteristics, clinical-pathological staging and histopathological characteristics were analysed. Survival analyses were determined using the Kaplan-Meier curve. A nomogram was established using Cox proportional hazard regression to identify the prognostic factors affecting the overall survival. The area under the curve, calibration curves and decision curve analysis were used to evaluate prognostic efficacy. Results We analyzed 362 patients classified as pT3aN0M0 stage with a median follow-up of 40 months. According to Cox univariate and multivariate analyses, weight loss greater than 5% in 6 months before surgery, stage V chronic kidney disease after radical nephrectomy, sarcomatoid pattern, and coagulative tumor necrosis were identified as predictors of overall survival. We developed a score and performed internal and external validation. The time-dependent receiver operating characteristic curve, area under the curve value and calibration curve analysis showed good prediction ability of the score. The nomogram can effectively predict and stratify overall survival after radical nephrectomy in patients with pT3aN0M0 renal cell carcinoma. Conclusion Patients with pT3aN0MO renal cell carcinoma exhibited different characteristics, and those with unfavourable characteristics deserve greater attention during follow-up. This nomogram provides an accurate prediction of overall survival after radical nephrectomy.
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Affiliation(s)
- Caio Vinícius Suartz
- Department of Urology, Hôpital Européen Georges PompidouUniversité Paris CitéParisFrance
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Maurício Dener Cordeiro
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Paulo Afonso de Carvalho
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Fábio Pescarmona Gallucci
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | | | - Leonardo Cardili
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - Arjun Sivaraman
- Department of UrologyWashington University in St. LouisSt. LouisMissouriUSA
| | - François Audenet
- Department of Urology, Hôpital Européen Georges PompidouUniversité Paris CitéParisFrance
| | - José Mauricio Mota
- Genitourinary Medical Oncology Service, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
| | - William Carlos Nahas
- Division of Urology, Instituto do Cancer do Estado de São PauloUniversity of São PauloSão PauloBrazil
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Tourinho-Barbosa R, Sanchez-Salas R, Sivaraman A, Borges RC, Candela L, Batista LT, Cathala N, Mombet A, Marra G, Sanchez LR, Boumezrag CB, Lanz C, Macek P, Cathelineau X, Korkes F. Urinary Symptoms Change and Quality of Life After Robotic Radical Prostatectomy: A Secondary Analysis of a Randomized Controlled Trial. Urology 2024; 185:73-79. [PMID: 38281669 DOI: 10.1016/j.urology.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/26/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE To present the patient-reported quality of life (QoL) outcomes from a prospective, randomized controlled trial comparing the use of pelvic floor muscle training (PFMT) and duloxetine after robot-assisted radical prostatectomy (RARP). METHODS We identified 213 men with organ-confined disease having post-RARP urinary incontinence who were randomly assigned to received PFMT, duloxetine, combined PFMT-duloxetine and pelvic floor muscle home exercises. Urinary symptoms burden was measured by marked clinical important difference improvement (MCID) defined by using the International Prostate Symptom Score (IPSS) difference of - 8 points (ΔIPSS ≤-8). QoL was assessed according to Visual Analog Scale (VAS), King's Health Questionnaire (KQH), and International Index of Erectile Function (IIEF-5). Multivariable regression analyses aimed to predict MCID, burden of urinary symptoms (IPSS ≥8), and patients reporting to be satisfied (IPSS QoL ≤2) or comfortable (VAS ≤1) post-RARP. RESULTS Moderate to severe urinary symptoms decreased from 48% preoperatively to 40%, 34%, and 23% at 3, 6, and 12months post-RARP. After surgery, MCID improvement was observed in 19% of patients, and deterioration in 3.3%. Large prostate was the only factor associated to MCID (OR 1.03 [95%CI 1.01-1.05], P = .005). At 6months, patients reached the same degree of preoperative satisfaction. Neurovascular bundle preservation was the only predictor of being comfortable regarding urinary symptoms postoperatively (OR 12.8 [CI95% 1.47-111.7], P = .02 at 3months) and was also associated to higher median postoperative IIEF-5. CONCLUSION Despite urinary incontinence following RARP, patients with larger prostates experience a reduction of lower urinary tract symptoms within a year, which subsequently elevates QoL. Furthermore, nerve-sparing surgery augments erectile function and urinary outcomes, shaping postoperative QoL.
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Affiliation(s)
- Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil; Department of Urology, Hospital Cardio Pulmonar, Salvador, Brazil
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Surgery, Division of Urology, McGill University, Montreal, Quebec, Canada.
| | - Arjun Sivaraman
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Castilho Borges
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France; Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Luigi Candela
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Lara Rodriguez Sanchez
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Chahrazad Bey Boumezrag
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
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Sanchez-Salas R, Tourinho-Barbosa R, Sivaraman A, Borges RC, Candela L, Cathala N, Mombet A, Marra G, Sanchez LR, Boumezrag CB, Lanz C, Macek P, Korkes F, Cathelineau X. Assessing the efficacy of pelvic floor muscle training and duloxetine on urinary continence recovery following radical prostatectomy: A randomized clinical trial. Prostate 2024; 84:158-165. [PMID: 37904330 DOI: 10.1002/pros.24634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/09/2023] [Accepted: 09/18/2023] [Indexed: 11/01/2023]
Abstract
BACKGROUND Urinary incontinence (UI) can negatively impact quality of life (QoL) after robot-assisted radical prostatectomy (RARP). Pelvic floor muscle training (PFMT) and duloxetine are used to manage post-RARP UI, but their efficacy remains uncertain. We aimed to investigate the efficacy of PFMT and duloxetine in promoting urinary continence recovery (UCR) after RARP. METHODS A randomized controlled trial involving patients with urine leakage after RARP from May 2015 to February 2018. Patients were randomized into 1 of 4 arms: (1) PFMT-biofeedback, (2) duloxetine, (3) combined PFMT-biofeedback and duloxetine, (4) control arm. PFMT consisted of pelvic muscle exercises conducted with electromyographic feedback weekly, for 3 months. Oral duloxetine was administered at bedtime for 3 months. The primary outcome was prevalence of continence at 6 months, defined as using ≤1 security pad. Urinary symptoms and QoL were assessed by using a visual analogue scale, and validated questionnaires. RESULTS From the 240 patients included in the trial, 89% of patients completed 1 year of follow-up. Treatment compliance was observed in 88% (92/105) of patients receiving duloxetine, and in 97% (104/107) of patients scheduled to PFMT-biofeedback sessions. In the control group 96% of patients had achieved continence at 6 months, compared with 90% (p = 0.3) in the PMFT-biofeedback, 73% (p = 0.008) in the duloxetine, and 69% (p = 0.003) in the combined treatment arm. At 6 months, QoL was classified as uncomfortable or worse in 17% of patients in the control group, compared with 44% (p = 0.01), 45% (p = 0.008), and 34% (p = 0.07), respectively. Complete preservation of neurovascular bundles (NVB) (OR: 2.95; p = 0.048) was the only perioperative intervention found to improve early UCR. CONCLUSIONS PFMT-biofeedback and duloxetine demonstrated limited impact in improving UCR after RP. Diligent NVB preservation, along with preoperative patient and disease characteristics, are the primary determinants for early UCR.
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Affiliation(s)
- Rafael Sanchez-Salas
- Department of Surgery, Division of Urology, McGill University, Montreal, Canada
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Tourinho-Barbosa
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Arjun Sivaraman
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Castilho Borges
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Luigi Candela
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Lara Rodriguez Sanchez
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Chahrazad Bey Boumezrag
- Department of Research, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Petr Macek
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Fernando Korkes
- Department of Urology, Faculdade de Medicina do ABC (ABC Medical School), São Paulo, Brazil
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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4
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Deivasigamani S, Kotamarti S, Rastinehad AR, Salas RS, de la Rosette JJMCH, Lepor H, Pinto P, Ahmed HU, Gill I, Klotz L, Taneja SS, Emberton M, Lawrentschuk N, Wysock J, Feller JF, Crouzet S, Kumar M P, Seguier D, Adams ES, Michael Z, Abreu A, Jack Tay K, Ward JF, Shinohara K, Katz AE, Villers A, Chin JL, Stricker PD, Baco E, Macek P, Ahmad AE, Chiu PKF, Crawford ED, Rogers CG, Futterer JJ, Rais-Bahrami S, Robertson CN, Hadaschik B, Marra G, Valerio M, Chong KT, Kasivisvanathan V, Tan WP, Lomas D, Walz J, Guimaraes GC, Mertziotis NI, Becher E, Finelli A, Kasraeian A, Lebastchi AH, Vora A, Rosen MA, Bakir B, Arcot R, Yee S, Netsch C, Meng X, de Reijke TM, Tan YG, Regusci S, Benjamin TGR, Olivares R, Noureldin M, Bianco FJ, Sivaraman A, Kim FJ, Given RW, Dason S, Sheetz TJ, Shoji S, Schulman A, Royce P, Shah TT, Scionti S, Salomon G, Laguna P, Tourinho-Barbosa R, Aminsharifi A, Cathelineau X, Gontero P, Stabile A, Grummet J, Ledbetter L, Graton M, Stephen Jones J, Polascik TJ. Primary Whole-gland Ablation for the Treatment of Clinically Localized Prostate Cancer: A Focal Therapy Society Best Practice Statement. Eur Urol 2023; 84:547-560. [PMID: 37419773 DOI: 10.1016/j.eururo.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/25/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
CONTEXT Whole-gland ablation is a feasible and effective minimally invasive treatment for localized prostate cancer (PCa). Previous systematic reviews supported evidence for favorable functional outcomes, but oncological outcomes were inconclusive owing to limited follow-up. OBJECTIVE To evaluate the real-world data on the mid- to long-term oncological and functional outcomes of whole-gland cryoablation and high-intensity focused ultrasound (HIFU) in patients with clinically localized PCa, and to provide expert recommendations and commentary on these findings. EVIDENCE ACQUISITION We performed a systematic review of PubMed, Embase, and Cochrane Library publications through February 2022 according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. As endpoints, baseline clinical characteristics, and oncological and functional outcomes were assessed. To estimate the pooled prevalence of oncological, functional, and toxicity outcomes, and to quantify and explain the heterogeneity, random-effect meta-analyses and meta-regression analyses were performed. EVIDENCE SYNTHESIS Twenty-nine studies were identified, including 14 on cryoablation and 15 on HIFU with a median follow-up of 72 mo. Most of the studies were retrospective (n = 23), with IDEAL (idea, development, exploration, assessment, and long-term study) stage 2b (n = 20) being most common. Biochemical recurrence-free survival, cancer-specific survival, overall survival, recurrence-free survival, and metastasis-free survival rates at 10 yr were 58%, 96%, 63%, 71-79%, and 84%, respectively. Erectile function was preserved in 37% of cases, and overall pad-free continence was achieved in 96% of cases, with a 1-yr rate of 97.4-98.8%. The rates of stricture, urinary retention, urinary tract infection, rectourethral fistula, and sepsis were observed to be 11%, 9.5%, 8%, 0.7%, and 0.8%, respectively. CONCLUSIONS The mid- to long-term real-world data, and the safety profiles of cryoablation and HIFU are sound to support and be offered as primary treatment for appropriate patients with localized PCa. When compared with other existing treatment modalities for PCa, these ablative therapies provide nearly equivalent intermediate- to long-term oncological and toxicity outcomes, as well as excellent pad-free continence rates in the primary setting. This real-world clinical evidence provides long-term oncological and functional outcomes that enhance shared decision-making when balancing risks and expected outcomes that reflect patient preferences and values. PATIENT SUMMARY Cryoablation and high-intensity focused ultrasound are minimally invasive treatments available to selectively treat localized prostate cancer, considering their nearly comparable intermediate- to long term cancer control and preservation of urinary continence to other radical treatments in the primary setting. However, a well-informed decision should be made based on one's values and preferences.
