Prostatectomy For Localized Prostate Cancer Research Articles

Robotic assisted radical prostatectomy for localised prostate cancer in thalidomide generation.

Thalidomide was used in the late 1950s and early 1960s as a sedative for morning sickness in pregnant women. It resulted in thousands of babies being born with various congenital anomalies, such as phocomelia. Subsequently, the drug was banned for this indication. Most of the survivors have become thalidomide adults and now they are in their fifties. We report the first case of a robot-assisted radical prostatectomy in a 54-year-old male with prostate cancer and phocomelia as a result of thalidomide embryopathy. He presented with a PSA of 3.3 and was diagnosed with Gleason 3+4 prostate cancer. An extra peritoneal approach was chosen due to his body habitus and to avoid extreme Trendelenburg tilt. Side docking with the da Vinci robot was employed and the prostatectomy was carried out in the standard extra peritoneal fashion. At 6months' follow-up his PSA is unrecordable and he is voiding well with minimal urinary incontinence, requiring 1pad/day. We aim to outline our approach and highlight the technical modifications in this rare physically disabling condition.

The feasibility of the Prostate cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) dietary and physical activity modifications: a qualitative study

BackgroundThere is increasing evidence that low levels of physical activity and diets low in fruit and vegetables and high in meat and dairy products are risk factors for prostate cancer disease progression. The Prostate cancer: Evidence of Exercise and Nutrition Trial (PrEvENT) aimed to assess a diet and physical activity intervention in men undergoing radical prostatectomy for localized prostate cancer. The trial included a qualitative component to explore the experiences of men participating in the trial in order to understand the acceptability of the intervention and data collection methods. We report the qualitative findings of the trial and consider how these can be used to inform future research.MethodsPrEvENT involved randomizing men to either a dietary and/or physical activity intervention. Semi-structured interviews were conducted with a purposive sample of 17 men on completion of the 6 month trial. Interviews took place in clinic or as telephone interviews, if requested by the participant, and were audio recorded, transcribed, and analyzed using the thematic-based framework approach. Analysis was conducted throughout the data collection process to allow emergent themes to be further explored in subsequent interviews.ResultsThree overarching themes were identified: acceptability of the intervention, acceptability of the data collection methods and trial logistics. Participants were predominantly positive about both the dietary and physical activity interventions and most men found the methods of data collection appropriate. Recommendations for future trials include consideration of alternative physical activity options, such as cycling or gym sessions, increased information on portion sizes, the potential importance of including wives or partners in the dietary change process and the possibility of using the pedometer or other wearable technology as part of the physical activity intervention.ConclusionsWe provide insight into the opinions and experiences of the acceptability of the PrEvENT diet and physical activity intervention from the participants themselves. The interventions delivered were acceptable to this sample of participants, as were the data collection methods utilized. We also highlight some considerations for further behavioural change interventions in prostate cancer and other similar populations.Trial registrationISRCTN, ISRCTN99048944. Registered on 17 November 2014.

Intérêt du compagnonnage chirurgical durant la période d’apprentissage de la prostatectomie radicale robot-assistée

Study of the learning curve of robot-assisted radical prostatectomy, evaluating intraoperative difficulties and postoperative complications according to Clavien-Dindo classification. Retrospective study of our first 157consecutive patients treated with robot-assisted prostatectomy for localized prostate cancer between September2011and December2014. Comparison of learning for each group of 50procedures and then comparison between patients operated on by a pair of two seniors specially trained for robotic surgery and patients operated on by one mixed pair including a surgeon junior coached by one senior of the first group. Only postoperative complications decreased significantly from the 51st patient (P=0.04). The curves showing the evolution of the operative time decreased with a parallel trend between the two pairs, but with more variability in the mixed pair. There was no significant difference in terms of intraoperative difficulties (P=0.59), nor postoperative complications (P=0.56) mainly of grade2. The blood loss, transfusion rate, duration of hospitalization and readmission rates did not differ. Lymph node dissection did not affect outcomes. For oncological results, the overall rate of positive surgical margins (R+) was 30.6% in the initial pair against 24.2% in the mixed group with no significant difference. Nevertheless, the subpopulation study objectified a R+ rate of 12.86% for pT2against 42.85% for pT3. The early involvement of a junior surgeon who did not receive specific training, but benefiting from the guidance of a senior surgeon, did not compromise the results while allowing a faster learning curve with a rate of operative complications close to the one observed by the senior pair. 4.

