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Qian H, Chi C, Tricard T, Zhu Y, Dong L, Wang Y, Sha J, Wang J, Ma Z, Wang Y, Liu J, Dong B, Pan J, Xue W. A Prospective Randomized Trial of Neoadjuvant Chemohormonal Therapy vs Hormonal Therapy in Locally Advanced Prostate Cancer Treated by Radical Prostatectomy. J Urol 2024; 211:648-655. [PMID: 38591703 DOI: 10.1097/ju.0000000000003876] [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: 08/11/2023] [Accepted: 01/15/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Benefits of docetaxel-based neoadjuvant chemohormonal therapy (NCHT) before radical prostatectomy (RP) remain largely unknown. We explored whether docetaxel-based NCHT would bring pathological benefits and improve biochemical progression-free survival (bPFS) over neoadjuvant hormonal therapy (NHT) in locally advanced prostate cancer. MATERIALS AND METHODS A randomized trial was designed recruiting 141 locally advanced, high-risk prostate cancer patients who were randomly assigned at the ratio of 2:1 to the NCHT group (75 mg/m2 body surface area every 3 weeks plus androgen deprivation therapy for 6 cycles) and the NHT group (androgen deprivation therapy for 24 weeks). The primary end point was 3-year bPFS. Secondary end points were pathological response including pathological downstaging and minimal residual disease rates. RESULTS The NCHT group showed significant benefits in 3-year bPFS compared to the NHT group (29% vs 9.5%, P = .002). At a median follow-up of 53 months, the NCHT group achieved a significantly longer median bPFS time than the NHT group (17 months vs 14 months). No significant differences were found between the 2 groups in pathological downstaging and minimal residual disease rates. CONCLUSIONS NCHT plus RP achieved significant bPFS benefits when compared with NHT plus RP in high-risk, locally advanced prostate cancer. A larger cohort with longer follow-up duration is essential in further investigation.
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Affiliation(s)
- Hongyang Qian
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Chenfei Chi
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Thibault Tricard
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
- Department of Urology, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yinjie Zhu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Liang Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yanqing Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jianjun Sha
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiayi Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Zehua Ma
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yan Wang
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiazhou Liu
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Baijun Dong
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Jiahua Pan
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Wei Xue
- Department of Urology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China
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Goto Y, Utsumi T, Maruo M, Kurozumi A, Noro T, Tanaka S, Sugawara S, Chiba K, Miyazaki K, Inoue A, Komaru A, Fukasawa S, Imamura Y, Sakamoto S, Nakatsu H, Suzuki H, Ichikawa T, Nagata M. Development and validation of novel nomogram to identify the candidates for extended pelvic lymph node dissection for prostate cancer patients in the robotic era. Int J Urol 2023; 30:659-665. [PMID: 37130793 DOI: 10.1111/iju.15195] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVES To determine candidates for extended pelvic lymph node dissection using a novel nomogram to assess the risk of lymph node invasion in Japanese prostate cancer patients in the robotic era. METHODS A total of 538 patients who underwent robot-assisted radical prostatectomy with extended pelvic lymph node dissection in three hospitals were retrospectively analyzed. Medical records were reviewed uniformly and the following data collected: prostate-specific antigen, age, clinical T stage, primary and secondary Gleason score at prostate biopsy, and percentage of positive core numbers. Finally, data from 434 patients were used for developing the nomogram and data from 104 patients were used for external validation. RESULTS Lymph node invasion was detected in 47 (11%) and 16 (15%) patients in the development and validation set, respectively. Based on multivariate analysis, prostate-specific antigen, clinical T stage ≥3, primary Gleason score, grade group 5, and percentage of positive cores were selected as variables to incorporate into the nomogram. The area under the curve values were 0.781 for the internal and 0.908 for the external validation, respectively. CONCLUSIONS The present nomogram can help urologists identify candidates for extended pelvic lymph node dissection concomitant with robot-assisted radical prostatectomy among patients with prostate cancer.
