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Deivasigamani S, Adams ES, Kotamarti S, Mottaghi M, Taha T, Aminsharifi A, Michael Z, Seguier D, Polascik TJ. Comparison of procedural anxiety and pain associated with conventional transrectal ultrasound prostate biopsy to magnetic resonance imaging-ultrasound fusion-guided biopsy: a prospective cohort trial. Prostate Cancer Prostatic Dis 2024; 27:294-299. [PMID: 38001362 DOI: 10.1038/s41391-023-00760-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/07/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Prostate cancer (PCa) diagnosis relies on biopsies, with transrectal ultrasound (TRUS) biopsies being common. Fusion biopsy (FB) offers improved diagnostic accuracy, but the pain and anxiety experienced by patients during biopsies is often overlooked. This study aims to compare pain and anxiety levels between standard TRUS-guided biopsy (STB) and systematic plus MRI/US fusion biopsy (STB + FB). MATERIALS AND METHODS The study involved adult men undergoing biopsies, receiving identical peri-procedural care, including 2% lidocaine jelly in the rectum and subsequent 1% lidocaine injections (10cc per side) into the prostate-seminal vesicle junction and prostatic apical areas bilaterally. The biopsy technique was chosen based on clinical and imaging findings. Pre- and post-biopsy anxiety levels were assessed using the State-Trait Anxiety Inventory (STAI) questionnaire, categorized as mild (20-37), moderate (38-44), or severe (45-80). Post-biopsy pain was evaluated on a numerical rating scale, ranging from 0 to 10. RESULTS Of the 165 patients, 99 underwent STB, and 66 underwent STB + FB. No significant differences were observed in age, race, prostate-specific antigen, prostate volume, or prior biopsies between the groups. The STB + FB group had more biopsy cores taken (16.2 vs. 12, p = 0.001) and a longer procedure time (23 vs. 10 min, p = 0.001). STB biopsy patients experienced lower post-procedural anxiety compared to STB + FB, with a mean difference of -7 (p = 0.001, d = 0.92). In the STB + FB group, 89% experienced severe post-procedural anxiety compared to 59% in STB (p = 0.002). There was no significant difference in post-procedural pain (p = 0.7). Patients with prior biopsies had significantly higher STAI(S) anxiety scores (p = 0.005), and the number of prior biopsies correlated with anxiety severity (p = 0.04) in STB + FB group. CONCLUSION In summary, STB + FB group demonstrated higher post-procedural anxiety levels than the STB group, with no difference in pain levels. Additionally, patients with a history of repeat biopsies were more likely to exhibit higher STAI(S) anxiety scores.
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Affiliation(s)
| | - Eric S Adams
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Srinath Kotamarti
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
| | - Mahdi Mottaghi
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
| | - Terek Taha
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Ziv Medical Center, Safed, Israel
| | - Ali Aminsharifi
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Zoe Michael
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
| | - Denis Seguier
- Department of Urology, Lille University, Lille, France
| | - Thomas J Polascik
- Department of Urology, Duke University Medical Center, Durham, NC, 27710, USA
- Section of Urology, Department of Surgery, Durham Veterans Affairs Medical Center, Durham, NC, 27710, USA
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Deivasigamani S, Kotamarti S, Gupta RT, Polascik TJ. Re: Low Cancer Yield in PI-RADS 3 Upgraded to 4 by Dynamic Contrast-enhanced MRI: Is It Time To Reconsider Scoring Categorization? Eur Urol 2024; 85:180-181. [PMID: 37743198 DOI: 10.1016/j.eururo.2023.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Affiliation(s)
| | | | - Rajan T Gupta
- Department of Urology, Duke Cancer Institute, Durham, NC, USA; Department of Radiology, Duke Cancer Institute, Durham, NC, USA
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Séguier D, Adams ES, Kotamarti S, D'Anniballe V, Michael ZD, Deivasigamani S, Olivier J, Villers A, Hoimes C, Polascik TJ. Intratumoural immunotherapy plus focal thermal ablation for localized prostate cancer. Nat Rev Urol 2023:10.1038/s41585-023-00834-y. [PMID: 38114768 DOI: 10.1038/s41585-023-00834-y] [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] [Accepted: 11/02/2023] [Indexed: 12/21/2023]
Abstract
Major advances have been made in the use of immunotherapy for the treatment of solid tumours, including the use of intratumourally injected immunotherapy instead of systemically delivered immunotherapy. The success of immunotherapy in prostate cancer treatment has been limited to specific populations with advanced disease, which is thought to be a result of prostate cancer being an immunologically 'cold' cancer. Accordingly, combining intratumoural immunotherapy with other treatments that would increase the immunological heat of prostate cancer is of interest. Thermal ablation therapy is currently one of the main strategies used for the treatment of localized prostate cancer and it causes immunological activation against prostate tissue. The use of intratumoural immunotherapy as an adjunct to thermal ablation offers the potential to elicit a systemic and lasting adaptive immune response to cancer-specific antigens, leading to a synergistic effect of combination therapy. The combination of thermal ablation and immunotherapy is currently in the early stages of investigation for the treatment of multiple solid tumour types, and the potential for this combination therapy to also offer benefit to prostate cancer patients is exciting.
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Affiliation(s)
- Denis Séguier
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA.
- Department of Urology, Lille University, Lille, France.
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER; UMR9020-U1277), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France.
| | - Eric S Adams
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Srinath Kotamarti
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Vincent D'Anniballe
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Zoe D Michael
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Sriram Deivasigamani
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
| | - Jonathan Olivier
- Department of Urology, Lille University, Lille, France
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER; UMR9020-U1277), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Arnauld Villers
- Department of Urology, Lille University, Lille, France
- Cancer Heterogeneity Plasticity and Resistance to Therapies (CANTHER; UMR9020-U1277), Univ. Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Christopher Hoimes
- Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, North Carolina, 27708, USA
| | - Thomas J Polascik
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, North Carolina, 27710, USA
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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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Deivasigamani S, Orabi H, El-Shafei A, Adams ES, Kotamarti S, Aminsharifi A, Davis L, Wu Y, J SJ, Polascik TJ. Intermediate-term oncological and functional outcomes of salvage cryotherapy for the management of prostate cancer recurrence after primary brachytherapy versus primary cryotherapy: A propensity score-matched analysis. Prostate 2023; 83:1373-1386. [PMID: 37469120 DOI: 10.1002/pros.24600] [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: 05/11/2023] [Revised: 06/18/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND Salvage cryotherapy (SCT) is widely used to treat prostate cancer (PCa) recurrence after radiotherapy (RT). We studied the intermediate oncological and functional outcomes of patients who underwent SCT following cryotherapy (CRYO-SCT) recurrence and compare it to recurrence after brachytherapy (BT-SCT). METHODS An IRB-approved retrospective cohort study utilizing patient data from the Cryo On-Line Data Registry and the Duke PCa database between 1992 and 2016. Biochemical recurrence (BCR) using Phoenix criteria was the primary endpoint assessed at 2- and 5-years post-SCT. Secondary endpoints assessed functional outcomes including urinary continence, erectile function, and recto-urethral fistula. Association between treatment and biochemical progression-free survival was assessed using inverse probability weighted (IPTW) Cox proportional hazards regression. The differences in the secondary functional outcomes were assessed by Pearson's χ2 test or Fisher's exact test, corrected for IPTW. RESULTS A total of 194 patients met inclusion criteria. The BCR rate for BT-SCT and CRYO-SCT was 23 (20.4%) and 17 (21%) at 2 years and 30 (26.5%) and 22 (27.2%) at 5 years according to Phoenix criteria. There was no statistical difference in 2 years (hazard ratio [HR] 0.9; 95% confidence interval [CI], 0.5-1.7, p = 0.7) or 5-year BCR (HR: 0.86; 95% CI, 0.5-1.5, p = 0.6) between the groups. The functional outcomes like urinary continence (p = 0.4), erectile function (p = 0.1), and recto-urethral fistula (p = 0.3) were not statistically different. CONCLUSION CRYO-SCT appears to be well tolerated, with comparable oncological and functional outcomes to patients failing primary BT. The findings also demonstrated that SCT can render a significant number of patients biochemically free of disease after initial CRYO with minimal morbidity. SCT is a viable treatment option to salvage local PCa recurrence following either BT or cryoablation failure.
