Prostate Cancer

Nancy N Wang, 1 Richard E Fan, 1 John T Leppert, 1,2 Pejman Ghanouni, 3 Christian A Kunder, 4 James D Brooks, 1 Benjamin I Chung, 1 Geoffrey A Sonn 1,3 1 Department of Urology, Stanford University School of Medicine, Stanford, CA, USA; 2 Veterans Affairs, Palo Alto Health Care System, Palo Alto, CA, USA; 3 Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA; 4 Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA Abstract: Utilization of pre-biopsy multiparametric MRI (mpMRI) is increasing. To optimize the usefulness of mpMRI, physicians should accurately quote patients a numerical risk of cancer based on their MRI. The Prostate Imaging Reporting and Data System (PIRADS) standardizes interpretation of mpMRI; however, reported rates of clinically significant prostate cancer (CSC) stratified by PIRADS score vary widely. While some publications use radical prostatectomy (RP) specimens as gold standard, others use biops...

BACKGROUND: Current trials are investigating radical intervention in men with metastatic prostate cancer. However, there is a lack of safety data for radical prostatectomy as therapy in this setting. OBJECTIVE: To examine perioperative outcomes and short-term complications after radical prostatectomy for locally resectable, distant metastatic prostate cancer. DESIGN, SETTING, AND PARTICIPANTS: A retrospective case series from 2007 to 2014 comprising 106 patients with newly diagnosed metastatic (M1) prostate cancer from the USA, Germany, Italy, and Sweden. INTERVENTION: Radical prostatectomy and extended pelvic lymphadenectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics were used to present margin status, continence, and readmission, reoperation, and overall complication rates at 90 d, as well as for 21 specific complications. Kaplan-Meier plots were used to estimate survival function. Intercenter variability and M1a/ M1b subgroups were examined. RESULTS ...

Grace Lu-Yao, PhD Higher survival rates were observed with radical prostatectomy (RP) and adjuvant radiotherapy (RT) compared with radiotherapy and androgen deprivation therapy (ADT) in men with locally advanced prostate cancer, according to a comparative analysis published in Cancer . 1,2 Results showed that 10 years after treatment, 89% of men who received radical prostatectomy and RT were still alive, compared with 74% of those who received RT and ADT, demonstrating a 15% survival benefit in the prostatectomy arm. The coprimary endpoints were prostate cancer–specific survival and overall survival (OS), both of which were improved in the prostatectomy/RT arm, regardless of tumor stage or Gleason score. “There is a lot of debate about whether to remove the whole prostate and follow up with radiation therapy,” senior author Grace Lu-Yao, PhD, associate director of Population Science at the Sidney Kimmel Cancer Center, said in a statement. “Or, as a second option, to spare the pros...

The associations between metabolic syndrome (MetS) and prostate cancer (CaP) outcomes following radical prostatectomy (RP) are not clear. This study aims to understand the role of MetS in influencing oncological outcomes at RP. Patients who underwent RP for CaP at our institution from 2000 to 2010 were identified; MetS prior to RP was ascertained with a modified version of the IDF-AHA/NHLBI using ICD-9 codes. Histopathological outcomes included surgical margins, pathological stage, and Gleason score (GS) upgrading. Long-term outcomes included biochemical recurrence (BCR), local recurrence, systemic progression, and CaP-specific mortality. Multivariable adjusted logistic regression and Cox proportional hazards regression assessed the association between MetS status and histopathological and long-term outcomes, respectively. Of 8,504 RP patients, 1,054 (12.4%) had MetS at the time of RP. MetS patients were older, had higher biopsy GS, but lower pre-op prostatic specific antigen (PSA), ...

The adoption of robotic technology in the treatment of prostate cancer (PCa) could lead to improvement in outcomes. To evaluate feasibility, to compare functional outcomes, and to assess the economic benefits of removing catheter on the postoperative day (POD) 3 versus POD 5 after robot-assisted radical prostatectomy (RARP). From September 2016 to May 2017, patients selected to undergo RARP for clinically localized PCa at a high-volume center were prospectively randomized into group 1 (POD 3; n=72) versus group 2 (POD 5, n=74). All patients underwent RARP with anatomical posterior and anterior reconstruction. The primary endpoint was to compare acute urinary retention (AUR) and urinary leakage rate in the two groups. The secondary endpoints were early and mid-term postoperative functional outcomes assessed through questionnaires (ICIQ-MLUTS, IPSS), early continence rate, and postoperative pain/discomfort (visual analog scale score). The economic impact of early catheter removal was...

