Surgical Management Of Prostate Cancer Research Articles

Characteristics and management of erectile dysfunction after various treatments for prostate cancer

Preface Currently, there are many wellestablished therapeutic options for early prostate cancer, and therefore, it is difficult for both urologists and patients to choose the optimal treatment. It is essential for urologists to counsel their patients according to reliable information about the advantages and disadvantages of each therapeutic option. We picked the topic for this issue, “Characteristics and management of erectile dysfunction after various treatments for prostate cancer,” because erectile dysfunction (ED) is one of the most frequent adverse events encountered in the management of prostate cancer. We invited six specialists to review each therapeutic option: radical prostatectomy, laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy, external beam radiotherapy, brachytherapy, and androgen deprivation therapy (ADT). Among these modalities, surgical interventions tend to induce a quick drop in erectile function with slow postoperative recovery. Early postoperative rehabilitation has been introduced, aiming at the early recovery of ED. On the contrary, radiation therapy tends to maintain the patient’s erectile function for a while after treatment but it gradually decreases. ADT may compromise not only the erectile function but also the libido level, and may result in significant deterioration of the patient’s quality of life. We hope these reviews will help urologists to counsel their patients with regards to decision-making in the management of early prostate cancer.

Lifelong Yearly Prostate Specific Antigen Surveillance is Not Necessary for Low Risk Prostate Cancer Treated With Radical Prostatectomy

Many patients undergoing radical prostatectomy in the prostate specific antigen era have a low risk of recurrence. Aggressive postoperative prostate specific antigen surveillance is costly and anxiety provoking. In this study we investigate the need for yearly prostate specific antigen measurements in patients with surgically treated low risk prostate cancer. We identified 2,219 patients who underwent radical prostatectomy between 1994 and 2004 for low risk localized prostate cancer. Low risk was defined as prostate specific antigen less than 10 ng/ml, pathological stage pT2c or less, Gleason score 6 or less, negative lymph nodes and negative surgical margins. Patients who underwent neoadjuvant or adjuvant therapy were excluded from analysis. Biochemical failure was defined as a prostate specific antigen greater than 0.4 ng/ml and prostate specific antigen values less than 0.15 ng/ml were considered undetectable. Biochemical failure rates were calculated according to the duration of the prostate specific antigen-free period after radical prostatectomy. A total of 142 (6.4%) patients experienced biochemical failure during the course of the study. The risk of biochemical failure decreased with increasing duration of the prostate specific antigen-free interval. For example 1, 3 and 5-year biochemical failure rates calculated at surgery were 1.8%, 4.2% and 6.3%, respectively. For patients with undetectable prostate specific antigen measurements 5 years after surgery the 1, 3 and 5-year biochemical failure rates were 0.0%, 0.7% and 1.3%, respectively. In addition, 1-year biochemical failure rates were 0.2%, 0.4%, 0.0% and 0.0% after a prostate specific antigen-free period of 1, 3, 5 and 10 years, respectively. The risk of biochemical failure is inversely proportional to the duration of the prostate specific antigen-free interval after radical prostatectomy in low risk patients. Biochemical failure 1 year after an undetectable prostate specific antigen is uncommon, especially after a prostate specific antigen-free period of 3 years. These data suggest that annual prostate specific antigen measurements are unnecessary, especially after a prostate specific antigen-free interval of 3 years. Prostate specific antigen measurements every 2 years should capture the majority of low risk patients who experience progression.

Robot-assisted surgery: applications in urology

Robot-assisted surgery: applications in urology Mathew C Raynor, Raj S PruthiDivision of Urologic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USAAbstract: The past decade has seen a dramatic shift in the surgical management of certain urologic conditions with the advent of a robotic surgical platform. In fact, the surgical management of prostate cancer has seen the most dramatic shift, with the majority of cases now being performed robotically. Technical refinements over the years have led to improved outcomes regarding oncologic and functional results. Recently, robotic surgery has also been utilized for the surgical management of bladder cancer, renal cancer, and other benign conditions. As further experience is gained and longer-term outcomes are realized, robotic surgery will likely play an increasing role in the surgical management of many urologic conditions.Keywords: robot-assisted surgery, robotic surgery, cystectomy, prostatectomy, partial nephrectomy

Robot-assisted surgery: applications in urology

The past decade has seen a dramatic shift in the surgical management of certain urologic conditions with the advent of a robotic surgical platform. In fact, the surgical management of prostate cancer has seen the most dramatic shift, with the majority of cases now being performed robotically. Technical refinements over the years have led to improved outcomes regarding oncologic and functional results. Recently, robotic surgery has also been utilized for the surgical management of bladder cancer, renal cancer, and other benign conditions. As further experience is gained and longer-term outcomes are realized, robotic surgery will likely play an increasing role in the surgical management of many urologic conditions.