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Affiliation(s)
| | - Srinath Kotamarti
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | | | | | - Herbert Lepor
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Peter Pinto
- Urologic Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Hashim U Ahmed
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | - Inderbir Gill
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Laurence Klotz
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | - Samir S Taneja
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Mark Emberton
- Division of Surgery, University College London, London, UK
| | - Nathan Lawrentschuk
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - James Wysock
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | | | | | | | - Denis Seguier
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, University Lille Nord de France, Lille, France
| | - Eric S Adams
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Zoe Michael
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Andre Abreu
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore
| | - John F Ward
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Katsuto Shinohara
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
| | - Aaron E Katz
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Arnauld Villers
- Department of Urology, University Lille Nord de France, Lille, France
| | - Joseph L Chin
- Department of Urology, University of Western Ontario, London, Ontario, Canada
| | | | - Eduard Baco
- Department of Urology, Oslo University Hospital, Oslo, Norway
| | - Petr Macek
- Department of Urology, Institute Mutualiste Montsouris, Paris, France
| | - Ardalan E Ahmad
- Department of Urology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Peter K F Chiu
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | - E David Crawford
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Craig G Rogers
- Vattikuti Urology Institute, Henry Ford Health, Detroit, MI, USA
| | - Jurgen J Futterer
- Department of Radiology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | | | - Cary N Robertson
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Boris Hadaschik
- Department of Urology, University Hospital Essen, Essen, Germany
| | - Giancarlo Marra
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Massimo Valerio
- Service of Urology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | | | - Wei Phin Tan
- Department of Urology, NYU School of Medicine, NYU Langone Health, New York, NY, USA
| | - Derek Lomas
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - Jochen Walz
- Department of Urology, Paoli-Calmettes Institute Cancer Center, Marseille, France
| | | | | | | | - Antonio Finelli
- Division of Urology, University of Toronto, Toronto, Ontario, Canada
| | | | - Amir H Lebastchi
- Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, CA, USA
| | - Anup Vora
- Chesapeake Urology, Silver Spring, MD, USA
| | - Mark A Rosen
- Department of Urology, Sutter Health, Sacramento, CA, USA
| | - Baris Bakir
- Department of Radiology, Istanbul University, Istanbul, Turkey
| | - Rohit Arcot
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA; Department of Urology, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Samuel Yee
- Department of Surgery, SH Ho Urology Centre, The Chinese University of Hong Kong, Hong Kong
| | | | - Xiaosong Meng
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Theo M de Reijke
- Department of Urology, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Yu Guang Tan
- Department of Urology, Singapore General Hospital, Singapore
| | - Stefano Regusci
- Department of Interventional Oncology, Swiss International Prostate Centelenor, Geneva, Switzerland
| | | | - Ruben Olivares
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | | | - Fernando J Bianco
- Urological Research Network, Urologist Specialist Group, Miami Lakes, FL, USA
| | - Arjun Sivaraman
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Fernando J Kim
- Division of Urology, Denver Health Medical Center and University of Colorado Hospital, Denver, CO, USA
| | | | - Shawn Dason
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Tyler J Sheetz
- Department of Urology, The Ohio State University, Columbus, OH, USA
| | - Sunao Shoji
- Department of Urology, Tokai University School of Medicine, Tokyo, Japan
| | - Ariel Schulman
- Department of Urology, Maimonides Health Medical Center, New York, NY, USA
| | - Peter Royce
- Division of Urology, Monash University, Melbourne, Australia
| | - Taimur T Shah
- Division of Urology, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Georg Salomon
- Martini-Clinic Prostate Cancer Center, University Clinic Eppendorf, Hamburg, Germany
| | - Pilar Laguna
- Department of Urology, Istanbul Medipol Mega University Hospital, Istanbul, Turkey
| | | | - Alireza Aminsharifi
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | | | - Paolo Gontero
- Department of Urology, The University Hospital of Turin, Turin, Italy
| | - Armando Stabile
- Unit of Urology/Division of Urology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Jeremy Grummet
- Division of Urology, Monash University, Melbourne, Australia
| | - Leila Ledbetter
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | - Margaret Graton
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA
| | | | - Thomas J Polascik
- Duke Cancer Institute and Duke University Medical Centre, Durham, NC, USA.
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5
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Berry JM, Hill H, Vetter JM, Bhayani SB, Henning GM, Pickersgill NA, Sivaraman A, Figenshau RS, Kim EH. Single-port vs multi-port robot-assisted renal surgery: analysis of perioperative outcomes for excision of high and low complexity renal masses. J Robot Surg 2023; 17:2149-2155. [PMID: 37256454 PMCID: PMC10230457 DOI: 10.1007/s11701-023-01637-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
There is emerging but limited data assessing single-port (SP) robot-assisted surgery as an alternative to multi-port (MP) platforms. We compared perioperative outcomes between SP and MP robot-assisted approaches for excision of high and low complexity renal masses. Retrospective chart review was performed for patients undergoing robot-assisted partial or radical nephrectomy using the SP surgical system (n = 23) at our institution between November 2019 and November 2021. Renal masses were categorized as high complexity (7+) or low complexity (4-6) using the R.E.N.A.L. nephrometry scoring system. Adjusting for baseline characteristics, patients were matched using a prospectively maintained MP database in a 2:1 (MP:SP) ratio. For high complexity tumors (n = 12), SP surgery was associated with a significantly longer operative time compared to MP (248.4 vs 188.1 min, p = 0.02) but a significantly shorter length of stay (1.9 vs 2.8 days, p = 0.02). For low complexity tumors (n = 11), operative time (177.7 vs 161.4 min, p = 0.53), estimated blood loss (69.6.0 vs 142.0 mL, p = 0.62), and length of stay (1.6 vs 1.8 days, p = 0.528) were comparable between SP and MP approaches. Increasing nephrometry score was associated with a greater relative increase in operative time for SP compared to MP renal surgery (p = 0.07) using best of fit linear modeling. SP robot-assisted partial and radical nephrectomy is safe and feasible for low complexity renal masses. For high complexity renal masses, the SP system is associated with a significantly longer operative time compared to the MP technique. Careful consideration should be given when selecting patients for SP robot-assisted kidney surgery.
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Affiliation(s)
- James M Berry
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
| | - Hayden Hill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Joel M Vetter
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Sam B Bhayani
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Grant M Henning
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Nicholas A Pickersgill
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Arjun Sivaraman
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - R Sherburne Figenshau
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA
| | - Eric H Kim
- Division of Urology, Department of Surgery, Washington University School of Medicine in St. Louis, 4960 Children's Place, St. Louis, MO, 63110, USA.
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6
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Baumann BC, Laugeman E, Kohlmyer S, Levine L, Russell K, Smith Z, Reimers M, Michalski JM, Picus J, Pachynski R, Sivaraman A, Thomas L, Smelser W, Sands K, Kim E, Frankel J, Moravan MJ, Gay HA, Price AT. ARTIA-Bladder: Daily Online Adaptive Short-Course Radiation Therapy (RT) and Concurrent Chemotherapy for Muscle-Invasive Bladder Cancer (MIBC): A Prospective Trial of an Individualized Approach for Reducing Bowel and Bladder Toxicity. Int J Radiat Oncol Biol Phys 2023; 117:e366. [PMID: 37785254 DOI: 10.1016/j.ijrobp.2023.06.2461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Concurrent chemo-radiotherapy is commonly prescribed for muscle-invasive bladder cancer (MIBC). Post hoc analysis of two large, randomized trials found that hypofractionation improves loco-regional control (LRC) vs. standard fractionation in this population. A challenge in traditional image-guided radiotherapy of the bladder is that daily changes in bladder position and size requires large margins to ensure target coverage. This makes it difficult to spare uninvolved bladder from high-dose treatment, increases the risk of bowel toxicity, and results in historical rates of acute G3+ toxicity exceeding 20-30%. Daily online adaptive RT (ART) may enable reduced, personalized margins that maintain target coverage while reducing dose to OARs. This prospective clinical trial will test whether: 1) participants undergoing ART for MIBC have a lower rate of acute G3+ GI/GU toxicity compared with the 31% historical control rate (Stage III BC2001 trial), and 2) 2-year LRC with ART will be non-inferior to historical controls (75%). MATERIALS/METHODS This multi-national trial will enroll 165 adult subjects with stage cT2-T4aN0M0 urothelial MIBC. Subjects will have undergone an attempt at maximal transurethral resection of bladder tumor. Patients with clinically involved nodes or G2+ GI or G3+ GU symptoms/conditions at baseline are ineligible. Concurrent with chemotherapy, participants will receive (at the discretion of the investigator) either 55 Gy in 20 fx to whole-bladder or 46 Gy in 20 fx to whole-bladder plus simultaneous in-field boost of 55 Gy in 20 fx to tumor bed. A personalized ITV will be derived for each subject based on bladder expansion, as assessed on two CT simulations separated by 30 min. Daily ART will be attempted for all subjects. The primary endpoint is acute G3+ GI/GU toxicity. Secondary endpoints are LRC; quality of life (EORTC QLQ-BLM30, EPIC 26 bowel and urinary); global function (EQ-5D-5L ); 2-year disease-free, bladder intact event-free, and overall survival; 2-year bladder cancer-specific mortality; NTCP model of acute GI toxicity for hypofractionated bladder RT; workflow feasibility of ART; improved target coverage ± reduced dose to critical OARs vs. non-ART dosimetry; acute G3+ GI/GU toxicity rate in subjects with ≥75% of their treatments as ART; and acute G3+ GI/GU toxicity in the cohort treated with partial bladder boost. Exploratory translational and correlative endpoints will also be examined. RESULTS This trial opened to enrollment on Feb 2, 2023; the study duration is expected to be 4-5 years. CONCLUSION This prospective clinical trial will provide robust clinical data to inform healthcare providers' decisions on the use of daily online ART and hypofractionation as a bladder preservation strategy for this population.