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Affiliation(s)
- Sriram Deivasigamani
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Hazem Orabi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Urology Department, Assiut University, Assiut, Egypt
| | - Ahmed El-Shafei
- Department of Urology, University of Florida Health, Jacksonville, Florida, USA
| | - Eric S Adams
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Srinath Kotamarti
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Ali Aminsharifi
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
- Department of Urology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Leah Davis
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
| | - Yuan Wu
- Duke Cancer Institute and Department of Statistics, Durham, North Carolina, USA
| | | | - Thomas J Polascik
- Department of Urologic Surgery and Duke Prostate Center, Duke University Medical Center, Durham, North Carolina, USA
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Deivasigamani S, Kotamarti S, Adams ES, Séguier D, Zhang D, Michael Z, Polascik TJ, Gupta RT. Reconciling discordance between PI-RADS 4 lesions and targeted biopsy: Early experience of a multidisciplinary quality improvement protocol with PI-RADS 4 subcategorization. Eur J Radiol 2023; 165:110929. [PMID: 37352682 DOI: 10.1016/j.ejrad.2023.110929] [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: 04/20/2023] [Revised: 05/27/2023] [Accepted: 06/12/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE PI-RADS 4 lesions are considered to have a "high" likelihood of clinically-significant prostate cancer (csPCa). However, patients undergoing targeted biopsy have a range of histologic findings. Understanding discordant cases is critical to improve diagnostic accuracy and inform subsequent management. We studied early findings from implementation of a multidisciplinary Quality Improvement (QI) protocol for reconciling discordance and evaluate the potential heterogeneity of PI-RADS 4. METHODS Patients with mpMRI PI-RADS 4 lesions undergoing fusion-targeted biopsy from January 2017 to May 2021 were retrospectively reviewed. The discordant targeted biopsy pathology (benign/GG1) was evaluated utilizing a QI protocol and all lesions were subcategorized based on ADC values. Positive Predictive Value (PPV) for PI-RADS 4 lesions overall and the Cancer Detection Rate (CDR) for subcategorized lesions were calculated. RESULTS 248 patients with 286 lesions were reviewed. Prior to re-review, PI-RADS 4 PPV for ≥ GG1 and ≥ GG2 lesions were 0.55 and 0.34, increasing to 0.67 and 0.43 following reconciliation. Lesion subcategorization based on ADC value as higher suspicion (4+) and lower suspicion (4-) resulted in 158 and 117 lesions, with reverse-fusion analysis revealing that 61% and 17% of lesions contained csPCa, respectively. Subgroup analysis among PI-RADS 4+ lesions led to an increase in the CDR to 75% and 61% for ≥ GG1 and ≥ GG2. CONCLUSION Use of multidisciplinary QI protocol to review discordance cases of PI-RADS 4 improves diagnostic accuracy and guides subsequent management. Our findings highlight the known heterogeneity of this category with reference to csPCa CDR, suggesting the potential value of PI-RADS 4 subcategorization.
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Affiliation(s)
- Sriram Deivasigamani
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA.
| | - Srinath Kotamarti
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA.
| | - Eric S Adams
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA.
| | - Denis Séguier
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA; Department of Urology, Lille University Hospital, Lille, France.
| | - Dylan Zhang
- Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA.
| | - Zoe Michael
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA.
| | - Thomas J Polascik
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA; Duke Cancer Institute Center for Prostate and Urologic Cancers, DUMC Box 103861, 20 Duke Medicine Circle, Durham, NC 27710, USA.
| | - Rajan T Gupta
- Duke University Medical Center, Department of Surgery, Division of Urologic Surgery and Duke Prostate Center, DUMC Box 2804, Durham, NC 27710, USA; Duke University Medical Center, Department of Radiology, DUMC Box 3808, Durham, NC 27710, USA; Duke Cancer Institute Center for Prostate and Urologic Cancers, DUMC Box 103861, 20 Duke Medicine Circle, Durham, NC 27710, USA.
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Michael ZD, Kotamarti S, Deivasigamani S, Seguier D, Polascik TJ. A Comprehensive Assessment of the Utility of Transperineal Template Prostate Mapping Biopsy: A 13-year Experience. Urology 2023; 177:115-121. [PMID: 37105359 DOI: 10.1016/j.urology.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To assess Duke's experience on the utility of transperineal template mapping biopsy (TTMB) for re-evaluating patients with persistently elevated prostate-specific antigen after prior negative biopsy, with pre-existing prostate cancer (PCa) already on active surveillance (AS), or considering focal therapy (FT). METHODS We retrospectively reviewed Duke patients undergoing TTMB. Functional outcomes were evaluated using International Index of Erectile Function-5 (IIEF-5) and International Prostate Symptom Score (IPSS). Complications within 30 days were recorded. Nonparametric statistical analyses compared functional measures from baseline to 2 and 6 weeks post-TTMB. RESULTS From 8/2009 to 1/2021, 218 patients underwent TTMB, with 57-month median follow-up. Complication rate was 17.4%, with the majority Clavien I. Overall PCa detection was 72.9%, with clinically significant PCa in 53.2%; for those without prior PCa diagnosis (n = 117), overall detection was 64.1% with clinically significant PCa in 49.5%. Of those on AS at TTMB (n = 86), 36 (41.8%) had Gleason upgrading. TTMB changed management for 59 (68.6%) patients, with 38 (44.2%) proceeding to whole-gland therapy and 21 (24.4%) electing FT. Regarding functional outcomes, IPSS were insignificantly different from baseline at 6 weeks (P = NS). Overall functional score impacts were minimal across subgroups; in groups with significant declines in IIEF-5, median score drops were ≤1 point and caused minimal/no movement in IIEF-5 scoring category. CONCLUSION In this cohort, TTMB offered enhanced cancer detection with overall minimal impact to functional outcomes. We conclude from this comprehensive assessment that TTMB provides value to rule out PCa, prevent overtreatment of those that can remain on AS, evaluate FT candidacy, and identify those needing whole-gland management.