POD-01.06: Monocentric Study of Feasibility and Safety of Intra-Sphincter Injections of Autologous Progenitor Muscular Cells in Patients with Urinary Incontinence Due To Sphincter Failure Following Radical Prostatectomy

Post-prostatectomy incontinence is a common side effect of curative surgical management of prostate cancer. The standard treatment in case of failure of conservative management is the placement of an artificial urinary sphincter. Other surgical treatments include balloon compression devices, suburethral sling, and periurethral injections. As an alternative to these options, cellular therapy has been experienced in animals with encouraging results, but studies in human beings are lacking. The primary objective was to evaluate the tolerance to intra-sphincter injections of autologous progenitor muscular cells in patients with urinary incontinence by sphincter failure following radical prostatectomy.

Robot-Assisted Laparoscopic Radical Prostatectomy

Purpose: Laparoscopic radical prostatectomy is an alternative to open prostatectomy in the surgical management of prostate cancer. The introduction of surgical robot to assist laparoscopic surgery served as a mechanical device to enhance the laparoscopic skills and improve surgical maneuverability with enhanced visual systems and the multi-axis articulating instruments. This review will introduce the evolution of surgical technique and current status of robotic-assisted laparoscopic prostatectomy. Materials and Methods: A review of literatures is conducted with the homepage of Korean Urologic Association and PubMed, a search tool of the National Library of Medicine and the National Institutes of Health, including the MEDLINE database. Results: After its approval by the United States FDA in 2000, the robotic technology has revolutionized the treatment of surgical management of prostate cancer. Robotic-assisted laparoscopic radical prostatectomy offers benefits of minimally invasive surgery with comparable oncological functional outcomes compared to standard surgical options. Conclusions: This technique is expected to evolve into one of the standard of care in treatment of localized prostate cancer. (Korean J Urol 2009; 50:97-104) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Pure and robotic-assisted laparoscopic radical prostatectomy: technology and techniques merge toimprove outcomes

Laparoscopic radical prostatectomy is rapidly becoming the preferred approach in the surgical management of prostate cancer. The enhanced visibility provided to the surgeon by magnification allows for a better definition of anatomical landmarks, which were not apparent with open, nonmagnified surgery. Recent descriptions of the periprostatic anatomy, including the fascial layers surrounding the prostate, the structure of the neurovascular bundles and the components of the urethral sphincteric complex, allow the surgeon to refine available surgical techniques and create new ones with the goal of maximizing potency and continence preservation. The advent of the da Vinci® robot to assist laparoscopic surgery served as a platform to enhance the surgeon’ laparoscopic skills and to define further technological needs, such as better 3D vision systems and the development of hand-held articulating instruments that maintain haptic perception. This review summarizes the newer technologies available, recent anatomical descriptions of the periprostatic area and refinements in technique. The ultimate goal of the merge of technology with refinements in technique and a better anatomical understanding is to continue to improve the surgical outcomes with laparoscopy.

Pure Laparoscopic and Robotic-Assisted Laparoscopic Radical Prostatectomy in the Management of Prostate Cancer

Until recently, open radical prostatectomy was the only approach for the surgical management of prostate cancer. Laparoscopy is now increasingly used as an alternative approach. The procedure can be performed directly or with robot assistance. We review the relevant literature regarding oncologic and functional outcomes with laparoscopic surgery in the management of localized prostate cancer. Oncologic and functional outcomes are similar between open and laparoscopic radical prostatectomy. Pure laparoscopic prostatectomy and robotic assisted laparoscopic prostatectomy result in less blood loss and shorter convalescence. Costs associated with the initial investment, disposables, and maintenance of the robot system are higher than for pure laparoscopic prostatectomy. Laparoscopic radical prostatectomy, either pure or robotic, is becoming the preferred approach for the surgical management of localized prostate cancer. Oncologic and functional outcomes are similar to the open approach.

Surgical management of prostate cancer: Advances based on a rational approach to the data

The management of localised prostate cancer has undergone important changes in the past two decades, with major improvements in surgical technique, a greater emphasis on structured assessment of quality of life, and a greater attempt to tailor treatment to biological risk. Disease diagnosis is predicated on identification of demographic risk factors, serum levels of prostate-specific antigen and its derivatives, and extended biopsy techniques. Surgical removal of the prostate may be accomplished by open or minimally invasive techniques and in experienced hands results in good functional outcomes a high rate of cure for those with organ confined disease. Radical prostatectomy is also appropriate in selected patients with locally advanced disease and after failed radiation therapy.

Early diagnosis and surgical management of prostate cancer

Prostate cancer is a significant cause of morbidity and mortality in the United States and Europe. The natural ageing of the population as well as the continued and widespread use of diagnostic tests such as prostate specific antigen (PSA), has led to an increase in the numbers of men diagnosed with localised prostate cancer. Screening to identify organ-confined disease has provoked much public and scientific attention, but remains controversial. Radical prostatectomy is one of the most challenging urological procedures performed. Improvements in technique due to better understanding of pelvic anatomy have reduced complications, with acceptable standards and excellent results in high-volume institutions. Continual refinements in technique and the recent introduction of laparoscopic radical prostatectomy are likely to improve functional outcome further. However the effectiveness of surgery in improving survival and quality of life, in men with early prostate cancer remains to be determined. The results from large randomised controlled trials are eagerly awaited.

