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Rahota RG, Salin A, Rahota DM. Testis sparing surgery for testicular masses: fact or fiction? Transl Androl Urol 2022; 11:1475-1476. [PMID: 36507486 PMCID: PMC9732690 DOI: 10.21037/tau-22-649] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Razvan-George Rahota
- Urology Department, Pelican Hospital, Oradea, Romania;,University of Oradea, Faculty of Medicine and Pharmacy Oradea, Oradea, Romania
| | | | - Diana-Maria Rahota
- University of Oradea, Faculty of Medicine and Pharmacy Oradea, Oradea, Romania;,Physical Recovery and Rehabilitation Clinical Hospital, Baile Felix, Oradea, Romania
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Laukhtina E, Moschini M, Krajewski W, Teoh JYC, Ploussard G, Soria F, Roghmann F, Muenker MA, Roumiguie M, Alvarez-Maestro M, Misrai V, Antonelli A, Tafuri A, Simone G, Mastroianni R, Zhao H, Rahota RG, D'Andrea D, Mori K, Albisinni S, Karakiewicz PI, Fajkovic H, Enikeev D, Montorsi F, Shariat SF, Pradere B. Oncological and safety profiles in patients undergoing simultaneous TURB and TURP. BJU Int 2022; 131:571-580. [PMID: 36134575 DOI: 10.1111/bju.15898] [Citation(s) in RCA: 1] [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: 12/01/2022]
Abstract
OBJECTIVES Evidence on the outcomes of simultaneous transurethral resection of bladder tumor (TURB) for bladder cancer and transurethral resection of the prostate (TURP) for obstructive benign prostatic hyperplasia is limited and contradictory. The aim of this study was to determine the oncological impact and adverse events of performing simultaneous TURB and TURP. MATERIALS AND METHODS Patients from twelve European hospitals treated with either TURB alone or simultaneous TURB and TURP (TURB+TURP) were retrospectively analyzed. A propensity-score matching (PSM) 1:1 was performed with patients from the TURB+TURP group matched to TURB-alone patients. Associations between surgery approach with recurrence-free (RFS) and progression-free (PFS) survivals were assessed in Cox regression models before and after PSM. We performed a subgroup analysis in patients with risk factors for recurrence (multifocality and/or tumor size >3cm). RESULTS A total of 762 men were included, among whom, 76% (n=581) underwent a TURB-alone and 24% (n=181) a TURB+TURP. There was no difference in terms of tumor characteristics between the groups. We observed comparable length of stay as well as complication rates including major complications (Clavien-Dindo grade ≥ 3) for the TURB alone versus TURB+TURP groups, while the latest led to longer operative time (p<0.001). During a median follow-up of 44 months, there were more recurrences in the TURB-alone (47%) compared to the TURB+TURP group (28%; p<0.001). Interestingly, there were more recurrences at the bladder neck/prostatic fossa in the TURB-alone group (55% vs. 3%; p<0.001). TURB+TURP procedures were associated with improved RFS (HR 0.39, 95% CI 0.29-0.53, p<0.001), but not PFS (HR 1.63, 95% CI 0.90-2.98, p=0.11). Within the PSM cohort of 254 patients, the simultaneous TURB+TURP was still associated with improved RFS (HR 0.33, 95% CI 0.22-0.49, p<0.001). This was also true in the subgroup of 380 patients with recurrence risk factors (HR 0.41, 95% CI 0.28-0.62, p<0.001). CONCLUSION In our contemporary cohort, simultaneous TURB and TURP seems to be oncologically safe option that may, even, improve RFS by potentially preventing disease recurrence at the bladder neck and in the prostatic fossa.