The prognostic significance of postoperative neutrophil-to-lymphocyte ratio after radical prostatectomy for localized prostate cancer

BackgroundThe pretreatment neutrophil-to-lymphocyte ratio has prognostic value after radical prostatectomy for treating localized prostate cancer. However, the use of postoperative neutrophil-to-lymphocyte ratio has not been evaluated in this population. We investigated the prognostic significance of early postoperative neutrophil-to-lymphocyte ratio after radical prostatectomy for prostate cancer.MethodsWe retrospectively reviewed clinical data from 2,302 patients with localized prostate cancer who underwent radical prostatectomy at our institution between years 2000 and 2010. Only patients with pre- and postoperative complete blood counts with differential results were included. Patients who received neoadjuvant or postoperative adjuvant treatment and those without adequate medical records were excluded. Kaplan-Meier analyses were performed to analyze biochemical recurrence-free survival and overall survival rates. Univariate and multivariate Cox regression models were used for each endpoint.ResultsKaplan-Meier curves showed that high postoperative neutrophil-to-lymphocyte ratio (>3.5) was significantly associated with decreased biochemical recurrence-free survival (p = 0.009) and overall survival (p = 0.010). In the univariate and multivariate Cox regression analyses, high postoperative neutrophil-to-lymphocyte ratio was a significant predictor of biochemical recurrence (hazard ratio 1.270, p = 0.008) and overall survival (hazard ratio 1.437, p = 0.033).ConclusionsOur results demonstrate that postoperative neutrophil-to-lymphocyte ratio is an independent factor for biochemical recurrence and overall survival in patients who underwent radical prostatectomy for prostate cancer. These findings suggest that neutrophil-to-lymphocyte ratio can be a potentially valuable tool for stratifying high-risk patients and facilitating choices of postoperative therapy in patients with prostate cancer.

Erratum to: Clinical characteristics and outcomes of HIV-seropositive men treated with surgery for prostate cancer.

The natural history and optimal management strategy for men with human immunodeficiency virus (HIV) and prostate cancer remain to be definitively characterized. This study was conducted to evaluate the clinical characteristics and outcomes of HIV-seropositive men treated with robotic-assisted radical laparoscopic prostatectomy for localized prostate cancer. After Institutional Review Board approval, a prospective database of 2175 operative cases of clinically localized prostate adenocarcinoma was reviewed. Thirteen patients were identified as HIV-positive. Tumor characteristics, operative outcomes, postoperative outcomes, histology (Gleason score), local invasion, biochemical recurrence, and surgical complications were compared with HIV-negative patients. There were no preoperative demographic differences between the HIV-positive and HIV-negative patients. HIV-positive patients had higher prostate specific antigen (PSA) levels at time of diagnosis which was not statistically significant. However, HIV-positive patients had higher D’Amico risk assessment (p < 0.05). There was no postoperative complication. HIV-positive patients treated with robotic prostatectomy had similarly favorable perioperative and short-term biochemical recurrence-free survival outcomes. Our findings show that minimally invasive prostatectomy can be safely considered as a therapeutic option in otherwise eligible HIV-positive patients with clinically significant prostate cancer. Further research is necessary to outline a diagnostic and treatment guideline for HIV-positive men in detection and treatment of prostate cancer.

Prognostic impact of preoperative neutrophil-to-lymphocyte ratio after radical prostatectomy in localized prostate cancer.

Neutrophil-to-lymphocyte ratio (NLR) has a prognostic value in patients with metastatic castration-resistant prostate cancer receiving systemic therapy. However, the prognostic significance of NLR was never previously evaluated in patients who underwent radical prostatectomy (RP) for prostate cancer. In the present study, we investigated the influence of NLR on survival after a RP for prostate cancer. We retrospectively reviewed clinical data of 2301 patients with prostate cancer who underwent RP at our institution between 2000 and 2010. Among these patients, we considered only patients who had a preoperative complete blood count with differential result available. Patients who received neoadjuvant or postoperative adjuvant treatment (radiation, androgen deprivation therapy or both) and those without adequate medical record were excluded. A Kaplan-Meier analysis was performed to analyze biochemical recurrence-free survival (BCRFS), overall survival (OS) and prostate cancer-specific survival (CSS). Univariate and multivariate Cox regression models were used for each end point. In total, 2067 patients were evaluated; median follow-up time was 78 months (interquartile range (IQR) 65-96), median age at RP was 66 years (IQR 61-70) and median preoperative NLR was 1.76 (IQR 1.35-2.40). A Kaplan-Meier analysis showed a significant association between high NLR (⩾1.76) and decreased CSS (P=0.005) and OS (P=0.003) but not with BCRFS (P=0.223). In the univariate and multivariate regression analyses, a high NLR was a significant predictor of CSS (hazard ratio (HR) 2.012, 95% confidence interval (CI) 1.222-3.310, P=0.006) and OS (HR 1.650, 95% CI 1.127-2.416, P=0.010). This study shows that in patients with prostate cancer preoperative NLR is an independent prognostic factor for OS and CSS after a RP and suggests that a preoperative hematologic workup should be considered in the risk assessment of these patients.

