Prostatectomy For Localized Prostate Cancer Research Articles

Racial and ethnic disparities in robot-assisted radical prostatectomy: testing the physician-level segregated and differential treatment hypotheses.

Mechanisms underlying racial and ethnic disparities in robot-assisted radical prostatectomy (RARP) vs open radical prostatectomy (ORP) are unclear. We sought to test 2 physician-level hypotheses: 1) Segregated Treatment and 2) Differential Treatment. This observational study used the New York State Cancer Registry linked to discharge records and included patients undergoing radical prostatectomy for localized prostate cancer from October 1, 2008 to December 31, 2018. For hypothesis 1, we examined the association between patient race and ethnicity and treating surgeon RARP use (high-use surgeons, low-use surgeons, and surgeons at non-RARP facilities). For hypothesis 2, we determined the association between patient race and ethnicity and receipt of RARP when matching on treating surgeon, age, year of procedure, and Gleason group. We explored the role of insurance in both analyses. This study included 18 926 patients (8.0% Hispanic, 16.9% non-Hispanic Black, 75.1% non-Hispanic White), with a mean age of 60.4 ± 7.1 years. Compared with non-Hispanic White patients, Hispanic and non-Hispanic Black patients had higher odds of being treated by low-RARP-use surgeons (odds ratio [OR] = 2.16, 95% confidence interval [CI] = 1.20 to 3.88; OR = 1.76, 95% CI = 1.06 to 2.94, respectively) and by surgeons at non-RARP facilities (OR = 4.19, 95% CI = 2.18 to 8.07; OR = 4.60, 95% CI = 2.58 to 8.23, respectively). In the matched cohorts, Hispanic and non-Hispanic Black patients were less likely to receive RARP than non-Hispanic White patients (OR = 0.78, 95% CI = 0.62 to 0.98; OR = 0.75, 95% CI = 0.57 to 1.00, respectively). These associations were partially attenuated after accounting for insurance. Racial and ethnic disparities in RARP use are related to patients being treated by different surgeons and treated differently by the same surgeons. Identifying and addressing multilevel barriers to equitable surgical treatment is needed to reduce disparities among prostate cancer patients.

Overall and metastasis-free survival of Afro-Caribbean patients with biochemical recurrence after radical prostatectomy.

Early salvage radiotherapy is indicated for patients with biochemical recurrence after radical prostatectomy. However, for various reasons, certain patients do not benefit from this treatment (OBS) or only at a late stage (LSR). There are few studies on this subject and none on a "high-risk" population, such as patients of African descent. Our objective was to estimate the metastasis-free (MFS) and overall survival (OS) of patients who did not receive salvage radiotherapy, and to identify risk factors of disease progression. This was a single-center retrospective study that included 154 patients, 99 in the OBS group and 55 in the LSR group. All were treated by total prostatectomy for localized prostate cancer between January 2000 and December 2020 and none received early salvage radiotherapy after biochemical recurrence. Baseline characteristics were similar between groups, except for the time to biochemical recurrence. The median follow-up was 10.0 and 11.8 years for the OBS and LSR groups, respectively. The median time from surgery to LSR was 5.1 years. The two groups did not show a significant difference in MFS: 90.6% at 10 years for the OBS group and 93.3% for the LSR group. The median MFS was 19.8 and 19.6 years for the OBS and LSR groups respectively. OS for the OBS group was significantly higher than that for the LSR group (HR: 2.14 [1.07-4.29]; p = 0.03), with 10-year OS of 95.9% for the OBS group and 76.1% for the LSR group. Median OS was 16 and 15.6 years for the OBS and LSR groups, respectively. In this study, we observed satisfactory metastasis-free and OS rates relative to those reported in the scientific literature. The challenge is not to question the benefit of early salvage radiotherapy, but to improve the identification of patients at risk of progression through the development of molecular and genomic tests for more highly personalized medicine.

