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Kawase M, Ebara S, Tatenuma T, Sasaki T, Ikehata Y, Nakayama A, Toide M, Yoneda T, Sakaguchi K, Teishima J, Makiyama K, Inoue T, Kitamura H, Saito K, Koga F, Urakami S, Koie T. Prognostic Importance of Lymphovascular Invasion for Specific Subgroup of Patients with Prostate Cancer After Robot-Assisted Radical Prostatectomy (The MSUG94 Group). Ann Surg Oncol 2024; 31:2154-2162. [PMID: 38200385 DOI: 10.1245/s10434-023-14691-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/16/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE This study aimed to investigate whether lymphovascular invasion (LVI) was associated with oncological outcomes in patients with prostate cancer (PCa) undergoing robotic-assisted radical prostatectomy (RARP). METHODS This retrospective multicenter cohort study was conducted on 3195 patients with PCa who underwent RARP in nine institutions in Japan. The primary endpoints were the associations between biochemical recurrence (BCR) and LVI and between BCR and clinicopathological covariates, while the secondary endpoints were the association between LVI and the site of clinical recurrence and metastasis-free survival (MFS). RESULTS In total, 2608 patients met the inclusion criteria. At the end of the follow-up period, 311 patients (11.9%) were diagnosed with BCR and none died of PCa. In patients with pathological stage T2 (pT2) + negative resection margins (RM-), and pT3+ positive RM (RM+), LVI significantly worsened BCR-free survival (BRFS). For patients with PCa who had pT3 and RM+, the 2-year BRFS rate in those with LVI was significantly worse than in those without LVI. Patients with LVI had significantly worse MFS than those without LVI with respect to pT3, RM+, and pathological Gleason grade (pGG). In multivariate analysis, LVI was significantly associated with BRFS in patients with pT3 PCa, and with worse MFS in PCa patients with pT3, RM+, and pGG ≥ 4. CONCLUSIONS LVI was an independent prognostic factor for recurrence and metastasis after RARP, particularly in patients with pT3 and RM+ PCa. Locally advanced PCa with positive LVI and RM+ requires careful follow-up because of the high likelihood of recurrence.
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Affiliation(s)
- Makoto Kawase
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shin Ebara
- Department of Urology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | | | - Takeshi Sasaki
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Japan
| | | | - Akinori Nakayama
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Masahiro Toide
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Tatsuaki Yoneda
- Department of Urology, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | | | - Jun Teishima
- Department of Urology, Kobe City Hospital Organization, Kobe City Medical Center West Hospital, Kobe, Japan
| | | | - Takahiro Inoue
- Department of Nephro-Urologic Surgery and Andrology, Mie University Graduate School of Medicine, Tsu, Japan
| | | | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Fumitaka Koga
- Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | | | - Takuya Koie
- Department of Urology, Gifu University Graduate School of Medicine, Gifu, Japan.
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Sood A, Zhang LT, Keeley J, Butaney M, Stricker M, Andrews JR, Grauer R, Peabody JO, Rogers CG, Menon M, Abdollah F. Optimizing anti-androgen treatment use among men with pathologic lymph-node positive prostate cancer treated with radical prostatectomy: the importance of postoperative PSA kinetics. Prostate Cancer Prostatic Dis 2024; 27:58-64. [PMID: 35794359 DOI: 10.1038/s41391-022-00572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/09/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Optimal postsurgical management of prostate cancer (PCa) patients with nodal metastasis at the time of radical prostatectomy remains unclear. We sought to examine the role of postoperative PSA kinetics and pathologic tumor characteristics in guiding additional hormonal therapy use in pN1 men. METHODS In total, 297 pN1 PCa patients treated with radical prostatectomy and ePLND between 2002 and 2018 were identified within our prospectively maintained institutional cancer data-registry. Following surgery, these patients were managed with either immediate androgen deprivation therapy (iADT) or observation with deferred ADT (dADT). The former was defined as ADT given within ≤6 months of surgery and the latter as >6 months. The primary outcome was metastasis. Regression-tree analysis was used to stratify patients into novel risk-groups based on post-prostatectomy tumor characteristics and PSA kinetics and the corresponding metastasis risk. Multivariable Cox regression analyses tested the impact of iADT versus observation ± dADT on metastasis, cancer-specific mortality, and overall mortality within each risk-group separately. RESULTS The median follow-up was 6.1 years (IQR 3.2-9.0). Regression-tree analysis stratified patients into 3 novel risk-groups (Harrell's C-index 0.79) based on PSA-nadir and time to biochemical failure: group 1 (low-risk) included patients with time to biochemical recurrence >6 months (n = 115), while groups 2 and 3 included patients with biochemical failure within ≤6 months with a postoperative PSA-nadir <1.05 ng/mL (group 2 [intermediate-risk], n = 125) or ≥1.05 ng/mL (group 3 [high-risk], n = 57), respectively. No other patient or tumor characteristics were significant for risk stratification. Within each risk-group, the 10-year metastasis-free survival rates with iADT versus observation ± dADT use were: group 1, 100% versus 95.4% (Log-rank p = 0.738), group 2, 80.6% versus 53.5% (Log-rank p = 0.016), and group 3, 41.5% versus 0% (Log-rank p = 0.015), respectively. Adjusted Cox regression analyses confirmed the benefit of iADT utilization in reducing metastasis in group 2 (p = 0.029) and group 3 (p = 0.008) patients, with no benefit for group 1 patients (p = 0.918). Similar results were noted for cancer-specific and overall mortality. CONCLUSIONS Following radical prostatectomy, early postoperative PSA kinetics may provide valuable information for guiding the timing of ADT initiation-this may reduce over- and undertreatment of pN1 PCa men.
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Affiliation(s)
- Akshay Sood
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Lawrence T Zhang
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Jacob Keeley
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Maxwell Stricker
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jack R Andrews
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James O Peabody
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Craig G Rogers
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Mani Menon
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Firas Abdollah
- VCORE-Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
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Ferrari MG, Jimenez-Uribe AP, Wang L, Hoeppner LH, Murugan P, Hahm E, Yu J, Kuzel TM, Gradilone SA, Mansini AP. Myeloid differentiation factor-2/LY96, a potential predictive biomarker of metastasis and poor outcomes in prostate cancer: clinical implications as a potential therapeutic target. Oncogene 2024; 43:484-494. [PMID: 38135694 PMCID: PMC10857939 DOI: 10.1038/s41388-023-02925-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Prostate cancer (CaP) is the most diagnosed cancer in males and the second leading cause of cancer deaths. Patients with localized tumors are generally curable. However, no curative treatment exists for patients with advanced and metastatic disease. Therefore, identifying critical proteins involved in the metastatic process would help to develop new therapeutic options for patients with advanced and aggressive CaP. We provide strong evidence that Myeloid differentiation factor-2 (MD2) plays a critical role in metastasis and CaP progression. Analysis of tumor genomic data showed that amplifications of MD2 and increased expression are associated with poor outcomes in patients. Immunohistochemistry analysis of tumor tissues showed a correlation between the expression of MD2 and cancer progression. The Decipher-genomic test validated the potential of MD2 in predicting metastasis. In vitro studies demonstrated that MD2 confers invasiveness by activating MAPK and NF-kB signaling pathways and inducing epithelial-mesenchymal transition. Furthermore, we show that metastatic cells release MD2 (sMD2). We measured serum-sMD2 in patients and found that the level is correlated to disease extent. We determined the significance of MD2 in metastasis in vivo and as a therapeutic target, showing that the molecular and pharmacological targeting of MD2 significantly inhibited metastasis in murine models. We conclude that MD2 predicts metastatic behavior, and serum-MD2 could be studied as a potential non-invasive biomarker for metastasis, whereas MD2 presence on prostate biopsy predicts adverse disease outcome. We suggest MD2-targeted therapies could be developed as potential treatments for aggressive metastatic disease.
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Affiliation(s)
- Marina G Ferrari
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
| | | | - Li Wang
- The Hormel Institute, Masonic Cancer Center, University of Minnesota, Austin, MN, USA
| | - Luke H Hoeppner
- The Hormel Institute, Masonic Cancer Center, University of Minnesota, Austin, MN, USA
| | - Paari Murugan
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, USA
| | - Eunsil Hahm
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jindan Yu
- Department of Urology and Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
- Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Timothy M Kuzel
- Department of Internal Medicine, Division of Hematology, Oncology and Cell Therapy, Rush Medical College, Chicago, IL, USA
| | | | - Adrian P Mansini
- Department of Urology, Rush University Medical Center, Chicago, IL, USA.
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Sood A, Grauer R, Diaz-Insua M, Tewari AK, Hemal AK, Shrivastava A, Peabody JO, Jeong W, Abdollah F, Rudzinski JK, Andrews JR, Gorin MA, Bhandari M, Menon M. 15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer. Prostate Cancer Prostatic Dis 2023; 26:778-786. [PMID: 37142635 DOI: 10.1038/s41391-023-00674-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/14/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND An informed decision regarding a treatment option requires data on its long-term efficacy and side-effect profile. While the side-effects of robotic radical prostatectomy have been well-quantified, the data on its long-term efficacy are lacking. We here provide 15-year oncological outcomes of clinically-localized prostate cancer (CLPCa) patients treated with robot-assisted laparoscopic prostatectomy (RALP). METHODS We treated 1,807 men with CLPCa with RALP between 2001 and 2005 and prospectively collected follow-up data through 2020. We examined the rates of biochemical failure (BCF), metastatic progression, secondary therapy use, PCa-specific mortality (PCSM), and overall survival (OS) using Kaplan-Meier and competing-risk cumulative incidence methods as appropriate. RESULTS The median follow-up was 14.1 years. Six hundred eight and 312 men had D'Amico intermediate- and high-risk disease, respectively. Overall, the 15-year rates of BCF, metastasis, secondary therapy use, PCSM, and OS were 28.1%, 4.0%, 16.3%, 2.5%, and 82.1%, respectively. The rates of oncologic failure increased with increasing D'Amico (preoperative) and Diaz (postoperative) risk scores - BCF, metastasis, and PCSM rates in D'Amico low-, intermediate-, and high-risk groups at 15-years were 15.2%, 38.3%, and 44.1% [BCF], 1.1%, 4.1%, and 13.0% [metastasis], and 0.5%, 3.4%, and 6.6% [PCSM], respectively, and in Diaz risk groups 1, 2, 3, 4, and 5 were 5.5%, 20.6%, 41.8%, 66.9%, and 89.2% [BCF], 0%, 0.5%, 3.2%, 20.5%, and 60.0% [metastasis], and 0%, 0.8%, 0.6%, 13.5%, and 37.5% [PCSM], respectively. The OS rates in D'Amico low-to-high and Diaz 1-to-5 risk groups at 15-years were 85.9%, 78.6%, and 75.2%, and 89.4%, 83.2%, 80.6%, 67.2%, and 23.4%, respectively. CONCLUSIONS Men diagnosed with clinically-localized prostate cancer in the contemporaneous PSA-screening era and treated with RALP achieve durable long-term oncological control. The data reported here (in a risk-stratified manner) represent the longest follow-up after robotic radical prostatectomy, and as such, should be of value when counseling patients regarding expected oncologic outcomes from RALP.
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Affiliation(s)
- Akshay Sood
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
- Department of Urology, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | - Ralph Grauer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mireya Diaz-Insua
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Ashutosh K Tewari
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ashok K Hemal
- Department of Urology, Wake Forest University, Winston-Salem, NC, USA
| | | | - James O Peabody
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Firas Abdollah
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Jan K Rudzinski
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jack R Andrews
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Michael A Gorin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Mani Menon
- VCORE - Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Bejrananda T, Pliensiri P. Prediction of biochemical recurrence after laparoscopic radical prostatectomy. BMC Urol 2023; 23:183. [PMID: 37953250 PMCID: PMC10642024 DOI: 10.1186/s12894-023-01350-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Radical prostatectomy (RP) has been considered primary treatment for localized prostate cancer. Biochemical recurrence (BCR) occur approximately 20-30% in five year after RP. We aim to develop a novel nomogram to predict BCR-free survival (BCRFS) and performed external validation using a validation cohort that may help clinicians to make better decision for tailoring adjuvant treatment to specific group of patients. MATERIALS AND METHODS This retrospective cohort study included 370 localized and regional prostate cancer patients who underwent laparoscopic radical prostatectomy (LRP) in Songklanagarind hospital between January 2010 and December 2019, the patients were divided into two groups (primary cohort and validation cohort). BCR-free survival was created using Kaplan-Meier curve. Predictive factors for BCR were identified with univariable and multivariable analysis using Cox proportional hazards model. Predictive nomogram was created using these identified factors and developed for the prediction of biochemical recurrence free survival (BCRFS) at 1 and 5 years after LRP. RESULTS For primary Songklanagarind cohort, BCR was found in 105 patients (44.7%). Overall 1-year BCR-free survival was 52.8%, and 5-year BCR-free survival was 45.7% with median time to BCR of 18.1 months. Multivariable analysis identified unfavorable factor to BCRRF which are high initial serum PSA (> 20) (p < 0.001; HR 3.2), ISUP Gleason grade group > = 3 (p 0.033; HR 2.2), positive surgical margins (p 0.046; HR 1.5), and seminal vesicle involvement (p < 0.001; HR 5.2) and using for develop a novel nomogram to predict BCR. Concordance index 0.78. CONCLUSION Prostate cancer patients with unfavorable factors, including high initial PSA (> 20), ISUP Gleason grade group > = 3, positive margin and extra-prostatic tumor extension are considered high risks and independent predictors of biochemical recurrence. This predictive models could potentially improve the 1 and 5-year BCR prediction after RP, according to the study's findings and will aid medical professionals in achieving the goal of clinical prediction and creating a proper management for the localized treatment of prostate cancer underwent laparoscopic radical prostatectomy.