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Affiliation(s)
- Yusuke Goto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takanobu Utsumi
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Masafumi Maruo
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Akira Kurozumi
- Department of Urology, Asahi General Hospital, Chiba, Japan
| | - Takahide Noro
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
| | - Satoki Tanaka
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sho Sugawara
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Kazuto Chiba
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Kanetaka Miyazaki
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Atsushi Inoue
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Atsushi Komaru
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
| | - Satoshi Fukasawa
- Prostate Center and Division of Urology, Chiba Cancer Center, Chiba, Japan
| | - Yusuke Imamura
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | | | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Chiba, Japan
| | - Tomohiko Ichikawa
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Maki Nagata
- Department of Urology, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
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Rossin G, Zorzi F, De Pablos-Rodríguez P, Biasatti A, Marenco J, Ongaro L, Perotti A, Tulone G, Traunero F, Piasentin A, Gomez-Ferrer A, Zucchi A, Trombetta C, Simonato A, Rubio-Briones J, Bartoletti R, Ramírez-Backhaus M, Claps F. Sentinel Lymph Node Biopsy in Prostate Cancer: An Overview of Diagnostic Performance, Oncological Outcomes, Safety, and Feasibility. Diagnostics (Basel) 2023; 13:2543. [PMID: 37568905 PMCID: PMC10416990 DOI: 10.3390/diagnostics13152543] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/29/2023] [Revised: 07/24/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Sentinel node biopsy (SNB) for prostate cancer (PCa) represents an innovative technique aimed at improving nodal staging accuracy. The routinary adoption of this procedure in patients undergoing radical prostatectomy (RP) might be crucial to identify candidates who could effectively benefit from extensive pelvic lymph nodal dissection (ePLND). Despite some promising results, SNB for PCa is still considered experimental due to the lack of solid evidence and procedural standardization. In this regard, our narrative review aimed to analyze the most recent literature in this field, providing an overview of both the diagnostic accuracy measures and the oncological outcomes of SNB.
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Affiliation(s)
- Giulio Rossin
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Federico Zorzi
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Pedro De Pablos-Rodríguez
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Arianna Biasatti
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Josè Marenco
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Luca Ongaro
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Alessandro Perotti
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy; (A.P.); (A.Z.); (R.B.)
| | - Gabriele Tulone
- Urology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy; (G.T.); (A.S.)
| | - Fabio Traunero
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Andrea Piasentin
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Alvaro Gomez-Ferrer
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Alessandro Zucchi
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy; (A.P.); (A.Z.); (R.B.)
| | - Carlo Trombetta
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
| | - Alchiede Simonato
- Urology Clinic, Department of Surgical, Oncological and Stomatological Sciences, University of Palermo, 90133 Palermo, Italy; (G.T.); (A.S.)
| | - José Rubio-Briones
- Clínica de Urología, Hospital VITHAS 9 de Octubre, 46015 Valencia, Spain;
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy; (A.P.); (A.Z.); (R.B.)
| | - Miguel Ramírez-Backhaus
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
| | - Francesco Claps
- Urological Clinic, Department of Medicine, Surgery and Health Sciences, University of Trieste, Strada di Fiume, 447, 34149 Trieste, Italy; (G.R.); (F.Z.); (A.B.); (L.O.); (F.T.); (A.P.); (C.T.)
- Department of Urology, Valencian Oncology Institute Foundation, FIVO, 46009 Valencia, Spain; (P.D.P.-R.); (J.M.); (A.G.-F.); (M.R.-B.)