Prostatic adenocarcinoma (PCa) with extraprostatic extension (EPE) detected on prostate needle biopsy (PNB) is an uncommon finding. We aimed to describe the clinical and pathologic findings in a large cohort of PCa patients treated with radical prostatectomy (RP) who had EPE identified on PNB. Using our institutional pathology database, we identified 83 PCa cases with EPE on PNB between 2000-2018 who underwent treatment with RP and had clinical follow-up information. Clinical and pathologic outcomes were examined. Sixty-five percent (54/83) of patients presented with clinical stage ≥T2 disease. On biopsy, 60% (50/83) of patients had grade group (GG) 4-5, and 81% (66/83) had perineural invasion. EPE was confirmed in the RP specimen in 98% (81/83) of cases. At RP, 59% (49/83) had positive surgical margins, 45% (37/83) had seminal vesicle invasion, and 37% (30/83) had lymph node involvement. Median length of follow-up after RP was 2 years. Overall, 45% (34/76) of patients received post-...

November 13, 2018 Share this content: Study of men who underwent salvage radical prostatectomy for radiorecurrent prostate cancer found a 10-year rate of biochemical progression-free survival of 33%. Salvage radical prostatectomy (SRP) may benefit carefully selected patients with recurrent prostate cancer (PCa) following radiotherapy, researchers concluded. The findings from their multi-institutional prospective study of 41 men who underwent open SRP for radiorecurrent PCa compare favorably with previous research suggesting that patients who respond best to SRP are those with lower PSA values and lower-grade disease prior to radiation treatment, and a prolonged post-radiotherapy PSA nadir, James L. Mohler, MD, of Roswell Park Comprehensive Cancer Center in Buffalo, New York, and colleagues reported in Prostate Cancer and Prostatic Diseases . Continue Reading Below The 41 men were enrolled from 1997 to 2006 as part of the Cancer and Leukemia Group B (CALGB) 9687 trial. The g...

Minimally invasive radical prostatectomy has rapidly been adopted as the primary means of surgical intervention for prostate cancer. Intraoperative tissue retraction relies on either gravity (via positioning) or use of additional ports and instrumentation. We report the use of a novel trocar-less magnetic retractor system to aid with tissue retraction. Three patients underwent robotic-assisted radical prostatectomy in the treatment of prostatic adenocarcinoma at a single tertiary care institution. All surgeries utilized the Levita™ Magnetic Surgical System (San Mateo, CA) without the use of a fourth robotic arm. The magnetic grasper was used to manipulate the bowel, peritoneum, seminal vesicles, and prostatic capsule. Demographic, pre-operative, and perioperative information were collected. No cases required placement of any additional ports. No intraoperative or immediate post-operative complications occurred. No tissue tearing or subjective tissue damage was noted by placement or rem...

Briefly Teen Leadership Hernando recently visited Oak Hill Hospital, touring the cardiac lab and emergency room. The group also had a chance to work with robotic-assisted surgery systems in the operating room. Pictured are members of Teen Hernando with team leaders from Oak Hill Hospital. RESIDENTS PASS THEIR BOARD EXAMS: Oak Hill Hospital announced that 100 percent of the graduating class of its Internal Medicine Residency program have passed their board certification exam, and are now certified in internal medicine by the American Board of Internal Medicine. The 2015-18 Internal Medicine graduates are the second class to graduate from Oak Hill Hospital's internal medicine residency program. Who's news DOCTORS PERFORM ROBOTIC PROSTATECTOMY: Omar Hamoui, M.D., and Nabeel Hamoui, M.D., urologists of Shoreline UroCare, recently performed the first robotic prostatectomy in Hernando County using advanced, four-arm robotic technology, at Bayfront Health Spring Hill. The docto...