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Affiliation(s)
- Zoe D Michael
- Department of Urology, Duke Cancer Institute, Durham, NC
| | | | | | - Denis Seguier
- Department of Urology, Lille University, Lille, France
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Dudinec JV, Wang SM, Kotamarti S, Morris KE, Polascik TJ, Moul JW. Clinical utility of multiple secondary combined tests in prostate cancer screening. Can J Urol 2023; 30:11538-11544. [PMID: 37344464] [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] [Indexed: 06/23/2023]
Abstract
INTRODUCTION The clinical utility of concurrent Prostate Health Index (PHI) and ExosomeDx Prostate Intelliscore (EPI) testing is unclear. We sought to examine the performance of combined PHI and EPI testing on men undergoing elevated PSA work up. MATERIALS AND METHODS Patients who received both EPI and PHI testing were identified from an institutional database of men referred to urology for an elevated total PSA. Cut points of EPI > 15.6 and PHI ≥ 36 were used to denote a positive test. Patients were placed into one of four groups determined by combination of EPI and PHI results. Demographic variables and biopsy recommendations were compared between groups. The concordance of test positivity between EPI and PHI was compared by Cohen's kappa. Demographic variables and secondary testing results were compared between patients' compliant and non-compliant with prostate biopsy recommendation. Biopsy pathology was compared between groups. RESULTS A total of 162 patients had both EPI and PHI testing. Median age was 65 years, with a median PSA of 6.64 ng/mL. Age (p = 0.001), PSA (< 0.001) and biopsy recommendation (< 0.001) differed between combined secondary screening test result groups. Seventy-five percent of patients with both a positive EPI and PHI were found to have prostate cancer, with 54.2% being ≥ Gleason 7. Cohen's kappa was 0.19, indicating poor concordance. The AUC of EPI and PHI for clinically significant cancer was 0.563 (95% CI: 0.4331-0.6923) and 0.685 (95% CI: 0.569-0.8) (p = 0.147). CONCLUSIONS Concurrently positive EPI and PHI indicate increased prostate cancer risk, with combined usage potentially influencing biopsy recommendation and compliance.
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Affiliation(s)
- John V Dudinec
- Department of Urology and Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Sabrina M Wang
- Department of Urology and Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Srinath Kotamarti
- Department of Urology and Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Kostantinos E Morris
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas J Polascik
- Department of Urology and Duke Cancer Institute, Duke University, Durham, North Carolina, USA
| | - Judd W Moul
- Department of Urology and Duke Cancer Institute, Duke University, Durham, North Carolina, USA
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Tan WP, Kotamarti S, Ayala A, Mahle R, Chen E, Arcot R, Chang A, Michael Z, Seguier D, Polascik TJ. Oncological and Functional Outcomes for Men Undergoing Salvage Whole-gland Cryoablation for Radiation-resistant Prostate Cancer. Eur Urol Oncol 2023; 6:289-294. [PMID: 36890104 DOI: 10.1016/j.euo.2023.02.007] [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: 09/11/2022] [Revised: 02/05/2023] [Accepted: 02/16/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND There is no consensus on the optimal approach for salvage local therapy in radiation-resistant/recurrent prostate cancer (RRPC). OBJECTIVE To investigate oncological and functional outcomes for men treated with salvage whole-gland cryoablation (SWGC) of the prostate for RRPC. DESIGN, SETTING, AND PARTICIPANTS We retrospectively reviewed our prospectively collected cryosurgery database between January 2002 and September 2019 for men who were treated with SWGC of the prostate at a tertiary referral center. INTERVENTION SWGC of the prostate. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcome was biochemical recurrence-free survival (BRFS) according to the Phoenix criterion. Secondary outcomes included metastasis-free survival, cancer-specific survival, and adverse events. RESULTS AND LIMITATIONS A total of 110 men with biopsy-proven RRPC were included in the study. Median follow-up for patients without biochemical recurrence (BCR) after SWGC was 71 mo (interquartile range [IQR] 42.3-116). BRFS was 81% at 2 yr and 71% at 5 yr. A higher prostate-specific antigen (PSA) nadir after SWGC was associated with worse BRFS. The median International Index of Erectile Function-5 score was 5 (IQR 1-15.5) before SWGC and 1 (IQR 1-4) after SWGC. Stress urinary incontinence, strictly defined as the use of any pads after treatment, was 5% at 3 mo and 9% at 12 mo. Clavien-Dindo grade ≥3 adverse events occurred in three patients (2.7%). CONCLUSIONS In patients with localized RPPC, SWGC achieved excellent oncological outcomes with a low rate of urinary incontinence, and represents an alternative to salvage radical prostatectomy. Patients with fewer positive cores and lower PSA tended to have better oncological outcomes following SWGC. PATIENT SUMMARY For men with prostate cancer that persists after radiotherapy, a freezing treatment applied to the whole prostate gland can achieve excellent cancer control. Patients who did not have elevated prostate-specific antigen (PSA) at 6 years after this treatment appeared to be cured.
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Affiliation(s)
- Wei Phin Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA; Duke University School of Medicine, Durham, NC, USA; Department of Urology, New York University Langone Health, New York, NY, USA
| | - Srinath Kotamarti
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | | | | | - Emily Chen
- Duke University School of Medicine, Durham, NC, USA
| | - Rohith Arcot
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Andrew Chang
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA; H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Zoe Michael
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Denis Seguier
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
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Morris KE, Kotamarti S, Polascik TJ, Moul JW. AUTHOR REPLY. Urology 2023; 175:149-150. [PMID: 37257987 DOI: 10.1016/j.urology.2022.12.060] [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: 06/21/2022] [Accepted: 12/05/2022] [Indexed: 06/02/2023]
Affiliation(s)
| | - Srinath Kotamarti
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, NC
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, NC
| | - Judd W Moul
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, NC.
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Morris KE, Kotamarti S, Polascik TJ, Moul JW. Re-thinking How We Use Prostate Health Index for African American Men. Urology 2023:S0090-4295(23)00176-0. [PMID: 36828263 DOI: 10.1016/j.urology.2022.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/02/2022] [Accepted: 12/05/2022] [Indexed: 02/24/2023]
Abstract
OBJECTIVE To assess how the validated Prostate Health Index (PHI) risk stratifications perform with African American (AA) men and establish a threshold PHI value to potentially rule out the need for prostate biopsy. MATERIALS AND METHODS AA men meeting FDA-specified indications for PHI testing (>50 years old, PSA 4-10 and negative DRE) who underwent subsequent biopsy were included. Rates of clinically significant prostate cancer (csPCa, as defined by Gleason score ≥7) across accepted PHI stratifications were recorded. Receiver operator curve (ROC) analysis was undertaken to assess PHI performance to predict csPCa. A phi cutoff providing 90% sensitivity was identified. Among AA men with PSA 4-10 ng/mL, the proportion of men who proceeded to biopsy upon physician recommendation was determined. RESULTS Two hundred nine patients met primary criteria; 91 (43.5%) of which had csPCA. The area under the curve for PHI predicting csPCa was 0.68 (95% CI: 0.61-0.75). Using a phi threshold of <23.0 to avoid biopsy provided 98.9% sensitivity, 9.3% specificity, and would have avoided 4.7% of biopsies. The proportion of those who proceeded to biopsy upon physician recommendation was 81.8%. CONCLUSIONS PHI demonstrated limited performance in our cohort, with current stratifications featuring misleadingly low cancer detection rates for these men. Furthermore, PHI had limited use to avoid prostate biopsy, as the proposed threshold of 23.0 only allowed 4.7% of men to avoid biopsy. Further work is needed to assess and optimize PHI usage in AA men; nonetheless, it may still have use in increasing compliance with biopsy recommendation.