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Shimbo M, Ohyama T, Endo F, Komatsu K, Kyono Y, Sano M, Narimoto K, Hattori K. Simplified approach to the medial internal iliac region using a uretero-hypogastric nerve fascia development procedure for extended pelvic lymph node dissection during robot-assisted radical prostatectomy for high-risk prostate cancer. Int J Urol 2023; 30:190-195. [PMID: 36305678 DOI: 10.1111/iju.15082] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 10/06/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Although several clinical guidelines for prostate cancer (PC) recommend extended pelvic lymph node dissection (ePLND) during radical prostatectomy for high-risk cases, there are several issues to consider, including certain technical aspects. A simplified approach to the medial internal iliac region and paravesical arteries has not been established. The uretero-hypogastric nerve fascia (UHF) envelopes the ureter, hypogastric nerve, and pelvic autonomic nerves. To preserve the UHF, it is possible to approach the medial side of the internal iliac vessels without injuring any important tissue. We analyzed technical feasibility and lymph node (LN) yields. PATIENTS AND METHODS After obtaining institutional review board approval, 265 high-risk PC patients with ePLND were identified. A da Vinci S or Xi robotic surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was used. We divided the patients into conventional (non-UHF) method and modified (UHF) groups. The numbers of LNs removed, procedure-related complications, and surgical outcomes were analyzed. RESULTS The median number of LNs removed was 19.0 in the non-UHF group and 22.0 in the UHF group (p = 0.004). Significantly more LNs were removed from the internal iliac region in the UHF group (p = 0.042). There was no difference in overall operative, console, or LN dissection time, or the severe complication rate (Clavien-Dindo grade ≥ III), between the non-UHF and UHF groups. CONCLUSIONS Our simplified approach using the UHF development technique is technically feasible, has no major complications, and allows for the removal of significantly more LNs compared with the conventional method.
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Affiliation(s)
- Masaki Shimbo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Takehiro Ohyama
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Fumiyasu Endo
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kenji Komatsu
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Yoko Kyono
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Masayuki Sano
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazutaka Narimoto
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
| | - Kazunori Hattori
- Department of Urology, St. Luke's International Hospital, Tokyo, Japan
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Hori S, Nakai Y, Tachibana A, Omori C, Nishimura N, Inoue K, Tomizawa M, Shimizu T, Morizawa Y, Gotoh D, Miyake M, Torimoto K, Yoneda T, Fujimoto K, Tanaka N. Clinical significance of limited and extended pelvic lymph node dissection during robot-assisted radical prostatectomy for patients with localized prostate cancer: A retrospective, propensity score matching analysis. Int J Urol 2023; 30:168-175. [PMID: 36305671 DOI: 10.1111/iju.15075] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES We investigated the diagnostic and therapeutic benefits of limited or extended pelvic lymph node dissection during a robot-assisted radical prostatectomy for localized prostate cancer. METHODS Diagnostic and therapeutic benefits were assessed according to the rates of pN1 and biochemical recurrence, respectively. The primary outcome was the biochemical recurrence-free rate, and secondary outcomes included the diagnostic and therapeutic benefits of pelvic lymph node dissection. RESULTS A total of 534 patients were analyzed. Out of the 534 patients, 207 (38.8%) received limited pelvic lymph node dissection while 134 (25.1%) received extended dissection. There were 297 patients with a Briganti index ≥5%. Extended dissections yielded significantly more resected lymph nodes (p < 0.0001), and 72.2% of cases of pN1 were located outside the obturator. The incidence rate of pN1 was 6.1%, and performance of extended lymph node dissection was an independent predictor for pN1 (odds ratio 9.0, 95% confidence interval 2.5-33.1). The rate of biochemical recurrence was 14.9%, and Cox proportional hazards regression analysis of the propensity score matched population revealed that patients with high or very-high risk tended to benefit from limited lymph node dissection (hazard ratio 8.4, 95% confidence interval 0.8-82.3) while the therapeutic benefit of extended dissection was unclear by comparison. CONCLUSIONS Extended pelvic lymph node dissection significantly improves diagnostic accuracy; however, the therapeutic benefit of pelvic lymph node dissection was not observed in this study.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Chihiro Omori
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Kuniaki Inoue
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Takuto Shimizu
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Nara, Japan.,Department of Prostate Brachytherapy, Nara Medical University, Nara, Japan