Ascertainment of postprostatectomy radiotherapy for prostate cancer in the Surveillance, Epidemiology, and End Results database.

Surveillance, Epidemiology, and End Results (SEER) data are frequently used to examine receipt of adjuvant radiotherapy (RT), but to the authors' knowledge the accuracy of data regarding second-course treatments is unknown. Using SEER-Medicare-linked data, the authors identified a cohort of men who underwent radical prostatectomy for localized prostate cancer with indications for RT due to adverse pathologic risk factors. Receipt of RT was compared between the SEER database and Medicare claims, with the latter considered to be the "gold standard." Multivariable logistic regression was used to assess factors associated with ascertainment of RT in SEER. A total of 3842 men were analyzed, 749 of whom were found to have Medicare claims for RT within 1 year of undergoing prostatectomy. SEER ascertainment of postprostatectomy RT was 56% overall: 76% among patients who received RT within 2 months of prostatectomy, 73% among patients who received RT between 2 to 4 months after prostatectomy, 63% among patients who received RT between 4 to 6 months after prostatectomy, 44% among patients who received RT between 6 to 8 months after prostatectomy, and 21% among patients who received RT between 8 to 12 months after prostatectomy. On multivariable analysis, increasing time from prostatectomy to RT was found to be significantly associated with decreased SEER ascertainment (odds ratio, 0.70 per month; P<.001). There also was variation noted by SEER region and urban/rural locale. SEER underascertains the receipt of postprostatectomy RT compared with Medicare claims, and the magnitude of the underascertainment increases with longer time between prostatectomy and RT. These findings have direct implications for the use of SEER data alone to assess patterns of care and guideline concordance for second-course treatment. Cancer 2016;122:3069-3074. © 2016 American Cancer Society.

Clinical characteristics and outcomes of HIV-seropositive men treated with surgery for prostate cancer

The natural history and optimal management strategy for men with human immunodeficiency virus (HIV) and prostate cancer remain to be definitively characterized. This study was conducted to evaluate the clinical characteristics and outcomes of HIV-seropositive men treated with robotic-assisted radical laparoscopic prostatectomy for localized prostate cancer. After Institutional Review Board approval, a prospective database of 2175 operative cases of clinically localized prostate adenocarcinoma was reviewed. Thirteen patients were identified as HIV-positive. Tumor characteristics, operative outcomes, postoperative outcomes, histology (Gleason score), local invasion, biochemical recurrence, and surgical complications were compared with HIV-negative patients. There were no preoperative demographic differences between the HIV-positive and HIV-negative patients. HIV-positive patients had higher prostate specific antigen (PSA) levels at time of diagnosis which was not statistically significant. However, HIV-positive patients had higher D'Amico risk assessment (p<0.05). There was no postoperative complication. HIV-positive patients treated with robotic prostatectomy had similarly favorable perioperative and short-term biochemical recurrence-free survival outcomes. Our findings show that minimally invasive prostatectomy can be safely considered as a therapeutic option in otherwise eligible HIV-positive patients with clinically significant prostate cancer. Further research is necessary to outline a diagnostic and treatment guideline for HIV-positive men in detection and treatment of prostate cancer.

Tumor volume improves the long-term prediction of biochemical recurrence-free survival after radical prostatectomy for localized prostate cancer with positive surgical margins.

To develop a novel application evaluating the effect of tumor volume (TV) and percentage of high-grade tumor volume (%HGTV) on long-term biochemical recurrence-free survival rate (BCRFS) after radical prostatectomy (RP) in patients with pT2 PCa. Retrospective analysis of 903 men with pT2 PCa between 1992 and 2004 at a single European tertiary care center was performed. Cox regression models identified risk factors for BCR. A nomogram was developed to predict the BCRFS at 5, 10 and 15years after RP. Decision curve analyses were performed to identify the net increase in cases identified by the full model. BCR-free survival rates at 5, 10 and 15years were 94, 90 and 86%. In Cox regression analyses, TV, %HGTV and positive surgical margin status (SM) were independent predictors of BCR. Predictive accuracies (PA) at 5, 10 and 15years of the base model (PSA, Gleason score, SM) were 76.8% (95% CI 67.9-78.2%), 70.5% (95% CI 64.9-75.0%) and 68.1% (95% CI 60.6-73.5%). The full model, including TV and %HGTV, achieved 76.9, 72.4 and 70.7%. These PA differences were statistically significant at 10 and 15years (p<0.001). TV and %HGTV could potentially serve as valuable measures to stratify patients at high risk of BCR. The use of our nomogram should be considered to counsel patients with pT2 disease and SM and to design appropriate follow-up or treatment regimens.