Transversal approach via a bladder neck and prostate combined longitudinal incision versus standard approach of robotic-assisted radical prostatectomy for localized prostate cancer: a retrospective analysis

BackgroundTransversal approach for robotic-assisted radical prostatectomy via a bladder neck and prostate combined longitudinal incision (L-RALP) is a novel surgical method for patients with respectable prostate cancer.MethodsThere were 669 patients with prostate cancer underwent L-RALP or S-RALP which identified from April 2016 to April 2020. The perioperative outcomes, Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) scores, sexual function and urinary control ability were included and compared between two groups.ResultsIn the 669 patients, 277 of them were included into the final analysis. 151 patients received S-RALP and 126 received L-RALP. Baseline features were balanced. Patients in the S-RALP group had significantly shorter average surgical time (135.93 vs 150.04 min; p < 0.001) than those in L-RALP group. Intraoperative bleeding volume, early postoperative complications rates, postoperative catheter removal time and hospital stays were comparable between two groups. There was no difference in biochemical recurrence at 3, 6, 12 and 18 months of follow-up. Of note, the urinary control function recovers of patients in the L-RALP group was significantly better than those in the S-RALP group. Moreover, patients in the L-RALP group had much better results of EPIC-CP (including urinary control and total score) than those in the S-RALP group at 6 week and 3, 6, 12 and 18 months.ConclusionsBoth S-RALP and L-RALP were safe and effective with similar long-term clinical outcomes in patients with respectable prostate cancer. Patients received L-RALP had significantly better postoperative outcomes including urinary control, and recovery period.

Lymphovascular Invasion at the Time of Radical Prostatectomy Adversely Impacts Oncological Outcomes.

Lymphovascular invasion, whereby tumour cells or cell clusters are identified in the lumen of lymphatic or blood vessels, is thought to be an essential step in disease dissemination. It has been established as an independent negative prognostic indicator in a range of cancers. We therefore aimed to assess the impact of lymphovascular invasion at the time of prostatectomy on oncological outcomes. We performed a multicentre, retrospective cohort study of 3495 men who underwent radical prostatectomy for localised prostate cancer. Only men with negative preoperative staging were included. We assessed the relationship between lymphovascular invasion and adverse pathological features using multivariable logistic regression models. Kaplan-Meier curves and Cox proportional hazard models were created to evaluate the impact of lymphovascular invasion on oncological outcomes. Lymphovascular invasion was identified in 19% (n = 653) of men undergoing prostatectomy. There was an increased incidence of lymphovascular invasion-positive disease in men with high International Society of Urological Pathology (ISUP) grade and non-organ-confined disease (p < 0.01). The presence of lymphovascular invasion significantly increased the likelihood of pathological node-positive disease on multivariable logistic regression analysis (OR 15, 95%CI 9.7-23.6). The presence of lymphovascular invasion at radical prostatectomy significantly increased the risk of biochemical recurrence (HR 2.0, 95%CI 1.6-2.4). Furthermore, lymphovascular invasion significantly increased the risk of metastasis in the whole cohort (HR 2.2, 95%CI 1.6-3.0). The same relationship was seen across D'Amico risk groups. The presence of lymphovascular invasion at the time of radical prostatectomy is associated with aggressive prostate cancer disease features and is an indicator of poor oncological prognosis.