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Affiliation(s)
| | - Srinath Kotamarti
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, NC
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, NC
| | - Judd W Moul
- Division of Urology, Department of Surgery, Duke Cancer Institute, Durham, NC.
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Kotamarti S, Polascik TJ. Focal cryotherapy for prostate cancer: a contemporary literature review. Ann Transl Med 2023; 11:26. [PMID: 36760265 PMCID: PMC9906190 DOI: 10.21037/atm-21-5033] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/23/2021] [Indexed: 11/06/2022]
Abstract
Objective To perform a comprehensive review of the contemporary literature regarding both functional and oncologic outcomes after primary focal cryotherapy for prostate cancer (PCa), providing these results as a foundation for discussing recent developments in the realm of focal therapy. Background Traditional treatments for PCa are often associated with debilitating functional side effects for patients. Due to advances in imaging and biopsy strategies, focal ablative therapies recently have garnered much interest and offer an alternative primary treatment for PCa patients with localized disease. Focal cryoablation utilizes heat extraction from tissues to generate an iceball and cause tissue destruction while sparing uninvolved prostatic regions. Optimized patient selection and postoperative management continue to be areas of interest and study as the field continues to develop. Methods A search was performed of the PubMed and Embase databases to identify articles pertaining to primary focal PCa cryoablation since our group's last comprehensive review in 2016. Conclusions Primary focal cryoablation for PCa offers optimized functional outcomes and a favorable adverse event profile. True evaluation of oncologic outcomes is hampered by lack of long-term follow-up and highly variable clinical endpoints across these studies. Nonetheless, outcomes appear adequate in the short- to medium-term time frame. Utilization of focal cryoablation is expected to grow with continued refinement of patient selection and management options in cases of treatment failure.
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Affiliation(s)
- Srinath Kotamarti
- Division of Urologic Surgery, Duke Cancer Institute, Durham, NC, USA
| | - Thomas J Polascik
- Division of Urologic Surgery, Duke Cancer Institute, Durham, NC, USA
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Kotamarti S, Armstrong AJ, Polascik TJ, Moul JW. Molecular Mechanisms of Castrate-Resistant Prostate Cancer. Urol Clin North Am 2022; 49:615-626. [DOI: 10.1016/j.ucl.2022.07.005] [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: 10/31/2022]
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Tan WP, Kotamarti S, Chen E, Mahle R, Arcot R, Chang A, Ayala A, Michael Z, Seguier D, Polascik TJ. Oncological and functional outcomes of men undergoing primary whole gland cryoablation of the prostate: A 20-year experience. Cancer 2022; 128:3824-3830. [PMID: 36107496 DOI: 10.1002/cncr.34458] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 05/31/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND This study reports the oncological and functional outcomes in men with localized prostate cancer (Pca) who were treated with primary whole gland cryoablation (WGC) of the prostate. METHODS The authors retrospectively reviewed their prospectively collected cryosurgery database between January 2002 and September 2019 for men who were treated with WGC of the prostate at a tertiary referral center. Primary outcome includes biochemical recurrence-free survival (BRFS). Secondary outcomes include failure-free survival (FFS), metastasis-free survival (MFS) and adverse events. RESULTS A total of 260 men were included in the study. Men having had prior treatment for Pca were excluded. Median follow-up was 107 months (interquartile range [IQR], 68.3-132.5 months). BRFS, FFS, and MFS at 10 years were 84%, 66%, and 96%, respectively. High risk D'Amico classification was associated with a lower BRFS and FFS on multivariable analysis. No patient had any Pca-related death during follow-up. American Urological Association symptoms score and bother index were unchanged following cryoablation. Median International Index of Erectile Function score precryoablation and post-cryoablation was 7 (IQR, 3-11) and 1 (IQR, 1-5), respectively. Stress urinary incontinence, defined as requiring any protective pads only occurred in five patients (2%). No patient developed a fistula. Grade > 2 Clavien-Dindo adverse events occurred in six (2.3%) patients. CONCLUSION WGC of the prostate can achieve excellent oncological and functional outcomes in men with localized Pca at the 10-year mark. Primary WGC may be a good option for men who desire to preserve urinary continence and have an excellent oncologic outcome. LAY SUMMARY Primary whole gland cryoablation is an alternative treatment option to radical prostatectomy and radiotherapy for men with organ-confined prostate cancer. Patients had excellent cancer outcomes 1 years after whole gland cryoablation, and patients with PSA nadir 0.1 ng/ml or lower after treatment were less likely to have disease recurrence.
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Affiliation(s)
- Wei Phin Tan
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- Duke University School of Medicine, Durham, North Carolina, USA
- Department of Urology, New York University Langone Health, New York City, New York, USA
| | - Srinath Kotamarti
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Emily Chen
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Rachael Mahle
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Rohith Arcot
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Andrew Chang
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
- H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida, USA
| | | | - Zoe Michael
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Denis Seguier
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Thomas J Polascik
- Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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15
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Michael ZD, Kotamarti S, Arcot R, Morris K, Shah A, Anderson J, Armstrong AJ, Gupta RT, Patierno S, Barrett NJ, George DJ, Preminger GM, Moul JW, Oeffinger KC, Shah K, Polascik TJ. Initial Longitudinal Outcomes of Risk-Stratified Men in Their Forties Screened for Prostate Cancer Following Implementation of a Baseline Prostate-Specific Antigen. World J Mens Health 2022:40.e60. [PMID: 36047079 DOI: 10.5534/wjmh.220068] [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: 04/25/2022] [Revised: 06/27/2022] [Accepted: 07/21/2022] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Prostate cancer (PCa) screening can lead to potential over-diagnosis/over-treatment of indolent cancers. There is a need to optimize practices to better risk-stratify patients. We examined initial longitudinal outcomes of mid-life men with an elevated baseline prostate-specific antigen (PSA) following initiation of a novel screening program within a system-wide network. MATERIALS AND METHODS We assessed our primary care network patients ages 40 to 49 years with a PSA measured following implementation of an electronic health record screening algorithm from 2/2/2017-2/21/2018. The multidisciplinary algorithm was developed taking factors including age, race, family history, and PSA into consideration to provide a personalized approach to urology referral to be used with shared decision-making. Outcomes of men with PSA ≥1.5 ng/mL were evaluated through 7/2021. Statistical analyses identified factors associated with PCa detection. Clinically significant PCa (csPCa) was defined as Gleason Grade Group (GGG) ≥2 or GGG1 with PSA ≥10 ng/mL. RESULTS The study cohort contained 564 patients, with 330 (58.5%) referred to urology for elevated PSA. Forty-nine (8.7%) underwent biopsy; of these, 20 (40.8%) returned with PCa. Eleven (2.0% of total cohort and 55% of PCa diagnoses) had csPCa. Early referral timing (odds ratio [OR], 4.58) and higher PSA (OR, 1.07) were significantly associated with PCa at biopsy on multivariable analysis (both p<0.05), while other risk factors were not. Referred patients had higher mean PSAs (2.97 vs. 1.98, p=0.001). CONCLUSIONS Preliminary outcomes following implementation of a multidisciplinary screening algorithm identified PCa in a small, important percentage of men in their forties. These results provide insight into baseline PSA measurement to provide early risk stratification and detection of csPCa in patients with otherwise extended life expectancy. Further follow-up is needed to possibly determine the prognostic significance of such mid-life screening and optimize primary care physician-urologist coordination.