Robot-Assisted Radical Prostatectomy for Localized Prostate Cancer in Asian Renal Transplant Recipients

BackgroundThe purpose of this study was to present our experience with robot-assisted radical prostatectomy (RARP) for localized prostate cancer in renal transplant recipients (RTRs) and to determine the feasibility and efficacy of RARP in these patients. MethodsWe retrospectively reviewed the medical records of 236 patients who underwent RARP for localized prostate cancer at our institution between August 2011 and July 2015 and identified 3 patients who were RTRs. We reviewed the available clinical data of the 3 patients. ResultsAll patients underwent RARP successfully without any major complications. The mean operation time was 162 minutes (range, 127–195 minutes). The mean estimated blood loss was 52 mL (range, 30–75 mL); therefore, the patients did not need any perioperative blood transfusion. In all cases, graft function, as determined according to the serum creatinine level, was stable during and after the operation. Pathological examination showed negative surgical margins with organ-confined disease in all patients. ConclusionsWe reported 3 RTRs with localized prostate cancer who were treated with RARP. RARP might be a feasible and effective minimally invasive technique for the treatment of localized prostate cancer in carefully selected RTRs.

MP04-14 PHASE IIA, RANDOMIZED PLACEBO-CONTROLLED TRIAL OF SINGLE HIGH DOSE CHOLECALCIFEROL (VITAMIN D3) AND DAILY GENISTEIN (G-2535) VERSUS PLACEBO IN MEN WITH EARLY STAGE PROSTATE CANCER UNDERGOING PROSTATECTOMY

You have accessJournal of UrologyProstate Cancer: Epidemiology & Natural History I1 Apr 2016MP04-14 PHASE IIA, RANDOMIZED PLACEBO-CONTROLLED TRIAL OF SINGLE HIGH DOSE CHOLECALCIFEROL (VITAMIN D3) AND DAILY GENISTEIN (G-2535) VERSUS PLACEBO IN MEN WITH EARLY STAGE PROSTATE CANCER UNDERGOING PROSTATECTOMY David F. Jarrard, Badrinath R. Konety, Joel Slaton, Wei Huang, Tracy Downs, Jill Kolesar, KyungMann Kim, Tom Havighurst, Margaret G. House, Howard L. Parnes, and Howard H. Bailey David F. JarrardDavid F. Jarrard More articles by this author , Badrinath R. KonetyBadrinath R. Konety More articles by this author , Joel SlatonJoel Slaton More articles by this author , Wei HuangWei Huang More articles by this author , Tracy DownsTracy Downs More articles by this author , Jill KolesarJill Kolesar More articles by this author , KyungMann KimKyungMann Kim More articles by this author , Tom HavighurstTom Havighurst More articles by this author , Margaret G. HouseMargaret G. House More articles by this author , Howard L. ParnesHoward L. Parnes More articles by this author , and Howard H. BaileyHoward H. Bailey More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1949AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Prostate cancer (PCa) represents an important target for chemoprevention given its prolonged natural history and predilection for afflicting an older population. Epidemiologic and laboratory data suggest that vitamin D and genistein (soy) in decreasing PCa progression. The effect of vitamin D on prostate epithelial cell proliferation and differentiation is well documented and genistein may augment this affect through inhibition of the CYP24 enzyme, which is responsible for intracellular vitamin D metabolism. In addition, both genistein and vitamin D inhibit the intraprostatic synthesis of prostaglandin E2, an important mediator of inflammation. In the current prospective, multicenter trial in patients undergoing radical prostatectomy for localized prostate cancer, the safety and effect of adding genistein to patients receiving a single, large dose of cholecalciferol was assessed. METHODS Men undergoing radical prostatectomy were randomly assigned to one of two treatment groups: (1) cholecalciferol: 200,000 IU as one dose at study entry plus genistein: 600 mg daily or (2) placebo cholecalciferol day 1 and placebo genistein PO daily for 21-28 days prior to radical prostatectomy. Serum and tissue analyses were performed and side-effects recorded. RESULTS A total of 15 patients were enrolled, 8 in the placebo arm and 7 in the vitamin D + genistein (VD+G) arm. All patients were compliant and completed the study. No significant differences in side effect profiles were noted. Utilization of the VD+G showed a trend toward increased calcitriol serum concentrations when compared to placebo (0.104 +/- 0.1 vs. 0.0013 +/-0.07; p=0.08); however, prostate tissue levels did not increase. Immunohistochemistry for marker analyses using VECTRA automated quantitation revealed a significant increase in AR expression (p=0.04) and a trend toward increased TUNEL staining (p=0.1) in prostate cancer tissues in men randomized to receive VD+G compared to placebo. CONCLUSIONS In this first study testing the combination of a single, large dose of cholecalciferol (200,000IU) and daily genistein (G-2535) the agents were well tolerated. While serum levels of calcitriol were increased on the intervention arm, prostate tissue levels were not. Increased prostatic AR expression (suggesting increased differentiation) and a trend toward increased TUNEL staining (increased apoptosis) were observed among men randomized to the combination. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e33-e34 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David F. Jarrard More articles by this author Badrinath R. Konety More articles by this author Joel Slaton More articles by this author Wei Huang More articles by this author Tracy Downs More articles by this author Jill Kolesar More articles by this author KyungMann Kim More articles by this author Tom Havighurst More articles by this author Margaret G. House More articles by this author Howard L. Parnes More articles by this author Howard H. Bailey More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