Effect of Variant Histopathology on Survival in Prostate Adenocarcinoma

Purpose: It was aimed to determine the possible effects of variant pathology associated with prostate adenocarcinoma on survival. Material and Methods: Data of patients who underwent radical prostatectomy for localized prostate cancer between January 2014 and 2020 were retrospectively analyzed. The survival rates according to the presence of variant histology associated with prostate adenocarcinoma were analyzed and compared in relation to the clinical and demographic data of the cases. Results: A total of 244 patients were operated for localized prostate cancer. Preoperative The ISUP grades and percentages of the patients were respectively as ISUP 1 (42%), ISUP 2 (38%), ISUP 3 (10%) and ISUP &gt; 3 (10%). Variant histopathology was present in 26% of the patients [intraductal (81%), foamy cell (11%), ductal (6%) and neuroendocrine (2%)]. When prostate cancer and prostate cancer associated with variant histopathology groups were compared, the mean age and postoperative 1st month PSA values were 62.29± 6.36 vs 64.33± 5.77 years p=(0.025) and 0.32± 1.53 and 1.01± 2.98 ng/dl (p=0.022) respectively. Mean follow-up time for prostate cancer and prostate cancer associated with variant pathology was statistically similar (60.33±21.66 vs. 60.42±16.88 months). The mortality rates of the patients with and without variant histopathology were respectively as 11% and 14% (p=0.416). Conclusions: Associated variant pathology does not show a statistically significant decrease in survival rates of patients with localized prostate cancer receiving standard therapy. Rather, advanced age may have a role in the non-significant 3% difference in survival rate.

Initial experience with Retzius-sparing robot-assisted radical prostatectomy compared to the conventional method: is it a suitable option for robotic prostatectomy beginners?

Background: Retzius-sparing robot-assisted radical prostatectomy (rsRARP) is a surgical procedure that can minimize the resection of surrounding prostate tissue by enabling access through the anterior surface of the Douglas pouch. We reported our initial experiences with rsRARP compared to conventional robot-assisted radical prostatectomy (RARP).Methods: Retrospective data were collected from March 2019 to June 2022, including 69 patients who underwent robotic radical prostatectomy for localized prostate cancer. The operations were performed at a single center, and we alternated between the two methods. Perioperative characteristics and oncologic and functional outcomes were analyzed.Results: In total, 35 patients underwent RARP and 34 patients underwent rsRARP. The preoperative characteristics of the patients were similar. Oncologic and functional parameters were analyzed postoperatively. Except for early recovery of urinary incontinence (immediate, 1 month, 3 months, 6 months: p&lt;0.001, p=0.002, p=0.004, and p=0.014, respectively), there were no significant differences between the two groups. We also analyzed trends in operation time and oncologic and functional outcomes according to the progression of rsRARP cases.Conclusions: rsRARP has the major advantage of enabling an early recovery from urinary incontinence after surgery, and it is also a good surgical approach that shows oncologically similar results to the conventional approach. It is also highly reproducible and can be recommended to surgeons new to robotic radical prostatectomy.

National Long-term Survival Estimates After Radical Prostatectomy for Prostate Cancer

ObjectiveTo examine survival and disease control outcomes, including metastasis-related survival outcomes, in a large contemporary cohort of patients undergoing radical prostatectomy for localized prostate cancer. MethodsWe conducted a retrospective study of men with localized prostate cancer treated with radical prostatectomy from 2005-2015 with follow up through 2019 in the Veterans Health Administration. We defined biochemical recurrence (BCR) as a PSA ≥0.2 ng/mL. We used a validated natural language processing encoded dataset to identify incident metastatic prostate cancer. We estimated overall survival from time of surgery, time of BCR, and time of first metastasis using the Kaplan-Meier method. We then estimated time from surgery to BCR, BCR to metastatic disease, and prostate-cancer specific survival from various time points using cumulative incidence considering competing risk of death. ResultsOf 21,992 men undergoing radical prostatectomy, we identified 5,951 (27%) who developed biochemical recurrence (BCR). Of men with BCR, 677 (11%) developed metastases. We estimated the 10-year cumulative incidence of BCR and metastases after BCR were 28% and 20%, respectively. Median overall survival after BCR was 14 years, with 10-year survival of 70%. From the time of metastasis, median overall survival approached 7 years, with 10-year overall survival of 34%. Prostate cancer-specific survival for the entire cohort at 10 years was 94%. ConclusionsIn this large contemporary national cohort, survival for men with biochemically-recurrent prostate cancer is longer than historical cohorts. When counseling patients and designing clinical studies, these updated estimates may serve as more reliable reflections of current outcomes.