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Affiliation(s)
- B C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - E Laugeman
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | | | - L Levine
- Varian Medical Systems, A Siemens Healthineers Company, Palo Alto, CA
| | - K Russell
- Varian Medical Systems, Palo Alto, CA
| | - Z Smith
- Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, MO
| | - M Reimers
- Washington University School of Medicine, Department of Medicine, Division of Medical Oncology, St. Louis, MO
| | - J M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO
| | - J Picus
- Department of Medicine, Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO
| | - R Pachynski
- Department of Medicine, Division of Hematology and Oncology, Washington University School of Medicine, St. Louis, MO
| | - A Sivaraman
- Washington University in St. Louis, St. Louis, MO
| | - L Thomas
- Washington University in St. Louis, St. Louis, MO
| | - W Smelser
- Washington University in St. Louis, St Louis, MO
| | - K Sands
- Washington University in St. Louis, St. Louis, MO
| | - E Kim
- Department of Surgery, Division of Urology, Washington University School of Medicine, St. Louis, MO
| | - J Frankel
- Washington University in St. Louis, St. Louis, MO
| | - M J Moravan
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, MO
| | - H A Gay
- Washington University School of Medicine in St. Louis, Department of Radiation Oncology, St. Louis, MO
| | - A T Price
- University Hospitals, Department of Radiation Oncology, Case Western Reserve University, Cleveland, OH
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7
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Sanchez-Salas R, Tourinho-Barbosa R, Sivaraman A, Pascuali C, Candela L, Cathala N, Mombet A, Marra G, Rodriguez Sanchez L, Chahrazad Bey Boumezrag C, Macek P, Lanz C, Korkes F, Cathelineau X. The IMPROVE Trial: Surgical technique remains the most important factor associated with recovery of urinary continence after radical prostatectomy. EUR UROL SUPPL 2023. [DOI: 10.1016/s2666-1683(23)00050-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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8
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Sharma G, Shah M, Ahluwalia P, Gautam G, Dasgupta P, Challacombe B, Bhandari M, Ahlawat R, Rawal S, Buffi N, Sivaraman A, Porter J, Rogers C, Mottire, Abaza R, Rha K, Moon D, Yuvaraja T, Parekh D, Capitanio U, Maes K, Porpiglia F, Turkeri L. Off-clamp versus on-clamp robot-assisted partial nephrectomy: A propensity-matched analysis. Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)01060-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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9
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Narayan G, Sabita P, Singh R, Sivaraman A. Comparison of the Haematological and Psychological Parameters between COVID-19 Positive Pregnant and Non Pregnant Female: A Case-control Study from Tertiary Care Centre, Puducherry, India. J Clin Diagn Res 2022. [DOI: 10.7860/jcdr/2022/52682.16139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Introduction: Pregnancy is associated with lot of physiological and psychological changes, and it becomes important to study these changes in the background of COVID-19. A simple Complete Blood Count (CBC) can help to indicate the COVID-19 disease severity. Aim: To understand the differences in the haematological and psychological parameters between COVID-19 infected pregnant females and age-matched non pregnant COVID-19 infected females. Materials and Methods: This case-control study was conducted in Department of Obstetrics and Gynaecology, Indira Gandhi Medical College and Research Institute, Puducherry, India, from October 2020 to December 2020. Data collection was in an ambispective manner. Haematological values {Total Leukocyte Count, neutrophil, lymphocyte, Neutrophil-Lymphocyte ratio (NLR) and Red Cell Distribution Width (RDW)} were obtained from routine CBC and for the psychological component (scalesbeliefs, practices for prevention of infection, fear, global) a pretested validated questionnaire was used. The questionnaire used the Likert scale and comprised of a total of 29 questions with a maximum score of 145. These scales analysed psychological apprehensions in general population and its impact on pregnancy and reproductive health of women. Categorical variables were expressed as mean±Standard Deviation (SD). Student t-test was used for comparison of means. Results: The present study included 80 participants with 40 in each of the pregnant and non pregnant group. The total leukocyte count, neutrophil, lymphocyte, NLR and RDW were the haematological parameters with statistically significant difference between the two groups (p-value <0.001). While the mean total score of COVID-19 psychological impact in the COVID-19 pregnant women was 79.42±20.18 and higher in COVID-19 non pregnant women (88.92±20.77). Conclusion: The significant difference in the haematological parameters of both the groups indicates the differential impact of COVID-19 in pregnant women. ‘Coronaphobia’ is on the rise and addressing this concern is important for holistic delivery of health care in patients.
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Chow AK, Wong R, Monda S, Bhatt R, Sands KG, Vetter J, Badhiwala N, DeClue A, Kim EH, Sivaraman A, Venkatesh R, Figenshau RS, Du K. Ex Vivo Porcine Model for Robot-Assisted Partial Nephrectomy Simulation at a High-Volume Tertiary Center: Resident Perception and Validation Assessment Using the Global Evaluative Assessment of Robotic Skills Tool. J Endourol 2021; 35:878-884. [PMID: 33261512 DOI: 10.1089/end.2020.0590] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: With increased demands on surgeon productivity and outcomes, residency robotics training increasingly relies on simulations. The objective of this study is to assess the validity and effectiveness of an ex vivo porcine training model as a useful tool to improve surgical skill and confidence with robot-assisted partial nephrectomy (RAPN) among urology residents. Methods: A 2.5 cm circular area of ex vivo porcine kidneys was marked as the area of the tumor. Tumor excision and renorrhaphy was performed by trainees using a da Vinci Si robot. All residents ranging from postgraduate year (PGY) 2 to 5 participated in four training sessions during the 2017 to 2018 academic year. Each session was videorecorded and scored using the global evaluative assessment of robotic skills (GEARS) by faculty members. Results: Twelve residents completed the program. Initial mean GEARS score was 16.7 and improved by +1.4 with each subsequent session (p = 0.008). Initial mean excision, renorrhaphy, and total times were 8.2, 13.9, and 22.1 minutes, which improved by 1.6, 2.0, and 3.6 minutes, respectively (all p < 0.001). Residents' confidence at performing RAPN and robotic surgery increased after completing the courses (p = 0.012 and p < 0.001, respectively). Overall, residents rated that this program has greatly contributed to their skill (4/5) and confidence (4.1/5) in robotic surgery. Conclusions: An ex vivo porcine simulation model for RAPN and robotic surgery provides measurable improvement in GEARS score and reduction in procedural time, although significant differences for all PGY levels need to be confirmed with larger study participation. Adoption of this simulation in a urology residency curriculum may improve residents' skill and confidence in robotic surgery.
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Affiliation(s)
- Alexander K Chow
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ryan Wong
- Department of Surgery, St. Louis University School of Medicine, St. Louis, Missouri, USA
| | - Steven Monda
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Rohit Bhatt
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kenneth G Sands
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Joel Vetter
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Niraj Badhiwala
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Angelia DeClue
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Eric H Kim
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Arjun Sivaraman
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ramakrishna Venkatesh
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kefu Du
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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11
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Chesnut GT, Tin AL, Sivaraman A, Takeda T, Lee T, Fainberg J, Benfante N, Sjoberg DD, Vargas HA, Fine SW, Scardino PT, Eastham JA, Coleman JA, Touijer KA, Zelefsky MJ, Ehdaie B. Defining the index lesion for potential salvage partial or hemi-gland ablation after radiation therapy for localized prostate cancer. Urol Oncol 2021; 39:495.e17-495.e24. [PMID: 33583697 DOI: 10.1016/j.urolonc.2021.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/17/2020] [Accepted: 01/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Salvage partial gland ablation (sPGA) has been proposed to treat some localized radiorecurrent prostate cancer. The role of prostate biopsy and magnetic resonance imaging (MRI) characteristics to identify patients eligible for sPGA is unknown. OBJECTIVE To evaluate the ability of MRI and prostate biopsy characteristics to identify an index lesion suitable for sPGA and validate this selection using detailed tumor maps created from whole-mount slides from salvage radical prostatectomy (sRP) specimens. DESIGN, SETTING, AND PARTICIPANTS Men who underwent sRP for recurrent prostate cancer following primary radiotherapy with external beam radiotherapy (EBRT) and/or brachytherapy between 2000 and 2014 at a single high-volume cancer center were eligible. Those with tumor maps, MRI and biopsy data were included in analysis. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcome was the ability of clinicopathologic and imaging criteria to identify patients who may be eligible for sPGA based on detailed tumor map from whole-mount sRP slides. RESULTS AND LIMITATIONS Of 216 men who underwent sRP following whole gland radiotherapy, tumor maps, MRI, and biopsy data were available for 77. Of these, 15 (19%) were determined to be eligible for sPGA based on biopsy-proven unilateral disease in contiguous sextant segments, a dominant lesion on MRI concordant with biopsy location or no focal region of interest, and no imaging evidence of extraprostatic disease. Review of tumor maps identified 6 additional men who would have met criteria for sPGA, resulting in sensitivity of 71% (95% C.I. 48%-89%) and specificity of 100% (lower bound of 95% C.I. 94%). None of the 15 men who met the criteria for sPGA on clinical data were identified incorrectly on tumor maps to require full gland surgery (upper bound of 95% C.I. 22%). Median tumor volume of the index lesion was 0.4 cc and recurrent cancer was noted in the apex, mid-gland, and base in 81%, 100%, and 29% of men. CONCLUSIONS In men with recurrent prostate cancer after radiotherapy, biopsy findings and MRI can be used to select index lesions potentially amenable for sPGA and can guide patient evaluation for inclusion in clinical trials of sPGA following radiation failure. Larger, prospective studies are required to evaluate both the role of MRI and clinical criteria in guiding focal salvage therapy and the effectiveness of this modality for radiorecurrent prostate cancer.
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Affiliation(s)
- Gregory T Chesnut
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY.
| | - Amy L Tin
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Arjun Sivaraman
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Toshikazu Takeda
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Taehyoung Lee
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan Fainberg
- Department of Urology, New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Nicole Benfante
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Samson W Fine
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Peter T Scardino
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - James A Eastham
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jonathan A Coleman
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Karim A Touijer
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Michael J Zelefsky
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Behfar Ehdaie
- Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
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12
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Sivaraman A, Marra G, Stabile A, Mombet A, Macek P, Lanz C, Cathala N, Moschini M, Carneiro A, Sanchez-Salas R, Cathelineau X. Does mpMRI guidance improve HIFU partial gland ablation compared to conventional ultrasound guidance? Early functional outcomes and complications from a single center. Int Braz J Urol 2021; 46:984-992. [PMID: 32822127 PMCID: PMC7527093 DOI: 10.1590/s1677-5538.ibju.2019.0682] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 01/29/2020] [Indexed: 11/21/2022] Open
Abstract
Background Focal therapy (FT) for localized prostate cancer (PCa) treatment is raising interest. New technological mpMRI-US guided FT devices have never been compared with the previous generation of ultrasound-only guided devices. Materials and Methods We retrospectively analyzed prospectively recorded data of men undergoing FT for localized low- or intermediate-risk PCa with US- (Ablatherm®-2009 to 2014) or mpMRI-US (Focal One®-from 2014) guided HIFU. Follow-up visits and data were collected using internationally validated questionnaires at 1, 2, 3, 6 and 12 months. Results We included n=88 US-guided FT HIFU and n=52 mpMRI-US guided FT HIFU respectively. No major baseline differences were present except higher rates of Gleason 3+4 for the mpMRI-US group. No major differences were present in hospital stay (p=0.1), catheterization time (p=0.5) and complications (p=0.2) although these tended to be lower in the mpMRI-US group (6.8% versus 13.2% US FT group). At 3 months mpMRI-US guided HIFU had significantly lower urine leak (5.1% vs. 15.9%, p=0.04) and a lower drop in IIEF scores (2 vs. 4.2, p=0.07). Of those undergoing 12-months control biopsy in the mpMRI-US-guided HIFU group, 26% had residual cancer in the treated lobe. Conclusion HIFU FT guided by MRI-US fusion may allow improved functional outcomes and fewer complications compared to US- guided HIFU FT alone. Further analysis is needed to confirm benefits of mpMRI implementation at a longer follow-up and on a larger cohort of patients.