The transrectal single-port laparoscopic radical prostatectomy in a cadaver model.

Radical prostatectomy is the most commonly used and most effective treatment for localized prostate cancer; however, this treatment modality is not without disadvantages. After describing the first technique of radical perineal prostatectomy, several techniques, including open, laparoscopic, and robotic retropubic radical prostatectomy were developed and preferred in the treatment of patients. The desire for reproducible, minimally invasive surgery, which reduces complication rates and maximizes cosmetic outcomes, is met by natural orifice transluminal endoscopic surgery (NOTES).[1] Akca et al.[2] revealed that radical prostatectomy may be performed using a transrectal NOTES route. The authors state that transrectal radical prostatectomy is technically feasible in the cadaver model and the transrectal NOTES route provides good exposure and easy access to the posterior surface of the prostate. Anatomy dissection studies using human cadavers are valuable to show surgeons exactly what is intended for them to see without the risk of disrupting the integrity of the cadaver.[3] We would like to congratulate the authors for an ethical cadaver study of a new treatment modality and for finding a cost-effective model to explore the feasibility of the technique. Rectal injury or rectal perforation is one of the most important complications in radical prostatectomy, and the frequency of this complication varies from 0% to 11% in the literature.[4] Additionally, a recent study showed that rectal perforation is an important cause of litigation in cases of radical prostatectomy in the United States of America, and this complication represents 40 % of all cases of negligence in the performance of radical prostatectomy surgery.[5] Even though the authors state that a meticulous repair of rectal mucosa makes this procedure less morbid than an inadvertent unrecognized rectal injury, a living human study may show that prolonged retraction on the rectal wall in the single port procedures can damage the viability of rectal tissue. Opening the gastrointestinal system can cause several complications, including sepsis and even death. Thus, concerning the motto ‘primum nil nocere’, an innovative technique should be experienced by using fundamental anatomical principles. Humphreys et al.[6] introduced another innovative surgical technique called NOTES radical prostatectomy for localized prostate cancer via a transurethral approach. This technique has the same advantages as transrectal NOTES radical prostatectomy, such as minimal invasiviness and improved cosmetic outcomes, with the lack of potential risks seen rectal injury. Nevertheless, the study by Akca et al.[2] is noteworthy, important, and will guide researchers in finding the best type of approach for radical prostatectomy surgery.

Comparison of oncological and health‐related quality of life outcomes between open and robot‐assisted radical prostatectomy for localised prostate cancer – findings from the population‐based Victorian Prostate Cancer Registry