The association of smoking with urinary and sexual function recovery following radical prostatectomy for localized prostate cancer: a systematic review and meta-analysis.

Urinary and sexual dysfunction after radical prostatectomy remains a major cause of morbidity, despite widespread availability of pharmacological and rehabilitative treatments. Smoking is a modifiable risk factor known to correlate with erectile and urinary dysfunction and we hypothesise that smoking cessation may improve post-prostatectomy urinary and sexual function recovery. Our objective is to systematically evaluate literature describing the association of smoking status with urinary and sexual function in men following radical prostatectomy. In total, 310 unique records were identified through a systematic search of the MEDLINE, EMBASE, Scopus, Web of Science, CINAHL and CENTRAL databases up to February 2023. Nine studies reported smoking status and post radical prostatectomy urinary and sexual function outcomes in men with localized prostate cancer. Risk of bias was assessed and meta-analysis included six studies. Smokers had inferior erectile function after prostatectomy compared to non-smokers (OR 0.73, [95% CI 0.56-0.95]) during follow-up, while urinary incontinence was not statistically different between groups (OR 1.20, [95% CI 0.75-1.91]). Smoking cessation improved the EPIC-26 sexual domain score with 6.6 points on average [p = 0.03] to a clinically significant maximum of 12.5 points at 18-24 months. Smoking is associated with impaired sexual function recovery after radical prostatectomy and quitting may improve sexual function >18 months. Current evidence shows no such association for urinary outcomes. Further studies are needed to corroborate findings.

"Keep It Short and Simple": Perceptions of patients and healthcare professionals on the use of a mobile health app in the care for patients undergoing radical prostatectomy.

Patients undergoing radical prostatectomy for localised prostate cancer generally have good long-term survival rates. However, late recurrences can occur and require lifelong follow-up. This research aims to investigate different stakeholders' perceptions on the use of mobile health (mHealth) applications for prostate cancer follow-up after radical prostatectomy. A cross-sectional qualitative study was conducted to explore stakeholders' perceptions of an mHealth application for follow-up after radical prostatectomy. Urologists, nurses, and patients treated with radical prostatectomy were interviewed, and data were transcribed and analysed using thematic analysis according to Qualitative Analysis Guide of Leuven. Recommended features for an ideal mHealth application were grouped according to the Persuasive Systems Design model. A total of 30 stakeholders, consisting of nurse specialists (n= 7), urologists (n= 8), and patients (n= 15), were interviewed. Expected benefits and barriers were mentioned and grouped in five overarching themes: healthcare optimisation, disease management, app compliance, legal and organisational requirements, and patient-mHealth interaction. Stakeholders provided a multitude of suggestions for an ideal mHealth app. Yet, not all types of stakeholders were interviewed, and patient selection limited generalisability of findings. Stakeholders indicate that an mHealth app in the care for post-prostatectomy patients can improve patient care and promote disease management but consider app compliance as a major challenge. We interviewed patients, nurses, and urologists about using an mHealth application for follow-up after radical prostatectomy. The participants agreed that an mHealth app could improve care optimisation and disease management, but some concerns and barriers were expressed. This resulted in a list of recommended features for an ideal app.