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Affiliation(s)
- Arjun Sivaraman
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Giancarlo Marra
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France.,Department of Urology, San Giovanni Battista Hospital, Città della Salute e della Scienza and University of Turin, Turin, Italy
| | - Armando Stabile
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Annick Mombet
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Petr Macek
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Camille Lanz
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Nathalie Cathala
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Marco Moschini
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Arie Carneiro
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France
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Vroomen LGPH, John NT, Fuijmori M, Sivaraman A, Felsen D, Srimathveeravalli G. A new intrasurgical technique to safely and reproducibly induce partial unilateral urinary obstruction and renal scarring in a Rat Model. Int Urol Nephrol 2020; 52:1209-1218. [PMID: 32124231 DOI: 10.1007/s11255-020-02421-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/30/2020] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Irreversible electroporation (IRE) uses microsecond-long electric pulses to kill cells through membrane permeabilization, without affecting surrounding extracellular structures. We evaluated whether IRE can be used to induce urinary obstruction for a rat model of renal scarring. MATERIALS AND METHODS Intrasurgical IRE (2000 V/cm, 90 pulses, 100 μs) with caliper electrodes was performed in the right proximal ureter in male rats (n = 24) which were euthanized at 2, 5, or 10 days post-treatment, following contrast-enhanced magnetic resonance imaging. Complete urinary tract (bilateral kidneys, ureter and bladder) was extracted, and scored on a five-point scale for renal dilation, ureteral dilation and hydronephrosis. Whole kidney sections underwent immunohistochemistry to quantify levels of macrophages (CD68), activated fibroblasts [α-smooth muscle actin (α-SMA)], collagen (Masson's Trichrome) and Hematoxylin and Eosin. Change in renal pelvis diameter and the number of glomeruli in the treated and contralateral urinary tract was also computed. RESULTS Intrasurgical IRE performed with non-invasive caliper electrodes resulted in immediate loss of peristalsis in the treated ureteral segment, and cell death in the ureteral muscularis along with urothelial sloughing. Dilation of the ureter was observed on gross anatomic evaluation and histopathology. Magnetic resonance imaging indicated partial stricture and urinary obstruction in IRE-treated urinary tract, without evidence of urinoma, leakage or fistula formation. Enlargement of the kidney with progressive renal dilation and hydronephrosis was evident between Day 2 and Day 10 post-treatment. Obstructed kidney demonstrated scarring with elevated levels of tissue collagen, macrophages and α-SMA-positive fibroblasts. There was a steady decrease in the number of glomeruli in the obstructed kidney, while glomeruli numbers in the contralateral kidney remained unchanged through the 10-day observation period. CONCLUSION IRE provides a safe and reproducible technique to induce partial ureteral obstruction and renal fibrosis in rat model without the need for ligation or its associated complications.
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Affiliation(s)
| | - Nirmal Thampi John
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Masashi Fuijmori
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Arjun Sivaraman
- Department of Urology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Diane Felsen
- Department of Urology, Institute for Pediatric Urology, Weill Cornell Medicine, New York, USA
| | - Govindarajan Srimathveeravalli
- Department of Mechanical and Industrial Engineering, University of Massachusetts, Amherst, USA. .,Institute for Applied Life Sciences, University of Massachusetts, Amherst, USA.
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14
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Senguttuvan Karthikeyan V, Mallya A, Sivaraman A, Galiano M, Rozet F, Cathala N, Barret E, Mombet A, Prapotnich D, Sanchez-Salas R, Cathelineau X. Oncological outcomes and pathological characteristics of cT1 upstaging to pT3a renal cell carcinoma compared with de novo pT3a tumors. Actas Urol Esp 2019; 43:234-240. [PMID: 30857765 DOI: 10.1016/j.acuro.2018.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The significance of upstaging of cT1 renal tumors to pT3a is not clear. We evaluate the incidence of upstaging, identify predictors and analyze oncological outcomes of these patients versus those who did not upstage. We also compared the oncological outcomes of cT1 upstaging to pT3a with de novo pT3a renal tumors. METHODS From a database of 1021 renal tumors with complete available follow-up data, 517 patients had cT1. Patients upstaging to pT3a were compared to those who did not. Baseline clinical, perioperative, histopathologic features and oncological outcomes were analysed. RESULTS Out of 517 cT1 patients, 105 (20.3%) upstaged to pT3a and 412 (79.7%) did not. Proportion of patients in each group undergoing partial and radical nephrectomy, postoperative tumor size, histology, margin status and lymph node involvement were similar. Among upstaged, 9 patients (8.6%) developed first recurrence as compared to only 3 (0.7%) in those not upstaging (P <0.001). The median time to recurrence (57 vs. 107 months; P <0.001) was lesser in de novo pT3a renal tumors. CONCLUSIONS Pathological upstaging from cT1 to pT3a and necrosis on histopathology were associated with recurrence. Advanced age, smoking, necrosis on histopathology, clear cell histology and higher Fuhrman grades contributed to pathological upstaging of cT1 tumors. De novo pT3a RCC had worse survival when compared to cT1 patients upstaging to pT3a RCC.
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15
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Bakavicius A, Sanchez-Salas R, Muttin F, Sivaraman A, Dell'Oglio P, Barret E, Rozet F, Mombet A, Prapotnich D, Cathala N, Cathelineau X. Comprehensive Evaluation of Focal Therapy Complications in Prostate Cancer: A Standardized Methodology. J Endourol 2019; 33:509-515. [PMID: 31017001 DOI: 10.1089/end.2018.0809] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Purpose: Today, up to one-third of newly diagnosed prostate cancer (PCa) cases may be suitable for focal treatment. The lack of data about the toxicity profiles of lesion-targeting therapies, however, has made it difficult to compare treatment modalities. The aim of the present study was to evaluate comprehensively the incidence, severity, and timing of onset of complications for PCa patients undergoing focal high-intensity focused ultrasound (HIFU) and focal cryosurgical ablation of the prostate (CSAP). Materials and Methods: A total of 336 patients were included who underwent focal HIFU or focal CSAP as a primary treatment for PCa between January 2009 and December 2017. Mean follow-up was 11 months (standard deviation: 3.0). All complications were captured and graded according to severity, and classified by timing of onset. Univariate and multivariate analysis was performed to identify predictors of the most common side effects. Results: There were 98 complications in 79/210 patients (38%) undergoing focal HIFU and 34 complications in 27/126 patients (21%) undergoing focal CSAP. In terms of severity, 95% of the complications of focal HIFU and 91% of the complications of focal CSAP were minor. Most complications presented in the early postoperative period. On multivariate analysis, subtotal HIFU was associated with acute urinary retention (AUR), while a smaller prostate size and longer catheterization time with dysuria. In CSAP patients, longer catheterization time was associated with AUR and urethral sloughing. The main limitation is the nonrandomized and retrospective nature. Conclusions: Focal HIFU and focal CSAP provide a tolerable toxicity, with primarily minor complications presenting in the early postoperative period.
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Affiliation(s)
- Arnas Bakavicius
- 1 Department of Urology, Institut Mutualiste Montsouris, Paris, France.,2 Urology Centre, Vilnius University, Vilnius, Lithuania
| | | | - Fabio Muttin
- 1 Department of Urology, Institut Mutualiste Montsouris, Paris, France.,3 Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Arjun Sivaraman
- 4 Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Paolo Dell'Oglio
- 1 Department of Urology, Institut Mutualiste Montsouris, Paris, France.,3 Unit of Urology, Division of Experimental Oncology, URI-Urological Research Institute, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eric Barret
- 1 Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Francois Rozet
- 1 Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | - Annick Mombet
- 1 Department of Urology, Institut Mutualiste Montsouris, Paris, France
| | | | - Nathalie Cathala
- 1 Department of Urology, Institut Mutualiste Montsouris, Paris, France
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Kayano PP, Carneiro A, Castilho TML, Sivaraman A, Claros OR, Baroni RH, Garcia RG, Mariotti GC, Smaletz O, Filippi RZ, Lemos GC. Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer. Int Braz J Urol 2019; 44:1106-1113. [PMID: 30325600 PMCID: PMC6442175 DOI: 10.1590/s1677-5538.ibju.2017.0552] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 08/05/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. MATERIALS AND METHODS A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. RESULTS In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. -0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 - 6.28]; p=0.024). CONCLUSIONS US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.
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Affiliation(s)
| | - Arie Carneiro
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
| | | | - Arjun Sivaraman
- Memorial Sloan Kettering Cancer Center - USA, New York, NY, EUA
| | | | | | | | | | - Oren Smaletz
- Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
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Sanchez-Salas R, de la Rosette J, Polascik TJ, Carneiro A, Sivaraman A, Cathelineau X, Walz J. Focal Therapy for Prostate Cancer: A More Vehement View of the Approach Could Translate into Real Benefits for Our Patients. Eur Urol 2018; 74:537-539. [DOI: 10.1016/j.eururo.2018.04.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/16/2018] [Indexed: 01/20/2023]
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Affiliation(s)
- Arjun Sivaraman
- Division of Urology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, Missouri
| | - Ramakrishna Venkatesh
- Division of Urology, Siteman Cancer Center, Washington University School of Medicine, Saint Louis, Missouri
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Sivaraman A, Scardino P, Eastham J. Outcomes of salvage radical prostatectomy following more than one failed local therapy. Investig Clin Urol 2018; 59:152-157. [PMID: 29744471 PMCID: PMC5934276 DOI: 10.4111/icu.2018.59.3.152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 12/27/2017] [Indexed: 11/18/2022] Open
Abstract
Purpose To describe the salvage radical prostatectomy (sRP) experience in patients presenting with recurrent, clinically localized prostate cancer after multiple failed local treatments. Materials and Methods Among the 251 sRP performed during 2000–2016, 11 patients had failed multiple local therapies. We describe baseline clinical characteristics at primary cancer diagnosis and prior to sRP, surgical information, complications and oncological outcomes. Results The mean±standard deviation age at sRP was 65±5 years and the median (interquartile range) serum prostate-specific antigen (PSA) level was 2 (1.3) ng/mL. The most common first and subsequent treatments were radiotherapy and cryotherapy, respectively, with median time of 24 months from the last local treatment. The median operative time was 180 minutes and median estimated blood loss was 750 mL. Five (45.5%) patients underwent additional procedures during sRP for pre-operative morbidity from prior treatments (rectourethral fistula, urethral stricture, incontinence). Post-operative complications requiring invasive intervention occurred in 7 (63.6%) patients. Over a median follow-up of 29 (12–96) months, 10 of the 11 men (90.9%) achieved an undetectable PSA in after sRP. Three of these men with an initially undetectable PSA level experienced biochemical recurrence; the remaining 7 are without evidence of disease. Overall, no local recurrence or systemic metastasis was identified at last follow-up. Conclusions sRP is technically feasible and offers durable cancer control in patients with recurrent prostate cancer despite having undergone multiple prior attempts at cure. These patients experience higher rates of post-operative complications and such patients must be appropriately counseled regarding the potential risks and benefits.