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Gondoputro W, Scheltema MJ, Blazevski A, Doan P, Thompson JE, Amin A, Geboers B, Agrawal S, Siriwardana A, Van Leeuwen PJ, van Oosterom MN, Van Leeuwen FW, Emmett L, Stricker PD. Robot-Assisted Prostate-Specific Membrane Antigen-Radioguided Surgery in Primary Diagnosed Prostate Cancer. J Nucl Med 2022; 63:1659-1664. [PMID: 35241483 PMCID: PMC9635675 DOI: 10.2967/jnumed.121.263743] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/17/2022] [Indexed: 01/20/2023] Open
Abstract
The objective of this study was to evaluate the safety and feasibility of 99mTc-based prostate-specific membrane antigen (PSMA) robot-assisted-radioguided surgery to aid or improve the intraoperative detection of lymph node metastases during primary robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa). Methods: Men with primary high-risk PCa (≥ cT3a, International Society of Urological Pathology (ISUP) grade group ≥ 3 or prostate-specific antigen of ≥ 15 ng/mL) with potential lymph node metastasis (Briganti nomogram risk > 10% or on preoperative imaging) were enrolled in the study. Patients underwent staging 68Ga-PSMA PET/CT scanning. Preoperatively, a 99mTc-labeled PSMA ligand (99mTc PSMA I&S; 500 MBq) was administered followed by SPECT/CT. A RARP including extended pelvic lymph node dissection was performed, with intraoperative tracing of PSMA-avid tissues using a prototype DROP-IN γ-probe. Resected specimens were also measured ex vivo. Histopathologic concordance with probe findings was evaluated. A radiotracer count of ≥ 1.5 times the background reference (in vivo), and ≥ 10 (absolute count) in the ex vivo setting, was considered positive. Results: Twelve patients were included (median age, 68 y, and prostate-specific antigen, 9.15 ng/mL). Most of the patients harbored ISUP 5 PCa (75%) and had avid lymph nodes on preoperative PSMA PET (64%). The DROP-IN probe aided resection of PSMA-avid (out-of-template) lymph nodes and residual disease at the prostate bed. Eleven metastatic lymph nodes were identified by the probe that were not observed on preoperative 68Ga-PSMA PET/CT. Of the 74 extraprostatic tissue specimens that were resected, 22 (29.7%) contained PCa. The sensitivity, specificity, positive predictive value, and negative predictive value of inpatient use of the γ-probe were 76% (95% CI, 53%-92%), 69% (95% CI, 55%-81%), 50%, and 88%, respectively. Ex vivo, the diagnostic accuracy was superior: 76% (95% CI, 53%-92%), 96% (95% CI, 87%-99%), 89%, and 91%, respectively, for sensitivity, specificity, positive predictive value, and negative predictive value. Of the missed lymph nodes in vivo (n = 5) and ex vivo (n = 5), 90% were micrometastasis (≤3 mm). No complications greater than Clavien-Dindo Grade I occurred. Conclusion: Robot-assisted 99mTc-based PSMA-radioguided surgery is feasible and safe in the primary setting, optimizing the detection of nodal metastases at the time of RARP and extended pelvic lymph node dissection. Further improvement of the detector technology may optimize the capabilities of robot-assisted 99mTc-based PSMA-radioguided surgery.
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Affiliation(s)
- William Gondoputro
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Matthijs J. Scheltema
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia
| | - Alexander Blazevski
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Paul Doan
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - James E. Thompson
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Amer Amin
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
| | - Bart Geboers
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia
| | - Shikha Agrawal
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia
| | - Amila Siriwardana
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia
| | - Pim J. Van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands
| | - Matthias N. van Oosterom
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands;,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, The Netherlands; and
| | - Fijs W.B. Van Leeuwen
- Department of Urology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, The Netherlands;,Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, The Netherlands; and
| | - Louise Emmett
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia;,Department of Theranostics and Nuclear Medicine, St Vincent’s Hospital Sydney, Darlinghurst, NSW, Australia
| | - Phillip D. Stricker
- Garvan Institute of Medical Research and Kinghorn Cancer Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Prostate Cancer Research Centre, Darlinghurst, NSW, Australia;,St. Vincent’s Clinical School, University of New South Wales, Sydney, Australia