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Affiliation(s)
- Tanan Bejrananda
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
| | - Pitchaya Pliensiri
- Division of Urology, Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
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Falagario UG, Knipper S, Pellegrino F, Martini A, Akre O, Egevad L, Grönberg H, Moschovas MC, Bravi CA, Tran J, Heiniger Y, von Kempis A, Schaffar R, Carrieri G, Rochat CH, Mottrie A, Ahlering TE, John H, Patel V, Graefen M, Wiklund P. Prostate Cancer-specific and All-cause Mortality After Robot-assisted Radical Prostatectomy: 20 Years' Report from the European Association of Urology Robotic Urology Section Scientific Working Group. Eur Urol Oncol 2023:S2588-9311(23)00168-2. [PMID: 37661459 DOI: 10.1016/j.euo.2023.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Evidence on long-term oncological efficacy is available only for open radical prostatectomy but remains scarce for robot-assisted radical prostatectomy (RARP). OBJECTIVE To validate the long-term survival rates after RARP and provide stratified outcomes based on contemporary prostate cancer (PCa) risk-stratification tools. DESIGN, SETTING, AND PARTICIPANTS A retrospective analysis of the European Association of Urology (EAU) Robotic Urology Section Scientific Working Group international multicenter database for RARP was performed. Patients who underwent RARP at seven pioneer robotic urology programs in Europe and the USA between 2002 and 2012 were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The primary outcomes were PCa-specific mortality and all-cause mortality. The probability of cancer-specific survival (CSS) was estimated with the competing risks method, and the probability of overall survival (OS) was estimated with the Kaplan-Meier method. RESULTS AND LIMITATIONS A total of 9876 patients who underwent RARP between 2002 and 2012 were included. Within follow-up, 1071 deaths occurred and 159 were due to PCa. At 15 yr of follow-up, CSS and OS were 97.6% (97.2%, 98.0%) and 85.5% (84.6%, 86.4%), respectively. Stratified analyses based on EAU risk groups at diagnosis and pT stage showed favorable survival rates, with low-risk (n = 4601, 46.6%), intermediate-risk (n = 4056, 41.1%), and high-risk (n = 1219, 12.3%) patients demonstrating CSS rates of 99%, 98%, and 90% at 15 yr, respectively. Notably, patients with pT3a disease had similar survival outcomes to those with pT2 disease, with worse CSS in patients with pT3b PCa (98.9% vs 97.4% vs 86.5%). Multivariable analyses identified age, prostate-specific antigen, biopsy Gleason grade group, clinical T stage, and treatment year as independent predictors of worse oncological outcomes. CONCLUSIONS Our multicenter study with long-term follow-up confirms favorable survival outcomes after RARP for localized PCa. Patients with low- and intermediate-risk disease face a higher risk of mortality from causes other than PCa. On the contrary, high-risk patients have a significantly higher risk of PCa-specific mortality. PATIENT SUMMARY In the present study, we reported the outcomes of patients with prostate cancer (PCa) who underwent robot-assisted radical prostatectomy between 10 and 20 yr ago, and we found a very low probability of dying from PCa in patients with low- and intermediate-risk PCa.
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Affiliation(s)
- Ugo Giovanni Falagario
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, University of Foggia, Foggia, Italy.
| | - Sophie Knipper
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Pellegrino
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alberto Martini
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Olof Akre
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | - Henrik Grönberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Marcio Covas Moschovas
- AdventHealth Global Robotics Institute, Orlando, FL, USA; University of Central Florida (UCF), Orlando, FL, USA
| | - Carlo Andrea Bravi
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium; Department of Urology, The Royal Marsden NHS Foundation Trust, London, UK
| | - Joshua Tran
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Yasmin Heiniger
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Robin Schaffar
- Department of Urology, Clinique Générale Beaulieu, Geneva, Switzerland
| | | | | | - Alexandre Mottrie
- Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium; ORSI Academy, Ghent, Belgium
| | - Thomas E Ahlering
- Department of Urology, University of California, Irvine Medical Center, Orange, CA, USA
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Vipul Patel
- AdventHealth Global Robotics Institute, Orlando, FL, USA; University of Central Florida (UCF), Orlando, FL, USA
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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7
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Liu X, Shi J, Li Z, Huang Y, Zhang Z, Zhang C. The Present and Future of Artificial Intelligence in Urological Cancer. J Clin Med 2023; 12:4995. [PMID: 37568397 PMCID: PMC10419644 DOI: 10.3390/jcm12154995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/10/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Artificial intelligence has drawn more and more attention for both research and application in the field of medicine. It has considerable potential for urological cancer detection, therapy, and prognosis prediction due to its ability to choose features in data to complete a particular task autonomously. Although the clinical application of AI is still immature and faces drawbacks such as insufficient data and a lack of prospective clinical trials, AI will play an essential role in individualization and the whole management of cancers as research progresses. In this review, we summarize the applications and studies of AI in major urological cancers, including tumor diagnosis, treatment, and prognosis prediction. Moreover, we discuss the current challenges and future applications of AI.
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Affiliation(s)
| | | | | | | | - Zhihong Zhang
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China; (X.L.)
| | - Changwen Zhang
- Tianjin Institute of Urology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China; (X.L.)
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8
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Wang H, Xie D, Lu J, Chu Y, Wang S, Qiao P, Wu L, Wang J. Case Report: Analysis of four cases of metastatic bladder masses after radical prostatectomy. Front Oncol 2023; 13:1211027. [PMID: 37576903 PMCID: PMC10417713 DOI: 10.3389/fonc.2023.1211027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023] Open
Abstract
Objective The aim of this study is to investigate the clinical characteristics and diagnostic and therapeutic methods of bladder metastasis after radical prostatectomy and to improve its diagnosis and treatment. Methods The clinical data of four patients with bladder metastasis after radical prostatectomy were retrospectively analyzed from January 2011 to December 2021. Three cases suffered from intermittent gross hematuria, and only one case was found to have an elevated prostate-specific antigen (PSA) value. Transurethral resection of bladder tumor was performed in four cases, in which one case also underwent resection of urethral mass. Three cases received endocrine therapy, one of which added intravesical instillation and radiation therapy. Another case received chemotherapy based on comprehensive treatment. Results According to the pathological and immunohistochemical results, three cases were acinar adenocarcinoma of the prostate with Gleason score of 9, and all cases were PSA positive and negative for cytokeratin 7 (CK7) and GATA binding protein 3 (GATA-3). One case was small cell neuroendocrine carcinoma of the prostate and was positive for chromogranin A (CGA), synaptophysin (SYN), and cluster of differentiation 56 (CD56). During the follow-up period of 4 to 13 months, one case was lost to follow-up and three cases were alive. Conclusion Bladder metastasis after radical prostatectomy is rare, and pathology combined with immunohistochemistry is the gold standard for its diagnosis. Pathological type determines its treatment. Systemic treatment is essential, and local treatment is the most palliative means. Early diagnosis and treatment is significant for better prognosis.
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Affiliation(s)
- Hao Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dawei Xie
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jun Lu
- Department of Pathology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yifan Chu
- Department of Urology, Beijing Daxing District People’s Hospital, Beijiing, China
| | - Siqi Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Peng Qiao
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Liyang Wu
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jianwen Wang
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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9
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Ferrari M, Wang L, Hoeppner L, Hahm E, Yu J, Kuzel T, Mansini A. Myeloid differentiation factor-2/LY96, a new predictive biomarker of metastasis in prostate cancer: Clinical implications as a potential therapeutic target. RESEARCH SQUARE 2023:rs.3.rs-2968406. [PMID: 37333086 PMCID: PMC10275058 DOI: 10.21203/rs.3.rs-2968406/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Relapsed prostate cancer (CaP), usually treated with androgen deprivation therapy, acquires resistance to develop into lethal metastatic castration-resistant CaP. The cause of resistance remains elusive, and the lack of biomarkers predictive of castration-resistance emergence is a stumbling block in managing the disease. We provide strong evidence that Myeloid differentiation factor-2 (MD2) plays a critical role in metastasis and CaP progression. Analysis of tumor genomic data and IHC of tumors showed a high frequency of MD2 amplification and association with poor overall survival in patients. The Decipher-genomic test validated the potential of MD2 in predicting metastasis. In vitro studies demonstrated that MD2 confers invasiveness by activating MAPK and NF-kB signaling pathways. Furthermore, we show that metastatic cells release MD2 (sMD2). We measured serum-sMD2 in patients and found that the level is correlated to disease extent. We determined the significance of MD2 as a therapeutic target and found that targeting MD2 significantly inhibited metastasis in a murine model. We conclude that MD2 predicts metastatic behavior and serum-MD2 is a non-invasive biomarker for tumor burden, whereas MD2 presence on prostate biopsy predicts adverse disease outcome. We suggest MD2-targeted therapies could be developed as potential treatments for aggressive metastatic disease.
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10
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Leitao MM, Kreaden US, Laudone V, Park BJ, Pappou EP, Davis JW, Rice DC, Chang GJ, Rossi EC, Hebert AE, Slee A, Gonen M. The RECOURSE Study: Long-term Oncologic Outcomes Associated With Robotically Assisted Minimally Invasive Procedures for Endometrial, Cervical, Colorectal, Lung, or Prostate Cancer: A Systematic Review and Meta-analysis. Ann Surg 2023; 277:387-396. [PMID: 36073772 PMCID: PMC9905254 DOI: 10.1097/sla.0000000000005698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess long-term outcomes with robotic versus laparoscopic/thoracoscopic and open surgery for colorectal, urologic, endometrial, cervical, and thoracic cancers. BACKGROUND Minimally invasive surgery provides perioperative benefits and similar oncological outcomes compared with open surgery. Recent robotic surgery data have questioned long-term benefits. METHODS A systematic review and meta-analysis of cancer outcomes based on surgical approach was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using Pubmed, Scopus, and Embase. Hazard ratios for recurrence, disease-free survival (DFS), and overall survival (OS) were extracted/estimated using a hierarchical decision tree and pooled in RevMan 5.4 using inverse-variance fixed-effect (heterogeneity nonsignificant) or random effect models. RESULTS Of 31,204 references, 199 were included (7 randomized, 23 database, 15 prospective, 154 retrospective studies)-157,876 robotic, 68,007 laparoscopic/thoracoscopic, and 234,649 open cases. Cervical cancer: OS and DFS were similar between robotic and laparoscopic [1.01 (0.56, 1.80), P =0.98] or open [1.18 (0.99, 1.41), P =0.06] surgery; 2 papers reported less recurrence with open surgery [2.30 (1.32, 4.01), P =0.003]. Endometrial cancer: the only significant result favored robotic over open surgery [OS; 0.77 (0.71, 0.83), P <0.001]. Lobectomy: DFS favored robotic over thoracoscopic surgery [0.74 (0.59, 0.93), P =0.009]; OS favored robotic over open surgery [0.93 (0.87, 1.00), P =0.04]. Prostatectomy: recurrence was less with robotic versus laparoscopic surgery [0.77 (0.68, 0.87), P <0.0001]; OS favored robotic over open surgery [0.78 (0.72, 0.85), P <0.0001]. Low-anterior resection: OS significantly favored robotic over laparoscopic [0.76 (0.63, 0.91), P =0.004] and open surgery [0.83 (0.74, 0.93), P =0.001]. CONCLUSIONS Long-term outcomes were similar for robotic versus laparoscopic/thoracoscopic and open surgery, with no safety signal or indication requiring further research (PROSPERO Reg#CRD42021240519).
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Affiliation(s)
- Mario M Leitao
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
- Department of Obstetrics and Gynecology, Weill Cornell Medical College, NY, NY, USA
| | - Usha S Kreaden
- Biostatistics and Global Evidence Management, Intuitive Surgical, Sunnyvale, CA, USA
| | - Vincent Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Bernard J Park
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - Emmanouil P Pappou
- Colorectal Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, NY, USA
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - David C Rice
- Department of Thoracic and Cardiovascular Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - George J Chang
- Department of Colon and Rectal Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emma C Rossi
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - April E Hebert
- Biostatistics and Global Evidence Management, Intuitive Surgical, Sunnyvale, CA, USA
| | | | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, NY, NY, USA
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11
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Jia Y, Quan S, Ren J, Wu H, Liu A, Gao Y, Hao F, Yang Z, Zhang T, Hu H. MRI radiomics predicts progression-free survival in prostate cancer. Front Oncol 2022; 12:974257. [PMID: 36110963 PMCID: PMC9468743 DOI: 10.3389/fonc.2022.974257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 01/31/2023] Open
Abstract
Objective To assess the predictive value of magnetic resonance imaging (MRI) radiomics for progression-free survival (PFS) in patients with prostate cancer (PCa). Methods 191 patients with prostate cancer confirmed by puncture biopsy or surgical pathology were included in this retrospective study, including 133 in the training group and 58 in the validation group. All patients underwent T2WI and DWI serial scans. Three radiomics models were constructed using univariate logistic regression and Gradient Boosting Decision Tree(GBDT) for feature screening, followed by Cox risk regression to construct a mixed model combining radiomics features and clinicopathological risk factors and to draw a nomogram. The performance of the models was evaluated by receiver operating characteristic curve (ROC), calibration curve and decision curve analysis. The Kaplan-Meier method was applied for survival analysis. Results Compared with the radiomics model, the hybrid model consisting of a combination of radiomics features and clinical data performed the best in predicting PFS in PCa patients, with AUCs of 0.926 and 0.917 in the training and validation groups, respectively. Decision curve analysis showed that the radiomics nomogram had good clinical application and the calibration curve proved to have good stability. Survival curves showed that PFS was shorter in the high-risk group than in the low-risk group. Conclusion The hybrid model constructed from radiomics and clinical data showed excellent performance in predicting PFS in prostate cancer patients. The nomogram provides a non-invasive diagnostic tool for risk stratification of clinical patients.