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Affiliation(s)
- Arjun Sivaraman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Peter Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Sivaraman A, Benfante N, Touijer K, Coleman J, Scardino P, Laudone V, Eastham J. Can pelvic node dissection at radical prostatectomy influence the nodal recurrence at salvage lymphadenectomy for prostate cancer? Investig Clin Urol 2018. [PMID: 29520383 PMCID: PMC5840122 DOI: 10.4111/icu.2018.59.2.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To verify the quality of pelvic lymph node dissection (PLND) performed at radical prostatectomy (RP) and its impact on nodal recurrence in patients undergoing salvage lymph node dissection (sLND). Materials and Methods Retrospective review of 48 patients who underwent sLND for presumed nodal recurrence, to describe the PLND characteristics at RP and correlate the anatomical sites and number of suspicious nodes reported in radiological imaging and final pathology of sLND. Results Overall, at RP, 8 (16.7%) did not undergo PLND, 32 (66.7%) and 8 (16.7%) received a “limited” (between external iliac vein and obturator nerve) and an “extended” (external iliac, hypogastric, and obturator) dissection, respectively. Median nodes removed during limited and extended dissection were 2 and 24, respectively. At sLND, the mean age was 61.3 years and median prostate specific antigen (PSA) was 1.07 ng/mL. Median nodes removed at sLND were 17 with a median of 2 positive nodes. Recurrent nodes were identified within the template of an extended PLND in 62.5%, 50.0% and 12.5% patients, respectively, following prior no, limited and extended dissection at RP. Recurrence outside the expected lymphatic drainage pathway was noted in 37.5% patients with prior extended dissection at RP. There was a correlation between imaging and pathology specimen in 83% for node location and 58.3% for number of anatomical sites involved. Conclusions In prostate cancer patients undergoing sLND, most had inadequate PLND at the original RP. Pattern of nodal recurrence may be influenced by the prior dissection and pre sLND imaging appears to underestimate the nodal recurrence.
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Affiliation(s)
- Arjun Sivaraman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Nicole Benfante
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Jonathan Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Peter Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Vincent Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
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Garcia-Barreras S, Sanchez-Salas R, Sivaraman A, Barret E, Secin F, Nunes-Silva I, Linares-Espinós E, Rozet F, Galiano M, Cathelineau X. Comparative Analysis of Partial Gland Ablation and Radical Prostatectomy to Treat Low and Intermediate Risk Prostate Cancer: Oncologic and Functional Outcomes. J Urol 2018; 199:140-146. [DOI: 10.1016/j.juro.2017.08.076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Silvia Garcia-Barreras
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Rafael Sanchez-Salas
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Eric Barret
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - Igor Nunes-Silva
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | | | - François Rozet
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Department of Urology, Institut Mutualiste Montsouris, Université Paris-Descartes, Paris, France
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Tay KJ, Scheltema MJ, Ahmed HU, Barret E, Coleman JA, Dominguez-Escrig J, Ghai S, Huang J, Jones JS, Klotz LH, Robertson CN, Sanchez-Salas R, Scionti S, Sivaraman A, de la Rosette J, Polascik TJ. Patient selection for prostate focal therapy in the era of active surveillance: an International Delphi Consensus Project. Prostate Cancer Prostatic Dis 2017; 20:294-299. [PMID: 28349978 DOI: 10.1038/pcan.2017.8] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 01/14/2017] [Accepted: 01/21/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whole-gland extirpation or irradiation is considered the gold standard for curative oncological treatment for localized prostate cancer, but is often associated with sexual and urinary impairment that adversely affects quality of life. This has led to increased interest in developing therapies with effective cancer control but less morbidity. We aimed to provide details of physician consensus on patient selection for prostate focal therapy (FT) in the era of contemporary prostate cancer management. METHODS We undertook a four-stage Delphi consensus project among a panel of 47 international experts in prostate FT. Data on three main domains (role of biopsy/imaging, disease and patient factors) were collected in three iterative rounds of online questionnaires and feedback. Consensus was defined as agreement in ⩾80% of physicians. Finally, an in-person meeting was attended by a core group of 16 experts to review the data and formulate the consensus statement. RESULTS Consensus was obtained in 16 of 18 subdomains. Multiparametric magnetic resonance imaging (mpMRI) is a standard imaging tool for patient selection for FT. In the presence of an mpMRI-suspicious lesion, histological confirmation is necessary prior to FT. In addition, systematic biopsy remains necessary to assess mpMRI-negative areas. However, adequate criteria for systematic biopsy remains indeterminate. FT can be recommended in D'Amico low-/intermediate-risk cancer including Gleason 4+3. Gleason 3+4 cancer, where localized, discrete and of favorable size represents the ideal case for FT. Tumor foci <1.5 ml on mpMRI or <20% of the prostate are suitable for FT, or up to 3 ml or 25% if localized to one hemi-gland. Gleason 3+3 at one core 1mm is acceptable in the untreated area. Preservation of sexual function is an important goal, but lack of erectile function should not exclude a patient from FT. CONCLUSIONS This consensus provides a contemporary insight into expert opinion of patient selection for FT of clinically localized prostate cancer.
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Affiliation(s)
- K J Tay
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - M J Scheltema
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - H U Ahmed
- Division of Surgery and Interventional Science, University College of London, London, UK
| | - E Barret
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - J A Coleman
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Dominguez-Escrig
- Servicio de Urología, Fundación Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - S Ghai
- University of Toronto, Toronto, ON, Canada
| | - J Huang
- Department of Pathology, Duke University, Durham, NC, USA
| | - J S Jones
- Cleveland Clinic, Cleveland, OH, USA
| | - L H Klotz
- Sunnybrook Medical Center, Toronto, ON, Canada
| | - C N Robertson
- Duke Cancer Institute, Duke University, Durham, NC, USA
| | - R Sanchez-Salas
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - S Scionti
- Saratosa Prostate Cancer Center, Sarasota, FL, USA
| | - A Sivaraman
- L'Institut Mutualiste Montsouris, Paris-Descartes University, Paris, France
| | - J de la Rosette
- Department of Urology, Academic Medical Center, Amsterdam, The Netherlands
| | - T J Polascik
- Duke Cancer Institute, Duke University, Durham, NC, USA
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Gandaglia G, Karnes RJ, Sivaraman A, Moschini M, Fossati N, Zaffuto E, DellʼOglio P, Cathelineau X, Montorsi F, Sanchez-Salas R, Briganti A. Are all grade group 4 prostate cancers created equal? Implications for the applicability of the novel grade grouping. Urol Oncol 2017; 35:461.e7-461.e14. [DOI: 10.1016/j.urolonc.2017.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 02/21/2017] [Accepted: 02/27/2017] [Indexed: 10/19/2022]
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Sivaraman A, Assel M, Hoetker A, Srimathveeravalli G, Ehdaie B, Akin O, Coleman J. MP70-03 CLINICAL PERFORMANCE OF MULTI PARAMETRIC MAGNETIC RESONANCE IMAGING IN THE FOLLOW-UP OF PARTIAL GLAND ABLATION FOR PROSTATE CANCER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sivaraman A, Sanchez-Salas R, Prapotnich D, Yu K, Olivier F, Secin FP, Barret E, Galiano M, Rozet F, Cathelineau X. Learning curve of minimally invasive radical prostatectomy: Comprehensive evaluation and cumulative summation analysis of oncological outcomes. Urol Oncol 2017; 35:149.e1-149.e6. [DOI: 10.1016/j.urolonc.2016.10.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 08/08/2016] [Accepted: 10/23/2016] [Indexed: 12/30/2022]
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Carneiro A, Sivaraman A, Sanchez-Salas R, Nunes-Silva I, Baghdadi M, Srougi V, di Trapani E, Uriburu Pizzaro F, Doizi S, Barret E, Rozet F, Galiano M, Cathelineau X. Higher number of transrectal ultrasound guided prostate biopsy cores is associated with higher blood loss and perioperative complications in robot assisted radical prostatectomy. Actas Urol Esp 2017; 41:155-161. [PMID: 27890493 DOI: 10.1016/j.acuro.2016.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 08/12/2016] [Accepted: 09/01/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. OBJECTIVES To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). MATERIAL AND METHODS A prospectively maintained database of 2,054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. RESULTS A total number of 1,042 patients in the group 1 (≤12 cores) and 1,012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; P=.03), but high grade complication (Clavien 3-4) were similar (G1 1.4 vs. G2 2.2%; P=.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; P=.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. CONCLUSION Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results.
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Carneiro A, Kayano P, Castilho T, Sivaraman A, Claros O, Neto A, Filippi R, Baroni R, Lemos G. PD61-04 COMPARISON OF GLEASON UPGRADING RATES IN TRANSRECTAL ULTRASOUND SYSTEMATIC RANDOM BIOPSIES VERSUS US-MRI FUSION BIOPSIES FOR PROSTATE CANCER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Laudone VP, Durany R, Ehdaie B, Leitao MM, Levine M, Mehrara B, Patel SG, Scardino PT, Sclafani LM, Sivaraman A, Stein D, Tseng B, Twersky R, Simon BA. Performing complex cancer surgery in the ambulatory setting. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.8_suppl.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
106 Background: The drive to move complex surgeries into the ambulatory setting will impact the cancer population. In anticipation, we developed an “ambulatory extended recovery” (AXR) program for pathway-based management of patients undergoing procedures with traditional 1-4 day hospital stays. Then in 2016 we opened the Josie Robertson Surgery Center (JR), a freestanding ambulatory surgical facility designed for complex cancer surgeries with one overnight stay. Methods: Using hospital databases we identified AXR cases eligible to be performed at JR and examined pathway completion (discharge home on POD 1), and 30-day institutional urgent care center (UCC) visits and readmissions. We compared AXR program results before and after opening JR in January 2016. Results: The most frequent AXR procedures were mastectomy ± immediate reconstruction, thyroidectomy, and minimally invasive prostatectomy, nephrectomy, and hysterectomy. 3307 and 2359 AXR procedures were done in 2015 and Jan-Sep 2016. In 2016 74% of AXR cases were performed at JR with the remainder at Memorial Hospital (MH), primarily for scheduling considerations or patient or surgical complexity. Pathway completion was 92% in 2015 and 95% in 2016 (p < 0.001). 30-day UCC visits/readmission rates were 8.8%/3.7% in 2015 and 8.6%/3.1% in 2016 (ns). Comparing cases at JR vs MH in 2016, pathway completion rates were 98.3% at JR vs 86.4% at MH (p < 0.001). Patient satisfaction was high for care provided at both facilities. Conclusions: Many complex cancer surgeries may be safely completed with a single overnight stay at a freestanding ambulatory facility. UCC visits and readmissions were not different between years, suggesting that quality of care was maintained in the ambulatory setting. The difference in pathway completion in 2016 at JR compared to MH may reflect successful triage of more medically complex patients and/or surgically complex procedures to MH.