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Affiliation(s)
- Zoe D Michael
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Srinath Kotamarti
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Rohith Arcot
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kostantinos Morris
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Anand Shah
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - John Anderson
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Andrew J Armstrong
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Rajan T Gupta
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Steven Patierno
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA.,Department of Family Medicine and Community Health, Duke University Medical Center, Durham, NC, USA
| | - Nadine J Barrett
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Daniel J George
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Glenn M Preminger
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Judd W Moul
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Kevin C Oeffinger
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Kevin Shah
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Thomas J Polascik
- The Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, USA.,Division of Urologic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA
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Kotamarti S, Gupta RT, Wang B, Séguier D, Michael Z, Zhang D, Abern MR, Huang J, Polascik TJ. Reconciling Discordance Between Prostate Biopsy Histology and Magnetic Resonance Imaging Suspicion - Implementation of a Quality Improvement Protocol of Imaging Re-review and Reverse-fusion Target Analysis. Eur Urol Oncol 2022; 5:483-493. [PMID: 35879190 DOI: 10.1016/j.euo.2022.06.007] [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: 05/15/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 11/04/2022]
Abstract
There is uncertainty with how to proceed when targeted prostate biopsy of suspicious multiparametric magnetic resonance imaging (mpMRI) lesions return without clinically significant prostate cancer (csPCa). While possible, there are error sources that could contribute to such discordance including the mpMRI read, mpMRI-ultrasound fusion, biopsy technique, and histologic classification. Consequences are potentially significant; mistakenly missing csPCa can lead to delays in curative treatment. Conversely, in cases of incorrect mpMRI interpretation, the patient may be subjected to unnecessary workup/burden. At our institution, we implemented a quality improvement (QI) initiative triggered after a discordant case occurs. This multidisciplinary review process incorporates mpMRI re-review and assessment of accurate lesion-sampling, termed "reverse-fusion." Herein, we describe the protocol, present sample cases, and discuss clinical implications.
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Affiliation(s)
- Srinath Kotamarti
- Division of Urology, Duke University Medical Center, Durham, NC, United States.
| | - Rajan T Gupta
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Department of Radiology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States
| | - Bangchen Wang
- Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Denis Séguier
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Department of Urology, Lille University, Lille, France
| | - Zoe Michael
- Division of Urology, Duke University Medical Center, Durham, NC, United States
| | - Dylan Zhang
- Department of Radiology, Duke University Medical Center, Durham, NC, United States
| | - Michael R Abern
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States
| | - Jiaoti Huang
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States; Department of Pathology, Duke University Medical Center, Durham, NC, United States
| | - Thomas J Polascik
- Division of Urology, Duke University Medical Center, Durham, NC, United States; Duke Cancer Institute Center for Prostate and Urologic Cancers, Durham, NC, United States
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Kotamarti S, Michael Z, Silver D, Teper E, Aminsharifi A, Polascik TJ, Schulman A. Device-related complications during renal cryoablation: insights from the Manufacturer and User Facility Device Experience (MAUDE) database. Urol Oncol 2022; 40:199.e9-199.e14. [DOI: 10.1016/j.urolonc.2022.03.002] [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] [Received: 10/10/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022]
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Kotamarti S, Séguier D, Arcot R, Polascik TJ. Assessment after focal therapy: what is the latest? Curr Opin Urol 2022; 32:260-266. [PMID: 35275100 DOI: 10.1097/mou.0000000000000988] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW To review assessment after focal therapy (FT) in the context of developments from the past two years. RECENT FINDINGS With a paucity of high-quality studies, recent findings are primarily reliant on results from institutional-based cohorts and reports of expert consensus. Notably, oncologic treatment failure should be further stratified into recurrence in the in-field or out-of-field ablation zone, and both regions should be surveilled postoperatively. Monitoring primarily consists of periodic evaluations of prostate-specific antigen (PSA) testing and magnetic resonance imaging, with histologic sampling needed to confirm suspicion of recurrence. Recent investigations into PSA derivatives, contrast-enhanced ultrasound, and prostate-specific membrane antigen imaging have shown preliminary promise. Although postablation functional outcomes are generally accepted to be excellent, they are limited by the wide range of patient-reported measures, variability in individual practice, and low questionnaire completion rates. SUMMARY There is still a need for high-level, long-term data to inform exact standardized protocols to manage patients after FT. A multifaceted approach is required to surveil patients and identify those at risk of recurrence. Embracing shared responsibility between the patient and clinician to fastidiously monitor the infield and out-of-field ablation zones postoperatively is critical to maximize oncologic outcomes.
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Affiliation(s)
- Srinath Kotamarti
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Denis Séguier
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
- Department of Urology, Lille University, Lille, France
| | - Rohith Arcot
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
| | - Thomas J Polascik
- Division of Urology, Duke Cancer Institute, Durham, North Carolina, USA
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Michael Z, Kotamarti S, Arcot R, Morris K, Shah A, Anderson J, Armstrong A, Gupta R, Preminger G, Moul J, Oeffinger K, Shah K, Polascik T. Longitudinal outcomes following implementation of baseline PSA risk stratification of men in their forties. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00452-3] [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: 11/04/2022]
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Kotamarti S, Michael Z, Silver D, Teper E, Aminsharifi A, Polascik T, Schulman A. Device-related complications during renal cryoablation: Insights from the manufacturer and user facility device experience (MAUDE) database. Eur Urol 2022. [DOI: 10.1016/s0302-2838(22)00307-4] [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: 11/04/2022]
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Kotamarti S, George A, Zhu A, Polascik TJ. Transrectal Ultrasound-Guided Biopsy Should Continue to Be a Standard of Care for The Detection of Prostate Cancer. Urology 2022; 164:21-24. [PMID: 35038489 DOI: 10.1016/j.urology.2022.01.005] [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: 11/17/2021] [Revised: 12/28/2021] [Accepted: 01/02/2022] [Indexed: 11/25/2022]
Abstract
For men choosing to screen for prostate cancer (PCa), biopsy remains critical for diagnosis. While transrectal ultrasound-guided (TRUS) biopsy has been the standard of care for many years, recent concerns regarding post-procedural infection have led to increased interest in prostatic sampling via the transperineal (TP) approach. However, TRUS biopsy features important patient-related and physician/practice-related advantages compared to the TP method, and there are several useful strategies to effectively mitigate infectious concerns. The benefits associated with TRUS biopsy, particularly patient comfort and efficient clinical workflow, are further accentuated by several key shortcomings associated with switching to the TP approach. Herein, we present an argument in favor of maintaining TRUS biopsy as standard practice, discussing significant topics including infectious complications, practice workflow and cost, cancer detection rates, and patient experience.