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Kong J, Lichtbroun B, Sterling J, Wang Y, Wang Q, Singer EA, Jang TL, Ghodoussipour S, Kim IY. Comparison of perioperative complications for extended vs standard pelvic lymph node dissection in patients undergoing radical prostatectomy for prostate cancer: a meta-analysis. Am J Clin Exp Urol 2022; 10:73-81. [PMID: 35528467 PMCID: PMC9077149] [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] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Pelvic lymph node dissection (PLND) is widely performed for staging in men undergoing radical prostatectomy (RP) for prostate cancer. Our goal was to synthesize all available evidence and data to evaluate perioperative complications for two templates of PLND, standard (sPLND) vs extended (ePLND), at the time of RP in patients with prostate cancer. METHODS A meta-analysis was performed on relevant literature about complications during PLND. Pubmed, Scopus, WebofScience, and Cochrane Library were systematically searched through July 2021. Meta-analysis was conducted with both fixed-effects and random-effects models to estimate risk ratios (RRs) between treatments. A subgroup analysis was also conducted based on surgery type - open vs robotic. RESULTS 13 (1 randomized clinical trial and 12 observational studies) studies published between 1997 and 2019 with a total of 7,036 patients were analyzed. Pooled data showed complications in a random-effects model was lower in the sPLND group than the ePLND group (RR, 0.62; 95% CI 0.40-0.97). In a subgroup analysis, neither the open surgery subgroup nor the robotic surgery subgroup showed significant differences in complication rate between sPLND and ePLND. CONCLUSION ePLND is associated with a significantly greater risk of perioperative complication compared to sPLND, but not when comparing these templates performed via a robotic approach. Additional studies comparing the complication rates of sPLND and ePLND when utilizing a robotic approach should be conducted.
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Affiliation(s)
- Jerry Kong
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
| | - Benjamin Lichtbroun
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Joshua Sterling
- Department of Urology, SUNY Upstate Medical UniversityNew York, USA
| | - Yaqun Wang
- Biostatistics and Epidemiology, Rutgers School of Public HealthNew Jersey, USA
| | | | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Saum Ghodoussipour
- Section of Urologic Oncology, Rutgers Cancer Institute of New JerseyNew Jersey, USA
- Division of Urology, Rutgers Robert Wood Johnson Medical SchoolNew Jersey, USA
| | - Isaac Yi Kim
- Department of Urology, Yale School of MedicineNew Haven, Connecticut, USA
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Miura N, Sugihara N, Funaki K, Kakuda T, Koyama K, Watanabe R, Sawada Y, Noda T, Nishimura K, Fukumoto T, Miyauchi Y, Kikugawa T, Saika T. Extended robot-assisted laparoscopic prostatectomy and extended pelvic lymph node dissection as a monotherapy in patients with very high-risk prostate cancer Patients. Cancer Med 2021; 10:7968-7976. [PMID: 34562303 PMCID: PMC8607267 DOI: 10.1002/cam4.4308] [Citation(s) in RCA: 2] [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: 04/30/2021] [Revised: 08/03/2021] [Accepted: 08/23/2021] [Indexed: 01/18/2023] Open
Abstract
Background Patients with very‐high‐risk prostate cancer (VHRPCa) have earlier biochemical recurrences (BCRs) and higher mortality rates. It remains unknown whether extended robot‐assisted laparoscopic prostatectomy (eRALP) without neoadjuvant or adjuvant therapy can improve the outcomes of VHRPCa patients. We aimed to determine the feasibility and efficacy of eRALP as a form of monotherapy for VHRPCa. Methods Data from 76 men who were treated with eRALP without neoadjuvant/adjuvant therapy were analyzed. eRALP was performed using an extrafascial approach. Extended pelvic lymph node (LN) dissection (ePLND) included nodes above the external iliac axis, in the obturator fossa, and around the internal iliac artery up to the ureter. The outcome measures were BCR, treatment failure (defined as when the prostate‐specific antigen level did not decrease to <0.1 ng/ml postoperatively), and urinary continence (UC). Kaplan–Meier, logistic regression, and Cox proportional‐hazards model were used to analyze the data. Results The median operative time was 246 min, and median blood loss was 50 ml. Twenty‐one patients experienced postoperative complications. Median follow‐up was 25.2 months; 19.7% of patients had treatment failure. Three‐year, BCR‐free survival rate was 62.0%. Castration‐resistant prostate cancer‐free survival rate was 86.1%. Overall survival was 100%. In 55 patients who had complete postoperative UC data, 47 patients (85.5%) recovered from their UC within 12 months. Clinical stage cT3b was an independent preoperative treatment failure predictor (p = 0.035), and node positivity was an independent BCR predictor (p = 0.037). The small sample size and retrospective nature limited the study. Conclusions This approach was safe and produced acceptable UC‐recovery rates. Preoperative seminal vesicle invasion is associated with treatment failure, and pathological LN metastases are associated with BCR. Therefore, our results may help informed decisions about neoadjuvant or adjuvant therapies in VHRPCa cases. Precis Extended robot‐assisted laparoscopic prostatectomy and extended pelvic lymph node dissection without adjuvant therapy is safe and effective for some patients with very‐high‐risk prostate cancer. The clinical stage and node positivity status predicted monotherapy failure, which may indicate good adjuvant therapy candidate.