Patient Preferences for Outcomes Associated With Surgical Management of Prostate Cancer

We used utility assessment to evaluate patient preferences for current urinary and sexual function after radical prostatectomy. We measured preferences in 209 community volunteers enrolled in a prostate cancer screening study who underwent radical prostatectomy between 1994 and 1998. We compared preferences in 3 outcome groups, namely men bothered by current urinary and sexual functioning, only bothered by current sexual functioning and not bothered by current sexual or urinary functioning. Preferences were assessed via a computer based interview using time trade-off and standard gamble methods. Current functioning was assessed via a standardized questionnaire. Median time trade-off and standard gamble utilities were high at 0.9 across outcome groups, indicating that men were not willing to give up many remaining life years (10% of remaining life expectancy) with current functioning to achieve ideal functioning. However, mean time trade-off and standard gamble scores significantly decreased as the burden increased in men bothered by current sexual and urinary function (0.77 and 0.82), bothered by current sexual function only (0.87 and 0.89) and not bothered by sexual or urinary function (0.92 and 0.96, respectively). Health related quality of life was generally good in this observational study of patients treated for prostate cancer with radical prostatectomy. In addition, those bothered by urinary and/or sexual function would not be willing to trade much of the remaining life span to achieve perfect functioning. However, the perception of side effects was bothersome enough in some men to warrant appropriate patient counseling regarding the potential risks and benefits.

Patient Preferences for Outcomes Associated With Surgical Management of Prostate Cancer

Patient Preferences for Outcomes Associated With Surgical Management of Prostate Cancer

RADICAL PROSTATECTOMY IN A COMMUNITY PRACTICE

We report the experience of a community based urologist with anatomical retropubic radical prostatectomy. We compared outcome data with that reported experience at several well-known academic institutions. Between May 1986 and December 2000, 382 consecutive patients underwent anatomical radical retropubic prostatectomy performed by a single community based urologist. Charts were reviewed to determine the positive margin rate, urinary continence, potency, hospitalization and the prostate specific antigen (PSA) recurrence rate. The positive margin rate was 9% overall but in the last 5 years it was 7% compared with 7% to 40% in previous studies at academic institutions. The urinary continence rate was 90% overall and 93% in the last 5 years when excluding men older than 70 years old, compared with 85% to 94% in the academic urological literature. The potency rate after the bilateral nerve sparing technique was 79% compared with 54% to 86% in academic series. Average hospitalization in the last 5 years was 1.5 days. Overall PSA recurrence rate and the rate of PSA recurrence as a function of preoperative PSA, postoperative stage and grade were similar to those at academic institutions. Anatomical radical prostatectomy can be performed at nonacademic institutions with results comparable to those at academic institutions.

PROSPECTIVE ASSESSMENT OF PATIENT REPORTED URINARY CONTINENCE AFTER RADICAL PROSTATECTOMY

PROSPECTIVE ASSESSMENT OF PATIENT REPORTED URINARY CONTINENCE AFTER RADICAL PROSTATECTOMY

Surgical management of prostate cancer. Contemporary results with anatomic radical prostatectomy

Surgical management of prostate cancer. Contemporary results with anatomic radical prostatectomy

Surgical management of prostate cancer. Contemporary results with anatomic radical prostatectomy

In men with clinically localized prostate cancer whose life expectancy exceeds 10 years, radical prostatectomy has been considered the preferred treatment. When the cancer is confined to the prostate, radical prostatectomy has yielded excellent long term, cancer-free survival results; however, when the cancer escapes from the prostate, recurrence rates increase progressively with the degree of cancer spread. The morbidity and mortality rates for prostate cancer are high because, in the past, the cancer usually was detected late. Recent advances in early detection and surgical technique have increased the opportunities to improve treatment outcomes. However, some authors have questioned the preference of radical prostatectomy over expectant management. This article presents the author's experience with anatomic radical prostatectomy, in which an undetectable postoperative serum prostate specific antigen (PSA) level was used to measure the success of therapy in approximately 1000 patients treated during the past decade. The results are compared with those reported from other centers that also have ample experience with this operation. Together, these results suggest that contemporary anatomic radical prostatectomy provides unexcelled cancer control with low mortality and morbidity rates. With PSA screening, it is now possible to detect prostate cancers sooner, when patients are younger and more of the tumors are organ confined. Therefore, the treatment outcomes should be correspondingly more favorable in the future. Prospective, randomized studies are underway to compare the results of radical prostatectomy with those of expectant management in patients with clinically localized disease. However, until other treatments are proved to be as effective as radical prostatectomy in a representative patient population, radical prostatectomy should be considered the preferred treatment for men with localized prostate cancer whose life expectancy exceeds 10 years. Cancer 1995 ;75 :1903-8.