The objective of our study was to evaluate the clinical significance of invisible prostate cancer (iPCa) on multiparametric magnetic resonance imaging (mpMRI) by analyzing clinical parameters and oncologic outcomes. We retrospectively reviewed the records of patients treated with radical prostatectomy (RP) from 2010 to 2015 at our institution. Before RP, all patients were confirmed to have prostate cancer based on prostate biopsy. We excluded patients who underwent neoadjuvant therapy. Additionally, we excluded patients who had incomplete mpMRI based on PI-RADS (Prostate Imaging Reporting and Data System). iPCa was defined as having no grade 3 or higher region of interests using a scoring system established by PI-RADS without limitations on interpretation from mpMRI by radiologists. We selected patients with iPCa using this protocol. We analyzed data using univariate and multivariate cox regression analysis, logistic analysis, Kaplan-Meier curves, and receiver operator characteristic ...

Persistent urinary incontinence (UI) and/or erectile dysfunction (ED) occur in 30-50% of post-radical prostatectomy patients regardless of nerve sparing approaches. Identification of potential treatment options for these patients will require testing in an animal model that develops these chronic conditions. The objective was to characterize a nonhuman primate (NHP) model of persistent post-prostatectomy ED and UI and then test the feasibility of periurethral injection of the chemokine CXCL-12. Ten adult male cynomolgus monkeys were used. Two were used for study of normal male nonhuman primate genitourinary anatomy. Five were used for measures of sexual behavior, peak intra-corporal pressure (ICP), abdominal leak point pressures (ALPP) 3 and 6-months post open radical prostatectomy (ORP). Three additional ORP animals received ultrasound-guided peri-urethral injection of chemokine CXCL12 6 weeks after ORP, and UI/ED evaluated for up to 3 months. The anatomy, innervation, and vascular ...

By Will Boggs MD NEW YORK (Reuters Health) - Men whose prostate cancer is treated with external beam radiotherapy (EBRT) could face a higher risk of bladder cancer than those treated with radical prostatectomy, according to a database study. "Physicians should recognize this risk factor for bladder cancer, especially in patients with concomitant risk factors (for example, smoking history)," Dr. Marco Moschini of the Medical University of Vienna told Reuters Health by email. Dr. Moschini and colleagues used data from the U.S. National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare insurance program-linked database to investigate the impact of treatment of primary prostate cancer on the subsequent risk of developing a second primary bladder cancer or rectal cancer. Among more than 84,000 men with localized prostate cancer included in the study, 39% were treated with radical prostatectomy and 61% were treated with EBRT. The five- and 10-y...

Preoperative counseling incorporating the best-case, worst-case, and most-likely outcome scenarios aid patients' decision making. This information is not readily available for prostate cancer counseling because most patient reported outcomes are presented as averages, which minimize individual patient experiences. Using the Expanded Prostate Index Composite (EPIC), we present data to characterize the best and worst-case after prostatectomy. EPIC bowel, urinary irritation and continence, and sexual function scores were measured among 1418 men (stratified by baseline function) undergoing prostatectomy. Patient-level functional trajectories were modeled using a Bayesian hierarchical model. The 5-year best and worst-case outcomes were defined as the upper 95th percentile and lower 5th percentile. At 5 years after surgery, among those with good baseline urinary continence, the best-case was a score of 100.0 (95% CrI; 100.0 - 100.0) and worst-case was 54.4 (42.2 - 63.7). Among men with...

To describe the first clinical experience with the novel purpose-built single-port robotic platform after FDA approval. Two male patients diagnosed with prostate cancer amenable of radical prostatectomy underwent single-port robot-assisted radical prostatectomy with bilateral pelvic lymph-nodes dissection performed by using the da Vinci SP Surgical System (Intuitive Surgical, Sunnyvale, CA, USA). The surgeries were completed through a 2.5-cm periumbilical incision through which a GelPOINT Mini advanced access platform (Applied Medical, Rancho Santa Margarita, CA, USA) and the dedicated 25-mm multichannel port accommodating a 12 × 10-mm oval articulating robotic camera, three 6-mm double-jointed articulating robotic instruments and a 6-mm accessory laparoscopic instrument were placed. One port for the assistant was placed at the level of the para-rectal line, at the planned final site for the drainage. The primary aim was to report, for the first time in the US after FDA approval of th...

