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Małkiewicz B, Kiełb P, Kobylański M, Karwacki J, Poterek A, Krajewski W, Zdrojowy R, Szydełko T. Sentinel Lymph Node Techniques in Urologic Oncology: Current Knowledge and Application. Cancers (Basel) 2023; 15:cancers15092495. [PMID: 37173960 PMCID: PMC10177100 DOI: 10.3390/cancers15092495] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/23/2023] [Accepted: 04/24/2023] [Indexed: 05/15/2023] Open
Abstract
Lymph node (LN) metastases have a significant negative impact on the prognosis of urological malignancies. Unfortunately, current imaging modalities are insufficient when it comes to detecting micrometastases; thus, surgical LN removal is commonly used. However, there is still no established ideal lymph node dissection (LND) template, leading to unnecessary invasive staging and the possibility of missing LN metastases located outside the standard template. To address this issue, the sentinel lymph node (SLN) concept has been proposed. This technique involves identifying and removing the first group of draining LNs, which can accurately stage cancer. While successful in breast cancer and melanoma, the SLN technique in urologic oncology is still considered experimental due to high false-negative rates and lack of data in prostate, bladder, and kidney cancer. Nevertheless, the development of new tracers, imaging modalities, and surgical techniques may improve the potential of the SLN procedures in urological oncology. In this review, we aim to discuss the current knowledge and future contributions of the SLN procedure in the management of urological malignancies.
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Affiliation(s)
- Bartosz Małkiewicz
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Paweł Kiełb
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Maximilian Kobylański
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Jakub Karwacki
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Adrian Poterek
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Wojciech Krajewski
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Romuald Zdrojowy
- University Center of Excellence in Urology, Department of Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
| | - Tomasz Szydełko
- University Center of Excellence in Urology, Department of Minimally Invasive and Robotic Urology, Wroclaw Medical University, 50-556 Wroclaw, Poland
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Klingenberg S, Fredsøe J, Sørensen KD, Ulhøi BP, Borre M, Jochumsen MR, Bouchelouche K. Recurrence rate after radical prostatectomy following primary staging of high-risk prostate cancer with 68Ga-PSMA PET/CT. Acta Oncol 2022; 61:1289-1294. [PMID: 36199168 DOI: 10.1080/0284186x.2022.2129442] [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: 12/24/2022]
Abstract
BACKGROUND Accurate primary staging is one of the most important issues for initial management of prostate cancer (PCa) patients to perform an optimal selection of patients for curative intended treatment. 68Ga-Prostate-Specific-Membrane-Antigen (PSMA) PET/CT was found superior to conventional imaging both for detection of recurrence after curative intended treatment and for primary staging. We studied the recurrence rate after radical prostatectomy in high-risk PCa patients primary staged with 68Ga-PSMA PET/CT compared with conventional imaging. MATERIAL AND METHODS The study included 247 D'Amico high-risk PCa patients treated with radical prostatectomy (RP) after primary staging with 68Ga-PSMA PET/CT and a reference group of 137 high-risk patients with RP after conventional imaging (99mTc bone scintigraphy and CT). Recurrence rates were assessed by Cox regression and Kaplan-Meier analysis. RESULTS The 5-year recurrence-free survival rate was 71.1% in the 68Ga-PSMA PET/CT cohort compared with 56.4% in the conventional imaging cohort. Primary staging by 68Ga-PSMA PET/CT reduced biochemical recurrence (BCR) risk by 42% (HR = 0.58 (0.41-0.83), p = .004). CONCLUSION The present data could indicate a lower recurrence rate after RP following primary staging with 68Ga-PSMA PET/CT compared to conventional imaging, likely due to improved selection of patients for surgery.
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Affiliation(s)
- Søren Klingenberg
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Jacob Fredsøe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Karina D Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Benedicte P Ulhøi
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Mads R Jochumsen
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine & PET-Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Johnson RP, Ratnacaram CK, Kumar L, Jose J. Combinatorial approaches of nanotherapeutics for inflammatory pathway targeted therapy of prostate cancer. Drug Resist Updat 2022; 64:100865. [PMID: 36099796 DOI: 10.1016/j.drup.2022.100865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
Prostate cancer (PC) is the most prevalent male urogenital cancer worldwide. PC patients presenting an advanced or metastatic cancer succumb to the disease, even after therapeutic interventions including radiotherapy, surgery, androgen deprivation therapy (ADT), and chemotherapy. One of the hallmarks of PC is evading immune surveillance and chronic inflammation, which is a major challenge towards designing effective therapeutic formulations against PC. Chronic inflammation in PC is often characterized by tumor microenvironment alterations, epithelial-mesenchymal transition and extracellular matrix modifications. The inflammatory events are modulated by reactive nitrogen and oxygen species, inflammatory cytokines and chemokines. Major signaling pathways in PC includes androgen receptor, PI3K and NF-κB pathways and targeting these inter-linked pathways poses a major therapeutic challenge. Notably, many conventional treatments are clinically unsuccessful, due to lack of targetability and poor bioavailability of the therapeutics, untoward toxicity and multidrug resistance. The past decade witnessed an advancement of nanotechnology as an excellent therapeutic paradigm for PC therapy. Modern nanovectorization strategies such as stimuli-responsive and active PC targeting carriers offer controlled release patterns and superior anti-cancer effects. The current review initially describes the classification, inflammatory triggers and major inflammatory pathways of PC, various PC treatment strategies and their limitations. Subsequently, recent advancement in combinatorial nanotherapeutic approaches, which target PC inflammatory pathways, and the mechanism of action are discussed. Besides, the current clinical status and prospects of PC homing nanovectorization, and major challenges to be addressed towards the advancement PC therapy are also addressed.
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Affiliation(s)
- Renjith P Johnson
- Polymer Nanobiomaterial Research Laboratory, Nanoscience and Microfluidics Division, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka 575018, India
| | - Chandrahas Koumar Ratnacaram
- Cell Signaling and Cancer Biology Division, Yenepoya Research Centre, Yenepoya (Deemed to be University), Mangalore, Karnataka 575018, India
| | - Lalit Kumar
- Department of Pharmaceutics, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka 576 104, India
| | - Jobin Jose
- NITTE Deemed-to-be University, NGSM Institute of Pharmaceutical Sciences, Department of Pharmaceutics, Mangalore 575018, India.