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Affiliation(s)
- Ekaterina Laukhtina
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Marco Moschini
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, University Center of Excellence in Urology, Wrocław Medical University, Wroclaw, Poland
| | - Jeremy Yuen-Chun Teoh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Guillaume Ploussard
- Department of Urology, La Croix du Sud Hospital, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Città della Salute e della Scienza di Torino, Torino School of Medicine, Torino, Italy
| | | | | | - Mathieu Roumiguie
- Department of Urology, University Hospital of Toulouse Rangueil, 1 Avenue du Professeur Jean Poulhès, 31400, Toulouse, France
| | | | - Vincent Misrai
- Department of Urology, Clinique Pasteur, Toulouse, France
| | | | | | | | | | - Hongda Zhao
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Razvan-George Rahota
- Department of Urology, La Croix du Sud Hospital, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - David D'Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Keiichiro Mori
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Simone Albisinni
- Service d'Urologie, Hôpital Erasme, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Harun Fajkovic
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Dmitry Enikeev
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, New York, USA.,Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan
| | - Benjamin Pradere
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, La Croix du Sud Hospital, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
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Saouli A, Rahota RG, Ziouziou I, Elhouadfi O, Karmouni T, Elkhader K, Koutani A, Andalousi AIA, Ploussard G. Safety and feasibility of same-day discharge laparoscopic radical prostatectomy: a systematic review. World J Urol 2022; 40:1367-1375. [PMID: 35157103 PMCID: PMC8853082 DOI: 10.1007/s00345-022-03944-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Day case or same-day discharge (SDD) pure laparoscopic or robot-assisted radical prostatectomy (RP) has risen over the last few years with the aim of discharging patients within 24 h, reducing costs and length of stay, and facilitating return to active life. We perform a systematic review of literature to evaluate the feasibility of SDD RP. Methods A systematic review search was performed and the following bibliographic databases were accessed: PubMed, Science Direct, Scopus, and Embase. This was carried out in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. Results Based on the literature search of 509 articles, 12 (1378 patients) met the inclusion criteria (mean age: 63 years). All studies were unicentric except one. The mean SDD surgeries experience per centre was 66 cases .The means operative time and blood loss were 154 min and 126.5 ml, respectively. Mean SDD failure was 7.4%. Concomitant lymph node dissection was performed in 56.2%. The overall complication rate was 10.2% of cases; with a majority of Clavien grade I or II. Mean readmission rate after discharge was 5%. SDD generated cost reductions compared to inpatient surgery with variable differences according to the considered healthcare system. Conclusions Day-case RP is a safe and feasible strategy in selected cases with multicentre proofs of concept. Its widespread use in routine practice needs further research due to biases in patient selection. Implementation of peri-operative pathways such as ERAS and prehabilitation improves patient adherence to SDD. Supplementary Information The online version contains supplementary material available at 10.1007/s00345-022-03944-1.
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Affiliation(s)
- Amine Saouli
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco.
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco.
| | | | - Imad Ziouziou
- Department of Urology, University Hospital of Agadir, Agadir, Morocco
| | - Othmane Elhouadfi
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Tarik Karmouni
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Khalid Elkhader
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Abdellatif Koutani
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
| | - Ahmed Iben Attya Andalousi
- Department of Urology B, Ibn Sina Hospital, CHU Ibn Sina, Rabat, Morocco
- Faculty of Medicine and Pharmacy, Mohammed V University, Souissi, Rabat, Morocco
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Rahota RG, Salin A, Gautier JR, Almeras C, Garnault V, Tollon C, Loison G, Beauval JB, Ploussard G. A prehabilitation programme implemented before robot-assisted radical prostatectomy improves peri-operative outcomes and continence recovery. BJU Int 2021; 130:357-363. [PMID: 34854212 DOI: 10.1111/bju.15666] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the impact of a routine, on-site, 1-day prehabilitation (PreHab) programme on peri-operative and continence recovery after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS All 303 consecutive RARPs performed between March 2018 and February 2020 since the routine implementation of PreHab were included in our study. PreHab was carried out according to the availability of the 1-day programme before the planned date of surgery (two sessions per month including four patients per session). The PreHab programme was implemented in 165 patients (54.5%). The primary endpoint was continence recovery, strictly defined as no safety pad use at 1 and 6 months. Secondary endpoints were peri-operative variables (blood loss, operating time, length of stay, transfusion, complications, and readmission rates). Comparisons were made according to whether the PreHab pathway was applied or not (PreHab+ vs PreHab-) in univariable and multivariable models. RESULTS The PreHab pathway was implemented for a stable proportion of patients over time (54.5%). The two cohorts were comparable in terms of preoperative and pathological features (P > 0.05). Length of stay was significantly shorter in the PreHab+ group (1.3 vs 1.9 days; P = 0.001). There was a trend towards fewer complications in the PreHab+ group (P = 0.061). Use of the PreHab pathway was independently correlated with higher continence rates at 1 month (37% vs 60%; P < 0.001) and 6 months (67.4% vs 87.3%; P < 0.001), even after controlling for age, body mass index, prostate volume, type of apical reconstruction, nerve-sparing surgery and lymph node dissection. The main limitation of the study was the absence of randomization. CONCLUSIONS Our experience demonstrates that the PreHab programme is the major predictor of improved peri-operative outcomes and continence recovery after RARP, with sustainable benefits 6 months after surgery.