To compare the short-term oncological and health-related quality of life (HRQOL) outcomes between open (ORP) and robot-assisted (RARP) radical prostatectomy in the population-based Victorian Prostate Cancer Registry. This is a prospective cohort of patients with prostate cancer who had RP (1117 ORP and 885 RARP) between January 2009 and June 2012. The oncological outcomes of interest were: positive surgical margin (PSM) and biochemical recurrence (BCR), defined as postoperative PSA level of >0.2ng/mL. The HRQOL outcomes were: sexual and urinary bother, assessed using the Expanded Prostate Cancer Index Composite at 1- and 2-years after diagnosis. For univariate comparison of continuous variables the Student's t-test or Mann-Whitney U-test were used, and the Pearson's chi-squared test was used for categorical variables. Bonferroni correction was applied to account for multiple testing, with a threshold for significance of P < 0.003 for univariate analyses. The inverse-probability-treatment-weighting (IPTW) approach was used to adjust for differences in baseline characteristics between ORP and RARP patients [including age, National Comprehensive Cancer Network (NCCN) risk categories, hospitals, and year of RP] in all multivariate analyses. Logistic regressions were used to analyse for PSM, Cox regressions for BCR, and ordinal logistic regressions for HRQOL outcomes. All multivariate analyses also adjusted for surgeons' average annual caseload, and employed the robust standard errors for clustering by surgeon. ORP and RARP patients were followed for a median of 19and 17months, respectively. The proportion of patientswith NCCN low-risk prostate cancer was significantly higher among RARP patients (21% vs 26%; P= 0.002). Most RPs was done in private hospitals (77% ORP, and 85% RARP, P < 0.001). A higher proportion of RARP patients were operated by surgeons with higher annual caseloads (65% RARP and 53% ORP operated by surgeons with >20case/year; P < 0.001). In the IPTW-adjusted multivariate analyses, RARP patients had a lower risk of PSM (odds ratio [OR] 0.56, 95% confidence interval [CI] 0.38-0.81), and BCR (hazard ratio [HR] 0.73, 95% CI 0.55-0.99). In the sensitivity analyses (excluding public hospital patients), the lower PSM risk with RARP remained (OR 0.63, 95% CI 0.38-0.81), but the lower BCR risk with RARP was no longer statistically significant (HR 0.79, 95% CI 0.57-1.12). At 1-year follow-up, 61% of ORP and 59% of RARP patients reported 'moderate-big' sexual bother (P = 0.2), while 14% of ORP and 11% of RARP patients reported 'moderate-big' urinary bother (P = 0.08). The sexual and urinary bothers at 2years were similar between ORP and RARP. In multivariate analyses, there were no statistically significant differences in the HRQOL outcomes between ORP and RARP. We report on a large population-based comparative study of ORP and RARP with better short-term oncological outcomes favouring RARP, but no significant differences in HRQOL outcomes. The results have to be interpreted taking into account significant surgeon heterogeneity in a population-based study.

Résultats fonctionnels et prise en charge des troubles fonctionnels après prostatectomie totale

To describe the functional results and treatment of functional dysfunctions after radical prostatectomy for localized prostate cancer. Bibliography search was performed from the database Medline (National Library of Medicine, Pubmed) selected according to the scientific relevance. The research was focused on continence, potency, les dyserections, couple sexuality, incontinence, treatments of postoperative incontinence, dysrection and trifecta. Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Despite recent developments in surgical techniques, post-radical prostatectomy urinary incontinence (pRP-UI) continues to be one of the most devastating complications, which affects 9-16% of patients. Sphincter injury and bladder dysfunction are the most common causes or pRP-UI. The assessment of severity of pRP-UI that affects the choice of treatment is still not well standardized but should include at least a pad test and self-administered questionnaires. The implantation of an artificial urinary sphincter AMS800 remains the gold standard treatment for patients with moderate to severe pRP-UI. The development of less invasive techniques such as the male sling of Pro-ACT balloons has provided alternative therapeutic options for moderate and slight forms of pRP-UI. Most groups now consider the bulbo-urethral compressive sling as the treatment of choice for patients with non-severe pRP-UI. The most appropriate second-line therapeutic strategy is not clearly determined. Recent therapies such as adjustable artificial urinary sphincters and sling and stem cells injections have been investigated. Maintenance of a satisfying sex life is a major concern of a majority of men facing prostate cancer and its treatments. It is essential to assess the couple's sexuality before treating prostate cancer in order to deliver comprehensive information and consider early therapeutic solutions adapted to the couple's expectations. Active pharmacological erectile rehabilitation (intracavernous injections or phosphodiesterase type 5 inhibitors [PDE5i] on demand, during in the month following surgery) or passive (daily PDE5i after surgery) might improve the quality of erections especially in response to PDE5i. Unimpaired aspects of sexual response (orgasm) may, when the erection is not yet recovered, represent an alternative allowing the couple to preserve intimacy and complicity. Androgen blockade is a major barrier to maintain or return to a satisfying sex. Trifecta is a simple tool to present in one way the results of radical prostatectomy: in case of bilateral neurovascular preservation, Trifecta is 60% whatever the surgical approach. Radical prostatectomy is an elaborate and challenging procedure when carcinological risk balances with functional results. Various treatments of postoperative incontinence and dysrections exist. Functional disorders after surgery have to be treated to ameliorate quality of life of patients.