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Marolleau J, Nguyen TA, Doucet L, Coste A, Schoentgen N, Rousseau B, Valeri A, Fournier G. [Morbidity of extended pelvic lymphadenectomy during robot-assisted laparoscopic prostatectomy for localized cancer prostate]. Prog Urol 2022; 32:1455-1461. [PMID: 36088200 DOI: 10.1016/j.purol.2022.07.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/02/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the morbidity specific of extended pelvic lymphadenectomy during robot-assisted laparoscopic radical prostatectomy in a 8 year retrospective study. MATERIAL We carried out a single-center, single-surgeon retrospective study on 342 consecutive patients who underwent a robot-assisted laparoscopic radical prostatectomy and extended pelvic lymphadenectomy, from July 2010 to March 2018. Postoperative complications were recorded up to 3 months after the operation. RESULTS Thirty (8.8%) patients had at least one complication related to lymphadenectomy including 1 vascular injury (0.3%), 7 injuries of the obturator nerve (2%), 5 venous thromboembolic complications (1.5%) including 4 pulmonary embolisms, 10 symptomatic lymphoceles (2.9%) and 8 lymphoedemas (2.3%). Of these complications, 13 were classified Clavien 1 (43.3%), 8 Clavien 2 (26.7%), 7 Clavien 3a (23.3%) and 2 Clavien 3b (6.7%). In univariate analysis a high age (P=0.04), high BMI (P<0.01) and pT stage (P=0.02) were significantly associated with complication whereas in multivariate analysis, only age (P=0.02) and BMI (P<0.01) lived were. In univariate analysis high BMI (P=0.04) and lymph node involvement (P=0.04) were associated with lymphatic complication. We did not find any other specific risk factor for the other complications. CONCLUSION With 8.8% of overall complications related to lymphadenectomy and 5% of complication classified Clavien grade 2 or higher, extended pelvic lymphadenectomy was not very morbid. Age and BMI were risk factors for a overall complication. BMI and lymph node involvement were risk factors for lymphatic complications. LEVEL OF PROOF 4.
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Affiliation(s)
| | - T A Nguyen
- Service d'urologie, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France
| | - L Doucet
- Laboratoire d'anatomo-pathologie, CHU, Brest, France
| | - A Coste
- LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France; Service de médecine infectieuse et tropicale, CHU, Brest, France
| | | | | | - A Valeri
- Service d'urologie, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France; CeRePP, Paris, France
| | - G Fournier
- Service d'urologie, CHU, Brest, France; Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, Brest, France; LaTIM, Inserm, UMR 1101, Université de Bretagne Occidentale, Brest, France; CeRePP, Paris, France
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5
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A Nomogram Predicting Lymph Node Metastasis in Patients with Prostate Cancer Undergoing Ultrasound-Guided Transrectal Prostate Biopsy. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03211-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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6
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Zapała P, Fus Ł, Lewandowski Z, Garbas K, Zapała Ł, Górnicka B, Radziszewski P. E-Cadherin, Integrin Alpha2 (Cd49b), and Transferrin Receptor-1 (Tfr1) Are Promising Immunohistochemical Markers of Selected Adverse Pathological Features in Patients Treated with Radical Prostatectomy. J Clin Med 2021; 10:jcm10235587. [PMID: 34884287 PMCID: PMC8658679 DOI: 10.3390/jcm10235587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/13/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
In patients treated for prostate cancer (PCa) with radical prostatectomy (RP), determining the risk of extraprostatic extension (EPE) and nodal involvement (NI) remains crucial for planning nerve-sparing and extended lymphadenectomy. The study aimed to determine proteins that could serve as immunohistochemical markers of locally advanced PCa. To select candidate proteins associated with adverse pathologic features (APF) reverse-phase protein array data of 498 patients was retrieved from The Cancer Genome Atlas. The analysis yielded 6 proteins which were then validated as predictors of APF utilizing immunohistochemistry in a randomly selected retrospective cohort of 53 patients. For univariate and multivariate analysis, logistic regression was used. Positive expression of TfR1 (OR 13.74; p = 0.015), reduced expression of CD49b (OR 10.15; p = 0.013), and PSA (OR 1.29; p = 0.013) constituted independent predictors of EPE, whereas reduced expression of e-cadherin (OR 10.22; p = 0.005), reduced expression of CD49b (OR 24.44; p = 0.017), and PSA (OR 1.18; p = 0.002) were independently associated with NI. Both models achieved high discrimination (AUROC 0.879 and 0.888, respectively). Immunohistochemistry constitutes a straightforward tool that might be easily utilized before RP. Expression of TfR1 and CD49b is associated with EPE, whereas expression of e-cadherin and CD49b is associated with NI. Since following immunohistochemical markers predicts respective APFs independently from PSA, in the future they might supplement existing preoperative nomograms or be implemented in novel tools.
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Affiliation(s)
- Piotr Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.Z.); (K.G.); (Ł.Z.); (P.R.)
| | - Łukasz Fus
- Department of Pathology, Medical University of Warsaw, 02-091 Warsaw, Poland;
- Correspondence: ; Tel.: +48-22-57-20-710
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Karolina Garbas
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.Z.); (K.G.); (Ł.Z.); (P.R.)
| | - Łukasz Zapała
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.Z.); (K.G.); (Ł.Z.); (P.R.)
| | - Barbara Górnicka
- Department of Pathology, Medical University of Warsaw, 02-091 Warsaw, Poland;
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Urology, Medical University of Warsaw, 02-091 Warsaw, Poland; (P.Z.); (K.G.); (Ł.Z.); (P.R.)
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Engels S, Michalik B, Meyer LM, Nemitz L, Wawroschek F, Winter A. Magnetometer-Guided Sentinel Lymph Node Dissection in Prostate Cancer: Rate of Lymph Node Involvement Compared with Radioisotope Marking. Cancers (Basel) 2021; 13:cancers13225821. [PMID: 34830975 PMCID: PMC8616036 DOI: 10.3390/cancers13225821] [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: 09/21/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
Simple Summary Pelvic lymph node dissection is recommended in prostate cancer according to the patients’ individual risk for nodal metastases. Targeted removal of sentinel lymph nodes increases the number of detected lymph node metastases in patients with prostate cancer. We previously established magnetometer-guided sentinel lymph node dissection in patients with prostate cancer to overcome logistical and technical disadvantages associated with the standard radioisotope-guided technique. This retrospective study compared the magnetometer-guided and standard techniques in terms of their ability to detect lymph node metastases. Using the magnetometer-guided technique, more sentinel lymph nodes were detected per patient. The detected rates of lymph node involvement matched the predictions in both techniques equally well. Our findings confirm the reliability of magnetometer-guided sentinel lymph node dissection and highlight the importance of the sentinel technique for detecting lymph node metastases in prostate cancer. Abstract Sentinel pelvic lymph node dissection (sPLND) enables the targeted removal of lymph nodes (LNs) bearing the highest metastasis risk. In prostate cancer (PCa), sPLND alone or combined with extended PLND (ePLND) reveals more LN metastases along with detecting sentinel LNs (SLNs) outside the conventional ePLND template. To overcome the disadvantages of radioisotope-guided sPLND in PCa treatment, magnetometer-guided sPLND applying superparamagnetic iron oxide nanoparticles as a tracer was established. This retrospective study compared the nodal staging ability between magnetometer- and radioisotope-guided sPLNDs. We analyzed data of PCa patients undergoing radical prostatectomy and magnetometer- (848 patients, 2015–2021) or radioisotope-guided (2092 patients, 2006–2015) sPLND. To reduce heterogeneity among cohorts, we performed propensity score matching and compared data considering sentinel nomogram-based probabilities for LN involvement (LNI). Magnetometer- and radioisotope-guided sPLNDs had SLN detection rates of 98.12% and 98.09%, respectively; the former detected more SLNs per patient. The LNI rates matched nomogram-based predictions in both techniques equally well. Approximately 7% of LN metastases were detected outside the conventional ePLND template. Thus, we confirmed the reliability of magnetometer-guided sPLND in nodal staging, with results comparable with or better than radioisotope-guided sPLND. Our findings highlight the importance of the sentinel technique for detecting LN metastases in PCa.