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Affiliation(s)
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | | | - Valérie Garnault
- Public Health Department, PMSI, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
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Rahota RG, Ploussard G, Gautier JR, Almeras C, Ducoin H, Tollon C, Assoun J, Loison G, Beauval JB, Salin A. First report of testis-sparing surgery for sertoliform cystadenoma: case presentation and review of literature. IJU Case Rep 2021; 4:425-428. [PMID: 34755074 PMCID: PMC8560452 DOI: 10.1002/iju5.12366] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/15/2021] [Accepted: 08/08/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Sertoliform cystadenoma is a very rare, benign lesion of the rete-testis difficult to distinguish from other malignancies of the testicle. CASE PRESENTATION We present the case of a 42-year-old male who presented with a right testicular mass, asymptomatic for 1 year. Clinical examination revealed a palpable, painless, and well-delimited right testicular superior pole nodule. Testicular ultrasound confirmed the nodule, whereas serum tumoral markers were normal. The patient underwent inguinal partial orchiectomy. Intraoperative excisional biopsy and frozen section pathology were performed, reporting undetermined tumoral origin with negative surgical margins. Ischemia time was 12 minutes. The final pathology report showed a Sertoliform cystadenoma of rete testis, with immunomorphology positive for AE1, CK7, and negative surgical margins. CONCLUSION To our knowledge, this is the first report of testicular sparing surgery for Sertoliform cystadenoma, a very rare benign tumor of rete testis. All previously reported cases were managed by radical inguinal orchidectomy.
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Affiliation(s)
| | | | | | | | - Henri Ducoin
- Department of Pathology La Croix du Sud Hospital Quint Fonsegrives France
| | - Christophe Tollon
- Department of Urology La Croix du Sud Hospital Quint Fonsegrives France
| | - Jacques Assoun
- Department of Radiology La Croix du Sud Hospital Quint Fonsegrives France
| | - Guillaume Loison
- Department of Urology La Croix du Sud Hospital Quint Fonsegrives France
| | | | - Ambroise Salin
- Department of Urology La Croix du Sud Hospital Quint Fonsegrives France
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Mazzone E, Gandaglia G, Ploussard G, Marra G, Valerio M, Campi R, Mari A, Minervini A, Serni S, Moschini M, Marquis A, Beauval JB, van den Bergh R, Rahota RG, Soeterik T, Roumiguiè M, Afferi L, Zhuang J, Tuo H, Mattei A, Gontero P, Cucchiara V, Stabile A, Fossati N, Montorsi F, Briganti A. Risk Stratification of Patients Candidate to Radical Prostatectomy Based on Clinical and Multiparametric Magnetic Resonance Imaging Parameters: Development and External Validation of Novel Risk Groups. Eur Urol 2021; 81:193-203. [PMID: 34399996 DOI: 10.1016/j.eururo.2021.07.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 07/29/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Despite the key importance of magnetic resonance imaging (MRI) parameters, risk classification systems for biochemical recurrence (BCR) in prostate cancer (PCa) patients treated with radical prostatectomy (RP) are still based on clinical variables alone. OBJECTIVE We aimed at developing and validating a novel classification integrating clinical and radiological parameters. DESIGN, SETTING, AND PARTICIPANTS A retrospective multicenter cohort study was conducted between 2014 and 2020 across seven academic international referral centers. A total of 2565 patients treated with RP for PCa were identified. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Early BCR was defined as two prostate-specific antigen (PSA) values of ≥0.2 ng/ml within 3 yr after RP. Kaplan-Meier and Cox regressions tested time and predictors of BCR. Development and validation cohorts were generated from the overall patient sample. A model predicting early BCR based on Cox-derived coefficients represented the basis for a nomogram that was validated externally. Predictors consisted of PSA, biopsy grade group, MRI stage, and the maximum diameter of lesion at MRI. Novel risk categories were then identified. The Harrel's concordance index (c-index) compared the accuracy of our risk stratification with the European Association of Urology (EAU), Cancer of the Prostate Risk Assessment (CAPRA), and International Staging Collaboration for Cancer of the Prostate (STAR-CAP) risk groups in predicting early BCR. RESULTS AND LIMITATIONS Overall, 200 (8%), 1834 (71%), and 531 (21%) had low-, intermediate-, and high-risk disease according to the EAU risk groups. The 3-yr overall BCR-free survival rate was 84%. No differences were observed in the 3-yr BCR-free survival between EAU low- and intermediate-risk groups (88% vs 87%; p = 0.1). The novel nomogram depicted optimal discrimination at external validation (c-index 78%). Four new risk categories were identified based on the predictors included in the Cox-based nomogram. This new risk classification had higher accuracy in predicting early BCR (c-index 70%) than the EAU, CAPRA, and STAR-CAP risk classifications (c-index 64%, 63%, and 67%, respectively). CONCLUSIONS We developed and externally validated four novel categories based on clinical and radiological parameters to predict early BCR. This novel classification exhibited higher accuracy than the available tools. PATIENT SUMMARY Our novel and straightforward risk classification outperformed currently available preoperative risk tools and should, therefore, assist physicians in preoperative counseling of men candidate to radical treatment for prostate cancer.