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Affiliation(s)
| | - Arvin George
- Department of Urology, University of Michigan Hospital, Ann Arbor, MI
| | - Alex Zhu
- Department of Urology, University of Michigan Hospital, Ann Arbor, MI
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22
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Kotamarti S, Schulman A. PD08-01 AN UPDATED REVIEW OF ADVERSE EVENTS RELATED TO THE INJECTION OF THE SPACEOAR
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HYDROGEL SYSTEM BEFORE RADIOTHERAPY FOR PROSTATE CANCER. J Urol 2021. [DOI: 10.1097/ju.0000000000001976.01] [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: 11/25/2022]
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Kotamarti S, Teper E, Silver D, Silver M, Schulman A. MP13-19 THE CONTEMPORARY PROFILE OF OCTOGENARIANS UNDERGOING RADICAL CYSTECTOMY IN THE UNITED STATES. J Urol 2021. [DOI: 10.1097/ju.0000000000001994.19] [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: 11/25/2022]
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Wood A, Shpeen B, Lee J, Snyder R, Xu Y, Kotamarti S, Teper E, Lubin M, Silver D, Becker KD, Meghal T, Schulman A. Management of localized prostate cancer during the Covid-19 pandemic at a multidisciplinary cancer center in New York City, New York. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.213] [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
213 Background: In March 2020, the coronavirus disease (COVID-19) spread across New York City. All non-emergent medical care was delayed, and healthcare resources were redirected to COVID-19 patients. Physicians managing prostate cancer faced unprecedented decisions to balance risks of the pandemic against risks of cancer progression. Here we review management of localized prostate cancer at an Urban Cancer Center in New York City during the height of the pandemic. Methods: We examined men with newly diagnosed, localized prostate cancer seen in initial consultation by Urology or Radiation Oncology between January 1 and June 30, 2020 (COVID-19 cohort). We reviewed cancer management, as well as the impact of the pandemic on treatment choice and patterns of care. Chi square and t-test analyses were performed to compare the COVID-19 cohort to a similar cohort managed before the pandemic from July 1, 2019 to December 31, 2019 (pre-COVID-19 cohort). Results: We identified 75 men in the COVID-19 cohort. NCCN risk profile: 20% low risk, 53.4% intermediate, and 26.7% high. During the height of the pandemic, there was 7 week pause in both new radiation therapy (RT) and radical prostatectomy. 11 patients continued previous RT, 1 of which developed a symptomatic covid infection and required a 2 week pause in treatment. During the operating room restart, 11 patients underwent radical prostatectomy including 8 with unfavorable-intermediate or high-risk disease. No surgical patients acquired COVID-19. Compared to the pre-COVID-19 cohort, the COVID-19 cohort had longer time from initial visit to treatment (92.1 days vs 71.0 days, p = 0.045) and a larger percentage of patients who were seen but did not return for management (25.3% vs 14%, p = 0.044). Conclusions: Our cancer center had a coordinated, 7-week cessation in primary RT and surgery for prostate cancer during the height of the COVID-19 pandemic. There were no severe COVID-19 infections among patients finishing RT, or the first cohort of men having surgery during the restart of treatments, suggesting that localized prostate cancer treatments can be safely delivered in the event of a second wave. We identified a substantial number of men who were seen, but did not return for management, highlighting a cohort who need to be reintegrated into the healthcare system. [Table: see text]
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Affiliation(s)
| | | | | | - Rose Snyder
- Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Yiqing Xu
- Maimonides Medical Center, Brooklyn, NY
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Kotamarti S, Silver M, Wood A, Teper E, Silver D, Schulman A. Do females have worse surgical outcomes after radical cystectomy? Impact of gender on 30-day complications in a national cohort. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.402] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
402 Background:: Men have higher rates of bladder cancer and are more likely to undergo cystectomy than women, yet women seem to have worse oncologic outcomes. This is attributed to biologic factors including adverse histologic variants and social factors including delay in diagnosis. There is early evidence that women also have worse surgical outcomes. We further examined the role of gender in 30-day perioperative outcomes following radical cystectomies in a national cohort. Methods: We examined the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2012 to 2016. The database was searched for CPT codes reflecting radical cystectomy and a diagnosis of “cancer of the bladder.” Frailty was estimated by the modified frailty index (functional status, diabetes, chronic obstructive pulmonary disorder, history of chronic heart failure, and hypertension requiring medication.) To compare demographic and perioperative characteristics between genders, Chi-Square analyses were performed for categorical variables, student’s t test to compare averages, and the Wilcoxon rank sum test for operative time and length of stay (LOS). Results: 4,681 radical cystectomies were identified including 842 (18.0%) females. Of the female cohort, average age was 68.6 (+/-11.2 years), 77.3% was Caucasian and 278 (33%) had a BMI of at least 30. There were no differences appreciated between genders with regards to age, average ASA score, frailty, or minimally-invasive approach (all p=NS). Compared to males, female gender was associated with longer operative time (350 vs. 336 min, p<0.009), length of stay (LOS) (8 vs 7, p<0.001) and lower rates of discharge to home (79.9% vs 87.0%, p<0.0001). Reoperation (4.8% vs. 6.0%), readmission (22.2% vs 20.6%), and death within 30 days (1.9% vs. 2.0%) were similar. Clavien 3 or greater was also similar among gender (Table). Conclusions: Female patients comprise a minority of radical cystectomies with slightly longer LOS and less home discharge than men, yet 30-day major complications, reoperation and mortality appear similar. [Table: see text]
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Griffiths L, Kotamarti S, Mikhail D, Sarcona J, Rastinehad AR, Villani R, Kreshover J, Hall SJ, Vira MA, Schwartz MJ, Richstone L. Extracapsular extension on multiparametric magnetic resonance imaging better predicts pT3 disease at radical prostatectomy compared to perineural invasion on biopsy. Can Urol Assoc J 2021; 15:261-266. [PMID: 33410741 DOI: 10.5489/cuaj.6909] [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: 11/19/2022]
Abstract
INTRODUCTION Risk assessment for non-organ-confined prostate cancer (PCa) is important in the surgical planning for radical prostatectomy (RP). Perineural invasion (PNI) on prostate biopsy has been associated with adverse pathological outcomes at prostatectomy. Similarly, the identification of suspected extracapsular extension (ECE) on multiparametric magnetic resonance imaging (mpMRI) has been shown to predict non-organ-confined disease. However, no prior study has compared these factors in predicting adverse pathology at prostatectomy. We evaluated mpMRI ECE and prostate biopsy PNI on multivariable analysis to determine their ability to predict pathological stage at time of RP. METHODS We retrospectively investigated the prostatectomy database at our institution to identify men who underwent prostate biopsy with pre-biopsy mpMRI and subsequent RP from 2013-2017. Multivariable regression analysis was performed to compare the association of mpMRI ECE (mECE) and PNI on prostate biopsy on the likelihood of finding pT3 disease on pathology post-prostatectomy. RESULTS Of a total 454 RP between 2013 and 2017, 191 patients met our inclusion criteria. Stage pT2 and pT3+ were found in 120 (62.8%) and 71 (37.2%) patients, respectively. Patients with mECE had 4.84 cumulative odds of worse pathological stage on RP (p=0.045) compared to PNI on biopsy, which showed cumulative odds of 2.25 (p=0.048). When controlling only for those patients without PNI, mECE was still found to be a significant predictor of pT3 disease at RP (p=0.030); however, in patients without mECE, PNI was not significant (p=0.062). CONCLUSIONS While mECE and biopsy PNI were both associated with worse pathological stage on RP, mECE had significantly higher cumulative odds compared to PNI. The significant predictive ability of mECE adds further clinical value to the use of mpMRI in PCa management. While validation in a larger cohort is required, these factors have important clinical implications with regards to early diagnosis of advanced disease and surgical planning.