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Affiliation(s)
- Noriyoshi Miura
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Naoya Sugihara
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Keisuke Funaki
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Toshio Kakuda
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kanae Koyama
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Ryuta Watanabe
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yuichiro Sawada
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Terutaka Noda
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Kenichi Nishimura
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Tetsuya Fukumoto
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Yuki Miyauchi
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Tadahiko Kikugawa
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takashi Saika
- Department of Urology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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Soeterik TFW, Hueting TA, Israel B, van Melick HHE, Dijksman LM, Stomps S, Biesma DH, Koffijberg H, Sedelaar M, Witjes JA, van Basten JPA. External validation of the Memorial Sloan Kettering Cancer Centre and Briganti nomograms for the prediction of lymph node involvement of prostate cancer using clinical stage assessed by magnetic resonance imaging. BJU Int 2021; 128:236-243. [PMID: 33630398 DOI: 10.1111/bju.15376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/30/2022]
Abstract
OBJECTIVES To evaluate the impact of using clinical stage assessed by multiparametric magnetic resonance imaging (mpMRI) on the performance of two established nomograms for the prediction of pelvic lymph node involvement (LNI) in patients with prostate cancer. PATIENTS AND METHODS Patients undergoing robot-assisted extended pelvic lymph node dissection (ePLND) from 2015 to 2019 at three teaching hospitals were retrospectively evaluated. Risk of LNI was calculated four times for each patient, using clinical tumour stage (T-stage) assessed by digital rectal examination (DRE) and by mpMRI, in the Memorial Sloan Kettering Cancer Centre (MSKCC; 2018) and Briganti (2012) nomograms. Discrimination (area under the curve [AUC]), calibration, and the net benefit of these four strategies were assessed and compared. RESULTS A total of 1062 patients were included, of whom 301 (28%) had histologically proven LNI. Using DRE T-stage resulted in AUCs of 0.71 (95% confidence interval [CI] 0.70-0.72) for the MSKCC and 0.73 (95% CI 0.72-0.74) for the Briganti nomogram. Using mpMRI T-stage, the AUCs were 0.72 (95% CI 0.71-0.73) for the MSKCC and 0.75 (95% CI 0.74-0.76) for the Briganti nomogram. mpMRI T-stage resulted in equivalent calibration compared with DRE T-stage. Combined use of mpMRI T-stage and the Briganti 2012 nomogram was shown to be superior in terms of AUC, calibration, and net benefit. Use of mpMRI T-stage led to increased sensitivity for the detection of LNI for all risk thresholds in both models, countered by a decreased specificity, compared with DRE T-stage. CONCLUSION T-stage as assessed by mpMRI is an appropriate alternative for T-stage assessed by DRE to determine nomogram-based risk of LNI in patients with prostate cancer, and was associated with improved model performance of both the MSKCC 2018 and Briganti 2012 nomograms.