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Affiliation(s)
- Elio Mazzone
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Giorgio Gandaglia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Guillame Ploussard
- La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer-Toulouse, Oncopole, Toulouse, France
| | - Giancarlo Marra
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Massimo Valerio
- Urology Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Mari
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Moschini
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alessandro Marquis
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Jean Baptiste Beauval
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | | | - Razvan-George Rahota
- La Croix du Sud Hospital, Quint Fonsegrives, France; Institut Universitaire du Cancer-Toulouse, Oncopole, Toulouse, France
| | - Timo Soeterik
- Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands; Department of Urology, St. Antonius Hospital, Santeon-group, The Netherlands
| | - Mathieu Roumiguiè
- Department of Urology and Renal Transplantation, Toulouse University Hospital, Toulouse, France
| | - Luca Afferi
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Junlong Zhuang
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, People's Republic of China
| | - Hongqian Tuo
- Department of Urology, Drum Tower Hospital, Medical School of Nanjing University, Institute of Urology, Nanjing University, Jiangsu, People's Republic of China
| | - Agostino Mattei
- Klinik Für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Paolo Gontero
- Department of Urology, Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Vito Cucchiara
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Armando Stabile
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
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Rahota RG, Diamand R, Malavaud B, Fiard G, Descotes JL, Peltier A, Beauval JB, Roumeguère T, Roumiguié M, Albisinni S, Ploussard G. Pathological features of Prostate Imaging Reporting and Data System (PI-RADS) 3 MRI lesions in biopsy and radical prostatectomy specimens. BJU Int 2021; 129:621-626. [PMID: 34358405 DOI: 10.1111/bju.15563] [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] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To assess the whole pathology spectrum of Prostate Imaging Reporting and Data System (PI-RADS) 3 lesions, identified on magnetic resonance imaging, using systematic (SB), targeted biopsy (TB) and radical prostatectomy (RP) specimen analysis. METHODS From a prospective database of patients undergoing RP after a combination of SB (median 12 cores) and fusion TB (median 3 cores), we included 150 PI-RADS 3 cases. Clinically significant prostate cancer (csPCa) was defined by a Grade Group 2 or more. The primary endpoints were unfavourable features in RP specimens. RESULTS Targeted biopsy was negative in 20.7% of patients. Final Grade Group 3 or more and a pT3 stage was reported in 36.7% and 38.7% of RP specimens. The upgrading rate was 38.2% between biopsy and RP specimens. The concordance rate between Grade Group on TB and RP was only 38.0%. The two independent predictive factors for unfavourable disease (pT3-4 and/or final Grade Group 3-5) were prostate-specific antigen density (PSAD; P = 0.001) and presence of csPCa on TB (odds ratio 3.7; P = 0.001). The risk of unfavourable disease was increased 2.3-fold and 5.8-fold, respectively, for patients with a PSAD between 0.15 and 0.20, and a PSAD >0.20 ng/mL/g. The 5-year biochemical recurrence-free survival rate was 93.2%. CONCLUSIONS PI-RADS 3 lesions exhibited aggressive features in almost 40% of cases. PSAD and presence of csPCa on TB are independent predictive factors for high-grade and/or extraprostatic disease. A combination of SB and TB improve grade prediction compared to use of TB alone.
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Affiliation(s)
| | - Romain Diamand
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Bernard Malavaud
- Urology Department, CHU Toulouse, Toulouse, France.,Urology Department, Institut Universitaire du Cancer Toulouse - Oncopôle, Toulouse, France
| | - Gaëlle Fiard
- Urology Department, CHU de Grenoble, Grenoble, France
| | | | | | | | - Thierry Roumeguère
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Simone Albisinni
- Urology Department, Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
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