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Affiliation(s)
| | - Robert Durany
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Marcia Levine
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Babak Mehrara
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Daniel Stein
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Beverly Tseng
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Brett A Simon
- Memorial Sloan Kettering Cancer Center, New York, NY
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Sivaraman A, Takaeda T, Vargas HA, Fine S, Eastham JA, Ehdaie B. Defining the index lesion for salvage partial gland ablation after radiation therapy for localized prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
105 Background: Our objective was to evaluate the impact of MRI and systematic biopsy characteristics to identify the index lesion for salvage partial gland ablation using tumor maps from whole mount slides of salvage radical prostatectomy (sRP) specimen. Methods: We identified 225 patients who underwent sRP between 2000 and 2014 and a tumor map was created from whole-mount slides in 77 patients. Among these patients, we selected men with a priori pre-treatment criteria considered eligible for PGA, including, biopsy proven unilateral disease concordant with a region of interest (ROI) on MRI, and excluding men with imaging suspicious for extra-capsular extension (ECE), seminal vesicle Invasion (SVI) or lymph node involvement (LNI). We describe the correlation between pre-treatment clinical characteristics and final radical prostatectomy whole mount specimen to select men eligible for PGA defined as hemi-gland ablation. Results: Among 77 patients with a tumor map of entirely-submitted and whole-mounted specimens, 15 patients were determined to be eligible for partial gland ablation based on pre-treatment clinical characteristics. The mean age was 60 years and median time from primary RT was 48 months. The median (IQR) tumor volume of the index lesion was 0.3 (0.4) cc. The location of the index lesion was determined to be the apex, mid-gland and base in 77%, 100% and 15% of patients, respectively. The median distance of the index tumor to the urethra was 0.5 (0.2) cm. The index tumor was confined to one lobe and concordant to the biopsy pathology and MRI data in all 15 patients (100%). There was no ECE, LNI or SVI identified in the sRP specimens. To account for those patients who did not have a tumor map of the whole-mount specimen, a sensitivity analysis was performed and determined that the clinical characteristics of the 77 patients with tumor maps were comparable to the entire 225 sRP cohort. Conclusions: Clinical characteristics guided by biopsy findings and MRI data can be used to select men for PGA with recurrent localized prostate cancer after radiation therapy and based on tumor maps from sRP specimen, we propose that salvage hemi-gland ablation including periurethral tissue is feasible.
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Affiliation(s)
| | | | | | - Samson Fine
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, NY
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Sivaraman A, Ehdaie B, Eastham JA, Coleman J, Touijer KA, O'Shaughnessy M, Stein D, Durany R, Laudone VP. Surgical center for ambulatory extended recovery: 30-day follow-up report of minimally invasive radical prostatectomy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
83 Background: In January 2016, we opened a novel, multidisciplinary ambulatory surgical center dedicated to perform complex cancer surgeries on an Ambulatory Extended Recovery (AXR) pathway specifically aimed at a 1-night or less hospital stay. This is a standalone facility separate from the inpatient hospital. The aim of this study is to evaluate the 30-day post-operative follow-up of Minimally Invasive Radical Prostatectomy (MIRP) performed in an ambulatory care setting. Methods: Between January 2016 – September 2016, we performed 424 MIRP in the AXR dedicated surgical center. The baseline demographics, cancer characteristics, surgical information and follow-up data were prospectively collected. We evaluated the 30-day complications, rate of falling-off the AXR pathway, rate of transfer to our inpatient hospital, number urgent care visits and need for re-admission. Results: MIRP was performed as robot assisted (85%) and laparoscopic (15%) procedures. The median (range) overall length of hospital stay was 27.1 (11.4 – 35.2) hours with a total operative time of 4.8 (3.1 – 9.3) hours with an estimated blood loss of 175 (20 - 800) ml. Nine patients (2.1%) fell off the AXR pathway and were transferred to the main hospital for further care. In the 30-day post-surgery period, complications were noted in 6.4% patients (Grade 1 -38%, 2 - 34% 3 – 27%), while urgent care visits and re-admission rates were 10.7% and 2.6% respectively. The median (range) time from surgery to re-admission was 16 (2 - 43) days. Conclusions: A multidisciplinary ambulatory surgical center with a dedicated AXR pathway represents a significant advancement in MIRP surgical care, providing a 1-night hospital stay in an ambulatory setting with acceptably low rates of complications, urgency care visits and re-admissions.
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Affiliation(s)
| | - Behfar Ehdaie
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Daniel Stein
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert Durany
- Memorial Sloan Kettering Cancer Center, New York, NY
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Barreras SG, Sanchez-Salas R, Sivaraman A, Barret E, Secin FP, Redondo C, Velilla G, Nunes-Silva I, Srougi V, Rembeyo G, Baghdadi M, Rozet F, Galiano M, Cathala N, Mombet A, Prapotnich D, Cathelineau X. Prospective comparative analysis of oncologic and functional outcomes between focal therapy and robotic radical prostatectomy. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
90 Background: Focal therapy (FT) is an emerging treatment alternative for organ-confined Prostate cancer (PCa). The aim is to perform a non-randomized prospective analysis to compare oncological, functional and morbidity outcomes after FT and robotic radical prostatectomy (RARP). Methods: From July 2009 to September 2015, 1883 patients underwent RARP and 373 FT. Of those, we selected 1410 men (1222 RARP and 236 FT) according to the NCCN PCa risk classification: 402(27.5%),388(26.6%) and 668(45.8%) patients were very low risk, low risk and intermediate risk, respectively. Within FT, 188 men underwent focal high-intensity focused ultrasound (HIFU) and 48 cryotherapy. Oncologic outcomes were analyzed in terms of biochemical recurrence (BCR) free survival (Phoenix definition for FT, and PSA >0.2 ng/dl in RARP), and the need for further treatment. FT failure was defined as any positive control biopsy after treatment. Overall suvival and metastasis free survival were estimated using Cox regression and Kaplan-Meier methods. Complications were graded as Clavien-Dindo classification. Functional outcomes were assessed with validated questionnaries for genitourinary symptoms and sexual function. Results: Median follow-up was 45.4 mo (IQR: 25.3-65.5). BCR-free survival was comparable among RARP and FT ( 10.6% RARP vs 9% FT, p 0.69). Patients with intermediate risk PCa were significantly associated with BCR in both groups (HR 8.47;95% CI 4.57-15.71; p< 0.001). In FT group positive biopsy in the treated lobe was seen in 42(17.7%) men. No differences were found in overall survival, neither mestastases free survival between treatments; (p 0.85 and p 0.142 respectively). FT was associated with higher risk of further treatments (HR 5.21; 95% CI 3.7-7.35; p <0.001). FT had higher rates of complications (15.3% vs 9% for RARP, p 0.004). RARP was associated with less continence recovery vs FT at 3, 6 and 12 mo (p <0.001). Potency is higher between FT men at 3,6 and 12 mo (<p 0.001). Conclusions: For selected patients with organ confined PCa, RARP and FT offered comparable oncological control with FT requiring higher additional treatments. Potency and continency appears to be better preserved in FT patients.
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Affiliation(s)
| | | | | | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Fernando P. Secin
- CEMIC University Hospital and San Lazaro Foundation, Capital Federal, Argentina
| | - Cristina Redondo
- Institut Mutualiste Monstsouris, University Paris-Descartes, Paris, France
| | - Guillermo Velilla
- Institut Mutualiste Monstsouris, University Paris-Descartes, Paris, France
| | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Gregory Rembeyo
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Nathalie Cathala
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Annick Mombet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Dominic Prapotnich
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Baghdadi M, Barret E, Sivaraman A, Sanchez-Salas R, Nunes-Silva I, Srougi V, Ahallal Y, Rembeyo G, Barreras SG, Rozet F, Galiano M, Cathelineau X. Focal cryo-hemiablation to treat unilateral localized prostate cancer: A prospective midterm oncologic and functional outcomes. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.e537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e537 Background: We report our mid-term oncologic and functional outcomes of focal cryo-hemiablation (FC-HA) for unilateral localized low-risk prostate cancer (PCa). Methods: Prospective single-arm interventional study analyzing mid-term data of PCa patients treated at our institution with FC-HA of diseased lobe. Inclusion criteria were men with unilateral localized cancer, PSA < 15 ng/ml, clinical stage T1c-T2a, Gleason score ≤ 7 (3+4), maximum number of cancer-cores < 33%, maximum cancer involvement in a single core < 50%, no extra prostatic extension in mp-MRI, no previous PCa-related treatment and life expectancy ≥10 yr. PSA was measured every 3 mo during 1st yr post treatment, and biannually thereafter. mp-MRI and biopsy of both lobes were routinely done at 12 mo, while repeat biopsies were driven by PSA elevations. Continence, urinary and erectile functions were assessed using ICS, IPSS and IIEF-5 questionnaires, respectively. Treatment failure (primary outcome) was defined as residual cancer in treated lobe at follow up. Results: We studied 52 men with mean (SD) age of 65.8 (7.2) yrs and median (IQR) follow-up of 31 (21-44) mo. Baseline criteria were: median (IQR) of PSA of 6.8 (5.4–8.0) ng/ml, total number of cancer-cores of 2 (1-3) and percentage cancer-cores of 17% (8-25), and total cancer-core length of 7 (3-12) mm. Gleason score was 6 (3+3) in 33 (63.5%) and 7 (3+4) in 19 (36.5%) patients. Follow-up biopsies were done in 1st, 2nd and 3rd yrs for 52 (100%), 28 (53.8%) and 15 (28.8%) patients, respectively, revealing cancer-cores in 13/52 (25%) patients. 6 (11.5%), 5 (9.6%) and 2 (3.8%) patients showed cancer in ipsilateral lobe, contralateral lobe and bilaterally, respectively. Treatment failure was observed in the treated lobe in 8 (15.4%) patients. Median (IQR) PSA significantly (p < 0.0001) declined to nadir PSA of 2.9 (1.5-4.2) ng/ml (57.4% reduction) at 3 mo. None of patients demonstrated undetectable PSA. All patients maintained continence with insignificant worsening of IPSS (p <0.92) and IIEF-5 (p <0.07) and low toxicity. Conclusions: FC-HA appears to maintain acceptable oncologic control in mid-term follow-up with preserved genitourinary functions and low toxicity.
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Affiliation(s)
- Mohammed Baghdadi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Eric Barret
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | | | - Igor Nunes-Silva
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Victor Srougi
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Youness Ahallal
- Department of Urology, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris ,France, Paris, France
| | - Gregory Rembeyo
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | | | - François Rozet
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Marc Galiano
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
| | - Xavier Cathelineau
- Institut Mutualiste Montsouris, University Paris-Descartes, Paris, France
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Carneiro A, Kayano PP, Castilho TML, Sivaraman A, Claros OR, Serpa Neto A, Filippi RZ, Baroni RH, Lemos GC. Comparison of Gleason upgrading rates in transrectal ultrasound systematic random biopsies versus US-MRI fusion biopsies for prostate cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
57 Background: US-MRI fusion biopsy (FB) showed that it improves the detection of clinically significant prostate cancer (PCa). A more accurate diagnostic method is desirable to avoid misclassification, which in turn is particularly important in appropriate decision making on treatment for PCa (active surveillance or focal therapy or radical treatment). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after the surgery in patients who underwent only TRUS systematic random biopsies versus US-MRI FB for PCa. Methods: A retrospective analysis of patients’ prospective collected data that underwent prostate biopsy and subsequent radical prostatectomy were included from January 2011 to June 2016 at our institution. The study cohort was divided into: US-MRI FB (Group A) and only TRUS systematic random biopsy (Group B). US-MRI FB was performed in patients who had a previous MRI with a focal lesion classified by Likert score ≥ 3, otherwise a TRUS systematic random biopsy was performed. All biopsies and surgical specimens were analyzed by the same uropathologist and MRIs were analyzed by two expert urological radiologists. Results: 73 men underwent US-MRI FB and 89 TRUS systematic random biopsy. The GU rate was higher in group B (31.5% vs 16.4%; p = 0.027). GU according to Gleason grade pattern was higher in Group B against Group A (40.4% vs 23.3%; p = 0.02). Analyses from separate Gleason grade pattern showed that Gleason score 3+4 presented less GU in group A (24.1% vs 52.6%; p = 0.043). The Bland-Altman plot analysis showed a higher bias in Group B compared to group A (-0.27 [-1.40 to 0.86] vs -0.01 [-1.42 to 1.39]). In the multivariable logistic regression the only independent predictor of GU was the use of TRUS systematic random biopsy (2.64 [1.11 – 6.28]; p = 0.024). Conclusions: The US-MRI FB appears to be related to a decrease in GU rate and an increase in the concordance between biopsy and final pathology in comparison to TRUS random biopsy, that leads to greater accuracy on diagnosis and better treatment decision.