MP77-16 MANAGEMENT OF BIOCHEMICAL RECURRENCE AND INCIDENT METASTATIC DISEASE AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP77-16 MANAGEMENT OF BIOCHEMICAL RECURRENCE AND INCIDENT METASTATIC DISEASE AFTER RADICAL PROSTATECTOMY FOR PROSTATE CANCER Ted Skolarus, Kristian Stensland, Daniel Herr, David Elliott, Jennifer Burns, Jordan Sparks, Chris Shin, Alexander Zaslavsky, Alexander Tsodikov, and Megan Caram Ted SkolarusTed Skolarus More articles by this author , Kristian StenslandKristian Stensland More articles by this author , Daniel HerrDaniel Herr More articles by this author , David ElliottDavid Elliott More articles by this author , Jennifer BurnsJennifer Burns More articles by this author , Jordan SparksJordan Sparks More articles by this author , Chris ShinChris Shin More articles by this author , Alexander ZaslavskyAlexander Zaslavsky More articles by this author , Alexander TsodikovAlexander Tsodikov More articles by this author , and Megan CaramMegan Caram More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003351.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prostate cancer recurrence after surgery often presents as asymptomatic, biochemically recurrent, non-metastatic castration-sensitive disease. The extent to which the use and timing of ADT in this setting is associated with progression to metastatic disease is largely unknown. For these reasons, we conducted a population-based study to examine associations between biochemical recurrence management and progression along the castration cascade. METHODS: We used national electronic health record, cancer registry, administrative, pharmacy, and laboratory data to conduct a retrospective cohort study of men undergoing radical prostatectomy for localized prostate cancer from 2005 through 2015 in the Veterans Health Administration. We followed men through 2019 for biochemical recurrence, defined as PSA ≥0.2 ng/mL, and incident metastatic disease, identified using a validated natural language processing algorithm. We used multivariable regression to examine associations between metastatic disease and patient, disease, and salvage management approaches including ADT. RESULTS: We identified 8,558 men with biochemical recurrence after radical prostatectomy. Most patients were managed with observation and/or salvage radiation therapy (70%). Metastatic disease occurred in 14% and on univariate analysis was associated with decreased time to biochemical recurrence (15.5 months, metastatic vs. 19.2 months non-metastatic), younger age at recurrence, positive surgical margins, higher pathologic stage and PSA at diagnosis (all p<0.01). Salvage ADT was used in 30% of patients with recurrence, mostly among men who remained non-metastatic (65%). Pre-ADT PSA was higher among men with metastatic disease (4.1 ng/mL metastatic vs. 0.9 ng/mL non-metastatic, p<0.001), as was castration-resistant drug use (48.2% metastatic vs. 4.5% non-metastatic, p<0.001). Salvage ADT was highly associated with metastatic disease in this observational study (adjusted odds ratio 6.04, 95% CI 4.68-7.81). CONCLUSIONS: Management of biochemically recurrent disease after radical prostatectomy varied widely, including the use and timing of ADT. We found metastatic disease occurred in about 1 in 7 men with recurrence and was associated with traditional risk factors. While most salvage ADT was for non-metastatic disease, the extent to which castration use in observational data reflects disease severity or incites castration-resistance and metastatic disease warrants further study. Source of Funding: NCI R01 CA242559 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1108 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ted Skolarus More articles by this author Kristian Stensland More articles by this author Daniel Herr More articles by this author David Elliott More articles by this author Jennifer Burns More articles by this author Jordan Sparks More articles by this author Chris Shin More articles by this author Alexander Zaslavsky More articles by this author Alexander Tsodikov More articles by this author Megan Caram More articles by this author Expand All Advertisement PDF downloadLoading ...

Index grade group is superior to composite grade group for prediction of biochemical recurrence following radical prostatectomy

The pathological grade of prostate cancer is the strongest predictor of recurrence. It is unclear whether the better predictor is the composite of all carcinomas within the prostate, or the highest grade lesion (index). The purpose of this study was to determine whether composite or index grade group better predicts biochemical recurrence (BCR). We undertook a retrospective analysis from a prospective institutional cohort study of men who underwent radical prostatectomy for localised prostate cancer between 2009 and 2020, in which an index and composite grade group was reported. The index grade in this study was defined as the highest grade of any tumour, usually with the highest stage, regardless of volume. Multivariate analysis and Kaplan-Meier plots were utilised. A total of 2024 men underwent radical prostatectomy during the study period; we analysed 1605 with composite grade group 2 or 3 prostate cancer. Median preoperative prostate specific antigen (PSA) was 5.9 ng/L, mean follow up was 56.8 months, 54% were pT2, 76% had multifocal disease and 16% had discordant index and composite grades. Patients with discordant index grade group had a higher risk of BCR [hazard ratio (HR) 2.22, p<0.0001]. The prevalence of BCR in the discordant group was higher at 1, 3, 5 and 7 years (4.7% vs 8.9%, 8.3% vs 18.1%, 14.5% vs 28.8% and 22.5% vs 49.5%, respectively). In cases of discordance, a higher index grade group is associated with increased rates of BCR after radical prostatectomy. Index rather than composite grade group should be used to counsel men post-operatively regarding prognosis and follow-up.