2501 ORAL A randomized, open-label, phase 2 study of enzalutamide as neoadjuvant therapy for patients undergoing prostatectomy for localized prostate cancer

2501 ORAL A randomized, open-label, phase 2 study of enzalutamide as neoadjuvant therapy for patients undergoing prostatectomy for localized prostate cancer

A single nucleotide polymorphism inADIPOQpredicts biochemical recurrence after radical prostatectomy in localized prostate cancer

Adiponectin has been implicated in prostate cancer (PCa) aggressiveness. However, the role of genetic variations in the adiponectin (ADIPOQ) gene in PCa progression remains unknown. To determine whether genetic variants in ADIPOQ are associated with the risk of biochemical recurrence (BCR) after radical prostatectomy (RP). We evaluated three common ADIPOQ polymorphisms in 728 men with clinically localized PCa who underwent RP. Multivariable Cox proportional hazards models and Kaplan-Meier analysis were used to assess their prognostic significance on BCR. The plasma adiponectin concentrations were measured by enzyme-linked immunosorbent assay. ADIPOQ rs182052 variant allele was associated with both increased risk of BCR [HR: 2.44; 95% confidence interval (CI): 1.57-;3.79, P = 6×10-5] and decreased adiponectin level (β = -0.048, P = 0.004). Stratified analyses demonstrated that the association was more pronounced in men with higher visceral adipose tissue. Our data support that the ADIPOQ rs182052 SNP may be a predictive biomarker for BCR after RP by a possible mechanism of altering the adiponectin level. If validated, genetic predictors of outcome may help individualizing treatment for PCa.

The long-term (10 and 15 years) survival outcome of radical prostatectomy for localized prostate cancer in Taiwanese population

The long-term (10 and 15 years) survival outcome of radical prostatectomy for localized prostate cancer in Taiwanese population

Influence of pathological factors on oncological outcomes after robot-assisted radical prostatectomy for localized prostate cancer: Results of a prospective study

PurposeTo assess the prognostic significance of lymphovascular invasion (LVI), maximum tumor diameter (MTD), high-grade prostatic intraepithelial neoplasia, perineural invasion, and length of positive surgical margins after robot-assisted radical prostatectomy (RARP). MethodsA single-institution prospective analysis of all patients who underwent RARP for localized prostate cancer was performed between January 2005 and June 2013. The primary end point was biochemical recurrence-free survival (BRFS). BRFS was estimated using the Kaplan-Meier method and compared to that from the log-rank test. Cox׳s proportional hazards regression univariate and multivariate analyses were performed to define the prognostic factors. ResultsOverall, 742 men were included. After a median follow-up of 31.4 months, biochemical recurrence occurred in 80 patients (10.8%). BRFS was 93%, 87%, and 80.7% at 1, 3, and 5 years, respectively. Progression to local recurrence occurred in 49 patients (6.6%). During the follow-up period, 3 patients experienced progression to metastatic disease and were treated with hormonotherapy. No patient died of disease during the study period. In multivariate analyses, Gleason score was the strongest predictor of BRFS (hazard ratio [HR] = 3.4; P<0.001). There were 3 other predictive factors of BRFS were LVI (HR = 7.64; P = 0.005), MTD (HR = 4.04; P =0.009), and margin length≥3mm (HR = 1.25; P = 0.04). ConclusionIn the era of serum prostate-specific antigen testing maturity in conjunction with a single approach to extirpation of the prostate gland by RARP, LVI, MTD, and positive surgical margins≥3mm are prognostic factors associated with BRFS after RARP. Consideration could be given to incorporate them in the pathology report of the radical prostatectomy specimens and they could assist physicians in clinical decision making.

MP6-05 THE ASSOCIATION OF PREOPERATIVE NEUTROPHIL TO LYMPHOCYTE RATIO WITH ONCOLOGIC OUTCOMES FOLLOWING RADICAL PROSTATECTOMY FOR PROSTATE CANCER