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8
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Recommandations françaises du Comité de cancérologie de l’AFU – actualisation 2020–2022 : cancer de la prostate. Prog Urol 2020; 30:S136-S251. [DOI: 10.1016/s1166-7087(20)30752-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Gilliland N, Vennam S, Geraghty R, Peacock J, Crockett M, Kearley S, Oxley J, Porter T, Waine E, Aning J, Rowe E, Koupparis A. Surgery for pathological T3a, T3b and lymph node positive, prostate cancer: surgical, functional and oncological outcomes. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820958207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To investigate and document the surgical, functional and oncological outcomes following surgery for high-risk prostate cancer patients. Patients and methods: Patients with pathological T3a, T3b and N1 disease were extracted from our prospectively updated institutional database. Data include demographics, preoperative cancer parameters, short and long-term complications and functional results. Details of biochemical recurrence, type and oncological outcome of salvage treatments, cancer-specific and overall survival were also obtained. Results: A total of 669 patients were included; 58.9% had T3a disease, 35.9% had pT3b and 11.4% N1 disease. With a median follow-up of 66 months (8–129), overall survival was 94.3%, cancer-specific survival was 98.7% and biochemical recurrence was 45.6%. Average inpatient stay was 1 day and the overall complication rate was 9.1%; 54.2% experienced a biochemical recurrence and 90.3% went on to have one or more salvage treatments, which were varied. Significant predictors of biochemical recurrence included pathological stage, any positive margin and patient age ( P<0.005). A total of 44.9% had an immediate biochemical recurrence, with 90% receiving subsequent treatment and 20.5% having a durable response. None of the patients receiving prostate bed radiotherapy alone had a durable response. 54% had a delayed biochemical recurrence, with 63.5% receiving subsequent treatment and 44% having a durable response. Conclusions: Surgery is associated with encouraging surgical and functional outcomes, cancer-specific survival and overall survival rates in these patients. Pathological stage is a significant predictor of biochemical recurrence. The present analysis shows that long-term observation for certain patients with biochemical recurrence is appropriate and questions the effectiveness of further local salvage treatments in patients with an immediate biochemical recurrence postoperatively. Level of evidence: II
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Affiliation(s)
- Niall Gilliland
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | | | - Robert Geraghty
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | | | - Matthew Crockett
- Department of Urology, Gloucestershire Hospitals NHS Foundation Trust, UK
| | | | - Jon Oxley
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | - Tim Porter
- Department of Urology, Yeovil District Hospital, UK
| | | | - Jonathan Aning
- The Bristol Urological Institute, North Bristol NHS Trust, UK
| | - Edward Rowe
- The Bristol Urological Institute, North Bristol NHS Trust, UK
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10
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Chavarriaga J, Barco-Castillo C, Santander J, Zuluaga L, Medina C, Trujillo C, Plata M, Caicedo JI. Predicting the Probability of Lymph Node Involvement with Prostate Cancer Nomograms: Can We Trust the Prediction Models? UROLOGÍA COLOMBIANA 2020. [DOI: 10.1055/s-0040-1713378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Introduction Prediction of lymph node involvement (LNI) is of paramount importance for patients with prostate cancer (PCa) undergoing radical prostatectomy (RP). Multiple statistical models predicting LNI have been developed to support clinical decision-making regarding the need of extended pelvic lymph node dissection (ePLND). Our aim is to evaluate the prediction ability of the best-performing prediction tools for LNI in PCa in a Latin-American population.
Methods Clinicopathological data of 830 patients with PCa who underwent RP and ePLND between 2007 and 2018 was obtained. Only data from patients who had ≥ 10 lymph nodes (LNs) harvested were included (n = 576 patients). Four prediction models were validated using this cohort: The Memorial Sloan Kettering Cancer Center (MSKCC) web calculator, Briganti v.2017, Yale formula and Partin tables v.2016. The performance of the prediction tools was assessed using the area under the receiver operating characteristic (ROC) curve (AUC).
Results The median age was 61 years old (interquartile range [IQR] 56–66), the median Prostate specific antigen (PSA) was 6,81 ng/mL (IQR 4,8–10,1) and the median of LNs harvested was 17 (IQR 13–23), and LNI was identified in 53 patients (9.3%). Predictions from the 2017 Briganti nomogram AUC (0.85) and the Yale formula AUC (0.85) were the most accurate; MSKCC and 2016 Partin tables AUC were both 0,84.
Conclusion There was no significant difference in the performance of the four validated prediction tools in a Latin-American population compared with the European or North American patients in whom these tools have been validated. Among the 4 models, the Briganti v.2017 and Yale formula yielded the best results, but the AUC overlapped with the other validated models.