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Affiliation(s)
- Yushan Jia
- Affiliated Hospital, Inner Mongolia Medical University, Hohhot, China
| | - Shuai Quan
- Department of Pharmaceuticals Diagnosis, GE Healthcare (China), Shanghai, China
| | - Jialiang Ren
- Department of Pharmaceuticals Diagnosis, GE Healthcare (China), Shanghai, China
| | - Hui Wu
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China,*Correspondence: Hui Wu, ; Aishi Liu,
| | - Aishi Liu
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China,*Correspondence: Hui Wu, ; Aishi Liu,
| | - Yang Gao
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Fene Hao
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Zhenxing Yang
- Department of Radiology, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Tong Zhang
- Affiliated Hospital, Inner Mongolia Medical University, Hohhot, China
| | - He Hu
- Affiliated Hospital, Inner Mongolia Medical University, Hohhot, China
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12
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Fulcoli V, Bianco M, Sartor G, Agostini A, Costa G, Laurini L. Safety of robot-assisted radical prostatectomy in an Italian spoke hospital: Long-term oncologic and functional outcomes with median 11.3 years follow-up. Urologia 2022; 89:248-256. [PMID: 35139712 DOI: 10.1177/03915603221077595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Robot-assisted radical prostatectomy (RARP) long-term oncologic outcomes were published in few studies. This paper provides a complete overview of RARP long-term oncologic and functional results produced in an Italian spoke hospital. METHODS From December 2004 to December 2010, 300 consecutive patients with prostate cancer were treated with extraperitoneal RARP. Biochemical recurrence-free survival (BCRFS), salvage therapy-free survival (STFS), prostate cancer specific survival (PCa-SS), and overall survival (OS) were estimated using the Kaplan-Meier analysis and log-rank test. Cox proportional hazard regression analysis was performed to identify predictors of BCR and ST. Crude rates of continence and potency recovery after surgery were reported. RESULTS Median follow-up was 135.6 months (IQR 20-184). At 15 years, BCR-FS, ST-FS, PCa-SS, and OS rates were 78% (95% CI 0.73-0.83), 85% (95% CI 0.81 -0.89), 98% (95% CI 0.97-100), and 89% (95% CI 0.84-0.94), respectively. On multivariate analysis, biopsy ISUP grade ⩾2, clinical stage ⩾pT3a, D'Amico high-risk patients subgroup, pathologic ISUP grade ⩾2, and multifocal/extensive positive margins were independent predictors of BCR. The same risk factors plus D'Amico intermediate risk patients subgroup were independent predictors of ST. After surgery, 280 (93.3%) and 93 (35.2%) patients experienced continence and potency recovery, respectively. The retrospective nature of the analysis and some selection biases represent the principal limitations of the study. CONCLUSION The results showed in the present study match those obtained in referral centers and this is an evidence against the general belief that best prostate cancer care in provided in high volume hospitals and against centralization. Adverse characteristics of the tumor remain the best predictors of BCR and ST.
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Affiliation(s)
- Vittorio Fulcoli
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy
| | - Marta Bianco
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy
| | | | - Andrea Agostini
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy
| | - Giuseppe Costa
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy.,Chief of Urologic Unit, Camposampiero Civil Hospital, Padua, Italy
| | - Lucio Laurini
- Urology Unit, Camposampiero Civil Hospital, Camposampiero, Padua, Italy.,Past Chief of Urologic Unit (Retired), Camposampiero Civil Hospital, Padua, Italy
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13
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Sood A, Jeong W, Palma-Zamora I, Abdollah F, Butaney M, Corsi N, Wurst H, Arora S, Kachroo N, Hassan O, Gupta N, Gorin MA, Menon M. Description of Surgical Technique and Oncologic and Functional Outcomes of the Precision Prostatectomy Procedure (IDEAL Stage 1-2b Study). Eur Urol 2021; 81:396-406. [PMID: 34872786 DOI: 10.1016/j.eururo.2021.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/23/2021] [Accepted: 10/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The existing treatment options for men with intermediate- or high-volume low-risk prostate cancer (PCa) are associated with a substantial risk of over- or undertreatment. The development of risk-adjusted therapies is an unmet need for these patients. OBJECTIVE To describe our novel technique of precision prostatectomy, a form of surgical focal therapy that allows radical excision of the index PCa lesion along with >90% prostatic tissue extirpation while preserving the prostatic capsule and seminal vesicle/vas deferens complex on the side contralateral to the dominant cancer lesion, and to report on medium-term functional and oncologic outcomes in the first 88 consecutive men who underwent this procedure between December 2016 and January 2020. DESIGN, SETTING, AND PARTICIPANTS Men with (1) prostate-specific antigen (PSA) ≤20 ng/ml, (2) clinical T stage ≤cT2, (3) a dominant unilateral lesion with Gleason ≤ 4 + 3 disease with any number or percentage of cores involved ipsilaterally on prostate biopsy, (4) no primary Gleason ≥4 lesion contralaterally, and (5) a preoperative Sexual Health Inventory of Men (SHIM) score of ≥17 (out of 25) with/without phosphodiesterase type-5 inhibitor use who consented to undergo precision prostatectomy were included in this single-arm, single-center, IDEAL stage 2b prospective development study. INTERVENTION Robotic precision prostatectomy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The safety and urinary, sexual, and oncologic outcomes of the precision prostatectomy technique were studied. Descriptive statistics and Kaplan-Meier analyses were used to assess 12-mo urinary continence (0-1 pad), 12-mo sexual potency (SHIM score ≥17), 36-mo freedom from clinically significant PCa (grade group ≥2), secondary treatments, metastatic disease, and mortality. RESULTS AND LIMITATIONS At study entry, the median age, PSA, and SHIM score were 60.0 yr (interquartile range [IQR] 54.2-65.9), 5.7 ng/ml (IQR 4.2-7.1), and 22 points (IQR 19-24), respectively. The median follow-up was 25 mo (IQR 14-38). At 12 mo, all patients were continent (0-1 pads), with 90.9% of patients using 0 pads. The median time to urinary continence was 1 mo (IQR 1-4). At 12 mo, 85% of all-comers and 90.2% of the preoperatively potent men were potent. The median time to sexual potency was 4 mo (IQR 4-12). From an oncologic standpoint, at 36 mo an estimated 93.4% of the patients were free from clinically significant residual PCa and 91.7% had not undergone any additional treatment. All patients were alive and free of metastatic disease at 36 mo. CONCLUSIONS Precision prostatectomy is technically safe and reproducible and offers excellent postoperative functional results. At 36-mo follow-up, the oncologic outcomes and secondary treatment rates appear to be superior to existing ablative focal therapy results. Pending long-term data, a risk-stratified surgical approach to PCa may avoid whole-gland therapy and preserve functional quality of life in men with localized PCa. PATIENT SUMMARY Precision prostatectomy is a new form of focal therapy for intermediate-risk prostate cancer in which a 5-10-mm rim of prostate capsule is left on the opposite side of the gland to where the dominant cancer is located. The technique appears to be safe and efficacious and adds to the growing armamentarium of risk-adapted therapies for treatment of localized prostate cancer that avoid the adverse effects on urinary and erectile function of whole-gland treatments.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA; VCORE Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA.
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | | | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA; VCORE Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA
| | - Mohit Butaney
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Nicholas Corsi
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Hallie Wurst
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Sohrab Arora
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Naveen Kachroo
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Oudai Hassan
- Department of Pathology, Henry Ford Hospital, Detroit, MI, USA
| | - Nilesh Gupta
- Department of Pathology, Henry Ford Hospital, Detroit, MI, USA
| | - Michael A Gorin
- Urology Associates and UPMC Western Maryland, Cumberland, MD, USA; Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA; VCORE Vattikuti Urology Institute Center for Outcomes Research, Analytics and Evaluation, Henry Ford Hospital, Detroit, MI, USA; Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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14
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Schuhmacher J, Heidu S, Balchen T, Richardson JR, Schmeltz C, Sonne J, Schweiker J, Rammensee HG, Thor Straten P, Røder MA, Brasso K, Gouttefangeas C. Vaccination against RhoC induces long-lasting immune responses in patients with prostate cancer: results from a phase I/II clinical trial. J Immunother Cancer 2021; 8:jitc-2020-001157. [PMID: 33184050 PMCID: PMC7662471 DOI: 10.1136/jitc-2020-001157] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2020] [Indexed: 12/13/2022] Open
Abstract
Background Peptide-based vaccination is a rational option for immunotherapy of prostate cancer. In this first-in-man phase I/II study, we assessed the safety, tolerability and immunological impact of a synthetic long peptide vaccine targeting Ras homolog gene family member C (RhoC) in patients with prostate cancer. RhoC is a small GTPase overexpressed in advanced solid cancers, metastases and cancer stem cells. Methods Twenty-two patients who had previously undergone radical prostatectomy received subcutaneous injections of 0.1 mg of a single RhoC-derived 20mer peptide emulsified in Montanide ISA-51 every 2 weeks for the first six times, then five times every 4 weeks for a total treatment time of 30 weeks. The drug safety and vaccine-specific immune responses were assessed during treatment and thereafter within a 13-month follow-up period. Serum level of prostate-specific antigen was measured up to 26 months postvaccination. Results Most patients (18 of 21 evaluable) developed a strong CD4 T cell response against the vaccine, which lasted at least 10 months following the last vaccination. Three promiscuouslypresented HLA-class II epitopes were identified. Vaccine-specific CD4 T cells were polyfunctional and effector memory T cells that stably expressed PD-1 (CD279) and OX-40 (CD134), but not LAG-3 (CD223). One CD8 T cell response was detected in addition. The vaccine was well tolerated and no treatment-related adverse events of grade ≥3 were observed. Conclusion Targeting of RhoC induced a potent and long-lasting T cell immunity in the majority of the patients. The study demonstrates an excellent safety and tolerability profile. Vaccination against RhoC could potentially delay or prevent tumor recurrence and metastasis formation. Trial registration number NCT03199872.
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Affiliation(s)
- Juliane Schuhmacher
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | - Sonja Heidu
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | | | - Jennifer Rebecca Richardson
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany
| | | | - Jesper Sonne
- Zelo Phase I Unit, DanTrials ApS, Copenhagen, Denmark
| | - Jonas Schweiker
- Department of Oncology, Haematology, Immunology, Rheumatology and Pulmonology, University Hospital of Tübingen, Tübingen, Germany
| | - Hans-Georg Rammensee
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany.,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
| | - Per Thor Straten
- Department of Oncology, Center for Cancer Immune Therapy (CCIT), University Hospital Herlev & Department of Immunology and Microbiology, University of Copenhagen, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Copenhagen Prostate Cancer Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Cécile Gouttefangeas
- Department of Immunology, Institute for Cell Biology, University of Tübingen, Tubingen, Germany .,Cluster of Excellence iFIT (EXC2180) "Image-Guided and Functionally Instructed Tumor Therapies", University of Tübingen, Tübingen, Germany.,German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), partner site Tübingen, Tübingen, Germany
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15
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Ekşi M, Evren İ, Akkaş F, Arıkan Y, Özdemir O, Özlü DN, Ayten A, Sahin S, Tuğcu V, Taşçı AI. Machine learning algorithms can more efficiently predict biochemical recurrence after robot-assisted radical prostatectomy. Prostate 2021; 81:913-920. [PMID: 34224165 DOI: 10.1002/pros.24188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To develop a model for predicting biochemical recurrence (BCR) in patients with long follow-up periods using clinical parameters and the machine learning (ML) methods. MATERIALS METHOD Patients who underwent robot-assisted radical prostatectomy between January 2014 and December 2019 were retrospectively reviewed. Patients who did not have BCR were assigned to Group 1, while those diagnosed with BCR were assigned to Group 2. The patient's demographic data, preoperative and postoperative parameters were all recorded in the database. Three different ML algorithms were employed: random forest, K-nearest neighbour, and logistic regression. RESULTS Three hundred and sixty-eight patients were included in this study. Among these patients, 295 (80.1%) did not have BCR (Group 1), while 73 (19.8%) had BCR (Group 2). The mean duration of follow-up and duration until the diagnosis of BCR was calculated as 35.2 ± 16.7 and 11.5 ± 11.3 months, respectively. The multivariate analysis revealed that NLR, PSAd, risk classification, PIRADS score, T stage, presence or absence of positive surgical margin, and seminal vesicle invasion were predictive for BCR. Classic Cox regression analysis had an area under the curve (AUC) of 0.915 with a sensitivity and specificity of 90.6% and 79.8%. The AUCs for receiver-operating characteristic curves for random forest, K nearest neighbour, and logistic regression were 0.95, 0.93, and 0.93, respectively. All ML models outperformed the conventional statistical regression model in the prediction of BCR after prostatectomy. CONCLUSION The construction of more reliable and potent models will provide the clinicians and patients with advantages such as more accurate risk classification, prognosis estimation, early intervention, avoidance of unnecessary treatments, relatively lower morbidity and mortality. The ML methods are cheap, and their powers increase with increasing data input; we believe that their clinical use will increase over time.
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Affiliation(s)
- Mithat Ekşi
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - İsmail Evren
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Fatih Akkaş
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Yusuf Arıkan
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Osman Özdemir
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Deniz N Özlü
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali Ayten
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Volkan Tuğcu
- Department of Urology, Bahcelievler Memorial Hospital, İstanbul, Turkey
| | - Ali I Taşçı
- Department of Urology, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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16
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Xia H, Yang D, He W, Zhu X, Yan Y, Liu Z, Liu T, Yang J, Tan S, Jiang J, Hou X, Gao H, Ni L, Lu J. Ultrasound-mediated microbubbles cavitation enhanced chemotherapy of advanced prostate cancer by increasing the permeability of blood-prostate barrier. Transl Oncol 2021; 14:101177. [PMID: 34271256 PMCID: PMC8287239 DOI: 10.1016/j.tranon.2021.101177] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 12/25/2022] Open
Abstract
Combination therapy increased cell apoptosis and the inhibition of cell viability. Combination therapy enhanced chemotherapy efficacy by increasing cell permeability. Success in developing an orthotopic model of prostate tumor implantation in mice. Combination therapy inhibited tumor growth and prolonged the survival of mice.
Although chemotherapy is an important treatment for advanced prostate cancer, its efficacy is relatively limited. Ultrasound-induced cavitation plays an important role in drug delivery and gene transfection. However, whether cavitation can improve the efficacy of chemotherapy for prostate cancer remains unclear. In this study, we treated RM-1 mouse prostate carcinoma cells with a combination of ultrasound-mediated microbubble cavitation and paclitaxel. Our results showed that combination therapy led to a more pronounced inhibition of cell viability and increased cell apoptosis. The enhanced efficacy of chemotherapy was attributed to the increased cell permeability induced by cavitation. Importantly, compared with chemotherapy alone (nab-paclitaxel), chemotherapy combined with ultrasound-mediated microbubble cavitation significantly inhibited tumor growth and prolonged the survival of tumor-bearing mice in an orthotopic mouse model of RM-1 prostate carcinoma, indicating the synergistic effects of combined therapy on tumor reduction. Furthermore, we analyzed tumor-infiltrating lymphocytes and found that during chemotherapy, the proportions of CTLA4+ cells and PD-1+/CTLA4+ cells in CD8+ T cells slightly increased after cavitation treatment.