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Affiliation(s)
- Luke Griffiths
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Srinath Kotamarti
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States.,Department of Urology, Maimonides Medical Center, Brooklyn, NY, United States
| | - David Mikhail
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States.,Department of Urology, Lenox Hill Hospital, New York, NY, United States
| | - Joseph Sarcona
- Department of Urology, Lenox Hill Hospital, New York, NY, United States
| | | | - Robert Villani
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Jessica Kreshover
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Simon J Hall
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Manish A Vira
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Michael J Schwartz
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States
| | - Lee Richstone
- Smith Institute for Urology, Northwell Health, New Hyde Park, NY, United States.,Department of Urology, Lenox Hill Hospital, New York, NY, United States
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Williams TR, Kotamarti S, Schulman A. Re: Outpatient Robot-Assisted Radical Prostatectomy: Are Patients Ready for Same-Day Discharge? by Dobbs et al. J Endourol 2020; 35:234. [PMID: 32380849 DOI: 10.1089/end.2020.0182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Thomas R Williams
- Department of Urology, Northwell Health, New Hyde Park, New York, USA
| | - Srinath Kotamarti
- Department of Surgery-Urology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ariel Schulman
- Department of Surgery-Urology, Maimonides Medical Center, Brooklyn, New York, USA
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Kotamarti S, Williams T, Silver M, Silver DA, Schulman AA. Rethinking the need for overnight admission after robotic-assisted laparoscopic prostatectomy. J Robot Surg 2020; 14:913-915. [PMID: 32602024 PMCID: PMC7322390 DOI: 10.1007/s11701-020-01115-1] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/24/2020] [Indexed: 02/06/2023]
Abstract
Robotic-assisted laparoscopic prostatectomy (RALP) is the gold standard for the surgical management of localized prostate cancer (PCa). Multi-institutional series have demonstrated complications and readmissions in less than 5% of patients and most are now discharged within 24 h of surgery. Recently, several high-volume surgeons demonstrated the safety of same-day discharge (SDD) after RALP. The main benefits include lower costs and reduced exposure to nosocomial infections and hospital errors. The leading arguments for criticism include potential suboptimal postoperative care and the risk of missing a catastrophic event. In recent years, important advances have further strengthened the argument for SDD including more structured perioperative care, integration of single-port robotic systems, and new challenges presented by the coronavirus 2019 (COVID-19) pandemic. Here, we provide further evidence demonstrating the safety of SDD in a multi-institutional cohort of patients and review the main arguments supporting the expanded use of this approach.
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Affiliation(s)
- Srinath Kotamarti
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Thomas Williams
- Hofstra-Northwell School of Medicine, 450 Lakeville Rd, Suite M42, Lake Success, NY, 11042, USA
| | - Michael Silver
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.,, 450 Clarkson Ave, BSB 4-32, Brooklyn, NY, 11203, USA
| | - David A Silver
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA
| | - Ariel A Schulman
- Maimonides Medical Center, 745 64th St. 4th Floor, Brooklyn, NY, 11220, USA.
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Aminsharifi A, Kotamarti S, Silver D, Schulman A. Major Complications and Adverse Events Related to the Injection of the SpaceOAR Hydrogel System Before Radiotherapy for Prostate Cancer: Review of the Manufacturer and User Facility Device Experience Database. J Endourol 2019; 33:868-871. [PMID: 31452385 DOI: 10.1089/end.2019.0431] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [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: 11/13/2022] Open
Abstract
Purpose: SpaceOAR® is a Food and Drug Administration-approved hydrogel injection used to create space between the prostate and rectum during prostate radiotherapy. It has shown to significantly reduce the rectal radiation dose with lower rates of rectal toxicity. Despite a high safety performance in initial trials, SpaceOAR remains in early clinical use. Thus, we examined emerging safety reports as the system becomes more widely utilized. Methods: We reviewed the SpaceOAR manufacturer website for the safety profile and complications associated with the SpaceOAR hydrogel. We then compared this with reports submitted to the Manufacturer and User Facility Device Experience (MAUDE) database. Results: The manufacturer website reported risks including pain, needle penetration, and/or gel injection into a nearby organ or blood vessel, local inflammation, infection, urinary retention, and local rectal injury or symptoms. There were 22 unique reports discussing 25 patient cases in the MAUDE database from January 2015 to March 2019, with an increasing number of reports each year up through 2018. Unique major complications including acute pulmonary embolism, severe anaphylaxis, prostatic abscess and sepsis, purulent perineal drainage, rectal wall erosion, and rectourethral fistula were reported. Conclusion: Despite well-documented clinical benefits of the SpaceOAR System, there are a number of severe and debilitating complications recently reported in proximity to gel injection. This highlights the need for further study of device complications in light of its increasing clinical use.