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Affiliation(s)
- Julian Chavarriaga
- Division of Urology, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Catalina Barco-Castillo
- Department of Urology, Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Jessica Santander
- Department of Urology, Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Laura Zuluaga
- Department of Urology, Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Camilo Medina
- Department of Urology, Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Carlos Trujillo
- Department of Urology, Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Mauricio Plata
- Department of Urology, Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Juan Ignacio Caicedo
- Department of Urology, Hospital Universitario, Fundación Santa Fe de Bogotá, Bogotá, Colombia
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Sebben M, Tafuri A, Porcaro AB, Artibani W, Cacciamani G. Response to: Bando et al. Diagnostic and therapeutic value of pelvic lymph node dissection in the fossa of Marcille in patients with clinically localized high-risk prostate cancer: Histological and molecular analyses. Prostate 2020; 80:795-796. [PMID: 32324906 DOI: 10.1002/pros.23987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/09/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Marco Sebben
- Department of Urology, Ospedale Sacro Cuore Don Calabria IRCCS, Negrar, Italy
| | - Alessandro Tafuri
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
- Department of Neurosciences, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy
| | - Antonio B Porcaro
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Walter Artibani
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Giovanni Cacciamani
- Catherine and Joseph Aresty Department of Urology, USC/Norris Institute of Urology, University of Southern California, Los Angeles, California
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Klingenberg S, Jochumsen MR, Ulhøi BP, Fredsøe J, Sørensen KD, Borre M, Bouchelouche K. 68Ga-PSMA PET/CT for Primary Lymph Node and Distant Metastasis NM Staging of High-Risk Prostate Cancer. J Nucl Med 2020; 62:214-220. [PMID: 32444374 DOI: 10.2967/jnumed.120.245605] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/05/2020] [Indexed: 12/24/2022] Open
Abstract
With the largest high-risk prostate cancer (PCa) cohort to date undergoing 68Ga-prostate-specific membrane antigen (PSMA) PET/CT primary staging, we aimed to, first, characterize the metastatic spread of PCa in relation to tumor 68Ga-PSMA uptake and the D'Amico classification and, second, compare 68Ga-PSMA PET/CT findings with radical prostatectomy and pelvic lymph node dissection (PLND) histopathology findings. Methods: The study included 691 consecutive newly diagnosed, biopsy-proven, treatment-naïve, D'Amico high-risk PCa patients primary-staged by 68Ga-PSMA PET/CT. PSMA SUVmax and metastatic findings were compared with prostate-specific antigen level, International Society of Urological Pathology (ISUP) grade, and clinical stage as traditional risk stratification parameters. Moreover, 68Ga-PSMA PET/CT findings were compared with histology findings in radical prostatectomy patients undergoing PLND. Undetected lymph node metastases (LNMs) underwent immunohistochemical PSMA staining. Results: Advanced disease (N1/M1) was observed in 35.3% of patients (244/691) and was associated with increasing prostate-specific antigen level, ISUP grade, and clinical stage. LNMs (N1/M1a) were detected in 31.4% (217/691) and bone metastases (M1b) in 16.8% (116/691). Advanced disease frequencies in patients with ISUP grades 2 and 3 were 10.8% (11/102) and 37.1% (33/89), respectively. Risk of advanced disease for cT2a, cT2b, and cT2c tumors was almost equal (24.2%, 27.9%, and 22.4%, respectively). We observed a weak correlation between SUVmax and biopsy ISUP grade (ρ = 0.21; P < 0.001) and a modest correlation between SUVmax and postprostatectomy ISUP grade (ρ = 0.38; P < 0.001). Sensitivity, specificity, positive and negative predictive value, and accuracy for LNM detection on 68Ga-PSMA PET/CT in the PLND cohort were 30.6%, 96.5%, 68.8%, 84.5%, and 83.1%, respectively. Undetected LNMs either were micrometastases located in the lymph node border or were without PSMA expression. Conclusion: In this high-risk PCa cohort, we identified advanced disease in about one third at diagnosis. ISUP grade was the superior predictor for advanced disease at diagnosis. We found a significant difference in frequency of advanced disease between ISUP grades 2 and 3, as supports the Gleason score 7 subdivision. Interestingly, we observed no significant differences in risk of advanced disease when comparing the different cT2 stages. The undetected LNMs were either PSMA-negative or micrometastases.
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Affiliation(s)
- Søren Klingenberg
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark .,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Mads R Jochumsen
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Benedicte P Ulhøi
- Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; and
| | - Jacob Fredsøe
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Karina D Sørensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Molecular Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Borre
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | - Kirsten Bouchelouche
- Department of Nuclear Medicine and PET Centre, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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13
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Milonas D, Venclovas Z, Muilwijk T, Jievaltas M, Joniau S. External validation of Memorial Sloan Kettering Cancer Center nomogram and prediction of optimal candidate for lymph node dissection in clinically localized prostate cancer. Cent European J Urol 2020; 73:19-25. [PMID: 32395318 PMCID: PMC7203765 DOI: 10.5173/ceju.2020.0079] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 01/20/2020] [Accepted: 02/17/2020] [Indexed: 12/12/2022] Open
Abstract
Introduction The aim of our study was to evaluate the external validity of the online Memorial Sloan Kettering Cancer Center (MSKCC) nomogram as a predictor for pelvic lymph node invasion (LNI) in men who underwent radical prostatectomy (RP) with pelvic lymph node dissection (PLND). Material and methods The study cohort consisted of 679 men with clinically localized prostate cancer (PCa) who underwent RP with PLND between 2005 and 2017. The area under curve (AUC) of the receiver operator characteristic analysis was used to quantify the accuracy of MSKCC nomogram to predict LNI. The specificity, sensitivity and negative predictive value were calculated to assess LNI probability cut-off. Results A total of 81 of 679 patients had LNI (11.9%). The AUC of MSKCC nomogram was 79%. Using the cut-off value of 7% (sensitivity 88.9%, specificity 45.2% and NPV 96.8%) a PLND could be omitted in 41% (279/679) of men. However, 3.2% (9/279) of men with LNI would be missed. MSKCC nomogram showed good calibration characteristics and high net benefit at decision curve analysis. Conclusions MSKCC nomogram in patients with PCa undergoing PLND has 79% discriminated accuracy for prediction of LNI in our cohort. Using a 7% nomogram cut-off, roughly 40% of men would be spared PLND with minimal risk to miss LNI.
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Affiliation(s)
- Daimantas Milonas
- Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania.,Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Zilvinas Venclovas
- Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania
| | - Tim Muilwijk
- Department of Urology, Leuven University Hospital, Leuven, Belgium
| | - Mindaugas Jievaltas
- Department of Urology, Lithuanian University of Health Sciences, Medical Academy, Kaunas, Lithuania
| | - Steven Joniau
- Department of Urology, Leuven University Hospital, Leuven, Belgium
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14
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Bando Y, Hinata N, Terakawa T, Furukawa J, Harada K, Nakano Y, Fujisawa M. Diagnostic and therapeutic value of pelvic lymph node dissection in the fossa of Marcille in patients with clinically localized high-risk prostate cancer: Histopathological and molecular analyses. Prostate 2020; 80:345-351. [PMID: 31899555 DOI: 10.1002/pros.23949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 12/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The optimal extent of lymph node dissection in radical prostatectomy has not been determined. Lymph nodes in the fossa of Marcille, which is an important pelvic lymphatic pathway and candidate for additional dissection, have not been evaluated at the molecular level. Here, we assessed by molecular analysis the presence of occult positive lymph nodes in the fossa of Marcille in patients with clinically localized high-risk prostate cancer. METHODS Fifty-two patients with clinically localized high-risk prostate cancer underwent pelvic lymph node dissection accompanied by robot-assisted radical prostatectomy. All nodal packets were dissected separately and grouped into right and left obturator, external and internal iliac regions (including common iliac region to ureter crossing), and fossa of Marcille. All lymph nodes were bisected and evaluated by histopathological or molecular analysis using a quantitative reverse transcription-polymerase chain reaction. The number of positive lymph nodes in the fossa of Marcille and the difference in detection rate were investigated using histopathological and molecular analyses. Perioperative complication rate and predictive factors for biochemical recurrence were evaluated. RESULTS In the molecular analysis, there were seven positive lymph nodes in the fossa of Marcille in three patients, which were coexistent with positive nodes in other regions. The detection rate of positive lymph nodes was significantly higher using molecular than histopathological analysis (P < .01). Perioperative complication rate within 90 days after the operation was 25.0% and no Clavien-Dindo grade ≥3 complication was confirmed. Detection of metastasis by histopathological and molecular analysis was a significant factor related to biochemical recurrence in the Cox proportional hazards regression model. CONCLUSIONS No case of positive lymph nodes in the fossa of Marcille that had skipped over other regions was confirmed. Additional lymph node dissection of fossa of Marcille did not lead to complete resection of molecularly positive lymph nodes.
