Prostate Cancer

The aim of this study was to describe age- related prostate cancer (PCa) characteristics in men after radical prostatectomy (RP). There were 2,373 men who underwent RP for clinically localized PCa between 2002 and 2017 and had complete data that were included into the study. Among them, 315 (13.3%) men aged ≤55 years (GR-1), 1,098 (46.3%) men aged between 56 to 65 years (GR-2) and 960 (40.4%) men aged older than 65 years (GR-3) were identified. All preoperative and pathological parameters were compared between all three groups and between each group separately. High-risk prostate cancer (HRPCa) cases were analyzed separately. Regression analysis was used to evaluate the impact of age on cancer aggressiveness. Clinical stage (cT), biopsy Gleason score and D'Amico risk groups were different comparing age-related study groups (all p <0.01), respectively. Preoperatively cT1 and Gleason 6 were in the highest rate for GR-1 in comparison with GR-3: 35.9 vs. 27.1%, p = 0.003 and 65.1%...

Patients who undergo radical prostatectomy with a history of transurethral resection of prostate (TURP) may have worse surgical or oncologic outcomes compared with patients with no history of TURP, according to the results of a meta-analysis. TURP is commonly used for benign prostatic hyperplasia, and prostate cancer can be found in as many as 3% to 16% of specimens from the procedure. It is currently recommended that radical prostatectomy occur in the first month after TURP or until 4 months after TURP in patients found to have prostate cancer.  Here, the researchers conducted a meta-analysis to compare outcomes of patients who had previous TURP prior to prostatectomy with patients with no TURP.  The study included data from 13 studies of 1163 patients with TURP history and 5587 patients without TURP history. Results suggested that a history of TURP was associated with a higher positive surgical margin rate (odds ratio, 1.31; P =.004) compared with non-TURP. Related...

Arousal incontinence (AI) occurs during physical or psychological sexual stimulation in men and has been described after radical prostatectomy (RP). The goals of this study are to describe the characteristics of men experiencing AI, outline the nature of their symptoms, and assess for predictors of this condition. A survey with questions on AI, stress urinary incontinence (SUI), the International Index of Erectile Function and International Prostate Symptom Score were sent out to men who had undergone an RP within the past 24 months at a single institution. The data were deidentified and analyzed using descriptive statistics. Comparisons between men with and without AI were made using t-tests and χ2 and Fisher exact tests. Logistic regression in univariable and multivariable analyses were used to define predictors of AI. The outcomes of this study included prevalence of AI, symptom severity and timing, patient and patient-perceived partner bother, management strategies used by the p...

[unable to retrieve full-text content] MRSI Parameters Can Predict Early Recurrence Postsurgery in Prostate Cancer | Oncology Newswatch    Oncology Learning Network https://ift.tt/2KScgkw

Arousal incontinence (AI) is a lesser known complication of radical prostatectomy (RP), and few data are available on its impact on self-esteem and sexual relationships. The goal of this study was to assess the impact of AI on patient self-esteem, confidence, and sexual relationships. This was a retrospective study. The validated Self-Esteem and Relationship (SEAR) questionnaire, as well as questions regarding AI, stress urinary incontinence (SUI), climacturia, International Prostate Symptom Score, and the International Index of Erectile Function erectile function domain, were sent to men who had undergone an RP within the past 24 months at a single institution. The data were de-identified and analyzed using descriptive statistics. The outcomes of this study include prevalence of AI, SEAR domain scores, patient and partner bother, management strategies employed by the patients, and the presence of concurrent climacturia or SUI. Fifty-three percent of men experienced post-operative ...