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Affiliation(s)
- Arie Carneiro
- Hospital Israelita Albert Einstein, Sao Paulo, Brazil
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Sivaraman A, Barret E. Reply to Runqiang Yuan and Hongxing Huang's Letter to the Editor re: Ernesto R. Cordeiro Feijoo, Arjun Sivaraman, Eric Barret, et al. Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes. Eur Urol 2016;69:214-20. Eur Urol 2017; 71:e148-e149. [PMID: 28161029 DOI: 10.1016/j.eururo.2017.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/19/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Arjun Sivaraman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Eric Barret
- Department of Urology, Institute Mutualiste Monstouris, Paris, France.
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Perez-Reggeti JI, Sanchez-Salas R, Sivaraman A, Linares Espinos E, de Gracia-Nieto AE, Barret E, Galiano M, Rozet F, Fregeville A, Renard-Penna R, Cathala N, Mombet A, Prapotnich D, Cathelineau X. High intensity focused ultrasound with Focal-One ® device: Prostate-specific antigen impact and morbidity evaluation during the initial experience. Actas Urol Esp 2016; 40:608-614. [PMID: 27543259 DOI: 10.1016/j.acuro.2016.04.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/22/2016] [Accepted: 04/22/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE We report our initial experience in the treatment of prostate cancer (PCa) with high-intensity focused ultrasound (HIFU) using the Focal-One® device. MATERIAL AND METHODS Retrospective review of the prospectively populated database. Between June 2014 to October 2015, 85 patients underwent HIFU (focal/whole-gland) treatment for localized PCa. Preoperative cancer localization was done with multiparametric magnetic resonance imaging (mpMRI) and transperineal mapping biopsies. Treatment was carried out using the Focal-One® device under general anesthesia. Oncological follow-up: PSA measurement and control biopsy with mpMRI according to protocol. Questionnaire-based functional outcome assessment was done. Complications were reported using Clavien classification. RESULTS The median PSA was 7.79ng/ml (IQR 6.32-9.16), with a median prostate volume of 38cc (IQR: 33-49.75). Focal and whole-gland therapy was performed in 64 and 21 patients respectively. Ten patients received salvage HIFU. Complications were encountered in 15% of cases, all Clavien 2 graded. Mean hospital stay was 1.8 days (0-7) and bladder catheter was removed on day 2 (1-6). Mean percentage reduction of PSA was 54%. Median follow-up was 3 months (IQR: 2-8). Functional outcomes: All patients were continents at 3 months and potency was maintained in 83% of the preoperatively potent. CONCLUSIONS Focal-One® HIFU treatment appears to be a safe procedure with few complications. Functional outcomes proved no urinary incontinence and sexual function were maintained in 83%.
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Affiliation(s)
- J I Perez-Reggeti
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia.
| | - A Sivaraman
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - E Linares Espinos
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | | | - E Barret
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - M Galiano
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - F Rozet
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - A Fregeville
- Departamento de Radiología, Institut Mutualiste Montsouris, París, Francia
| | - R Renard-Penna
- Departamento de Radiología, Pitié-Salpêtrière Hospital, París, Francia
| | - N Cathala
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - A Mombet
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - D Prapotnich
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Departamento de Urología, Institut Mutualiste Montsouris, París, Francia
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Ahallal Y, Sanchez-Salas R, Sivaraman A, Barret E, Secin F, Validire P, Rozet F, Galiano M, Cathelineau X. Clinical performance of transperineal template guided mapping biopsy for therapeutic decision making in low risk prostate cancer. Actas Urol Esp 2016; 40:615-620. [PMID: 27527686 DOI: 10.1016/j.acuro.2016.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To evaluate the role of Transperineal Template guided Mapping Biopsy (TTMB) in determining the management strategy in patients with low risk prostate cancer (PCa). METHODS We retroscpectively evaluated 169 patients who underwent TTMB at our institution from February 2008 to June 2011. Ninety eight of them harbored indolent PCa defined as: Prostate Specific Antigen<10ng/ml, Gleason score 6 or less, clinical stage T2a or less, unilateral disease and a maximum of one third positive cores at first biopsy and<50% of the core involved. TTMB results were analyzed for Gleason score upgrading and upstaging as compared to initial TransRectal UltraSound (TRUS) biopsies and its influence on the change in the treatment decisions. RESULTS TTMB detected cancer in 64 (65%) patients. The upgrade, upstage and both were noted in 33% (n=21), 12% (n=8) and 7% (n=5) respectively of the detected cancers. The disease characteristics was similar to initial TRUS in 30 (48%) patients and TTMB was negative in 34 (35%) patients. Prostate volume was significantly smaller in patients with upgrade and/or upstage noted at TTMB (45.4 vs 37.9; P=.03). TTMB results influenced 73.5% of upgraded and/or upstaged patients to receive radical treatment while 81% of the patients with unmodified stage and/or grade continued active surveillance or focal therapy. CONCLUSIONS In patients with low risk PCa diagnosed by TRUS, subsequent TTMB demonstrated cancer upgrade and/or upstage in about one-third of the patients and resulted in eventual change in treatment decision.
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Sivaraman A, Kumhar M, Sahu UK, Mali MK. Infantile (Preductal) Coarctation of Aorta Presenting as Cerebellar Infarct - A Rare Presentation. J Assoc Physicians India 2016; 64:93-94. [PMID: 27805349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Coarctation of aorta is a common congenital heart defect. The diagnosis may be missed unless a highindex of suspicion is maintained, and is often delayed until the patient develops congestive heart failure (CHF), (common in infants) or hypertension (common in older children). It seldom goes undiagnosed till adulthood and frequently leads to complications as a result of long-standing high blood pressure. Intracranial haemorrhage, premature coronary artery disease, aortic aneurysms and rupture have all been reported. But it is rare to see a patient with preductal (infantile) coarctation survive childhood and presents with an infarct in adulthood. We herein present a case report of a young woman who came with vomiting and giddiness and was diagnosed as a case of cerebellar infarct due to a concealed preductal (infantile) coarctation of aorta.
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Affiliation(s)
| | - Maniram Kumhar
- Professor, Jawahar Lal Nehru Medical College and Hospital, Ajmer, Rajasthan
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Sivaraman A, Sanchez-Salas R, Castro-Marin M, Barret E, Guillot-Tantay C, Prapotnich D, Cathelineau X. Evolution of prostate biopsy techniques. Looking back on a meaningful journey. Actas Urol Esp 2016; 40:492-8. [PMID: 27269481 DOI: 10.1016/j.acuro.2016.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 02/28/2016] [Accepted: 02/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND The technique of prostate biopsy has evolved a long way since its inception to being a safe diagnostic procedure. The principles of the biopsy technique continue to improvise with the knowledge about prostate cancer and availability of newer treatment options like active surveillance and focal therapy. Currently, we depend on accurate cancer information from the biopsy more than ever for deciding the ideal treatment option. AIM The aim of this review is to present the major milestones in prostate biopsy technique evolutions and its impact on the prostate cancer management. ACQUISITION OF EVIDENCE We performed a detailed non-systematic literature review to present the historical facts on the transformations in prostate biopsy techniques and also the direction of present research to improve accurate cancer detection. SUMMARY OF EVIDENCE There is a clear change in trend in biopsy technique before and after the introduction of transrectal ultrasound and prostate specific antigen. In the earlier era, the biopsies were aimed at palpable nodules and obtaining adequate prostatic tissue for diagnosis while the later era has moved towards detection of non-palpable and early prostate cancer. Recently, there is an increasing trend towards image guided targeted biopsies to extract maximum cancer information from minimum biopsy cores. CONCLUSION Prostate biopsy techniques have seen major changes since its inception and have a major impact on prostate cancer management. There is a great potential for research which can further support the newer treatment options like focal therapy.
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Capogrosso P, Sanchez-Salas R, Salonia A, Cathala N, Mombet A, Sivaraman A, Barret E, Montorsi F, Cathelineau X. Recovery of urinary continence after radical prostatectomy. Expert Rev Anticancer Ther 2016; 16:1039-52. [PMID: 27636115 DOI: 10.1080/14737140.2016.1233818] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION In the era of minimally-invasive surgery, urinary incontinence (UI) after radical prostatectomy (RP) still represents a troublesome issue for a considerable rate of patients. Factors associated with the risk of post-RP UI, need to be carefully assessed throughout the overall clinical management process thus including the pre-operative, intra-operative and post-operative setting. AREAS COVERED This review analyses current published evidences regarding clinical and surgical aspects associated with urinary continence (UC) recovery after RP. A careful evaluation of patient's clinical characteristics should be carried out before surgery in order to properly counsel the patients regarding the risk of UI. In the last two decades, the advent of robotic surgery has led to an overall improvement of functional outcomes after RP, thanks to the development of different surgical strategies based on either the 'preservation' or the 'reconstruction' of the anatomical elements responsible for urinary continence. Finally, several therapeutic strategies including either a conservative approach, or pharmacological and surgical treatments, should be carefully considered for the post-operative management of UI. Expert commentary: A comprehensive pre-operative patient's clinical assessment, along with a proper and well-conducted surgical procedure and an effective post-operative care management are essential element to achieve a high probability of UC recovery.
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Affiliation(s)
- Paolo Capogrosso
- a Università Vita-Salute San Raffaele , Milan , Italy.,b Division of Experimental Oncology/Unit of Urology, URI , IRCCS Ospedale San Raffaele , Milan , Italy.,c Department of Urology , L'Institut Mutualiste Montsouris , Paris , France
| | | | - Andrea Salonia
- a Università Vita-Salute San Raffaele , Milan , Italy.,b Division of Experimental Oncology/Unit of Urology, URI , IRCCS Ospedale San Raffaele , Milan , Italy
| | - Nathalie Cathala
- c Department of Urology , L'Institut Mutualiste Montsouris , Paris , France
| | - Annick Mombet
- c Department of Urology , L'Institut Mutualiste Montsouris , Paris , France
| | - Arjun Sivaraman
- c Department of Urology , L'Institut Mutualiste Montsouris , Paris , France
| | - Eric Barret
- c Department of Urology , L'Institut Mutualiste Montsouris , Paris , France
| | - Francesco Montorsi
- a Università Vita-Salute San Raffaele , Milan , Italy.,b Division of Experimental Oncology/Unit of Urology, URI , IRCCS Ospedale San Raffaele , Milan , Italy
| | - Xavier Cathelineau
- c Department of Urology , L'Institut Mutualiste Montsouris , Paris , France
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Linares Espinós E, Barret E, Sivaraman A, Pérez-Reggeti JI, Sánchez-Salas R, Rozet F, Galiano M, Cathelineau X. [Localized prostate cancer Focal Therapy: "A la carte" Model]. ARCH ESP UROL 2016; 69:345-352. [PMID: 27416638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Focal therapy has settled as an alternative to radical treatment in selected cases of localized prostate cancer. The selection of patients who are candidates for focal therapy is based on imaging diagnosis relying on multiparametric MRI and image fusion techniques. Thanks to the oncological results and safety profiles of initial series, various energy sources have been developed over the last years. The availability of multiple types of energy sources for focal therapy, commits us to evaluate what type of energy would be the optimal depending on patient's profile and type of lesion. A unique energy for focal therapy would be ideal, but facing the research of the various types of energy we must identify which one is recommended for each lesion. With the experience of our center in different approaches of focal therapy we propose the "A LA CARTE" MODEL based on localization of the lesion. We present the criteria the "a la carte" model is based on, supported by the published evidence on the use of different ablative therapies for the treatment of localized prostate cancer. Lesion localization, technical characteristics of each type of energy, patient's profile and secondary effects must be considered in every choice of focal therapy.