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Affiliation(s)
- Yukari Bando
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nobuyuki Hinata
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoaki Terakawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Junya Furukawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenichi Harada
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuzo Nakano
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masato Fujisawa
- Department of Urology, Kobe University Graduate School of Medicine, Kobe, Japan
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15
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Perez IM, Jambor I, Kauko T, Verho J, Ettala O, Falagario U, Merisaari H, Kiviniemi A, Taimen P, Syvänen KT, Knaapila J, Seppänen M, Rannikko A, Riikonen J, Kallajoki M, Mirtti T, Lamminen T, Saunavaara J, Pahikkala T, Boström PJ, Aronen HJ. Qualitative and Quantitative Reporting of a Unique Biparametric MRI: Towards Biparametric MRI‐Based Nomograms for Prediction of Prostate Biopsy Outcome in Men With a Clinical Suspicion of Prostate Cancer (IMPROD and MULTI‐IMPROD Trials). J Magn Reson Imaging 2019; 51:1556-1567. [DOI: 10.1002/jmri.26975] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/29/2019] [Accepted: 10/02/2019] [Indexed: 01/01/2023] Open
Affiliation(s)
- Ileana Montoya Perez
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Ivan Jambor
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
- Department of RadiologyIcahn School of Medicine at Mount Sinai New York New York USA
| | - Tommi Kauko
- Auria Clinical InformaticsTurku University Hospital Turku Finland
| | - Janne Verho
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Otto Ettala
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Ugo Falagario
- Department of UrologyUniversity of Foggia Foggia Italy
- Department of UrologyIcahn School of Medicine at Mount Sinai New York New York USA
| | - Harri Merisaari
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Department of Future TechnologiesUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Aida Kiviniemi
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
| | - Pekka Taimen
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Kari T. Syvänen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Juha Knaapila
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Marjo Seppänen
- Department of SurgerySatakunta Central Hospital Pori Finland
| | - Antti Rannikko
- Department of UrologyHelsinki University and Helsinki University Hospital Helsinki Finland
| | - Jarno Riikonen
- Department of UrologyTampere University Hospital and University of Tampere Tampere Finland
| | - Markku Kallajoki
- Institute of BiomedicineUniversity of Turku and Department of Pathology, Turku University Hospital Turku Finland
| | - Tuomas Mirtti
- Department of PathologyUniversity of Helsinki Helsinki Finland
| | - Tarja Lamminen
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Jani Saunavaara
- Department of Medical PhysicsTurku University Hospital Turku Finland
| | - Tapio Pahikkala
- Department of Future TechnologiesUniversity of Turku Turku Finland
| | - Peter J. Boström
- Department of UrologyUniversity of Turku and Turku University Hospital Turku Finland
| | - Hannu J. Aronen
- Department of Diagnostic RadiologyUniversity of Turku Turku Finland
- Medical Imaging Centre of Southwest FinlandTurku University Hospital Turku Finland
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16
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Tosco L, Devos G, De Coster G, Roumeguère T, Everaerts W, Quackels T, Dekuyper P, Van Cleynenbreugel B, Van Damme N, Van Eycken E, Ameye F, Joniau S. Development and external validation of a nomogram to predict lymph node invasion after robot assisted radical prostatectomy. Urol Oncol 2019; 38:37.e11-37.e20. [PMID: 31727561 DOI: 10.1016/j.urolonc.2019.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 07/30/2019] [Accepted: 10/02/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prediction of lymph node invasion (LNI) after radical prostatectomy has been rarely assessed in robotically assisted laparoscopic radical prostatectomy (RALP) series. We aimed to develop and externally validate a pretreatment nomogram for the prediction of LNI following RALP in patients with high- and intermediate-risk prostate cancer. METHODS 1654 RALP patients were prospectively collected between 2009 and 2016 from academic and community hospitals. We included patients with intermediate- and high-risk prostate cancer who underwent pelvic lymph node dissection (e-PLND). Logistic regression analysis was applied to construct a nomogram to predict LNI. Centers were randomly assigned to the training cohort (80%) and validation cohort (20%). The discriminative accuracies were evaluated by the areas under the curve and by the calibration plot. The net benefit of the nomogram to predict LNI was assessed by decision curve analysis and a cut-off was proposed. RESULTS In total, 14% of the patients in our cohort had pN1 disease. Applying logistic regression analysis, the following covariates were chosen to develop the nomogram: initial PSA, clinical T stage, biopsy Gleason sum, and proportion of positive biopsy cores. The nomogram showed a median discriminative accuracy of 73% and excellent calibration. The net benefit of the model ranged between 7% and 51% predicted risk of LNI. A cut-off to perform e-PLND was set at 7%. This would permit a 29% of avoidable e-PLND, missing 9.4% of patients with LNI. CONCLUSIONS We developed and externally validated a nomogram to predict LNI in patients treated with RALP from a prospective, multi-institutional, nationwide series. A risk of LNI > 7% is proposed as cut-off above which e-PLND is recommended.
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Affiliation(s)
- Lorenzo Tosco
- Urology, University Hospitals Leuven, Leuven, Belgium; Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy.