Recognition of Postoperative Cystography Features by Artificial Intelligence to Predict Recovery from Postprostatectomy Urinary Incontinence: A Rapid and Easy Way to Predict Functional Outcome.

Post-operative cystography has been used to predict the recovery of postprostatectomy urinary incontinence (PPI) in patients with localized prostate cancer. This study aimed to validate the predictive value of cystography for PPI and utilize a deep learning model to identify favorable and unfavorable features. Medical records and cystography images of patients who underwent robotic-assisted radical prostatectomy for localized prostate cancer were retrospectively reviewed. Specific cystography features, including anastomosis leakage, a downward bladder neck (BN), and the bladder neck angle, were analyzed for the prediction of PPI recovery. Favorable and unfavorable patterns were categorized based on the three cystography features. The deep learning model used for transfer learning was ResNet 50 and weights were trained on ImageNet. We used 5-fold cross-validation to reduce bias. After each fold, we used a test set to confirm the model's performance. A total of 170 consecutive patients were included; 31.2% experienced immediate urinary continence after surgery, while 93.5% achieved a pad-free status and 6.5% were still incontinent in the 24 weeks after surgery. We divided patients into a fast recovery group (≤4 weeks) and a slow recovery group (&gt;4 weeks). Compared with the slow recovery group, the fast recovery group had a significantly lower anastomosis leakage rate, less of a downward bladder neck, and a larger bladder neck angle. Test data used to evaluate the model's performance demonstrated an average 5-fold accuracy, sensitivity, and specificity of 93.75%, 87.5%, and 100%, respectively. Postoperative cystography features can predict PPI recovery in patients with localized prostate cancer. A deep-learning model can facilitate the identification process. Further validation and exploration are required for the future development of artificial intelligence (AI) in this field.

SC236 - Assessing the role of frailty status on oncologic and functional outcomes in patients treated with robot-assisted radical prostatectomy for localized prostate cancer

SC236 - Assessing the role of frailty status on oncologic and functional outcomes in patients treated with robot-assisted radical prostatectomy for localized prostate cancer

Systematic literature review of cost-effectiveness analyses of robotic-assisted radical prostatectomy for localised prostate cancer

ObjectivesReview and assess cost-effectiveness studies of robotic-assisted radical prostatectomy (RARP) for localised prostate cancer compared with open radical prostatectomy (ORP) and laparoscopic radical prostatectomy (LRP).DesignSystematic review.SettingPubMed, Embase, Scopus, International HTA...

LBA64 Duration of androgen suppression with post-operative radiotherapy (DADSPORT): A collaborative meta-analysis of aggregate data

The DADSPORT Meta-analysis Collaboration conducted a systematic review and meta-analysis of results from NRG/RTOG 9601, GETUG-AFU 16, NRG/RTOG 0534 and newly-available, RADICALS-HD trials to assess the effect of hormone therapy (HT) in men receiving radiotherapy (RT) following radical prostatectomy for localised prostate cancer.

Biochemical failure and toxicity in treatment with brachytherapy and external beam radiotherapy compared with radical prostatectomy in localized prostate cancer.