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Affiliation(s)
- Haizhui Xia
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Decao Yang
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing 100191, China
| | - Wei He
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Xuehua Zhu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Ye Yan
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Zenan Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Tong Liu
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing 100191, China
| | - Jianling Yang
- Institute of Medical Innovation and Research, Peking University Third Hospital, Beijing 100191, China
| | - Shi Tan
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Jie Jiang
- Department of Ultrasound, Peking University Third Hospital, Beijing 100191, China
| | - Xiaofei Hou
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Huile Gao
- Key Laboratory of Drug-Targeting and Drug Delivery System of the Education Ministry, Sichuan Engineering Laboratory for Plant-Sourced Drug and Sichuan Research Center for Drug Precision Industrial Technology, West China School of Pharmacy, Sichuan University, Chengdu 610064, China
| | - Ling Ni
- Institute for Immunology and School of Medicine, Tsinghua University, Medical Research Building, Beijing 100084, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China.
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17
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Zhao HB, Zeng YR, Han ZD, Zhuo YJ, Liang YK, Hon CT, Wan S, Wu S, Dahl D, Zhong WD, Wu CL. Novel immune-related signature for risk stratification and prognosis in prostatic adenocarcinoma. Cancer Sci 2021; 112:4365-4376. [PMID: 34252262 PMCID: PMC8486177 DOI: 10.1111/cas.15062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/16/2021] [Accepted: 07/06/2021] [Indexed: 12/14/2022] Open
Abstract
A substantial proportion of prostatic adenocarcinoma (PRAD) patients experience biochemical failure (BCF) after radical prostatectomy (RP). The immune microenvironment plays a vital role in carcinogenesis and the development of PRAD. This study aimed to identify a novel immune-related gene (IRG)-based signature for risk stratification and prognosis of BCF in PRAD. Weighted gene coexpression network analysis was carried out to identify a BCF-related module in a discovery cohort of patients who underwent RP at the Massachusetts General Hospital. The median follow-up time was 70.32 months. Random forest and multivariate stepwise Cox regression analyses were used to identify an IRG-based signature from the specific module. Risk plot analyses, Kaplan-Meier curves, receiver operating characteristic curves, univariate and multivariate Cox regression analyses, stratified analysis, and Harrell's concordance index were used to assess the prognostic value and predictive accuracy of the IRG-based signature in the internal discovery cohort; The Cancer Genome Atlas database was used as a validation cohort. Tumor immune estimation resource database analysis and CIBERSORT algorithm were used to assess the immunophenotype of PRAD. A novel IRG-based signature was identified from the specific module. Five IRGs (BUB1B, NDN, NID1, COL4A6, and FLRT2) were verified as components of the risk signature. The IRG-based signature showed good prognostic value and predictive accuracy in both the discovery and validation cohorts. Infiltrations of various immune cells were significantly different between low-risk and high-risk groups in PRAD. We identified a novel IRG-based signature that could function as an index for assessing tumor immune status and risk stratification in PRAD.
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Affiliation(s)
- Hai-Bo Zhao
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Urology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yan-Ru Zeng
- Department of Anesthesiology, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Zhao-Dong Han
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Urology, The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
| | - Yang-Jia Zhuo
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Urology, The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
| | - Ying-Ke Liang
- Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Urology, The Second Affiliated Hospital, South China University of Technology, Guangzhou, China
| | - Chi Tin Hon
- Macau Institute of Systems Engineering, Macau University of Science and Technology, Macau, China
| | - Song Wan
- Department of Urology, Huadu District People's Hospital, Southern Medical University, Guangzhou, China
| | - Shulin Wu
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Douglas Dahl
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Wei-De Zhong
- Guangdong Provincial Institute of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Urology, Guangdong Key Laboratory of Clinical Molecular Medicine and Diagnostics, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China.,Department of Urology, The Second Affiliated Hospital, South China University of Technology, Guangzhou, China.,Macau Institute for Applied Research in Medicine and Health, Macau University of Science and Technology, Macau, China
| | - Chin-Lee Wu
- Department of Urology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
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18
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Deep Learning with Quantitative Features of Magnetic Resonance Images to Predict Biochemical Recurrence of Radical Prostatectomy: A Multi-Center Study. Cancers (Basel) 2021; 13:cancers13123098. [PMID: 34205786 PMCID: PMC8234539 DOI: 10.3390/cancers13123098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/19/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Biochemical recurrence after radical prostatectomy is vitally important for long-term oncological control and subsequent treatment of these patients. We applied radiomic technique to extract features from MR images of prostate cancer patients, and used deep learning algorithm to establish a predictive model for biochemical recurrence with high accuracy. The model was validated in 2 indepented cohorts with superior predictive value than traditional stratification systems. With the aid of this model, we are able to distinghuish patients with higher risk of developing biochemical recurrence at early stage, thus providing a window to initiate neoadjuvant or adjuvant therapies for prostate cancer patients. Abstract Biochemical recurrence (BCR) occurs in up to 27% of patients after radical prostatectomy (RP) and often compromises oncologic survival. To determine whether imaging signatures on clinical prostate magnetic resonance imaging (MRI) could noninvasively characterize biochemical recurrence and optimize treatment. We retrospectively enrolled 485 patients underwent RP from 2010 to 2017 in three institutions. Quantitative and interpretable features were extracted from T2 delineated tumors. Deep learning-based survival analysis was then applied to develop the deep-radiomic signature (DRS-BCR). The model’s performance was further evaluated, in comparison with conventional clinical models. The model achieved C-index of 0.802 in both primary and validating cohorts, outweighed the CAPRA-S score (0.677), NCCN model (0.586) and Gleason grade group systems (0.583). With application analysis, DRS-BCR model can significantly reduce false-positive predictions, so that nearly one-third of patients could benefit from the model by avoiding overtreatments. The deep learning-based survival analysis assisted quantitative image features from MRI performed well in prediction for BCR and has significant potential in optimizing systemic neoadjuvant or adjuvant therapies for prostate cancer patients.
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19
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A novel nomogram provides improved accuracy for predicting biochemical recurrence after radical prostatectomy. Chin Med J (Engl) 2021; 134:1576-1583. [PMID: 34133352 PMCID: PMC8280057 DOI: 10.1097/cm9.0000000000001607] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Various prediction tools have been developed to predict biochemical recurrence (BCR) after radical prostatectomy (RP); however, few of the previous prediction tools used serum prostate-specific antigen (PSA) nadir after RP and maximum tumor diameter (MTD) at the same time. In this study, a nomogram incorporating MTD and PSA nadir was developed to predict BCR-free survival (BCRFS). Methods: A total of 337 patients who underwent RP between January 2010 and March 2017 were retrospectively enrolled in this study. The maximum diameter of the index lesion was measured on magnetic resonance imaging (MRI). Cox regression analysis was performed to evaluate independent predictors of BCR. A nomogram was subsequently developed for the prediction of BCRFS at 3 and 5 years after RP. Time-dependent receiver operating characteristic (ROC) curve and decision curve analyses were performed to identify the advantage of the new nomogram in comparison with the cancer of the prostate risk assessment post-surgical (CAPRA-S) score. Results: A novel nomogram was developed to predict BCR by including PSA nadir, MTD, Gleason score, surgical margin (SM), and seminal vesicle invasion (SVI), considering these variables were significantly associated with BCR in both univariate and multivariate analyses (P < 0.05). In addition, a basic model including Gleason score, SM, and SVI was developed and used as a control to assess the incremental predictive power of the new model. The concordance index of our model was slightly higher than CAPRA-S model (0.76 vs. 0.70, P = 0.02) and it was significantly higher than that of the basic model (0.76 vs. 0.66, P = 0.001). Time-dependent ROC curve and decision curve analyses also demonstrated the advantages of the new nomogram. Conclusions: PSA nadir after RP and MTD based on MRI before surgery are independent predictors of BCR. By incorporating PSA nadir and MTD into the conventional predictive model, our newly developed nomogram significantly improved the accuracy in predicting BCRFS after RP.
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20
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Su SH, Chang YH, Huang LK, Chu YC, Kan HC, Liu CY, Lin PH, Yu KJ, Wu CT, Pang ST, Chuang CK, Shao IH. Clinical predictors for biochemical failure in patients with positive surgical margin after robotic-assisted radical prostatectomy. TUMORI JOURNAL 2021; 108:270-277. [PMID: 33845702 DOI: 10.1177/03008916211007928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Patients with positive surgical margins (PSMs) after radical prostatectomy for localized prostate cancer have a higher risk of biochemical failure (BCF). We investigated the risk factors of BCF in patients with PSMs after robotic-assisted radical prostatectomy (RARP). METHODS We evaluated 462 patients who underwent RARP in a single medical center from 2006 through 2013. Of them, 61 with PSMs did not receive any treatment before BCF. Kaplan-Meier curve and Cox regression analysis were used to compare patients with (n = 19) and without (n = 41) BCF. RESULTS Overall, 13.2% of patients had PSMs, and of those, 31.7% experienced BCF during follow-up. The mean follow-up duration was 43.7 months (42.4 [non-BCF] vs 46.35 (BCF], p = 0.51). In univariant analyses, the platelet to lymphocyte ratio (6.26 [non-BCF] vs 8.02 [BCF], p = 0.04) differed statistically. When patients were grouped by pathologic grade ≦2 or ≧3 (p = 0.004), the BCF-free survival rates differed significantly. Seminal vesicle invasion also differed significantly (5 [non-BCF] vs 7 [BCF], p = 0.005). Patients with undetectable nadir prostate-specific antigen (PSA) after RARP (BCF rate 4/34) differed statistically from those with detectable PSA after RARP (BCF rate 15/26) (p < 0.001). In the multivariate analysis, the platelet/lymphocyte (P/L) ratio, pathologic grade, and undetectable nadir PSA remained statistically significant. CONCLUSIONS In patients who undergo RARP and have PSMs, P/L ratio >9 preoperatively, pathologic grade ⩾3, and detectable nadir PSA after RARP should be considered adverse features. Early intervention such as salvage radiation therapy or androgen deprivation therapy should be offered to these patients.
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Affiliation(s)
- Shih-Huan Su
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ying-Hsu Chang
- Department of Urology, New Taipei City TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei Municipal, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Kang Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yuan-Cheng Chu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hung-Cheng Kan
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Yi Liu
- Department of Urology, New Taipei City TuCheng Hospital, Chang Gung Memorial Hospital and Chang Gung University, New Taipei Municipal, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Po-Hung Lin
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Jie Yu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Te Wu
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - See-Tong Pang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Keng Chuang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Hung Shao
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.,Department of Medicine, Chang Gung University, Taoyuan, Taiwan.,Cancer Genome Research Center, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
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21
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Vermassen T, Van Den Broeck A, Lumen N, Callewaert N, Rottey S, Delanghe J. Tissue N-linked glycosylation as potential prognostic biomarker for biochemical recurrence-free survival. Biomarkers 2021; 26:275-285. [PMID: 33657946 DOI: 10.1080/1354750x.2021.1891290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE Only few biomarkers have been evaluated for their prognostic value following radical prostatectomy. We explored if tissue N-glycosylation shows prognostic properties for biochemical recurrence (BCR)-free survival. MATERIALS AND METHODS Tissue N-glycosylation profile was determined from 82 prostate cancer (PCa) patients and prognostic features were compared to clinical and biochemical parameters for BCR-free survival. RESULTS Majority presented with Gleason score 3 + 4 (41%), extensive local disease (62%) and without pelvic lymph nodes invasion (83%). Several parameters (low T stage, low Gleason score, low EAU risk groups for BCR, absence of positive surgical margins, high ratio of fucosylated triantennary structures on total of multiantennary structures [3AFc/MA], low ratio of fucosylated biantennary with core-branched N-acetylglucosamine on total of biantennary structures, and high ratio of triantennary structures on total of multiantennary structures) proved to have a univariate beneficial effect on BCR-free survival. Multivariate analysis proved positive surgical margins and 3AFc/MA to be independent prognosticators. CONCLUSIONS Tissue N-glycans are a powerful prognostic tool and can be an asset in PCa as the ratio of 3AFc/MA is independently associated with BCR-free survival. This could be of clinical use in guiding patients following radical prostatectomy, e.g. referral to adjuvant radiotherapy. Further elaboration of this biomarker is warranted.
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Affiliation(s)
- Tijl Vermassen
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Nico Callewaert
- Department for Molecular Biomedical Research, VIB-UGent Center for Medical Biotechnology, Ghent, Belgium
| | - Sylvie Rottey
- Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joris Delanghe
- Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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22
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The Predictive Role of Prostate-Specific Antigen Changes Following Transurethral Resection of the Prostate for Patients with Localized Prostate Cancer. Cancers (Basel) 2020; 13:cancers13010074. [PMID: 33383882 PMCID: PMC7796215 DOI: 10.3390/cancers13010074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/28/2022] Open
Abstract
Simple Summary A part of localized prostate cancer (PC) was an incidental finding in patients who received transurethral resection of the prostate (TURP) for urinary symptoms. The present study examined whether changes in prostate-specific antigen (PSA) levels after TURP possess a predictive value for localized PC. Our data revealed that patients at intermediate risk who are associated with tumor involvement ≤5% in TURP specimens, PSA_TURP ≤ 4 ng/mL, and ≥68% PSA reduction following TURP might be suitable for conservation management instead of immediate local therapy. Moreover, for patients with no pre-TURP PSA, Gleason score (GS) < 7, and low PSA_TURP could potentially be utilized to select which patients could be considered for conservative management after TURP. The findings suggest the pathologic finding of TURP and changes in PSA could be used as adjuvant markers to guide a risk-adaptive strategy for patients with localized PC. Abstract Regarding localized prostate cancer (PC), questions remain regarding which patients are appropriate candidates for conservative management. Some localized PC was an incidental finding in patients who received transurethral resection of the prostate (TURP) for urinary symptoms. It is known that TURP usually affects the level of prostate-specific antigen (PSA). In the present study, we examined whether changes in PSA levels after TURP possess a predictive value for localized PC. We retrospectively reviewed the clinical data of 846 early-stage PC patients who underwent TURP for urinary symptoms upon diagnosis at our hospital. Of 846 patients, 687 had tumor involvement in TURP specimens, and 362 had post-TURP PSA assessment. Our data revealed that, in addition to low GS and PSA levels at diagnosis, ≤5% tumor involvement in TURP specimens, greater PSA reduction (≥68%) following TURP, and post-TURP PSA ≤ 4 were significantly associated with better progression-free survival (PFS). Survival analysis revealed that the addition of prostate-directed local therapy significantly improved PFS in intermediate- and high-risk groups, but not in the low-risk group. Moreover, in the intermediate-risk group, local therapy improved PFS only for patients who were associated with post-TURP PSA > 4 ng/mL or <68% PSA reduction following TURP. We also found that local therapy had no obvious improvement in PFS for those with post-TURP ≤ 4 ng/mL regardless of pre-TURP PSA. In conclusion, conservative management is considered for patients at low or intermediate risk who have greater PSA reduction following TURP and low post-TURP PSA. Therefore, the levels of PSA following TURP might be helpful for risk stratification and the selection of patients for conservative management.