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Affiliation(s)
- Alireza Aminsharifi
- Division of Urology, Duke Cancer Institute, Duke University Hospital, Durham, North Carolina.,Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - David Silver
- Division of Urology, Maimonides Medical Center, Brooklyn, New York
| | - Ariel Schulman
- Division of Urology, Maimonides Medical Center, Brooklyn, New York
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Griffiths L, Kotamarti S, Vasudevan V, Gurram S, Lamba S, Zaman S, Sheehan P, Hall S, Vira M. MP40-17 WHAT IS THE IMPACT OF NUMBER OF LESIONS IDENTIFIED ON MULTI-PARAMETRIC MAGNETIC RESONANCE IMAGING? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.1284] [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: 10/17/2022]
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Kotamarti S, Yee A, Marziliano A, Vilaró J, Levy M, Ben-Levi E, Villani R, Diefenbach M, Vira M, Hall S. MP17-19 HOW LOW CAN YOU GO: HOW DO VERY-LOW RISK AND LOW RISK PROSTATE CANCER PATIENTS FARE ON ACTIVE SURVEILLANCE? J Urol 2018. [DOI: 10.1016/j.juro.2018.02.574] [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: 11/25/2022]
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Kotamarti S, Rothberg MB, Danzig MR, Levinson J, Saad S, Korets R, McKiernan JM, Badani KK. Increasing volume of non-neoplastic parenchyma in partial nephrectomy specimens is associated with chronic kidney disease upstaging. Clin Genitourin Cancer 2014; 13:239-43. [PMID: 25497585 DOI: 10.1016/j.clgc.2014.11.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 07/02/2014] [Revised: 11/05/2014] [Accepted: 11/11/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We examined the effect of non-neoplastic parenchymal volumes (NNPVs) in partial nephrectomy (PN) surgical specimens on long-term postoperative renal function. PN for renal cortical neoplasms has demonstrated superior long-term renal function outcomes compared with radical nephrectomy. Minimizing the distance between the surgical margin and tumor will reduce the NNPV removed. The role of NNPV on postoperative outcomes has been preliminarily investigated, with varying results. Thus, we sought to determine the association between the NNPV removed and postoperative chronic kidney disease (CKD) staging. MATERIALS AND METHODS Our institutional database was queried for patients who had undergone PN from 1990 to 2012. The demographic and pathologic data were collected. The ellipsoid formula was used to calculate the surgical specimen and tumor volumes, which were then subtracted from each other to determine the NNPV. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease formula. Binary logistic regression analysis was used to determine the predictors of postoperative CKD upstaging according to the eGFR. RESULTS A total of 584 patients meeting the inclusion criteria had undergone PN. On binary logistic regression analysis, controlling for age, tumor volume, surgical modality, and preoperative CKD stage, an increasing NNPV in the surgical specimen was independently associated with postoperative CKD upstaging (odds ratio, 1.004; P = .007). CONCLUSION An increasing NNPV removed during PN correlated with CKD upstaging using the eGFR; therefore, additional emphasis should be placed on healthy parenchymal preservation, with long-term follow-up to ensure adequate oncologic outcomes.
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Affiliation(s)
- Srinath Kotamarti
- Department of Urology, Columbia University Medical Center, New York, NY.
| | | | - Matthew R Danzig
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Jared Levinson
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Shumaila Saad
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Ruslan Korets
- Department of Urology, Columbia University Medical Center, New York, NY
| | - James M McKiernan
- Department of Urology, Columbia University Medical Center, New York, NY
| | - Ketan K Badani
- Department of Urology, Columbia University Medical Center, New York, NY
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Danzig MR, Weinberg AC, Ghandour RA, Kotamarti S, McKiernan JM, Badani KK. The Association Between Socioeconomic Status, Renal Cancer Presentation, and Survival in the United States: A Survival, Epidemiology, and End Results Analysis. Urology 2014; 84:583-9. [DOI: 10.1016/j.urology.2014.05.024] [Citation(s) in RCA: 19] [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: 04/21/2014] [Revised: 05/15/2014] [Accepted: 05/23/2014] [Indexed: 01/26/2023]
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Schubert T, Danzig MR, Kotamarti S, Ghandour RA, Lascano D, Dubow BP, Decastro GJ, Benson MC, McKiernan JM. Mixed low- and high-grade non-muscle-invasive bladder cancer: a histological subtype with favorable outcome. World J Urol 2014; 33:847-52. [DOI: 10.1007/s00345-014-1383-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 08/11/2014] [Indexed: 11/30/2022] Open
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Kotamarti S, Rothberg MB, Danzig M, Saad S, Levinson J, Benson MC, McKiernan JM, Badani KK. PD16-09 MINIMIZING NORMAL PARENCHYMAL LOSS DURING PARTIAL NEPHRECTOMY PRESERVES LONG-TERM RENAL FUNCTION WITHOUT IMPACTING LOCAL RECURRENCE. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Danzig M, Ghandour R, Kotamarti S, Schubert T, RoyChoudhury A, Pierorazio P, Badani K, Allaf M, McKiernan J. MP54-04 PARTIAL NEPHRECTOMY IS EQUIVALENT TO ACTIVE SURVEILLANCE IN PRESERVING RENAL FUNCTION FOR PATIENTS WITH SMALL RENAL MASSES. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.1593] [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: 10/25/2022]
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37
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Danzig M, Kotamarti S, Ghandour R, Dubow B, Rothberg M, RoyChoudhury A, Benson M, McKiernan J, Badani K. PD12-08 METFORMIN AND STATINS ACT SYNERGISTICALLY TO REDUCE BIOCHEMICAL RECURRENCE RISK IN DIABETICS FOLLOWING RADICAL PROSTATECTOMY. J Urol 2014. [DOI: 10.1016/j.juro.2014.02.980] [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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Pasupuleti LV, Cook KM, Sifri ZC, Kotamarti S, Calderon GM, Alzate WD, Livingston DH, Mohr AM. Does selective beta-1 blockade provide bone marrow protection after trauma/hemorrhagic shock? Surgery 2012; 152:322-30. [PMID: 22938894 PMCID: PMC3432948 DOI: 10.1016/j.surg.2012.06.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [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: 01/07/2012] [Accepted: 06/07/2012] [Indexed: 01/18/2023]
Abstract
BACKGROUND Previously, nonselective beta-blockade (BB) with propranolol demonstrated protection of the bone marrow (BM) after trauma and hemorrhagic shock (HS). Because selective beta-1 blockers are used commonly for their cardiac protection, the aim of this study was to more clearly define the role of specific beta adrenergic receptors in BM protection after trauma and HS. METHODS Male Sprague-Dawley rats underwent unilateral lung contusion (LC) followed by HS for 45 minutes. After resuscitation, animals were injected with a selective beta-blocker, atenolol (B1B), butoxamine (B2B), or SR59230A (B3B). Animals were killed at 3 hours or 7 days. Heart rate and blood pressure were measured throughout the study period. BM cellularity, growth of hematopoietic progenitor cells (HPCs) in BM, and hemoglobin levels (Hb) were assessed. RESULTS Treatment with a B2B or B3B after LCHS restored both BM cellularity and BM HPC colony growth at 3 hours and 7 days. In contrast, treatment with a B1B had no effect on BM cellularity or HPC growth but did decrease heart effectively rate throughout the study. Treatment with a B3B after LCHS increased Hb as compared with LCHS alone. CONCLUSION After trauma and HS, protection of BM for 7 days was seen with use of either a selective beta-2 or beta-3 blocker. Use of a selective beta-1 blocker was ineffective in protecting the BM despite a physiologic decrease in heart rate. Therefore, the protection of BM is via the beta-2 and beta-3 receptors and it is not via a direct cardiovascular effect.
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Affiliation(s)
- Latha V Pasupuleti
- Division of Trauma, Department of Surgery, UMDNJ-New Jersey Medical School, Newark, NJ, USA
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Pasupuleti L, Cook K, Kotamarti S, Walter A, Sifri Z, Livingston D, Mohr A. Does Selective Beta 1 Blockade Provide Bone Marrow Protection Following Trauma/Hemorrhagic Shock? J Surg Res 2012. [DOI: 10.1016/j.jss.2011.11.589] [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: 10/14/2022]
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