BackgroundLocalized prostate cancer (T1–3N0M0) has therapeutic options such as radical prostatectomy (RP), external beam radiation therapy (EBRT) and brachytherapy (BT). However, the evidence of the outcome of these treatments is limited and no studies have been conducted comparing biochemical failure (BF) and toxicity associated with surgical treatment and EBRT + high-dose brachytherapy (HDBT) in the region.Materials and methodsRetrospective cohort study, clinical records of patients diagnosed with localized prostate cancer between 2014 and 2018 were reviewed at one of the main private neoplasm centers in Lima, Peru; Cox regression was used for both the BF outcome and the grade 2 toxicity outcome, calculating the hazard ratio (HR) with 95% confodence interval (CI).ResultsOf 549 patients, 76.3% (419) received RP as primary treatment, and 72% were between 50 and 70 years old at the time of diagnosis. The patients treated with EBRT + HDBT presented worse characteristics. The EBRT + HDBT group had a 40% lower risk of presenting BF (HR = 0.6; 95% CI: 0.4–0.9), and also a 50% greater risk of presenting toxicity greater than or equal to grade 2 (HR = 1.5; 95% CI: 1.0–2.0) than the group treated with RP.ConclusionOur results show that when comparing patients treated with EBRT + HDBT and RP, BF was greater in RP, and post-treatment toxicity was greater in EBRT + HDBT.

Новый метод передней реконструкции структур малого таза при робот-ассистированной радикальной простатэктомии для улучшения раннего удержания мочи.

Introduction. Prostate cancer is one of the most common oncological diseases in men. Robot-assisted radical prostatectomy is associated with better urinary continence, compared with open and laparoscopic technique. Their oncologic outcomes are comparable. However, urinary incontinence after this surgery remains a challenge. Aim. To present a new technique of anterior reconstruction of pelvic structures during robot-assisted radical prostatectomy and evaluate its efficacy and safety. Materials and methods. We evaluated the results of treatment of 50 patients after robot-assisted radical prostatectomy for localised prostate cancer. They treated during the period from November 2020 till June 2021 in one medical centre. All surgeries were performed using transperitoneal access with anatomical-sparing technique. The anterior reconstruction of pelvic structures was performed with endopelvic fascia. All patients were informed about the study and signed the consent. The main perioperative parameters were assessed, as well as early oncological and functional outcomes. Evaluation the results of immediate and early urinary continence was carried out on the basis of questionnaire data. Results. The mean operative time was 140 min (110–170 min), mean console time was 72,5 min (45–100 min), the duration of the anterior reconstruction was 5,25 min (3,0–7,5 min). The average intraoperative blood loss was 50 ml (15–75 ml). There were no III-IV Clavien-Dindo complications. The 74% of patients were continent immediately after the surgery. The continent rate in a month after the surgery was 93%. Conclusion. This technique of robotic-assisted radical prostatectomy with anterior reconstruction is safe and effective. It does not increase the risk of complications and have no detrimental effect the oncological outcomes, while its early functional results are promising.

Recurrence, metastasis, and survival after radical prostatectomy in the era of advanced treatments.

5090 Background: Accurate survival estimates after prostatectomy are critical for patient counseling, treatment decisions, and trial design. Prior prostate cancer natural history studies may not reflect contemporary outcomes and often lack key endpoints (e.g. incident metastases). For these reasons, we explored population-based recurrence and survival following radical prostatectomy. Methods: We conducted a retrospective study of men with localized prostate cancer treated with radical prostatectomy from 2005-2015 with follow up through 2019 in the Veterans Health Administration. We excluded men with adjuvant radiation or hormonal therapy and defined biochemical recurrence (BCR) as a PSA ≥0.2 ng/mL. We used a validated natural language processing encoded dataset to identify incident metastatic disease. We then estimated actuarial time from surgery to BCR, BCR to metastatic disease, and metastatic disease to death using Kaplan-Meier methods. Results: Of 22,033 men post-prostatectomy, 5,963 (27%) developed BCR, with 5- and 10-year BCR estimates of 21% and 29% (Table). Of 5,963 men with BCR, 678 (11%) developed metastasis, with 5- and 10-year metastasis-free survival from time of BCR of 91% and 77%. Of these 678 men with metastases, 235 died (35%), with 5- and 10-year overall survival of 61% and 47%. Median actuarial overall survival from incident metastatic disease was 8.8 years. Conclusions: On average, we found a man undergoing radical prostatectomy for localized prostate cancer can expect about a 1 in 4 chance of biochemical recurrence. Of men with BCR, we identified a 1 in 10 chance of developing metastases, surviving nearly 9 years after incident metastasis. Both metastasis-free survival after biochemical recurrence and overall survival after developing metastasis appear to have lengthened consistent with a long natural history after prostate cancer surgery. Novel advanced prostate cancer treatments may help explain these findings, though their optimal use warrants further study especially as advanced imaging techniques to characterize recurrence increase. [Table: see text]