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23
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Asimakopoulos AD, Annino F, Mugnier C, Lopez L, Hoepffner JL, Gaston R, Piechaud T. Robotic radical prostatectomy: analysis of midterm pathologic and oncologic outcomes: A historical series from a high-volume center. Surg Endosc 2020; 35:6731-6745. [PMID: 33289056 PMCID: PMC8599245 DOI: 10.1007/s00464-020-08177-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/15/2020] [Indexed: 11/12/2022]
Abstract
Background Identifying predictors of positive surgical margins (PSM) and biochemical recurrence (BCR) after radical prostatectomy (RP) may assist clinicians in formulating prognosis. Aim of the study was to report the midterm oncologic outcomes, to identify the risk factors for PSM and BCR and assess the impact of the PSM on BCR-free survival following robot-assisted laparoscopic radical prostatectomy (RALP). Methods From 2005 to 2010, 1679 consecutive patients underwent transperitoneal RALP. Data was retrospectively collected by an independent statistical company and analyzed in 2014. Median postoperative follow-up was 33.5 mo. BCR was defined as any detectable serum prostate-specific antigen (PSA) ≥ 0.2 ng/mL in two consecutive measurements. BCR-free survival was estimated using the Kaplan–Meier method. Univariate and multivariate analysis were applied to identify risk factors for PSM and BCR. Results In pN0/pNx cancers, pathologic stage was pT2 in 1186 patients (71.8%), pT3 in 455 patients (27.6%), and pT4 in 11 patients (0.6%). PSM rate was 17.4% and 36.9% of pT2 and pT3 cancers, respectively. Pathologic Gleason score was < 7, = 7 and > 7 in 42.1%, 53% and 4.9% of the patients, respectively. Overall BCR-free survival was 73.1% at 5 years; the 5-year BCR-free survival was 87.9% for pT2 with negative surgical margins. PSA, Gleason score (both bioptic and pathologic), pathologic stage (pT) and surgeon's volume were significant independent predictors of PSM. PSA, pathologic Gleason score, pT and PSM were significant independent predictors of BCR-free survival. Seminal vesicle-sparing, nerve-sparing approach and the extent of nerve-sparing (intra vs interfascial dissection) did not negatively affect margin status or BCR rates. Conclusions PSMs are a predictor of BCR. Being the only modifiable factor influencing the PSM rate, surgical experience is confirmed as a key factor for high-quality oncologic outcomes.
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Affiliation(s)
- Anastasios D Asimakopoulos
- Department of Urology, Clinique Saint Augustin, Bordeaux, France. .,Department of Surgical Sciences, Unit of Urology, Fondazione PTV Policlinico Tor Vergata, Rome, Italy.
| | - Filippo Annino
- Department of Urology, Clinique Saint Augustin, Bordeaux, France.,Unit of Urology, Ospedale San Donato, Arezzo, Italy
| | - Camille Mugnier
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Laurent Lopez
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | | | - Richard Gaston
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
| | - Thierry Piechaud
- Department of Urology, Clinique Saint Augustin, Bordeaux, France
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24
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Bonet X, Moschovas MC, Onol FF, Bhat KR, Rogers T, Ogaya-Pinies G, Rocco B, Sighinolfi MC, Woodlief T, Vigués F, Patel V. The surgical learning curve for salvage robot-assisted radical prostatectomy: a prospective single-surgeon study. Minerva Urol Nephrol 2020; 73:600-609. [PMID: 33256361 DOI: 10.23736/s2724-6051.20.04077-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The aim of this study was to report the overall results and the learning curve (LC) in salvage robot-assisted radical prostatectomy (sRARP) patients, in terms of morbidity, oncological and functional outcomes in a single surgeon tertiary-referral center. METHODS One hundred and twenty patients underwent sRARP by a single surgeon (V.P.) from 2008 to 2018. To assess the trends in the learning experience they were sub-divided in 4 groups of 30 consecutive patients based on date of surgery. The Kaplan-Meier method and regression models were used to identify survival estimations and predictors of potency, continence and biochemical failure (BCF) at 12 months. RESULTS As the learning experience for sRALP increased operative time (OT) was significantly shorter (from 139.5 to 121 minutes) and the amount of nerve-sparing (NS) undertaken increased (from 46% to 80%). While complications rate remained stable, estimated blood loss (EBL) and radiographic anastomotic leaks (RAL) decreased through the groups (from 124 to 69 ml and 40% to 16,7%, respectively). BCF and continence rates at 12 months after sRARP were similar among groups (23-36% and 36,7-50%, respectively) and chance of potency rates tended to increase (from 3.3% to 16-23%) but was not statistically significant. In a multivariate analysis, predictors for BCF were PSM and GS 8-10. Non-radiation primary treatment was the unique predictor of continence at 12 months after sRARP. CONCLUSIONS Our data may suggest a decreasing trend in terms of OT and EBL through the sRARP learning curve. While morbidity remained stable through the time, RAL trended towards a decline. A higher degree of NS was observed through the groups and there was a slight correlation trend between surgical expertise and potency recovery. PSM and GS 8-10 were predictors of BCF and non-radiation primary treatment predicted a better continence after sRARP.
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Affiliation(s)
- Xavier Bonet
- Bellvitge University Hospital, Barcelona, Spain - .,Advent Health Global Robotics Institute, Celebration, FL, USA -
| | | | - Fikret F Onol
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Kulthe R Bhat
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Travis Rogers
- Advent Health Global Robotics Institute, Celebration, FL, USA
| | - Gabriel Ogaya-Pinies
- Advent Health Global Robotics Institute, Celebration, FL, USA.,Rey Juan Carlos University Hospital, Madrid, Spain
| | - Bernardo Rocco
- Advent Health Global Robotics Institute, Celebration, FL, USA.,University of Modena and Reggio Emilia, Modena, Italy
| | | | - Tracey Woodlief
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | | | - Vipul Patel
- Advent Health Global Robotics Institute, Celebration, FL, USA
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25
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Huang MM, Schwen ZR, Biles MJ, Alam R, Gabrielson AT, Patel HD, Day J, Pierorazio PM, Pavlovich CP. A Comparative Analysis of Surgical Scar Cosmesis Based on Operative Approach for Radical Prostatectomy. J Endourol 2020; 35:138-143. [PMID: 32731747 DOI: 10.1089/end.2020.0649] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: Recent developments in minimally invasive approaches to radical prostatectomy (RP) for localized prostate cancer have improved oncological outcomes, but may also affect surgical scar cosmesis, an important component of survivorship and patient quality of life. Our aim was to evaluate surgical scar appearance based on operative approach to RP using a validated tool for evaluating psychosocial impact of scar appearance. Methods: Men between the ages of 45 and 80 were surveyed on an online crowdsourcing platform. Well-healed surgical scars after open, multiport (MP) robotic (transperitoneal and extraperitoneal), and single-port (SP) robotic RP were digitally rendered on stock photos to control for patient appearance. Respondents evaluated images using the SCAR-Q© psychosocial impact domain. Additionally, different RP scars were ranked by appearance and assigned 10-point appearance scores. Results: Two hundred thirty-four surveys were included for analysis (completion rate 84.2%). The median age was 54 (IQR: 49-61) and 35% (85/234) had previous abdominal surgery, of which 45% (38/85) was robotic or laparoscopic. SP scars had better psychosocial impact scores (median 100 out of 100 vs 69 and 58) than MP and open, respectively (both p < 0.001). SP scars were consistently ranked higher by appearance (median rank 1, IQR: 1-1) than MP (2, IQR: 2-3) and open (3, IQR: 3-4) (p < 0.001). SP without assistant port had the highest appearance score (median 9, IQR: 7-9) among all scars (p < 0.001). Conclusion: SP scars scored highest on psychosocial impact and were consistently ranked highest in appearance. These findings may be informative for optimizing both cosmetic appearance and quality of life for patients undergoing RP.
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Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zeyad R Schwen
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael J Biles
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ridwan Alam
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew T Gabrielson
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jeff Day
- Department of Art as Applied to Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christian P Pavlovich
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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26
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Huang MM, Patel HD, Wainger JJ, Su ZT, Becker REN, Han M, Pierorazio PM, Allaf ME. Comparison of Perioperative and Pathologic Outcomes Between Single-port and Standard Robot-assisted Radical Prostatectomy: An Analysis of a High-volume Center and the Pooled World Experience. Urology 2020; 147:223-229. [PMID: 32896583 DOI: 10.1016/j.urology.2020.08.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/16/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To perform an early comparative study of outcomes between single-port and robot-assisted laparoscopic radical prostatectomy (SP-RALRP) and standard RALRP at our institution and pooled analysis of series to date. PATIENTS AND METHODS Patients with organ-confined prostate cancer undergoing SP-RALRP at a high-volume institution were identified retrospectively along with reported SP-RALRP series to date. Data were compared to a contemporary prospective cohort of men undergoing standard RALRP. Patient demographics, perioperative and postoperative data, and complications categorized by the Clavien-Dindo system were compared for the institutional and pooled SP-RALRP cohorts to standard RALRP. RESULTS A total of 208 SP-RALRP cases were identified (26 from our institution) and compared to 376 standard RALRP cases. In the institutional analysis, there was no difference in operative time, length of stay, overall complications (15.4% vs 17.3%, P= 1.0), major (Clavien ≥III) complications (3.8% vs 3.7%, P = .6), inpatient opioid use, or patient-reported pain scores; median estimated blood loss (100 mL vs 150 mL, P = .02) and number of lymph nodes removed (5.5 vs 9, P = .002) were lower for SP-RALRP. In the pooled analysis, 208 patients receiving SP-RALRP had similar estimated blood loss and complication rates but fewer lymph nodes removed (P = .02) and marginally longer operating time (+16 minutes, P = .01) compared to standard RALRP. The difference in rate of positive surgical margins was not statistically significant (31.3% vs 24.5%, P = .08). CONCLUSION Based on an early experience with SP-RALRP at a high-volume center and a pooled analysis of SP series to date, perioperative and pathologic outcomes appear nearly equivalent compared to standard RALRP.
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Affiliation(s)
- Mitchell M Huang
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Hiten D Patel
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Julia J Wainger
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Zhuo T Su
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Russell E N Becker
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Misop Han
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Phillip M Pierorazio
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Mohamad E Allaf
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD
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Lyon TD, Henry MR, Shah PH, Boorjian SA, Tollefson MK, Frank I. Development of a technique for evaluating the presence of malignant cells in prostatic fluid during robotic prostatectomy. Urol Oncol 2020; 39:192.e1-192.e6. [PMID: 32868191 DOI: 10.1016/j.urolonc.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/31/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION To develop a technique to collect fluid expressed during robot-assisted radical prostatectomy (RARP) to assess whether malignant cells may have been inadvertently introduced into the surgical field. METHODS Men with clinically localized grade group 2 to 5 prostate adenocarcinoma undergoing RARP were identified. Following bladder neck division, fluid expressed via prostatic urethra during seminal vesicle dissection was aspirated (specimen A). After specimen removal, an ex vivo seminal vesicle aspiration was performed as well (specimen B). Specimens were prepared with ThinPrep (Hologic, Marlborough, MA) and stained with 4 immunohistochemical markers: keratin-7, PAX-8, prostate-specific antigen (PSA), and prostatic acid phosphatase (PACP). RESULTS Between December 2018 and May 2019, 15 men undergoing RARP were included. Median age was 60 years (range: 47-77), median PSA 8.5 ng/ml (range 5.1-24), and 7 (47%) had AUA high-risk disease. Specimen A had adequate cellularity in 13 patients (87%). Five patients were excluded from assessment of malignancy due to acellularity of specimen A (n = 2) or specimen B (n = 3). Three of the remaining 10 patients (30%) had cytologic features suspicious for malignancy on specimen A. Immunohistochemistry supported prostatic origin with positive PSA and PACP staining and negative PAX8 stains. Specimen B was not suspicious in any patient. CONCLUSION We report a technique for intraoperative collection of fluid expressed during RARP. Three patients with adverse pathologic features had evidence of cancer cells within the operative field. Further work is needed to confirm this observation and to determine whether these cells are associated with adverse oncologic outcomes.
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Affiliation(s)
| | - Michael R Henry
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Paras H Shah
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | | | - Igor Frank
- Department of Urology, Mayo Clinic, Rochester, MN.
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Pukl M, Keyes S, Keyes M, Guillaud M, Volavšek M. Multi-scale tissue architecture analysis of favorable-risk prostate cancer: Correlation with biochemical recurrence. Investig Clin Urol 2020; 61:482-490. [PMID: 32734723 PMCID: PMC7458870 DOI: 10.4111/icu.20200018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/06/2020] [Accepted: 03/24/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose Prostate cancer (PCa) with biopsy-based grade group (GG) 1 or 2 characteristics has a favorable outcome, yet some cases still progress after radical prostatectomy and present with biochemical recurrence (BCR). We hypothesized that the multi-scale tissue architecture (MSTA) analysis score would correlate with the aggressive PCa phenotype and could be used as a tool for risk assessment to improve the management of patients with favorable-risk PCa. Materials and Methods MSTA was evaluated in needle-biopsy samples from 115 patients with favorable-risk PCa, as defined by GG1 and GG2, a prostate-specific antigen (PSA) level of <10 ng/mL, a clinical stage of cT1c to cT2b, and general Gleason GG (GGG) and expert pathologist-assessed GG (EGG). Algorithms based on Voronoi diagrams were applied to all Feulgen-thionin-stained diagnostic areas. One hundred tissue architecture features were calculated and an MSTA score, a linear combination of the most discriminant features, was generated. Correlation of MSTA score with BCR and other clinical variables was investigated. Results In a univariate regression model, EGG, clinical stage, and MSTA were significant predictors of BCR (respective p-values: 0.0016, 0.016, and 0.028). Survival analysis showed that patients with a high MSTA score were more likely to experience BCR than were patients with a low MSTA score (odds ratio, 2.9). Combining MSTA with GG assessment resulted in a significant stratification of risk for BCR. Conclusions MSTA score could be used as an objective adjunct risk stratification tool to pathologist assessments and could improve the management of patients with favorable-risk PCa.