| | - Gaëtan Devos
- Urology, University Hospitals Leuven, Leuven, Belgium
| | | | - Thierry Roumeguère
- Department of Urology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Thierry Quackels
- Department of Urology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Peter Dekuyper
- Department of Urology, AZ Maria Middelares, Gent, Belgium
| | | | | | | | - Filip Ameye
- Department of Urology, AZ Maria Middelares, Gent, Belgium
| | - Steven Joniau
- Urology, University Hospitals Leuven, Leuven, Belgium
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17
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Geißen W, Engels S, Aust P, Schiffmann J, Gerullis H, Wawroschek F, Winter A. Diagnostic Accuracy of Magnetometer-Guided Sentinel Lymphadenectomy After Intraprostatic Injection of Superparamagnetic Iron Oxide Nanoparticles in Intermediate- and High-Risk Prostate Cancer Using the Magnetic Activity of Sentinel Nodes. Front Pharmacol 2019; 10:1123. [PMID: 31680943 PMCID: PMC6797623 DOI: 10.3389/fphar.2019.01123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 08/30/2019] [Indexed: 01/05/2023] Open
Abstract
Due to the high morbidity of extended lymph node dissection (eLND) and the low detection rate of limited lymph node dissection (LND), targeted sentinel lymph node dissection (sLND) was implemented in prostate cancer (PCa). Subsequently, nonradioactive sentinel lymph node (SLN) detection using magnetic resonance imaging (MRI) and a magnetometer after intraprostatic injection of superparamagnetic iron oxide nanoparticles (SPIONs) was successfully applied in PCa. To validate the reliability of this approach, considering the magnetic activity of SLNs or whether it is sufficient to dissect only the most active SLNs as shown in other tumor entities for radio-guided sLND, we analyzed magnetometer-guided sLND results in 218 high- and intermediate-risk PCa patients undergoing eLND as a reference standard. Using a sentinel nomogram to predict lymph node invasion (LNI), a risk range was determined up to which LND could be dispensed with or sLND only would be adequate. In total, 3,711 LNs were dissected, and 1,779 SLNs (median, 8) were identified. Among 78 LN-positive patients, there were 264 LN metastases (median, 2). sLND had a 96.79% diagnostic rate, 88.16% sensitivity, 98.59% specificity, 97.1% positive predictive value (PPV), 93.96% negative predictive value (NPV), 4.13% false-negative rate, and 0.92% additional diagnostic value (LN metastases only outside the eLND template). For intermediate-risk patients only, the sensitivity, specificity, PPV, and NPV were 100%. Magnetic activities of SLNs were heterogeneous regardless of metastasis. The accuracy of predicting the presence of metastases for each LN from the proportion of activity was only 57.3% in high- and 65% in intermediate-risk patients. Patients with LNI risk of less than 5% could have been spared LND, as no positive LNs were found in this group. For patients with an LNI risk between 5% and 20%, sLND-only would have been sufficient to detect almost all LN metastases; thus, eLND could be dispensed with in 36% of patients. In conclusion, SPION-guided sLND is a reliable alternative to eLND in intermediate-/high-risk PCa. No conclusions can be drawn from magnetic SLN activity regarding the presence of metastases. LND could be dispensed with according to a nomogram of predicted probability for LNI of 5% without losing any LN-positive patient. Patients with LNI risk between 5% and 20% could be spared eLND by performing sLND.
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18
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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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19
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van Poppel H, Everaerts W, Tosco L, Joniau S. Open and robotic radical prostatectomy. Asian J Urol 2018; 6:125-128. [PMID: 31061797 PMCID: PMC6488736 DOI: 10.1016/j.ajur.2018.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022] Open
Abstract
Open retropubic radical prostatectomy has been the "gold standard" treatment for locally confined prostate cancer (PCa) but in recent years minimal invasive techniques as laparoscopy and robot-assisted prostatectomy have become widely available. The trifecta of the surgical treatment of PCa is cancer control, the preservation of continence, and erectile potency. Over the years the complication rates of radical prostatectomy have become very limited with improved cancer control and better functional results. We review the indications and the surgical technique of radical prostatectomy, be it open or laparoscopic, eventually robot-assisted as well as the pre- and postoperative measures and the surgery-related consequences.
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Affiliation(s)
- Hendrik van Poppel
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Lorenzo Tosco
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
| | - Steven Joniau
- Department of Urology, University Hospital, K.U. Leuven, Leuven, Belgium
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20
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Rozet F, Hennequin C, Beauval JB, Beuzeboc P, Cormier L, Fromont-Hankard G, Mongiat-Artus P, Ploussard G, Mathieu R, Brureau L, Ouzzane A, Azria D, Brenot-Rossi I, Cancel-Tassin G, Cussenot O, Rebillard X, Lebret T, Soulié M, Penna RR, Méjean A. RETRACTED: Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : cancer de la prostate French ccAFU guidelines – Update 2018–2020: Prostate cancer. Prog Urol 2018; 28:S79-S130. [PMID: 30392712 DOI: 10.1016/j.purol.2018.08.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (http://www.elsevier.com/locate/withdrawalpolicy).
Cet article est retiré de la publication à la demande des auteurs car ils ont apporté des modifications significatives sur des points scientifiques après la publication de la première version des recommandations.
Le nouvel article est disponible à cette adresse: DOI:10.1016/j.purol.2019.01.007.
C’est cette nouvelle version qui doit être utilisée pour citer l’article.
This article has been retracted at the request of the authors, as it is not based on the definitive version of the text because some scientific data has been corrected since the first issue was published.
The replacement has been published at the DOI:10.1016/j.purol.2019.01.007.
That newer version of the text should be used when citing the article.
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Affiliation(s)
- F Rozet
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, institut mutualiste Montsouris, université René-Descartes, 42, boulevard Jourdan, 75674, Paris, France.
| | - C Hennequin
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service de radiothérapie, Saint-Louis Hospital, AP-HP, 75010, Paris, France
| | - J-B Beauval
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, oncologie médicale, institut universitaire du cancer Toulouse-Oncopole, CHU Rangueil, 31100, Toulouse, France
| | - P Beuzeboc
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Foch, 92150, Suresnes, France
| | - L Cormier
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, CHU François-Mitterrand, 21000, Dijon, France
| | - G Fromont-Hankard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; CHU de Tours, 2, boulevard Tonnellé, 37000, Tours, France
| | - P Mongiat-Artus
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, Paris cedex 10, France
| | - G Ploussard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, clinique La Croix du Sud-Saint-Jean Languedoc, institut universitaire du cancer, 31100, Toulouse, France
| | - R Mathieu
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital de Rennes, 2, rue Henri-le-Guilloux, 35033, Rennes cedex 9, France
| | - L Brureau
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Inserm, U1085, IRSET, 97145 Pointe-à-Pitre, Guadeloupe
| | - A Ouzzane
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Claude-Huriez, CHRU de Lille, rue Michel-Polonovski, 59000, Lille, France
| | - D Azria