Retzius-sparing robot-assisted laparoscopic radical prostatectomy (rsRARP) allows entire prostatectomy procedure via the pouch of Douglas. In low- and intermediate-risk prostate cancer (PCa) there is level 1 evidence that the Retzius-sparing approach impacts early continence recovery. Since specific data on aggressive and locally advanced cancer is lacking and avoiding rsRARP is presently suggested, we investigated urinary and sexual recovery, perioperative complications and early oncologic outcomes after rsRARP in this particular cohort. Prospectively collected data of 50 consecutive men (median age 66 years) with high-risk PCa who underwent rsRARP in a single institution was analysed retrospectively. The follow-up for all patients was 12 months after surgery. 3 vs. 12 months after surgery, 82% vs. 98% of men used no pad or one safety pad and 50% vs. 72% used no pad. 89% of patients did not observe a decline of continence if postoperative radiotherapy was carried out. Considering th...

Local treatment of the primary by either radical prostatectomy or radiation therapy is discussed controversially. The role of cytoreductive radical prostatectomy has been evaluated in few retrospective clinical studies but data of prospective randomized clinical phase-III trials are lacking. It is the purpose of this review to reflect the current knowledge on indication, functional and oncological outcomes of cytoreductive radical prostatectomy to objectively highlight what can be expected from this approach. Cytoreductive radical prostatectomy (cRP) is associated with a long overall survival of more than 7 years and it is associated with a clinical progression-free survival of more than 6 years. When compared with nonsurgical approaches it becomes evident that about one-third of the patients will develop symptomatic local progression within 3 years whereas none of the surgically treated patients will experience such symptoms. cRP is associated with a low rate of significant complicat...

[unable to retrieve full-text content] Low free testosterone linked with ED in post-RP males    Urology Times https://ift.tt/2ODP2jg

Prediction of lymph node invasion (LNI) after radical prostatectomy has been rarely assessed in robotically assisted laparoscopic radical prostatectomy (RALP) series. We aimed to develop and externally validate a pretreatment nomogram for the prediction of LNI following RALP in patients with high- and intermediate-risk prostate cancer. 1654 RALP patients were prospectively collected between 2009 and 2016 from academic and community hospitals. We included patients with intermediate- and high-risk prostate cancer who underwent pelvic lymph node dissection (e-PLND). Logistic regression analysis was applied to construct a nomogram to predict LNI. Centers were randomly assigned to the training cohort (80%) and validation cohort (20%). The discriminative accuracies were evaluated by the areas under the curve and by the calibration plot. The net benefit of the nomogram to predict LNI was assessed by decision curve analysis and a cut-off was proposed. In total, 14% of the patients in our coh...

To compare 10-year oncologic treatment outcomes of radical prostatectomy (RP) vs external beam radiation therapy (EBRT) vs brachytherapy (BT) for patients with intermediate risk prostate cancer (IRPC). A retrospective analysis using propensity score matching was performed on 1,503 IRPC patients who underwent treatment from 2004 to 2007. 819 underwent RP, 574 underwent EBRT to a median dose of 75.3 Gray, and 110 underwent BT using Iodine-125. Biochemical failure was defined by the American Urological Association (AUA) definition of failure for RP, and the Phoenix definition for EBRT and BT. Median follow-up was 10.0 years for RP, 9.6 for EBRT, and 9.8 for BT. Neoadjuvant androgen deprivation therapy (NADT) was given in 0.6% of RP, 58.9% of EBRT, and 12.7% of BT patients, p<0.0001. Only 14% of BT received supplemental external radiation. The adjusted 10-year freedom from biochemical failure (FFBF) was 80.2% for BT vs 57.1% for RP vs 57.0% for EBRT, p=0.0003. Subset analysis of unfav...

[unable to retrieve full-text content] Ten-year treatment outcomes of radical prostatectomy vs external beam radiation therapy vs brachytherapy for 1,503 patients with intermediate risk prostate cancer    MD Linx https://ift.tt/32QZE3c

A robotic system, developed by Shanghai-based tech company MicroPort, has helped complete a Robot Assisted Laparoscopic Radical Prostatectomy (RALRP) at a hospital in the metropolis, China’s first such surgery by a domestically made device. (Photo/China Youth Daily) (ECNS) -- A robotic system, developed by Shanghai-based tech company MicroPort, has helped complete a Robot Assisted Laparoscopic Radical Prostatectomy (RALRP) at a hospital in the metropolis, China’s first such surgery by a domestically made device.  The system, named Tumai, allows the surgeon to move robotic arms and complete the surgery with a better range of motion than that of the human hand, cutting the operation time and creating less impact on nerves and blood vessels.  In the United States, 85 percent of patients receive treatment through the use of RALRP surgery.  Sun Yinghao, an academician at the Chinese Academy of Engineering, said till now China’s RALRP surgeries were completed using import...