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Affiliation(s)
- Miha Pukl
- Department of Urology, General Hospital Celje, Celje, Slovenia.
| | - Sarah Keyes
- Department of Integrative Oncology, BC Cancer, Vancouver, BC, Canada
| | - Mira Keyes
- Department of Radiation Oncology, BC Cancer, Vancouver, BC, Canada
| | - Martial Guillaud
- Department of Integrative Oncology, BC Cancer, Vancouver, BC, Canada
| | - Metka Volavšek
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Suh J, Yoo S, Park J, Cho MC, Jeong CW, Ku JH, Kwak C, Kim HH, Jeong H. Differences in risk factors for biochemical recurrence after radical prostatectomy stratified by the degree of obesity: Focused on surgical methods. Sci Rep 2020; 10:10157. [PMID: 32576921 PMCID: PMC7311457 DOI: 10.1038/s41598-020-67237-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022] Open
Abstract
This study aims to evaluate differences in the risk factors for biochemical recurrence (BCR) for radical prostatectomy stratified by degree of obesity, focusing on the surgical method used. All 3099 patients who underwent radical prostatectomy in two medical centres from January 2008 to March 2018 were retrospectively reviewed. Patients were divided into three groups based on body mass index: ‘normal’, ‘overweight’, and ‘obese’. Risk factors associated with biochemical recurrence were compared between different degrees of obesity. We analysed the contributing risk factors of BCR-free survival using univariate and multivariable Cox hazard models. There were 378 (12.2%) and 1815 (58.6%) patients in the ‘obese’ and ‘overweight’ groups, respectively. Accordingly, 1324 patients underwent retropubic radical prostatectomy (RRP), and 1775 underwent robotic-assisted laparoscopic prostatectomy (RALP). Multivariable analysis showed that patients who underwent RALP had significantly lower BCR free survival in the ‘overweight’ and ‘obese’ groups than those who underwent RRP, with adjusted hazard ratios of 0.75 (95% CI 0.59–0.95, p-value = 0.01) and 0.55 (95% CI 0.33–0.90, p-value = 0.02), respectively. The degree of obesity was not directly associated with BCR-free survival. Robotic prostatectomy showed greater benefits in BCR-free survival than open prostatectomy in the ‘overweight’ and ‘obese’ groups.
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Affiliation(s)
- Jungyo Suh
- Hospital Medicine Center, Department of Urology, Seoul National University Hospital, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Sangjun Yoo
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Juhyun Park
- Department of Urology, Asan Medical Center, Seoul, South Korea
| | - Min Chul Cho
- Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Chang Wook Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Hyeon Ku
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Cheol Kwak
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Hoe Kim
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea.,Department of Urology, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyeon Jeong
- Department of Urology, Seoul National University College of Medicine, Seoul, South Korea. .,Department of Urology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
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30
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Falagario U, Veccia A, Weprin S, Albuquerque EV, Nahas WC, Carrieri G, Pansadoro V, Hampton LJ, Porpiglia F, Autorino R. Robotic-assisted surgery for the treatment of urologic cancers: recent advances. Expert Rev Med Devices 2020; 17:579-590. [PMID: 32342705 DOI: 10.1080/17434440.2020.1762487] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION As the medical field is moving toward personalized and tailored approaches, we entered the era of precision surgery for the management of genitourinary cancers1. This is facilitated by the implementation of new technologies, among which robotic surgery stands out for the significant impact in the surgical field over the last two decades. AREAS COVERED This article reviews the latest evidence on robotic surgery for the treatment of urologic cancers, including prostate, kidney, bladder, testis, and penile cancer. Functional and oncologic outcomes, new surgical techniques, new imaging modalities, and new robotic platforms are discussed. EXPERT OPINION Robotic surgery had a growing role in the management of genitourinary cancers over the past 10 years. Despite a lack of high-quality evidence comparing the effectiveness of robotic to open surgery, the robotic approach allowed a larger adoption of a minimally invasive surgical approach, translating into lower surgical morbidity and shorter hospital stay. New robotic platforms might allow to explore novel surgical approaches, and new technologies might facilitate surgical navigation and intraoperative identification of anatomical structures, allowing a more tailored and precise surgery. It is an exciting time for robotic surgery, and upcoming technological advances will offer better outcomes to urologic cancer patients.
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Affiliation(s)
- Ugo Falagario
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Alessandro Veccia
- Division of Urology, VCU Health System , Richmond, Virginia, USA.,Urology Unit, ASST Spedali Civili Hospital , Brescia, Italy.,Department of Medical and Surgical Specialties, Radiological Science, and Public Health, University of Brescia , Italy
| | - Samuel Weprin
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Emanuel V Albuquerque
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - William C Nahas
- Divisão De Urologia, Faculdade De Medicina Da Universidade De São Paulo, Instituto Do Câncer De Estado De São Paulo , São Paulo, Brazil
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia , Foggia, Italy
| | - Vito Pansadoro
- Department of Urology, Vincenzo Pansadoro Foundation , Rome, Italy
| | - Lance J Hampton
- Division of Urology, VCU Health System , Richmond, Virginia, USA
| | - Francesco Porpiglia
- Division of Urology, University of Turin, San Luigi Gonzaga Hospital , Orbassano, Italy
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Survival After Robotic-Assisted Prostatectomy for Localized Prostate Cancer: An Epidemiologic Study. Ann Surg 2019; 274:e507-e514. [PMID: 31663972 DOI: 10.1097/sla.0000000000003637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDS To determine the potential survival benefit associated with robotic-assisted laparoscopic prostatectomy (RALP) compared to open radical prostatectomy (ORP) for prostate cancer. SUMMARY OF BACKGROUND DATA RALP has become the dominant surgical approach for localized disease in the absence of randomized clinical evidence and despite of the factor that RALP is more expensive than ORP. METHODS We performed a cohort study involving patients who underwent RALP and ORP for localized prostate cancer at the Commission on Cancer-accredited hospitals in the United States. Overall survival was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards models, and propensity score-matched analyses. An interrupted time-series analysis using the surveillance, epidemiology, and end results program database was also performed. RESULTS From 2010 to 2011, 37,645 patients received RALP and 12,655 patients received ORP. At a median follow-up of 60.7 months, RALP was associated with improved overall survival by both univariate [hazard ratio (HR), 0.69; P < 0.001] and multivariate analysis (HR, 0.76; P < 0.001) compared with ORP. Propensity score-matched analysis demonstrated improved 5-year all-cause mortality (3.9% vs 5.5%, HR, 0.73; P < 0.001) for RALP. The interrupted time-series analysis demonstrated the adoption of robotic surgery coincided with a systematic improvement in the 5-year cancer-specific survival rate of 0.17% (95% confidence interval, 0.06-0.25) per year after 2003 (P = 0.004 for change of trend), as compared to the time before adoption of RALP (1998-2003, annual percentage change, 0.01%; 95% confidence interval, -0.06 to 0.08). Sensitivity analysis suggested that the results from the interrupted time-series analysis were consistent with the improvement in the all-cause mortality demonstrated in the survival analysis (P = 0.87). CONCLUSIONS In this epidemiologic analysis, RALP was associated with a small but statistically significant improvement in 5-year all-cause mortality compared to ORP for localized prostate cancer. This is the first time in the literature to report a survival benefit with RALP. Our findings have significant quality and cost implications, and provide assurance regarding a dominant adoption of more expensive technology in the absence of randomized controlled trials.
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Kim R, Kim CK, Park JJ, Kim JH, Seo SI, Jeon SS, Lee HM. Prognostic Significance for Long-Term Outcomes Following Radical Prostatectomy in Men with Prostate Cancer: Evaluation with Prostate Imaging Reporting and Data System Version 2. Korean J Radiol 2019; 20:256-264. [PMID: 30672165 PMCID: PMC6342765 DOI: 10.3348/kjr.2018.0613] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/02/2018] [Indexed: 12/12/2022] Open
Abstract
Objective To retrospectively determine whether the use of the Prostate Imaging Reporting and Data System (PI-RADS) version 2 (v2) helps predict long-term outcomes for prostate cancer (PCa) patients following radical prostatectomy (RP). Materials and Methods A total of 166 patients with localized PCa evaluated with multiparametric magnetic resonance imaging (mpMRI) at 3T before RP were enrolled. Three groups were created based on PI-RADS v2 score used to predict clinical outcomes: group A, ≥ 3; group B, ≥ 4; group C, 5. We calculated biochemical recurrence-free survival (RFS) and progression-free survival (PFS). Cox proportion hazards models were used to identify variables predictive of biochemical recurrence and disease progression. Results During a median follow-up of 9.1 years, biochemical recurrence occurred in 67 patients (40.4%) and disease progression occurred in 55 patients (33.1%). In all groups, 10-year RFS and 10-year PFS were significantly lower for PI-RADS scores ≥ 3, ≥ 4 and 5 than for score < 3, < 4 and < 5 (p <0.05), respectively. In multivariate analysis, PI-RADS score ≥ 3 and score 5 were significant independent risk marker for biochemical recurrence (hazard ratio [HR] = 5.58, p = 0.018; HR = 1.75, p = 0.033) and disease progression (HR = 3.99, p = 0.047; HR = 2.31, p = 0.040). Moderate inter-observer agreement was seen for PI-RADS scoring. Conclusion PI-RADS v2 may be used to predict long-term outcomes following RP in PCa.
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Affiliation(s)
- Ran Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Kyo Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Medical Device Management and Research, SAIHST, Sungkyunkwan University, Seoul, Korea.
| | - Jung Jae Park
- Department of Radiology, Chungnam National University Hospital, Daejeon, Korea
| | - Jae Hun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Lu CH, Ou YC, Huang LH, Weng WC, Chang YK, Chen HL, Hsu CY, Tung MC. Early Dutasteride Monotherapy in Patients With Elevated Serum Prostate-Specific Antigen Levels Following Robot-Assisted Radical Prostatectomy. Front Oncol 2019; 9:691. [PMID: 31428576 PMCID: PMC6687841 DOI: 10.3389/fonc.2019.00691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 07/12/2019] [Indexed: 12/29/2022] Open
Abstract
Background: To evaluate the efficacy of early dutasteride administration in patients with a detectable prostate-specific antigen (PSA) levels after robot-assisted radical prostatectomy (RARP). Methods: We retrospectively analyzed RARP patients whose pathological stage is T2a to T3b without lymph node or distant metastasis from 2007 to 2017. All patients received a daily dose of 0.5 mg of dutasteride when post-RARP PSA levels were increasing but had not achieved biochemical recurrence. PSA levels were monitored every 3 months after dutasteride administration. None of the patients received radiotherapy (RT) or androgen-deprivation therapy (ADT) before taking dutasteride. All follow-ups were begun from RARP to January 2019 or to the date of RT/ADT. Results: Thirty-five patients were included in this analysis. The median followed up was 53.6 months. Twenty-two patients (62.9%) showed a PSA response in which the PSA decreased more than 10% at the first follow-up after dutasteride administration. The Pathological stage > T2 (p = 0.012) and positive surgical margin (p = 0.046) were prognostic factors for a PSA response. Twenty-three out of 35 included patients (65.7%) did not require further RT/ADT. The significant risk factor was the PSA level (p = 0.011) at the beginning of dutasteride treatment. The cut-off value of the PSA level to avoid further RT/ADT was 0.195 ng/ml. Conclusions: Early dutasteride administration showed a significant decline in the PSA levels of patients with pathology stage >T2 and positive surgical margin in our retrospective hypothesis-generating study. If dutasteride was provided before the PSA value increased to 0.195 ng/ml after RARP, it would reduce the probability of acquirement of RT/ADT.
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Affiliation(s)
- Chin-Heng Lu
- Division of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Yen-Chuan Ou
- Division of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Li-Hua Huang
- Division of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Wei-Chun Weng
- Division of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Yu-Kang Chang
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Hung-Lin Chen
- Department of Medical Research, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Chao-Yu Hsu
- Division of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
| | - Min-Che Tung
- Division of Urology, Department of Surgery, Tungs' Taichung Metroharbor Hospital, Taichung, Taiwan
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Fossati N, Gandaglia G, Briganti A, Montorsi F. The emerging role of PET-CT scan after radical prostatectomy: still a long way to go. Lancet Oncol 2019; 20:1193-1195. [PMID: 31375470 DOI: 10.1016/s1470-2045(19)30501-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/19/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Nicola Fossati
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan 20131, Italy
| | - Giorgio Gandaglia
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan 20131, Italy
| | - Alberto Briganti
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan 20131, Italy
| | - Francesco Montorsi
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan 20131, Italy.