To report the recommendations of the 6th International Consultation on Incontinence (ICI) on post-prostatectomy urinary incontinence. The 6th ICI committee on surgical treatment of urinary incontinence in men assessed and reviewed the outcomes of surgical therapy and updated the prior recommendations published in 2013. Articles from peer-reviewed journals, abstracts from scientific meetings, and literature searches by hand and electronically formed the basis of this review. The resulting guidelines were presented at the 2016 ICI meeting in Tokyo, Japan. Voiding diary and pad tests are valuable for assessing quantity of leakage. Cystoscopy and/or urodynamics may be useful in guiding therapy depending on the type of incontinence and presumed etiology. Artificial Urinary Sphincter (AUS) is the preferred treatment for men with moderate to severe stress urinary incontinence (SUI) after RP. Male slings are an acceptable approach for men with mild to moderate SUI. Much discussion centers on...

Approximately 29,000 men die from prostate cancer each year in the United States. When diagnosed in the early organ-confined stage, there are multiple options for treatment depending on patient characteristics and preferences, including brachytherapy, external beam radiation therapy, or surgery. Robotic-assisted laparoscopic radical prostatectomy (RALP) has become the preferred modality of surgical treatment by most practicing urologists due to improved dexterity and visualization with equivalent oncologic and functional outcomes when compared with open prostatectomy. During RALP, there are various steps that can potentially damage or traumatize the cavernosal nerves, causing compromised potency levels postoperatively. Intraoperative stretch injury, neuropraxia, thermal damage, lateral traction on nerves, etc. are all known to contribute to decreased potency postoperatively. Interestingly, sixty-eight percent of sexually active men without prostate cancer were willing to trade in 10 %...

Post-prostatectomy overactive bladder (OAB) is a common and challenging condition to manage. The aim of the present report was to review the recent evidences regarding OAB symptoms that develop in men after prostatectomy and how to manage them. The prevalence of OAB after radical prostatectomy may range from 15.2 to 37.8%. Recent studies have highlighted the role of the urethrogenic mechanism (facilitation of the urethrovesical reflex due to stress urinary incontinence (SUI)) in the genesis of post-prostatectomy OAB in a significant proportion of patients. Several other pathophysiological factors such as iatrogenic decentralization of the bladder, defunctionalized bladder due to severe SUI, detrusor underactivity, or bladder outlet obstruction might be involved. The evaluation should aim to identify the underlying mechanism to tailor the treatment, which could range from SUI surgery, to fixing a urethral stricture, improving bladder emptying or using the conventional spectrum of OAB t...

First thing’s first: What is a prostatectomy? Radical prostatectomy refers to the operation to remove the prostate gland and the tissue around it. Usually, it’s recommended for men younger than 75 who have prostate cancer and are expected to live at least 10 more years with the condition. If you have prostate cancer but it hasn’t spread beyond your prostate, there’s a good chance this surgery could cure you completely. However, like any surgery, it comes with a low risk of more serious complications. So, what is minimally invasive prostatectomy? Over the last few decades, the development of robot-assisted technology has slowly changed how doctors treat patients with cancer. At Mount Elizabeth Hospital, the robot used to treat prostate cancer is one of the most technologically advanced in the world. It features a high-definition 3D camera and robotic arms controlled by a state-of-the-art console. It is also capable of removing the entire prostate by making only a few small incisio...

To examine the association between body mass index (BMI) and aggressive biochemical recurrence (BCR) using the Shared Equal Access Regional Cancer Hospital (SEARCH) database. We identified 4,123 men with complete data treated by radical prostatectomy between 1988 and 2015. We tested the association between BMI and BCR using Cox models and among men with BCR, PSA doubling time (PSADT) was compared across BMI categories using linear regression. Models were adjusted for age, race, PSA, biopsy Gleason score, clinical stage, year, and surgical center. Overall, 922 men (22%) were normal weight (BMI <25 kg/m2), 1863 (45%) were overweight (BMI 25-29.9), 968 (24%) were obese (BMI 30-34.9), and 370 (9%) were moderately or severely obese (BMI ≥35). After adjustment for multiple clinical characteristics, higher BMI was significantly associated with higher risk of BCR (p=0.008). Among men with a BCR, men in the four BMI categories had similar multivariable adjusted PSADT values (increasing BMI...