Cost-effectiveness of Robotic-Assisted Radical Prostatectomy for Localized Prostate Cancer in the UK

The cost-effectiveness of different surgical techniques for radical prostatectomy remains a subject of debate. Emergence of recent critical clinical data and changes in surgical equipment costs due to their shared use by different clinical specialties necessitate an updated cost-effectiveness analysis in a centralized, largely government-funded health care system such as the UK National Health Service (NHS). To compare robotic-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) and laparoscopic-assisted radical prostatectomy (LRP) using contemporary data on clinical outcomes, costs, and surgical volumes in the UK. This economic analysis used a Markov model developed to compare the cost-effectiveness of RARP, LRP, and ORP to treat localized prostate cancer. The model was constructed from the perspective of the UK NHS. The model simulated 65-year-old men who underwent radical prostatectomy for localized prostate cancer and were followed up for a 10-year period. Data were analyzed from May 1, 2020, to July 31, 2021. Robotic-assisted radical prostatectomy, LRP, and ORP. Quality-adjusted life-years (QALYs), costs (direct medical costs and costs outside the NHS), and incremental cost-effectiveness ratios (ICERs). Compared with LRP, RARP cost £1785 (US $2350) less and had 0.24 more QALYs gained; thus, RARP was a dominant option compared with LRP. Compared with ORP, RARP had 0.12 more QALYs gained but cost £526 (US $693) more during the 10-year time frame, resulting in an ICER of £4293 (US $5653)/QALY. Because the ICER was below the £30 000 (US $39 503) willingness-to-pay threshold, RARP was more cost-effective than ORP in the UK. The most sensitive variable influencing the cost-effectiveness of RARP was the lower risk of biochemical recurrence (BCR). Scenario analysis indicated RARP would remain more cost-effective than ORP as long as the BCR hazard ratios comparing RARP vs ORP were less than 0.99. These findings suggest that in the UK, RARP has an ICER lower than the willingness-to-pay threshold and thus is likely a cost-effective surgical treatment option for patients with localized prostate cancer compared with ORP and LRP. The results were mainly driven by the lower risk of BCR for RARP. These findings may differ in other health care settings where different thresholds and costs may apply.

Laparoscopic Radical Cystectomy with Ileal Neobladder for Metachronous Bladder Cancer Following Laparoscopic Radical Prostatectomy : A Case Report

A 67-year-old man presented with gross hematuria. The patient underwent laparoscopic radical prostatectomy for localized prostate cancer 8 years ago. Metachronous bladder cancer (pT1, high-grade and pTis) was diagnosed by transurethral resection. Laparoscopic radical cystectomy and construction of an ileal neobladder were performed. During the operation, mild adhesion was observed between the bladder and rectum ; however, there were no intraoperative complications. The patient had dysuria 2 months postoperatively, and neovesical-urethral anastomotic stricture was revealed by cystoscopy. We performed transurethral incision, and the patient voided properly except for mild incontinence. There was no evidence of recurrence 4 years after the operation.