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Inserm U1194, ICM, université de Montpellier, 34298, Montpellier, France
| | - I Brenot-Rossi
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Institut Paoli-Calmettes, 232, boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - G Cancel-Tassin
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; GRC no 5 ONCOTYPE-URO, institut universitaire de cancérologie, Sorbonne université, 75020, Paris, France
| | - O Cussenot
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Tenon, AP-HP, Sorbonne université, 75020, Paris, France
| | - X Rebillard
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, clinique mutualiste Beau-Soleil, 119, avenue de Lodève, 34070, Montpellier, France
| | - T Lebret
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital Foch, 92150, Suresnes, France
| | - M Soulié
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Centre hospitalier universitaire Rangueil, 31059, Toulouse, France
| | - R Renard Penna
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; GRC no 5 ONCOTYPE-URO, institut universitaire de cancérologie, Sorbonne université, 75020, Paris, France; Service de radiologie, hôpital Tenon, AP-HP, 75020, Paris, France
| | - A Méjean
- Comité de cancérologie de l'Association française d'urologie, groupe prostate, maison de l'urologie, 11, rue Viète, 75017, Paris, France; Service d'urologie, hôpital européen Georges-Pompidou, université Paris Descartes, Assistance publique des hôpitaux de Paris (AP-HP), 75015, Paris, France
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Rozet F, Hennequin C, Beauval JB, Beuzeboc P, Cormier L, Fromont-Hankard G, Mongiat-Artus P, Ploussard G, Mathieu R, Brureau L, Ouzzane A, Azria D, Brenot-Rossi I, Cancel-Tassin G, Cussenot O, Rebillard X, Lebret T, Soulié M, Renard Penna R, Méjean A. Recommandations françaises du Comité de Cancérologie de l’AFU – Actualisation 2018–2020 : cancer de la prostate. Prog Urol 2018; 28 Suppl 1:R81-R132. [DOI: 10.1016/j.purol.2019.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/02/2023]
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Preisser F, Nazzani S, Bandini M, Marchioni M, Tian Z, Saad F, Chun FKH, Shariat SF, Montorsi F, Huland H, Graefen M, Tilki D, Karakiewicz PI. Racial disparities in lymph node dissection at radical prostatectomy: A Surveillance, Epidemiology and End Results database analysis. Int J Urol 2018; 25:929-936. [DOI: 10.1111/iju.13780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/17/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Felix Preisser
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
- Academic Department of Urology; IRCCS Policlinico San Donato; University of Milan; Milan Italy
| | - Marco Bandini
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
- Department of Urology and Division of Experimental Oncology; Urological Research Institute; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - Michele Marchioni
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
- Department of Urology; SS Annunziata Hospital; “G.D'Annunzio” University of Chieti; Chieti Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
| | - Felix KH Chun
- Department of Urology; University Hospital Frankfurt am Main; Frankfurt am Main Germany
| | | | - Francesco Montorsi
- Department of Urology and Division of Experimental Oncology; Urological Research Institute; IRCCS San Raffaele Scientific Institute; Milan Italy
| | - Hartwig Huland
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center; University Hospital Hamburg-Eppendorf; Hamburg Germany
- Department of Urology; University Hospital Hamburg-Eppendorf; Hamburg Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit; Division of Urology; University of Montreal Health Center; Montreal Quebec Canada
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23
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Imaging modalities in synchronous oligometastatic prostate cancer. World J Urol 2018; 37:2573-2583. [PMID: 30069582 PMCID: PMC6868105 DOI: 10.1007/s00345-018-2416-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/18/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose Along with a number of other malignancies, the term “oligometastatic” prostate cancer has recently emerged. It represents an attempt to define a subtype of cancer with a limited metastatic load that might perform more favorably than a distinctly disseminated disease, or even one that may be managed in a potentially curative way. Since there is currently a knowledge gap of what imaging modalities should be utilized to classify patients as having this type of tumor, we aimed to shed light on the role of conventional and marker-based imaging in the setting of synchronous oligometastatic prostate cancer as well as summarize the available evidence for its clinical application. Methods A literature search on December 15th 2017 was conducted using the Pubmed database. Results Functional imaging techniques like 68Ga PSMA. 68Ga PSMA PET-CT has currently been shown the best detection rates for the assessment of nodal, bone and visceral metastases, especially for smaller lesions at low PSA levels. Conclusions Functional imaging helps detect low-burden disease metastatic patients. However, these imaging modalities are not available in every center and thus clinicians may be prone to prescribe systemic treatment rather than referring patients for cytoreductive treatments. We hope that the ongoing prospective trials will help guide clinicians in making a more personalized management of synchronous metastatic patients.
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24
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Hueting TA, Cornel EB, Somford DM, Jansen H, van Basten JPA, Pleijhuis RG, Korthorst RA, van der Palen JAM, Koffijberg H. External Validation of Models Predicting the Probability of Lymph Node Involvement in Prostate Cancer Patients. Eur Urol Oncol 2018; 1:411-417. [PMID: 31158080 DOI: 10.1016/j.euo.2018.04.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 04/20/2018] [Accepted: 04/26/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multiple statistical models predicting lymph node involvement (LNI) in prostate cancer (PCa) exist to support clinical decision-making regarding extended pelvic lymph node dissection (ePLND). OBJECTIVE To validate models predicting LNI in Dutch PCa patients. DESIGN, SETTING, AND PARTICIPANTS Sixteen prediction models were validated using a patient cohort of 1001 men who underwent ePLND. Patient characteristics included serum prostate specific antigen (PSA), cT stage, primary and secondary Gleason scores, number of biopsy cores taken, and number of positive biopsy cores. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Model performance was assessed using the area under the receiver operating characteristic curve (AUC). Calibration plots were used to visualize over- or underestimation by the models. RESULTS AND LIMITATIONS LNI was identified in 276 patients (28%). Patients with LNI had higher PSA, higher primary Gleason pattern, higher Gleason score, higher number of nodes harvested, higher number of positive biopsy cores, and higher cT stage compared to patients without LNI. Predictions generated by the 2012 Briganti nomogram (AUC 0.76) and the Memorial Sloan Kettering Cancer Center (MSKCC) web calculator (AUC 0.75) were the most accurate. Calibration had a decisive role in selecting the most accurate models because of overlapping confidence intervals for the AUCs. Underestimation of LNI probability in patients had a predicted probability of <20%. The omission of model updating was a limitation of the study. CONCLUSIONS Models predicting LNI in PCa patients were externally validated in a Dutch patient cohort. The 2012 Briganti and MSKCC nomograms were identified as the most accurate prediction models available. PATIENT SUMMARY In this report we looked at how well models were able to predict the risk of prostate cancer spreading to the pelvic lymph nodes. We found that two models performed similarly in predicting the most accurate probabilities.