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35
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Ng C, Teoh JY, Chiu PK, Yee C, Chan C, Hou SS, Kaouk J, Chan ES. Robot‐assisted single‐port radical prostatectomy: A phase 1 clinical study. Int J Urol 2019; 26:878-883. [DOI: 10.1111/iju.14044] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/26/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Chi‐Fai Ng
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Jeremy Yuen‐Chun Teoh
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Peter Ka‐Fung Chiu
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Chi‐Hang Yee
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Chi‐Kwok Chan
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Simon See‐Ming Hou
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
| | - Jihad Kaouk
- Glickman Urological and Kidney Institute Cleveland Ohio USA
| | - Eddie Shu‐Yin Chan
- S.H. Ho Urology Center, Department of SurgeryPrince of Wales Hospital, The Chinese University of Hong Kong Hong Kong
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36
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Jin K, Qiu S, Liao XY, Zheng XN, Tu X, Tang LS, Yang L, Wei Q. Transurethral resection of the prostate is an independent risk factor for biochemical recurrence after radical prostatectomy for prostate cancer. Asian J Androl 2019; 22:217-221. [PMID: 31210148 PMCID: PMC7155793 DOI: 10.4103/aja.aja_54_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Biochemical recurrence (BCR) is important for measuring the oncological outcomes of patients who undergo radical prostatectomy (RP). Whether transurethral resection of the prostate (TURP) has negative postoperative effects on oncological outcomes remains controversial. The primary aim of our retrospective study was to determine whether a history of TURP could affect the postoperative BCR rate. We retrospectively reviewed patients with prostate cancer (PCa) who had undergone RP between January 2009 and October 2017. Clinical data on age, prostate volume, serum prostate-specific antigen levels (PSA), biopsy Gleason score (GS), metastasis stage (TNM), D'Amico classification, and American Society of Anesthesiologists (ASA) classification were collected. Statistical analyses including Cox proportional hazard models and sensitivity analyses which included propensity score matching, were performed, and the inverse-probability-of-treatment-weighted estimator and standardized mortality ratio-weighted estimator were determined. We included 1083 patients, of which 118 had a history of TURP. Before matching, the non-TURP group differed from the TURP group with respect to GS (P = 0.047), prostate volume (mean: 45.19 vs 36.00 ml, P < 0.001), and PSA level (mean: 29.41 vs 15.11 ng ml−1, P = 0.001). After adjusting for age, PSA level, T stage, N stage, M stage, and GS, the TURP group showed higher risk of BCR (hazard ratio [HR]: 2.27, 95% confidence interval [CI]: 1.13–3.94, P = 0.004). After matching (ratio 1:4), patients who underwent TURP were still more likely to develop BCR according to the adjusted propensity score (HR: 2.00, 95% CI: 1.05–3.79, P = 0.034). Among patients with PCa, those with a history of TURP were more likely to develop BCR after RP.
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Affiliation(s)
- Kun Jin
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Shi Qiu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China.,Center of Biomedical Big Data, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xin-Yang Liao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiao-Nan Zheng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Xiang Tu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lian-Sha Tang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu 610041, China
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Azhar RA, Elkoushy MA, Aldousari S. Robot-assisted urological surgery in the Middle East: Where are we and how far can we go? Arab J Urol 2019; 17:106-113. [PMID: 31285921 PMCID: PMC6600062 DOI: 10.1080/2090598x.2019.1601003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives: To evaluate robot-assisted surgery (RAS) in Urology in the Middle East, and its status and future perspectives. Methods: A Medical Literature Analysis and Retrieval System Online (MEDLINE) search was performed using the following keywords: ‘robotics’, ‘robot-assisted surgery’, ‘laparoscopy’, at first with each specific procedure name, such as radical cystectomy, followed by ‘Middle East’ and country names. All abstracts and articles in English that adhered to the scope of the current issue were selected, giving special consideration to relevant landmark articles and those describing trends and the future of RAS in Urology. Results: Only a few index case reports characterised RAS in the Middle East. The Middle East possess only 1% of the da Vinci® Surgical Systems (Intuitive Surgical Inc., Sunnyvale, CA, USA) installed worldwide, including 19 in Saudi Arabia; six in Qatar; two in each of Kuwait and Lebanon; three in the United Arab Emirates; and only one in Egypt. The total number of RAS performed in the Middle East is low compared to Europe and the USA. Many countries in the Middle East still lack surgical robots despite having the expertise and appropriate caseload, whilst others seem not to utilise the surgical robot at a suitable rate, as reflected by the sparse number of operated cases and outgoing publications. There are major differences in RAS availability, usage, and perception according to the geographical place of practice and acceptance of robots by surgeons and patients. Conclusion: RAS in Urology continues to grow in the Middle East, with increasing caseloads and diversity of operated cases. Acceptance of robots by Middle East surgeons is significantly increasing. Abbreviations: 3D: three-dimensional; KSA: Kingdom Saudi Arabia;MIS: minimally invasive surgery; RAA: robot-assisted adrenalectomy; RAP: robot-assisted pyeloplasty; (O)(RA)PN: (open) (robot-assisted) partial nephrectomy; RAS: robot-assisted surgery; (O)(RA)RC: (open) (robot-assisted) radical cystectomy; (RA)RP: (robot-assisted) radical prostatectomy; SAUC: Sabah Al-Ahmad Urology Center
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Affiliation(s)
- Raed A Azhar
- Department of Urology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed A Elkoushy
- Department of Urology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Saad Aldousari
- Department of Surgery, Urology Unit, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
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Kanehira M, Takata R, Ishii S, Ito A, Ikarashi D, Matsuura T, Kato Y, Obara W. Predictive factors for short-term biochemical recurrence-free survival after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients. Int J Clin Oncol 2019; 24:1099-1104. [PMID: 30972506 DOI: 10.1007/s10147-019-01445-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 04/04/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND We aimed to assess the short-term oncological outcomes of robot-assisted laparoscopic radical prostatectomy to determine the predictive factors associated with biochemical recurrence in high-risk prostate cancer patients. METHODS A total of 331 patients with localized prostate cancer underwent robot-assisted laparoscopic radical prostatectomy. Of them, 113 patients were diagnosed with high-risk prostate cancer according to the D'Amico risk group classification. We evaluated the association between pre- or postoperative predictive factors and biochemical recurrence using Cox regression analysis. RESULTS The 2-year biochemical recurrence-free survival rate was 65.0% in the high-risk group. On univariate analyses, PSA level > 20 ng/mL, Gleason pattern 5 component on biopsy, pathological stage T3 or higher, perineural invasion, and positive surgical margin were predictive factors for biochemical recurrence. On multivariate analysis, PSA level > 20 ng/mL, Gleason pattern 5 component on biopsy, perineural invasion, and positive surgical margin were identified as independent predictive factors. The 2-year biochemical recurrence-free survival rate was 36.5% for patients with PSA level > 20 ng/mL and/or Gleason pattern 5 component on biopsy. CONCLUSIONS PSA level > 20 ng/mL and/or presence of the Gleason pattern 5 component on biopsy are predictive factors for early biochemical recurrence after robot-assisted laparoscopic radical prostatectomy in high-risk prostate cancer patients. We considered that these patients require a combined modality therapy to improve their prognosis.
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Affiliation(s)
- Mitsugu Kanehira
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan.
| | - Ryo Takata
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Shuhei Ishii
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Akito Ito
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Daiki Ikarashi
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Tomohiko Matsuura
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Yoichiro Kato
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
| | - Wataru Obara
- Department of Urology, Iwate Medical University Hospital, 19-1 Uchimaru, Morioka, Iwate, 020-8505, Japan
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Kang JK, Chung JW, Chun SY, Ha YS, Choi SH, Lee JN, Kim BS, Yoon GS, Kim HT, Kim TH, Kwon TG. Oncological and functional outcomes following robot-assisted laparoscopic radical prostatectomy at a single institution: a minimum 5-year follow-up. Yeungnam Univ J Med 2018; 35:171-178. [PMID: 31620590 PMCID: PMC6784708 DOI: 10.12701/yujm.2018.35.2.171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/30/2018] [Accepted: 06/01/2018] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate mid-term oncological and functional outcomes in patients with prostate cancer treated by robot-assisted laparoscopic radical prostatectomy (RALP) at our institution. Methods We retrospectively reviewed the medical records of 128 patients with prostate cancer who underwent RALP at our institution between February 2008 and April 2010. All patients enrolled in this study were followed up for at least 5 years. We analyzed biochemical recurrence (BCR)-free survival using a Kaplan-Meier survival curve analysis and predictive factors for BCR using multivariate Cox regression analysis. Continence recovery rate, defined as no use of urinary pads, was also evaluated. Results Based on the D’Amico risk classification, there were 30 low-risk patients (23.4%), 47 intermediate-risk patients (38.8%), and 51 high-risk patients (39.8%), preoperatively. Based on pathological findings, 50.0% of patients (64/128) showed non-organ confined disease (≥T3a) and 26.6% (34/128) had high grade disease (Gleason score ≥8). During a median follow-up period of 71 months (range, 66-78 months), the frequency of BCR was 33.6% (43/128) and the median BCR-free survival was 65.9 (0.4-88.0) months. Multivariate Cox regression analysis revealed that high grade disease (Gleason score ≥8) was an independent predictor for BCR (hazard ratio=4.180, 95% confidence interval=1.02-17.12, p=0.047). In addition, a majority of patients remained continent following the RALP procedure, without the need for additional intervention for post-prostatectomy incontinence. Conclusion Our study demonstrated acceptable outcomes following an initial RALP procedure, despite 50% of the patients investigated demonstrating high-risk features associated with non-organ confined disease.
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Affiliation(s)
- Jun-Koo Kang
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jae-Wook Chung
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - So Young Chun
- Biomedical Research Institute, Kyungpook National University Hospital, Daegu, Korea
| | - Yun-Sok Ha
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seock Hwan Choi
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jun Nyung Lee
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Bum Soo Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Ghil Suk Yoon
- Department of Pathology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Tae Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae-Hwan Kim
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Tae Gyun Kwon
- Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea
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Bianchi L, Gandaglia G, Fossati N, Larcher A, Pultrone C, Turri F, Selli C, de Groote R, de Naeyer G, Borghesi M, Schiavina R, Brunocilla E, Briganti A, Montorsi F, Mottrie A. Oncologic outcomes in prostate cancer patients treated with robot-assisted radical prostatectomy: results from a single institution series with more than 10 years follow up. MINERVA UROL NEFROL 2018; 71:38-46. [PMID: 30547906 DOI: 10.23736/s0393-2249.18.03285-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) has gained increasing diffusion as standard of care in the surgical treatment of prostate cancer (PCa) patients, even in the absence of robust long-term oncologic comparative data. This article is a report of oncologic outcomes of RARP at more than 10 years follow-up. METHODS We retrospectively evaluated 173 consecutive PCa patients underwent RARP between 2002 and 2005 at a single European center with complete clinic and pathologic data and potential follow-up of at least 10 years. Kaplan-Meier analyses assessed biochemical recurrence free survival (BCR-FS), clinical recurrence free survival (CR-FS), cancer specific mortality free survival (CSM-FS), other causes mortality free survival (OCM-FS) in the overall population and CR-FS after stratification according to pathologic stage and Gleason score. Multi-variable Cox regression analyses were performed to assess the predictors of BCR and CR. RESULTS Median follow-up (Interquatile Range [IQR]) was 133 (123-145) months. The BCR-FS, CR-FS, CSM-FS and OCM-FS rates at median follow-up were 73.4%, 81.1%, 95.7%, and 68.6%, respectively. Patients staged as pT3b-T4 and men with Gleason score 8-10 experienced significantly lower CR-FS rates as compared to those with less aggressive pathologic features (all P≤0.001). At multivariable analysis, pathologic Gleason score 8-10 (Hazard Ratio [HR]: 2.85), pathologic stage pT3b-pT4 (HR: 2.76) and adjuvant therapy (HR: 2.09 for radiotherapy [RT] and HR: 13.66 for androgen deprivation therapy [ADT]) were independent predictors of BCR (all p≤0.02). While, pathologic Gleason score 8-10 (HR: 4.05) and pathologic stage pT3b-pT4 (HR: 6.78) were found to be independently related to higher risk of CR (all P≤0.03). Retrospective data and limited number of patients included could have affected our analyses. CONCLUSIONS In experienced centers, RARP allows optimal oncologic outcomes at long term follow-up. Adverse pathologic characteristics are independent predictors of BCR and CR.
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Affiliation(s)
- Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy - .,Department of Urology, OLV, Aalst, Belgium - .,ORSI Academy, Melle, Belgium -
| | - Giorgio Gandaglia
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alessandro Larcher
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristian Pultrone
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Filippo Turri
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Department of Urology, University of Pisa, Pisa, Italy
| | - Cesare Selli
- Department of Urology, University of Pisa, Pisa, Italy
| | | | | | - Marco Borghesi
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Riccardo Schiavina
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Eugenio Brunocilla
- Department of Urology, University of Bologna, Bologna, Italy.,Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium.,Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy.,Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Cardio-Nephro-Thoracic Sciences Doctorate, University of Bologna, Bologna, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alexandre Mottrie
- Department of Urology, OLV, Aalst, Belgium.,ORSI Academy, Melle, Belgium
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Centenera MM, Hickey TE, Jindal S, Ryan NK, Ravindranathan P, Mohammed H, Robinson JL, Schiewer MJ, Ma S, Kapur P, Sutherland PD, Hoffmann CE, Roehrborn CG, Gomella LG, Carroll JS, Birrell SN, Knudsen KE, Raj GV, Butler LM, Tilley WD. A patient-derived explant (PDE) model of hormone-dependent cancer. Mol Oncol 2018; 12:1608-1622. [PMID: 30117261 PMCID: PMC6120230 DOI: 10.1002/1878-0261.12354] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/25/2018] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
Breast and prostate cancer research to date has largely been predicated on the use of cell lines in vitro or in vivo. These limitations have led to the development of more clinically relevant models, such as organoids or murine xenografts that utilize patient-derived material; however, issues related to low take rate, long duration of establishment, and the associated costs constrain use of these models. This study demonstrates that ex vivo culture of freshly resected breast and prostate tumor specimens obtained from surgery, termed patient-derived explants (PDEs), provides a high-throughput and cost-effective model that retains the native tissue architecture, microenvironment, cell viability, and key oncogenic drivers. The PDE model provides a unique approach for direct evaluation of drug responses on an individual patient's tumor, which is amenable to analysis using contemporary genomic technologies. The ability to rapidly evaluate drug efficacy in patient-derived material has high potential to facilitate implementation of personalized medicine approaches.