You have accessJournal of UrologyProstate Cancer: Markers II1 Apr 2015MP6-05 THE ASSOCIATION OF PREOPERATIVE NEUTROPHIL TO LYMPHOCYTE RATIO WITH ONCOLOGIC OUTCOMES FOLLOWING RADICAL PROSTATECTOMY FOR PROSTATE CANCER Vidit Sharma, Patrick A. Cockerill, Boyd R. Viers, Laureano J. Rangel, Rachel E. Carlson, R. Jeffrey Karnes, and Matthew K. Tollefson Vidit SharmaVidit Sharma More articles by this author , Patrick A. CockerillPatrick A. Cockerill More articles by this author , Boyd R. ViersBoyd R. Viers More articles by this author , Laureano J. RangelLaureano J. Rangel More articles by this author , Rachel E. CarlsonRachel E. Carlson More articles by this author , R. Jeffrey KarnesR. Jeffrey Karnes More articles by this author , and Matthew K. TollefsonMatthew K. Tollefson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.252AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Elevated neutrophil-lymphocyte ratio (NLR) is a marker of systemic inflammation associated with adverse outcomes in multiple malignancies. Although NLR has prognostic value in the metastatic prostate cancer (PCa) setting, its prognostic role in localized PCa remains unclear. Here we evaluate the association of pre-operative NLR with long-term oncologic outcomes after radical prostatectomy (RP). METHODS A prospectively maintained institutional registry was queried for all men undergoing RP for PCa between 1990–2007. Men without an NLR within 90 days prior to RP and those receiving neoadjuvant therapy were excluded. Ten-year oncologic outcomes were compared between patients with an NLR > 5 and those with an NLR < 5 using univariate and multivariate models. RESULTS We identified 8350 patients with a median follow up of 9.7 years (IQR 6.7-14.1). Overall, 18.7% (1568/8350) of patients had a pre-RP NLR > 5. These patients were more likely to have: pT3/4 disease at RP (22% vs 17.1%, p<0.001), positive margins (33.2% vs 25.8%, p<0.001), adjuvant hormonal (13.8% vs 8.2%, p<0.001) and radiation therapy (4.7% vs 3.2%, p=0.006). Patients with NLR > 5 were also more likely to receive salvage hormonal therapy during follow up (14.0% 11.4%, p=0.004). Table 1 provides the univariate and multivariate hazard ratios comparing 10-year oncologic outcomes between the two NLR cohorts. After controlling for age, preoperative PSA, Gleason score, pathologic stage, and adjuvant hormonal or radiation therapy, NLR > 5 remained a significant predictor of biochemical recurrence (Hazard Ratio 1.13, p=0.02) and demonstrated a trend towards increased overall mortality (Hazard Ratio 1.12, p=0.06). CONCLUSIONS An elevated pre-operative NLR is significantly associated with locally advanced prostate cancer and is thereby associated with higher rates of positive margins and adjuvant therapy. NLR is also independently associated with an increased risk of biochemical recurrence. Further study is warranted to explore the implications of NLR on long term outcomes following radical prostatectomy for localized prostate cancer. Comparing 10 year Oncologic Outcomes between NLR > 5 and NLR < 5 10 year Outcome Univariate Hazard Ratio (95% CI) Univariate P-value Multivariate Hazard Ratio (95% CI) Multivariate P-value Biochemical recurrence 1.10 (0.99-1.22) P=0.07 1.13 (1.02-1.25) P=0.02 Systemic progression 0.92 (0.73-1.15) P=0.45 0.94 (0.74-1.18) P=0.59 Prostate cancer death 0.99 (0.71-1.37) P=0.93 0.98 (0.70-1.36) P=0.88 Death for any reason 1.13 (1.01-1.28) P=0.03 1.12 (1.00-1.26) P=0.06 Multivariate models accounted for age, preoperative PSA, Gleason score, pathologic stage, and adjuvant hormonal or radiation therapy © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e55-e56 Peer Review Report Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Vidit Sharma More articles by this author Patrick A. Cockerill More articles by this author Boyd R. Viers More articles by this author Laureano J. Rangel More articles by this author Rachel E. Carlson More articles by this author R. Jeffrey Karnes More articles by this author Matthew K. Tollefson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

MP6-06 PROSTATE HEALTH INDEX PREDICTS UPGRADING OF MEN ON 5-ALPHA REDUCTASE INHIBITORS

RESULTS: We identified 8350 patients with a median follow up of 9.7 years (IQR 6.7-14.1). Overall, 18.7% (1568/8350) of patients had a pre-RP NLR > 5. These patients were more likely to have: pT3/ 4 disease at RP (22% vs 17.1%, p 5 were also more likely to receive salvage hormonal therapy during follow up (14.0% 11.4%, p1⁄40.004). Table 1 provides the univariate and multivariate hazard ratios comparing 10-year oncologic outcomes between the two NLR cohorts. After controlling for age, preoperative PSA, Gleason score, pathologic stage, and adjuvant hormonal or radiation therapy, NLR > 5 remained a significant predictor of biochemical recurrence (Hazard Ratio 1.13, p1⁄40.02) and demonstrated a trend towards increased overall mortality (Hazard Ratio 1.12, p1⁄40.06). CONCLUSIONS: An elevated pre-operative NLR is significantly associated with locally advanced prostate cancer and is thereby associated with higher rates of positive margins and adjuvant therapy. NLR is also independently associated with an increased risk of biochemical recurrence. Further study is warranted to explore the implications of NLR on long term outcomes following radical prostatectomy for localized prostate cancer.