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Affiliation(s)
- Timo F W Soeterik
- Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands.,Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Tom A Hueting
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Bas Israel
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Lea M Dijksman
- Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands.,Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Saskia Stomps
- Department of Urology, Hospital Group Twente, Hengelo/Almelo, The Netherlands
| | - Douwe H Biesma
- Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands.,Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michiel Sedelaar
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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Salih Boga M, Ates M. Timing of lymphadenectomy during robot-assisted radical cystectomy: before or after cystectomy? Fifteen cases with totally intracorporeal urinary diversions. Wideochir Inne Tech Maloinwazyjne 2020; 15:596-601. [PMID: 33294075 DOI: 10.5114/wiitm.2020.93793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 02/18/2020] [Indexed: 01/28/2023] Open
Abstract
Introduction Many publications detail the level and number of lymphadenectomies, whereas the timing of pelvic lymph node dissection (PLND) is infrequently discussed in the robot-assisted radical cystectomy (RARC) series. Aim To determine the effects of performing PLND before or after cystectomy in totally intracorporeal RARC on operative outcomes. Material and methods A total of 15 patients included in the study underwent RARC and intracorporeal orthotopic neobladder. Of these, 8 patients underwent PLND before cystectomy (group 1), whereas 7 underwent PLND after cystectomy (group 2). Demographic information, intraoperative data, and post-operative outcomes were recorded for each patient. Results The mean ± SD age was 61.87 ±6.76 years. Overall mean operation time (OT) was 537.33 ±63.07 min. The mean EBL and hospitalization time were 322.33 ±69.92 ml and 13.87 ±5.2 days. The number of LN removed was 23.75 ±3.454 for group 1 and 13.71 ±6.873 for group 2 (p = 0.007). The postoperative pathological stages were: pT2(5), pT3(2), pT4(1) for group 1, pT2(4), pT3(2), pT4(1) for group 2. Surgical margins were negative in all patient. Overall complications occurred in 7 (46.6%) patients. Only the number of LN removed was statistically significant in favor of group 1 (p = 0.007). Mean follow-up was 15.87 months. Conclusions Our initial experience with performing extended PLND (ePLND) before or after cystectomy in totally intracorporeal RARC appears to be favorable, with similar oncological results and acceptable complication rates. However, although the number of cases is too low for statistical evaluation, it seems to be advantageous to perform ePLND before cystectomy in terms of LN number and operation time.
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Abstract
INTRODUCTION Radical cystectomy and extended pelvic lymph node dissection (ePLND) are the gold standard treatment for muscle-invasive bladder cancer and BCG unresponsive nonmuscle-invasive bladder cancer. In this article, we review the rationale for ePLND in the treatment of bladder cancer and the evidence supporting the equipoise between robot-assisted (RA) and open ePLND. A step-by-step guide of robot-assisted ePLND (RA ePLND) is provided to illustrate the techniques currently employed at our institution. MATERIALS AND METHODS Medline and PubMed electronic databases were queried for English language articles on bladder cancer, ePLND, and RA ePLND. In addition, a step-by-step video of RA ePLND was assembled with narration and accompanying explanations of each step to illustrate our current techniques. Key images from the video were selected for illustration of the relevant anatomical landmarks. RESULTS ePLND with a minimum nodal yield of 10 to 14 is tantamount in the treatment of bladder cancer. The number of lymph nodes resected influenced survival in both pathologically node positive and negative patients. In addition, RA ePLND was found to have equipoise as open ePLND by several groups. In our surgical atlas video, we illustrate key surgical steps, including port placement and exposure. Also, anatomic landmarks of dissection for the internal iliac, external iliac/obturator, and higher nodal packets are described in detail. CONCLUSIONS We illustrate the techniques for a thorough RA ePLND, with the intention to help the robotic surgeon to meet the 10 to 14 nodal yield mandated by the Bladder Cancer Collaborative Group.