To assess the impact of excluding Gleason Grade Group 1 (GG1) prostate cancer (PCa) cores from current pre-radical prostatectomy (RP) nomograms. Multi-institutional retrospective chart review performed on all RP patients with prostate biopsy between 2008-2018. Patients individually assessed using Memorial Sloan Kettering Cancer Center (MSKCC) and Briganti nomograms using the following iterations: 1) Original [ORIG] - all available core data and 2) Selective [SEL] - GG1 cores considered negative. Nomogram outcomes, lymph node invasion - LNI, extracapsular extension - ECE, organ-confined disease - OCD, seminal vesicle invasion - SVI, compared across iterations and stratified based on biopsy GG. Clinically significant impact on management (CSIM) defined as change in LNI risk above or below 2% or 5% (Δ2/Δ5). Nomogram outcomes validated with RP pathology. 7718 men met inclusion criteria. In men with GG2 who also had GG1 cores, SEL better predicted LNI (MSKCC - ORIG 4.97% vs. SEL 3.50%; Br...

Dietary factors and physical activity may alter prostate cancer progression. We explored the feasibility of lifestyle interventions following radical prostatectomy for localised prostate cancer. Patients were recruited into a presurgical observational cohort; following radical prostatectomy, they were offered randomisation into a 2×3 factorial randomised controlled trial (RCT). A single National Health Service trust in the South West of England, UK. Those with localised prostate cancer and listed for radical prostatectomy were invited to participate. Random allocation was performed by the Bristol Randomised Trial Collaboration via an online system. Men were randomised into both a modified nutrition group (either increased vegetable and fruit, and reduced dairy milk; or lycopene supplementation; or control) and a physical activity group (brisk walking or control) for 6 months. Only the trial statistician was blind to allocations. Primary outcomes were measures of feasibility: ran...

The appropriate timing of radiotherapy (RT) for patients after radical prostatectomy (RP) with adverse pathological features (APFs) remains controversial. This systematic review was conducted to compare the efficacy of adjuvant radiotherapy (ART) and salvage radiotherapy (SRT). PubMed, EMBASE, Web of Science and the Cochrane Library electronic databases were searched to retrieve the required. The hazard ratio (HR) and corresponding 95% confidence interval (CI) of overall survival (OS), biochemical recurrence-free survival (BRFS) and distant metastases-free survival (DMFS) were extracted. The survival benefits of ART with SRT (including early salvage radiotherapy (ESRT)) were analyzed. The process of the meta-analysis was performed with RevMan version 5.3. A total of fifteen retrospective studies were finally included in the final analysis including 5586 patients. The pooled analysis indicated that ART could achieve better control of prostate cancer and improve OS (p = 0.0006), BRFS (...

Since a comprehensive knowledge of pelvic anatomy and the prostatic surrounding tissues, many technical improvements were allowed to perform a safer radical prostatectomy with better visualization and preservation of the cavernous nerves. Walsh et al. was a pioneer in the development of an innovative retropubic radical prostatectomy in the 1980s. In the recent years, the widespread use of robotic platform as the gold-standard to perform a radical prostatectomy allowed a large number of urologic surgeons to offer good oncological and functional outcomes. Beyond this point, robotic surgeries have elevated costs related to their implementation, particularly in developing countries. It is highly recommended that the surgical teams involved with a robotic surgery program are motivated to optimize costs and to improve their results. We reported results of a Robotic-Assisted Radical Prostatectomy (RARP) series performed in patients with localized prostate cancer in a high-volume cancer cent...