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Affiliation(s)
- E Linares Espinós
- Hospital Universitario Infanta Sofía. Universidad Europea de Madrid. Madrid. España
| | - E Barret
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - A Sivaraman
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | | | - R Sánchez-Salas
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - F Rozet
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - M Galiano
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
| | - X Cathelineau
- Institut Montsouris. Université Paris-Descartes. Paris. Francia
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Sivaraman A. High intensity focused ultrasound for Focal Therapy of prostate cancer. ARCH ESP UROL 2016; 69:311-316. [PMID: 27416634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
High Intensity Focused Ultrasound (HIFU) is a heat based energy source used for tissue ablation. HIFU has several clinical applications and prostate cancer ablation is one of the uses that have been explored for more than a decade. Focal therapy is an alternative treatment option for selected patients with low/intermediate PCa, that is based on complete ablation of tumor within the prostate with preservation of normal parenchyma and better preservation of Genitourinary functions. In spite of PCa being predominantly a multi-centric disease, it is postulated that a specific dominant (large volume) 'index lesion' dictates the biological behavior of the cancer and subsequent lethality of the disease. The use of HIFU for focal ablation of PCa, have demonstrated satisfactory cancer control with fewer morbidity and better preservation of continence and erection. The aim of this article is to present the readers with a brief review of the principles, devices available for clinical uses, published clinical experience and future directions and research opportunities in focal HIFU ablation of prostate cancer.
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Affiliation(s)
- A Sivaraman
- Department of Urology. Institut Montsouris. Université Paris-Descartes. Paris. France
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Linares Espinos E, Sivaraman A, Sanchez-Salas R, Perez-Reggeti JI, Pamela A, Barret E, Galiano M, Rozet F, Prapotnich D, Cathala N, Mombet A, Cathelineau X. MP40-04 MINIMALLY INVASIVE SALVAGE PROSTATECTOMY AFTER PRIMARY RADIATION OR ABLATION TREATMENT: COMPLICATIONS, FUNCTIONAL AND LONG-TERM ONCOLOGICAL OUTCOMES. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sivaraman A, Ahallal Y, Sanchez-Salas R, Linares Espinos E, Perez-Reggeti JI, Russo A, Armando Hernandez Palacios G, Barret E, Galiano M, Rozet F, Cathelineau X. MP16-11 ROUTINE USE OF MAGNETIC RESONANCE IMAGING IN PROSTATE CANCER FACILITATES BETTER CANDIDATE SELECTION FOR ACTIVE SURVEILLANCE. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.2576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Karthikeyan VS, Mallya A, Sivaraman A, Sanchez-Salas R, Galiano M, Rozet F, Barret E, Cathelineau X. MP75-01 RECURRENCE IN PATHOLOGIC UPSTAGING TO PT3A IN CT1 RENAL TUMORS. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.1719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Galiano M, Guillot-Tantay C, Sivaraman A, Slaoui H, Barret E, Rozet F, Sanchez-Salas R, Cathelineau X. Superficial Implantation of the I-Stop TOMS Transobturator Sling in the Treatment of Postprostatectomy Urinary Incontinence: Description of a Novel Technique and 1-Year Outcomes. Urology 2016; 90:195-8. [DOI: 10.1016/j.urology.2015.10.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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Pavan N, Zargar H, Sanchez-Salas R, Castillo O, Celia A, Gallo G, Sivaraman A, Cathelineau X, Autorino R. Robot-assisted Versus Standard Laparoscopy for Simple Prostatectomy: Multicenter Comparative Outcomes. Urology 2016; 91:104-10. [PMID: 26948530 DOI: 10.1016/j.urology.2016.02.032] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/13/2016] [Accepted: 02/20/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To report a comparative analysis of laparoscopic simple prostatectomy (LSP) vs robot-assisted simple prostatectomy (RASP). PATIENTS AND METHODS Consecutive cases of LSP and RASP done between 2003 and 2014 at 3 participating institutions were included in this retrospective analysis. The effectiveness of the two procedures was determined by performing a paired analysis of main functional and surgical outcomes. A multivariate analysis was also conducted to determine the factors predictive of "trifecta" outcome (combination of International Prostate Symptom Score <8, Qmax > 15 mL/second, and no perioperative complications). RESULTS A total of 319 patients underwent minimally invasive simple prostatectomy at the participating institutions over the study period. Total prostate volume was larger in the RASP group (median 118.5 mL vs 109 mL, P = .02). Median estimated blood loss tended to be higher for LSP (300 mL vs 350 mL, P = .07). There was no difference in terms of catheterization time (P = .3) and hospital stay (P = .42). A higher rate of overall postoperative complications was recorded in the RASP group (17.7% vs 5.3%), but rate of major complications was not significantly different between the two techniques (2.3 vs 2.1, P = .6). Subjective and objective parameters significantly improved for both LSP and RASP. On multivariable analysis, only two factors were associated with likelihood of obtaining a favorable (trifecta) outcome: age (odds ratio: 0.94; P = .03) and body mass index (odds ratio: 0.84; P = .03). CONCLUSION Both LSP and RASP can be regarded as safe and effective minimally invasive surgical treatments for bladder outlet obstruction due to large prostate glands.
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Affiliation(s)
- Nicola Pavan
- Urology Institute, University Hospitals, Cleveland, OH; Urology Clinic, Department of Medical, Surgical and Health Science, University of Trieste, Italy
| | - Homayoun Zargar
- Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | | | - Octavio Castillo
- Department of Urology, Clinica Indisa, Universidad Andres Bello, Santiago, Chile
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | - Gaetano Gallo
- Department of Urology, San Bassiano Hospital, Bassano del Grappa, Italy
| | | | | | - Riccardo Autorino
- Urology Institute, University Hospitals, Cleveland, OH; Urology Unit, Second University of Naples, Napoli, Italy.
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Feijoo ERC, Sivaraman A, Barret E, Sanchez-Salas R, Galiano M, Rozet F, Prapotnich D, Cathala N, Mombet A, Cathelineau X. Focal High-intensity Focused Ultrasound Targeted Hemiablation for Unilateral Prostate Cancer: A Prospective Evaluation of Oncologic and Functional Outcomes. Eur Urol 2016; 69:214-20. [DOI: 10.1016/j.eururo.2015.06.018] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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Perez-Reggeti JI, Sanchez-Salas R, Linares Espinos E, Ingels A, Sivaraman A, Saad M, Rozet F, Barret E, Galiano M, Cathala N, Mombet A, Prapotnich D, Cathelineau X. Long-term oncological and functional outcomes of prostate sparing cystectomy: Single tertiary care institution experience. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
413 Background: To analyze the oncological and functional outcome of Prostate Sparing Cystectomy (PSC) in the treatment of Bladder Cancer (BC) in a single tertiary care referral institution. Methods: At our institution, we treated 147 patients (1992 – 2014) with PSC for muscle invasive BC and recurrent high grade non-muscle invasive BC. Out of these, 64 patients received a standardized PSC technique featuring a Millin adenomectomy between 2001 – 2014 and composed the population of the study. Inclusion criteria were: Normal prostate examination and prostate specific antigen (PSA) +/- negative transrectal ultrasound guided biopsies; Frozen section negative for cancer in prostatic urethra prostate base, distal ureters and trigone. Oncological outcome was evaluated with Overall survival (OS); Cancer-specific survival (CSS); Recurrence-free survival (RFS). Functional outcomes: Continence - being pad-free or leak-free requiring ≤ 1 pad per day/night. Sexual function was assessed by self- reported erectile function sufficient for intercourse with or without medical treatment. Results: Median age was 62 years (IQR 55-67,5) with a median follow-up of 70 months (IQR 46-103). Thirty one (48,4%) patients ≤ pT1, 19 (29,7%) pT2, 14 (21,9%) ≥ pT3 at pathological diagnosis. Lymphadenectomy was performed in 95,3% of the cases. Positive lymph nodes were found in 4.9% patients and 3.1% patients showed positive surgical margins. Ten patients (15,7%) had Clavien grade 3–5 complications.The 5 and 10-y survival rates were OS: 84,7% and 68,3%; CSS: 84,7% and 77,5%; RFS: 76% and 65,5% respectively. No case of recurrence at the remnant prostatic urothelium was observed. Pad-free and leak-free continence, were achieved in 85.9% and 93.8% for daytime continence respectively, with 50% and 85,9% for night continence, respectively. Erectile function was maintained in 56,3%. Prostate cancer was diagnosed in 3 (4,7%) patients, 2 at the pathology report of the adenomectomy followed with active surveillance, and 1 was diagnosed during the follow up being treated with brachytherapy. Conclusions: PSC appears to be an oncologically safe procedure with adequate functional outcomes in treating selected patients with BC.
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Sivaraman A, Sanchez-Salas R, Prapotnich D, Barret E, Mombet A, Cathala N, Rozet F, Galiano M, Cathelineau X. Robotics in urological surgery: evolution, current status and future perspectives. Actas Urol Esp 2015; 39:435-41. [PMID: 25801676 DOI: 10.1016/j.acuro.2014.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/04/2014] [Accepted: 10/07/2014] [Indexed: 11/29/2022]
Abstract
CONTEXT Robotic surgery is rapidly evolving and has become an essential part of surgical practice in several parts of the world. Robotic technology will expand globally and most of the surgeons around the world will have access to surgical robots in the future. It is essential that we are updated about the outcomes of robot assisted surgeries which will allow everyone to develop an unbiased opinion on the clinical utility of this innovation. OBJECTIVE In this review we aim to present the evolution, objective evaluation of clinical outcomes and future perspectives of robot assisted urologic surgeries. ACQUISITION OF EVIDENCE A systematic literature review of clinical outcomes of robotic urological surgeries was made in the PUBMED. Randomized control trials, cohort studies and review articles were included. Moreover, a detailed search in the web based search engine was made to acquire information on evolution and evolving technologies in robotics. SYNTHESIS OF EVIDENCE The present evidence suggests that the clinical outcomes of the robot assisted urologic surgeries are comparable to the conventional open surgical and laparoscopic results and are associated with fewer complications. However, long term results are not available for all the common robotic urologic surgeries. There are plenty of novel developments in robotics to be available for clinical use in the future. CONCLUSION Robotic urologic surgery will continue to evolve in the future. We should continue to critically analyze whether the advances in technology and the higher cost eventually translates to improved overall surgical performance and outcomes.
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Affiliation(s)
- A Sivaraman
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - R Sanchez-Salas
- Department of Urology, Institute Mutualiste Montsouris, París, Francia.
| | - D Prapotnich
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - E Barret
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - A Mombet
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - N Cathala
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - F Rozet
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - M Galiano
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
| | - X Cathelineau
- Department of Urology, Institute Mutualiste Montsouris, París, Francia
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