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Affiliation(s)
- Margaret M. Centenera
- Freemasons Foundation Centre for Men's HealthAdelaide Medical SchoolUniversity of AdelaideSAAustralia
- South Australian Health and Medical Research InstituteAdelaideSAAustralia
| | - Theresa E. Hickey
- Dame Roma Mitchell Cancer Research LaboratoriesAdelaide Medical SchoolUniversity of AdelaideSAAustralia
| | - Shalini Jindal
- Dame Roma Mitchell Cancer Research LaboratoriesAdelaide Medical SchoolUniversity of AdelaideSAAustralia
| | - Natalie K. Ryan
- Freemasons Foundation Centre for Men's HealthAdelaide Medical SchoolUniversity of AdelaideSAAustralia
- South Australian Health and Medical Research InstituteAdelaideSAAustralia
| | | | - Hisham Mohammed
- Knight Cancer Early Detection Advanced Research CenterOregon Health and Science UniversityPortlandORUSA
| | - Jessica L. Robinson
- Transcription Factor LaboratoryCancer Research UKCambridge InstituteCambridge UniversityUK
| | | | - Shihong Ma
- Department of UrologyUT Southwestern Medical Center at DallasTXUSA
| | - Payal Kapur
- Department of UrologyUT Southwestern Medical Center at DallasTXUSA
| | | | - Clive E. Hoffmann
- Breast ClinicBurnside War Memorial HospitalToorak GardensSAAustralia
| | | | | | - Jason S. Carroll
- Transcription Factor LaboratoryCancer Research UKCambridge InstituteCambridge UniversityUK
| | | | - Karen E. Knudsen
- Kimmel Cancer CenterThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ganesh V. Raj
- Department of UrologyUT Southwestern Medical Center at DallasTXUSA
| | - Lisa M. Butler
- Freemasons Foundation Centre for Men's HealthAdelaide Medical SchoolUniversity of AdelaideSAAustralia
- South Australian Health and Medical Research InstituteAdelaideSAAustralia
| | - Wayne D. Tilley
- Freemasons Foundation Centre for Men's HealthAdelaide Medical SchoolUniversity of AdelaideSAAustralia
- Dame Roma Mitchell Cancer Research LaboratoriesAdelaide Medical SchoolUniversity of AdelaideSAAustralia
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The CPC Risk Calculator: A New App to Predict Prostate-specific Antigen Recurrence During Follow-up After Radical Prostatectomy. Eur Urol Focus 2018; 4:360-368. [DOI: 10.1016/j.euf.2016.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 10/19/2016] [Accepted: 11/18/2016] [Indexed: 11/18/2022]
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Xiang C, Liu X, Chen S, Wang P. Prediction of Biochemical Recurrence Following Radiotherapy among Patients with Persistent PSA after Radical Prostatectomy: A Single-Center Experience. Urol Int 2018; 101:47-55. [DOI: 10.1159/000488536] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
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Rajan P, Hagman A, Sooriakumaran P, Nyberg T, Wallerstedt A, Adding C, Akre O, Carlsson S, Hosseini A, Olsson M, Egevad L, Wiklund F, Steineck G, Wiklund NP. Oncologic Outcomes After Robot-assisted Radical Prostatectomy: A Large European Single-centre Cohort with Median 10-Year Follow-up. Eur Urol Focus 2018; 4:351-359. [PMID: 28753802 DOI: 10.1016/j.euf.2016.10.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/17/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) treatment has been widely adopted with limited evidence for long-term (>5 yr) oncologic efficacy. OBJECTIVE To evaluate long-term oncologic outcomes following RARP. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of 885 patients who underwent RARP as monotherapy for PCa between 2002 and 2006 in a single European centre and followed up until 2016. INTERVENTION RARP as monotherapy. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Biochemical recurrence (BCR)-free survival (BCRFS), salvage therapy (ST)-free survival (STFS), prostate cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method, and event-time distributions were compared using the log-rank test. Variables predictive of BCR and ST were identified using Cox proportional hazards models. RESULTS AND LIMITATIONS We identified 167 BCRs, 110 STs, 16 PCa-related deaths, and 51 deaths from other/unknown causes. BCRFS, STFS, CSS, and OS rates were 81.8%, 87.5%, 98.5%, and 93.0%, respectively, at median follow-up of 10.5 yr. On multivariable analysis, the strongest independent predictors of both BCR and ST were preoperative Gleason score, pathological T stage, positive surgical margins (PSMs), and preoperative prostate-specific antigen. PSM >3mm/multifocal but not ≤3mm independently affected the risk of both BCR and ST. Study limitations include a lack of centralised histopathologic reporting, lymph node and post-operative tumour volume data in a historical cohort, and patient-reported outcomes. CONCLUSIONS RARP appears to confer effective long-term oncologic efficacy. The risk of BCR or ST is unaffected by ≤3mm PSM, but further follow-up is required to determine any impact on CSS. PATIENT SUMMARY Robot-assisted surgery for prostate cancer is effective 10 yr after treatment. Very small (<3mm) amounts of cancer at the cut edge of the prostate do not appear to impact on recurrence risk and the need for additional treatment, but it is not yet known whether this affects the risk of death from prostate cancer.
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Affiliation(s)
- Prabhakar Rajan
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Barts Cancer Institute, Centre for Molecular Oncology, Queen Mary University of London, London, UK; Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK.
| | - Anna Hagman
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Prasanna Sooriakumaran
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Urology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Tommy Nyberg
- Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden; Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Wallerstedt
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Christofer Adding
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Stefan Carlsson
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden
| | - Abolfazl Hosseini
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Olsson
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Lars Egevad
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - N Peter Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Division of Urology, Karolinska Institutet, Stockholm, Sweden.
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Terakawa T, Katsuta E, Yan L, Turaga N, McDonald KA, Fujisawa M, Guru KA, Takabe K. High expression of SLCO2B1 is associated with prostate cancer recurrence after radical prostatectomy. Oncotarget 2018; 9:14207-14218. [PMID: 29581838 PMCID: PMC5865664 DOI: 10.18632/oncotarget.24453] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 02/01/2018] [Indexed: 01/22/2023] Open
Abstract
Solute carrier organic anion (SLCO) gene families encode organic anion transport proteins, which are transporters that up-take a number of substrates including androgens. Among them, high expression of SLCO2B1 is known to associate with the resistance to androgen deprivation therapy in prostate cancer (PCa). We hypothesized that high expression of SLCO genes enhances PCa progression by promoting the influx of androgen. Here, we demonstrated the impact of the expression levels of SLCO2B1 on prognosis in localized PCa after radical prostatectomy (RP) utilizing 494 PCa cases in The Cancer Genome Atlas (TCGA). SLCO2B1 high expression group showed significantly worse Disease-free survival (DFS) after RP (p = 0.001). The expression level of SLCO2B1 was significantly higher in advanced characteristics including Gleason Score (GS ≤ 6 vs GS = 7; p = 0.047, GS = 7 vs GS ≥ 8; p = 0.002), pathological primary tumor (pT2 vs pT3/4; p < 0.001), and surgical margin status (positive vs negative; p = 0.013), respectively. There was a significant difference in DFS between these two groups only in GS ≥ 8 patients (p = 0.006). Multivariate analysis demonstrated that only SLCO2B1 expression level was an independent predictor for DFS after RP in GS ≥ 8. SLCO2B1 high expressed tumors in GS ≥ 8 not only enriched epithelial mesenchymal transition (EMT) related gene set, (p = 0.027), as well as Hedgehog (p < 0.001), IL-6/JAK/STAT3 (p < 0.001), and K-ras signaling gene sets (p < 0.001), which are known to promote EMT, but also showed higher expression of EMT related genes, including N-cadherin (p = 0.024), SNAIL (p = 0.001), SLUG (p = 0.001), ZEB-1 (p < 0.001) and Vimentin (p < 0.001). In conclusion, PCa with high expression of SLCO2B1 demonstrated worse DFS, which might be due to accelerated EMT.
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Affiliation(s)
- Tomoaki Terakawa
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eriko Katsuta
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Li Yan
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, NY, USA
| | - Nitesh Turaga
- Department of Biostatistics and Bioinformatics, Roswell Park Cancer Institute, NY, USA
| | - Kerry-Ann McDonald
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Khurshid A Guru
- Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Kazuaki Takabe
- Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA.,Department of Surgery, University at Buffalo, Jacobs School of Medicine and Biomedical Sciences, The State University of New York Buffalo, NY, USA.,Department of Breast Surgery and Oncology, Tokyo Medical University, Tokyo, Japan.,Department of Surgery, Yokohama City University, Yokohama, Japan.,Department of Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Kenigsberg AP, Llukani E, Deng FM, Melamed J, Zhou M, Lepor H. The Use of Magnetic Resonance Imaging to Predict Oncological Control Among Candidates for Focal Ablation of Prostate Cancer. Urology 2018; 112:121-125. [DOI: 10.1016/j.urology.2017.10.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/29/2017] [Accepted: 10/10/2017] [Indexed: 01/31/2023]
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Jang WS, Kim MS, Jeong WS, Chang KD, Cho KS, Ham WS, Rha KH, Hong SJ, Choi YD. Does robot-assisted radical prostatectomy benefit patients with prostate cancer and bone oligometastases? BJU Int 2017; 121:225-231. [DOI: 10.1111/bju.13992] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Won Sik Jang
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Myung Soo Kim
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Won Sik Jeong
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Ki Don Chang
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Kang Su Cho
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Won Sik Ham
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Koon Ho Rha
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Sung Joon Hong
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
| | - Young Deuk Choi
- Department of Urology; Urological Science Institute; Yonsei University College of Medicine; Seoul Korea
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Dell’Oglio P, Stabile A, Gandaglia G, Zaffuto E, Fossati N, Bandini M, Suardi N, Karakiewicz PI, Shariat SF, Montorsi F, Briganti A. New surgical approaches for clinically high-risk or metastatic prostate cancer. Expert Rev Anticancer Ther 2017; 17:1013-1031. [DOI: 10.1080/14737140.2017.1374858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Paolo Dell’Oglio
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Armando Stabile
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Emanuele Zaffuto
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Fossati
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Bandini
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nazareno Suardi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pierre I. Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada
| | - Shahrokh F. Shariat
- Department of Urology, Medical University of Vienna and General Hospital, Vienna, Austria
| | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Kenigsberg AP, Tamada T, Rosenkrantz AB, Llukani E, Deng FM, Melamed J, Zhou M, Lepor H. Multiparametric magnetic resonance imaging identifies significant apical prostate cancers. BJU Int 2017; 121:239-243. [PMID: 28805295 DOI: 10.1111/bju.13987] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine if multiparametric (mp) magnetic resonance imaging (MRI) can identify significant apical disease, thereby informing decisions regarding preservation of the membranous urethra. MATERIALS AND METHODS Men undergoing radical prostatectomy (RP) between January 2012 and June 2016, who underwent a 12-core transrectal ultrasonography-guided systematic biopsy (SB), preoperative 3-Tesla MRI, and sectioning of the prostate specimen with tumour foci mapping, were extracted from a single surgeon's prospective longitudinal outcomes database. Apical SB and mpMRI lesion results were compared with regard to their ability to predict aggressive tumours in the prostatic apex (PA), defined as prostate cancer grade group >1. RESULTS Of the 100 men who met the eligibility criteria, 43 (43%) exhibited aggressive prostate cancer in the distal 5 mm of the apex. A Likert score >2 in the apical one-third of the prostate was found to be more reliable than any cancer found on apical SB at detecting aggressive cancer in the apex. On multivariate regression analysis, which included Likert score in the apex, age, prostate-specific antigen (PSA) level, prostate size and presence of any cancer on apical biopsy, only Likert score (P = 0.005) and PSA level (P = 0.025) were significant and independent predictors of aggressive cancer in the distal apex. CONCLUSION The results of the study showed that MRI was superior to SB at identifying aggressive prostate cancer within the distal PA and may be useful for planning the extent of apical preservation during RP.
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Affiliation(s)
| | - Tsutomu Tamada
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Andrew B Rosenkrantz
- Department of Radiology, New York University School of Medicine, New York, NY, USA
| | - Elton Llukani
- Department of Urology, New York University School of Medicine, New York, NY, USA
| | - Fang-Ming Deng
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Jonathan Melamed
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Ming Zhou
- Department of Pathology, New York University School of Medicine, New York, NY, USA
| | - Herbert Lepor
- Department of Urology, New York University School of Medicine, New York, NY, USA
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Fujimura T, Fukuhara H, Taguchi S, Yamada Y, Sugihara T, Nakagawa T, Niimi A, Kume H, Igawa Y, Homma Y. Robot-assisted radical prostatectomy significantly reduced biochemical recurrence compared to retro pubic radical prostatectomy. BMC Cancer 2017; 17:454. [PMID: 28662644 PMCID: PMC5492400 DOI: 10.1186/s12885-017-3439-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 06/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background The pathological and oncological outcomes of retro-pubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) have not been sufficiently investigated. Methods Treatment-naïve patients with localized prostate cancer (PC) (n = 908; RRP, n = 490; and RARP, n = 418) were enrolled in the study. The clinicopathological outcomes, rate and localization of the positive surgical margin (PSM), localization of PSM, and biochemical recurrence (BCR)-free survival groups were compared between RRP and RARP. Results The median patient age and serum PSA level (ng/mL) at diagnosis were 67 years and 7.9 ng/ml, respectively, for RRP, and 67 years and 7.6 ng/ml, respectively, for RARP. The overall PSM rate with RARP was 21%, which was 11% for pT2a, 12% for pT2b, 9.8% for pT2c, 43% for pT3a, 55% for pT3b, and 0% for pT4. The overall PSM rate with RRP was 44%, which was 12% for pT2a, 18% for pT2b, 43% for pT2c, 78% for pT3a, 50% for pT3b, and 40% for pT4. The PSM rate was significantly lower for RARP in men with pT2c and pT3a (p < 0.0001 for both). Multivariate analysis showed that RARP reduced the risk of BCR (hazard ratio; 0.6, p = 0.009). Conclusions RARP versus RRP is associated with an improved PSM rate and BCR. To examine the cancer-specific survival, further investigations are needed.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Hiroshi Fukuhara
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoru Taguchi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yuta Yamada
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toru Sugihara
- Department of Urology, Japan Red Cross Hospital, 4-1-22 Hiroo, Shibuya-ku, Tokyo, Japan
| | - Tohru Nakagawa
- Department of Urology, Teikyo University, 2-11-1 Kaga, Itabashi-ku, Tokyo, Japan
| | - Aya Niimi
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Haruki Kume
- Department of Urology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yasuhiko Igawa
- Department of Urology, Japan Red Cross Hospital, 4-1-22 Hiroo, Shibuya-ku, Tokyo, Japan.,Department of Continence Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Yukio Homma
- Department of Urology, Japan Red Cross Hospital, 4-1-22 Hiroo, Shibuya-ku, Tokyo, Japan
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