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Affiliation(s)
- Roger Li
- Department of Urology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - Firas G Petros
- Department of Urology, The University of Texas MD Anderson Cancer Center , Houston, Texas
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center , Houston, Texas
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Porcaro AB, Corsi P, Inverardi D, Sebben M, Tafuri A, Processali T, Mattevi D, De Marchi D, Pirozzi M, Cerruto MA, Amigoni N, Rizzetto R, Brunelli M, Siracusano S, Artibani W. Prostate-specific antigen associates with extensive lymph node invasion in high-risk prostate cancer. Tumori 2018; 104:307-311. [PMID: 29714659 DOI: 10.1177/0300891618765567] [Citation(s) in RCA: 3] [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: 11/15/2022]
Abstract
OBJECTIVE To evaluate clinical predictors of lymph node invasion (LNI) in patients with high-risk prostate cancer undergoing radical prostatectomy (RP) with extended pelvic lymph node dissection (ePLND). METHODS A contemporary cohort of 116 patients, who underwent ePLND during RP, was retrospectively evaluated. Patients were classified into 3 groups including cases without LNI (group 1), with 1 to 3 positive nodes (group 2; limited LNI), and with more than 3 positive nodes (group 3; extensive LNI). The multinomial logistic regression model (multivariate analysis) evaluated the risk of LNI. RESULTS Overall, 30 patients (25.9%) had LNI, which was limited in 17 cases (14.7%) and extensive in 13 subjects (11.2%). Median prostate-specific antigen (PSA) was higher in cases with limited (11.4 ng/mL) or extensive (23.5 ng/mL) LNI than cases without (7.3 ng/mL) and the difference was significant ( p <.0001). Median proportion of biopsy-positive cores was higher in limited (0.64) or extensive (0.54) LNI than cases without (0.34) and the difference was significant ( p < .0001). The distribution of other factors did not show any significant difference among the groups. On multivariate analysis, only higher values of PSA significantly affected the odds of extensive LNI when compared to cases without (odds ratio, 1.054; p = .005); PSA showed a fair discrimination power (area under the curve 0.792). CONCLUSION PSA was the only independent predictor of extensive LNI and could be an important preoperative factor for stratifying high-risk patients.
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Affiliation(s)
- Antonio B Porcaro
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Paolo Corsi
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Inverardi
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Sebben
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Tafuri
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Tania Processali
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Daniele Mattevi
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide De Marchi
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Marco Pirozzi
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria A Cerruto
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Nelia Amigoni
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Rizzetto
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Matteo Brunelli
- 2 Department of Pathology, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Salvatore Siracusano
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Walter Artibani
- 1 Urologic Clinic, University Hospital, Ospedale Policlinico, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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Dobruch J, Piotrowicz S, Skrzypczyk M, Gołąbek T, Chłosta P, Borówka A. Clinical value of extended pelvic lymph node dissection in patients subjected to radical prostatectomy. Wideochir Inne Tech Maloinwazyjne 2014; 9:64-70. [PMID: 24729812 DOI: 10.5114/wiitm.2014.40986] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 09/29/2013] [Accepted: 10/11/2013] [Indexed: 11/18/2022] Open
Abstract
Introduction Extended pelvic lymph node dissection (ePLND) is advised to complement radical prostatectomy (RP) in intermediate and high risk prostate cancer patients. Aim To assess the risk of nodal involvement in patients subjected to laparoscopic radical prostatectomy and to characterize the group of patients with lymph node (LN) metastases. Material and methods Data of patients subjected to laparoscopic radical prostatectomy with ePLND between February 2011 and June 2013 were analyzed. The LN that were removed included presacral nodes, common, external and internal iliac nodes and obturator ones. Results Mean number of removed LNs was 19. Metastases within LN were found in 13 (16.6%) patients. In comparison to those without LN involvement, patients who were found to have LN metastases had a greater number of positive biopsy cores (3.7 vs. 5.3, p < 0.01), maximum percentage of cancer in biopsy core (47.0 vs. 67.6, p < 0.01), greater biopsy and specimen Gleason scores (7.0 vs. 7.7 and 7.0 vs. 7.8) and more frequently advanced clinical and pathological stage. The most frequent landing sites of prostate cancer were obturator and presacral nodes (100% and 38%). Eleven patients (85%) among those with positive LN had locally advanced disease. Conclusions The risk of LN metastases in intermediate and high risk prostate cancer patients is significant. Therefore, if radical prostatectomy is chosen, ePLND should be performed. The majority of patients with involvement of pelvic LN have locally advanced disease which would refer them to adjuvant radiation if managed without nodal dissection.
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