Agnieszka Strączyńska, Magdalena Weber-Rajek, Katarzyna Strojek, Zuzanna Piekorz, Hanna Styczyńska, Aleksander Goch, Agnieszka Radzimińska Department of Physiotherapy, Nicolaus Copernicus University in Torun Collegium Medicum in Bydgoszcz, Bydgoszcz, Poland Correspondence: Magdalena Weber-Rajek Department of Physiotherapy, Nicolaus Copernicus University in Torun Collegium Medicum in Bydgoszcz, ul. Jagiellońska 13-15, Bydgoszcz 85-067, Poland Email magdawr69@gmail.com Purpose: The purpose of this study was to determine the efficacy of pelvic floor muscle training (PFMT) in the treatment of urinary incontinence (UI) in men after radical prostatectomy (RP). Methods: PubMed, ScienceDirect, and Cochrane Library databases were searched for studies published in years 2000–2019. We included randomized controlled trials in English which compare clinic-based vs home-based PFMT, preoperative and postoperative PFMT, supervised vs unsupervised PFMT, and PFMT alone vs no treatment at all. ...

To evaluate mid-term oncological and functional outcomes in patients with prostate cancer treated by robot-assisted laparoscopic radical prostatectomy (RALP) at our institution. We retrospectively reviewed the medical records of 128 patients with prostate cancer who underwent RALP at our institution between February 2008 and April 2010. All patients enrolled in this study were followed up for at least 5 years. We analyzed biochemical recurrence (BCR)-free survival using a Kaplan-Meier survival curve analysis and predictive factors for BCR using multivariate Cox regression analysis. Continence recovery rate, defined as no use of urinary pads, was also evaluated. Based on the D'Amico risk classification, there were 30 low-risk patients (23.4%), 47 intermediate-risk patients (38.8%), and 51 high-risk patients (39.8%), preoperatively. Based on pathological findings, 50.0% of patients (64/128) showed non-organ confined disease (≥T3a) and 26.6% (34/128) had high grade disease (Gleason ...

To comprehensively evaluate the efficacy and safety of Retzius sparing (RS) for men undergoing robot-assisted laparoscopic prostatectomy (RARP). We searched four electronic databases and reference lists of relevant studies for eligible research published before March 11, 2019. After quality assessment, eligible studies were synthesized for relevant outcomes, including positive surgical margin (PSM), continence, incontinence, complication, console time, and hospital stay. Two randomized clinical trials and four observational studies were included in this study. Quantitative syntheses revealed significantly higher PSM rates in RS-RARP compared with conventional RARP (c-RARP) (odds ratio [OR] 1.68, p = 0.02). Furthermore, we found significantly higher PSM rates at the anterior site in RS-RARP compared with c-RARP (OR 4.34, p = 0.03) and significantly lower incontinence rates in RS-RARP in the first month (OR 0.30, p < 0.001) and 12th month (OR 0.25, p < 0.001). Our syntheses reve...

The current study aimed to carry out a comprehensive meta-analysis on the existing evidence to quantify and compare the oncological, surgical and functional outcomes following radical prostatectomy between TURP group and Non-TURP group. A systematic literature search was conducted using EMBASE, PubMed and Cochrane databases to identify relevant studies published in English up to March 2019. A meta-analysis was conducted using Review Manager. There were 13 studies included in the present study. Our results suggest that TURP group demonstrates a significantly higher positive surgical margin rate, bladder neck reconstruction rate and overall complication rate compared with Non-TURP group (OR = 1.31, 95% CI 1.09-1.58, P = 0.004, I2 = 0%; OR = 14.36, 95% CI 2.93-70.45, P = 0.001, I2 = 81%; OR = 2.63, 95% CI 1.87-3.71, P < 0.00001, I2 = 0%); whereas TURP group demonstrates a significantly lower nerve sparing rate compared with Non-TURP group (OR = 0.30, 95% CI 0.22-0.43, P < 0.00001,...