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Affiliation(s)
- Tom A Hueting
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
| | - Erik B Cornel
- Department of Urology, Ziekenhuisgroep Twente, Hengelo, The Netherlands
| | - Diederik M Somford
- Department of urology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Hanneke Jansen
- Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | | | - Rick G Pleijhuis
- Department of Internal Medicine, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Ruben A Korthorst
- Department of Urology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job A M van der Palen
- Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands; Medisch spectrum Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
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25
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Bianchi L, Schiavina R, Borghesi M, Bianchi FM, Briganti A, Carini M, Terrone C, Mottrie A, Gacci M, Gontero P, Imbimbo C, Marchioro G, Milanese G, Mirone V, Montorsi F, Morgia G, Novara G, Porreca A, Volpe A, Brunocilla E. Evaluating the predictive accuracy and the clinical benefit of a nomogram aimed to predict survival in node-positive prostate cancer patients: External validation on a multi-institutional database. Int J Urol 2018; 25:574-581. [DOI: 10.1111/iju.13565] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 02/19/2018] [Indexed: 11/30/2022]
Affiliation(s)
| | | | - Marco Borghesi
- Department of Urology; University of Bologna; Bologna Italy
| | | | - Alberto Briganti
- Unit of Urology/Division of Oncology; URI; IRCCS San Raffaele Hospital; Milan Italy
| | - Marco Carini
- Department of Urology; University of Florence; Florence Italy
| | - Carlo Terrone
- Department of Urology; University of Genoa; Genoa Italy
| | - Alex Mottrie
- Department of Urology; OLV Hospital; Aalst Belgium
| | - Mauro Gacci
- Department of Urology; University of Florence; Florence Italy
| | - Paolo Gontero
- Department of Urology; University of Turin; Turin Italy
| | - Ciro Imbimbo
- Department of Urology; University of Naples; Naples Italy
| | | | | | | | - Francesco Montorsi
- Unit of Urology/Division of Oncology; URI; IRCCS San Raffaele Hospital; Milan Italy
| | | | | | - Angelo Porreca
- Department of Urology; Abano Hospital; Abano Terme Italy
| | - Alessandro Volpe
- Department of Urology; University of Eastern Piedmont; Novara Italy
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26
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Nocera L, Sood A, Dalela D, Gild P, Rogers CG, Peabody JO, Montorsi F, Menon M, Briganti A, Abdollah F. Rate and Extent of Pelvic Lymph Node Dissection in the US Prostate Cancer Patients Treated With Radical Prostatectomy. Clin Genitourin Cancer 2018; 16:e451-e467. [DOI: 10.1016/j.clgc.2017.10.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/25/2017] [Accepted: 10/09/2017] [Indexed: 12/11/2022]
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Sivaraman A, Benfante N, Touijer K, Coleman J, Scardino P, Laudone V, Eastham J. Can pelvic node dissection at radical prostatectomy influence the nodal recurrence at salvage lymphadenectomy for prostate cancer? Investig Clin Urol 2018. [PMID: 29520383 PMCID: PMC5840122 DOI: 10.4111/icu.2018.59.2.83] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose To verify the quality of pelvic lymph node dissection (PLND) performed at radical prostatectomy (RP) and its impact on nodal recurrence in patients undergoing salvage lymph node dissection (sLND). Materials and Methods Retrospective review of 48 patients who underwent sLND for presumed nodal recurrence, to describe the PLND characteristics at RP and correlate the anatomical sites and number of suspicious nodes reported in radiological imaging and final pathology of sLND. Results Overall, at RP, 8 (16.7%) did not undergo PLND, 32 (66.7%) and 8 (16.7%) received a “limited” (between external iliac vein and obturator nerve) and an “extended” (external iliac, hypogastric, and obturator) dissection, respectively. Median nodes removed during limited and extended dissection were 2 and 24, respectively. At sLND, the mean age was 61.3 years and median prostate specific antigen (PSA) was 1.07 ng/mL. Median nodes removed at sLND were 17 with a median of 2 positive nodes. Recurrent nodes were identified within the template of an extended PLND in 62.5%, 50.0% and 12.5% patients, respectively, following prior no, limited and extended dissection at RP. Recurrence outside the expected lymphatic drainage pathway was noted in 37.5% patients with prior extended dissection at RP. There was a correlation between imaging and pathology specimen in 83% for node location and 58.3% for number of anatomical sites involved. Conclusions In prostate cancer patients undergoing sLND, most had inadequate PLND at the original RP. Pattern of nodal recurrence may be influenced by the prior dissection and pre sLND imaging appears to underestimate the nodal recurrence.
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Affiliation(s)
- Arjun Sivaraman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Nicole Benfante
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Karim Touijer
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Jonathan Coleman
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Peter Scardino
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Vincent Laudone
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
| | - James Eastham
- Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, NY, USA
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Maderthaner L, Furrer MA, Studer UE, Burkhard FC, Thalmann GN, Nguyen DP. More extended lymph node dissection template at radical prostatectomy detects metastases in the common iliac region and in the fossa of Marcille. BJU Int 2017; 121:725-731. [DOI: 10.1111/bju.13993] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Lydia Maderthaner
- Department of Urology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Marc A. Furrer
- Department of Urology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Urs E. Studer
- Department of Urology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Fiona C. Burkhard
- Department of Urology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - George N. Thalmann
- Department of Urology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
| | - Daniel P. Nguyen
- Department of Urology; Inselspital; Bern University Hospital; University of Bern; Bern Switzerland
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Winter A, Kneib T, Wasylow C, Reinhardt L, Henke RP, Engels S, Gerullis H, Wawroschek F. Updated Nomogram Incorporating Percentage of Positive Cores to Predict Probability of Lymph Node Invasion in Prostate Cancer Patients Undergoing Sentinel Lymph Node Dissection. J Cancer 2017; 8:2692-2698. [PMID: 28928857 PMCID: PMC5604200 DOI: 10.7150/jca.20409] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 05/28/2017] [Indexed: 11/05/2022] Open
Abstract
Objectives: To update the first sentinel nomogram predicting the presence of lymph node invasion (LNI) in prostate cancer patients undergoing sentinel lymph node dissection (sPLND), taking into account the percentage of positive cores. Patients and Methods: Analysis included 1,870 prostate cancer patients who underwent radioisotope-guided sPLND and retropubic radical prostatectomy. Prostate-specific antigen (PSA), clinical T category, primary and secondary biopsy Gleason grade, and percentage of positive cores were included in univariate and multivariate logistic regression models predicting LNI, and constituted the basis for the regression coefficient-based nomogram. Bootstrapping was applied to generate 95% confidence intervals for predicted probabilities. The area under the receiver operator characteristic curve (AUC) was obtained to quantify accuracy. Results: Median PSA was 7.68 ng/ml (interquartile range (IQR) 5.5-12.3). The number of lymph nodes removed was 10 (IQR 7-13). Overall, 352 patients (18.8%) had LNI. All preoperative prostate cancer characteristics differed significantly between LNI-positive and LNI-negative patients (P<0.001). In univariate accuracy analyses, the proportion of positive cores was the foremost predictor of LNI (AUC, 77%) followed by PSA (71.1%), clinical T category (69.9%), and primary and secondary Gleason grade (66.6% and 61.3%, respectively). For multivariate logistic regression models, all parameters were independent predictors of LNI (P<0.001). The nomogram exhibited a high predictive accuracy (AUC, 83.5%). Conclusion: The first update of the only available sentinel nomogram predicting LNI in prostate cancer patients demonstrates even better predictive accuracy and improved calibration. As an additional factor, the percentage of positive cores represents the leading predictor of LNI. This updated sentinel model should be externally validated and compared with results of extended PLND-based nomograms.
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Affiliation(s)
- Alexander Winter
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Kneib
- Working Group Statistics and Econometrics, Georg-August University Göttingen, Göttingen, Germany
| | - Clara Wasylow
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Lena Reinhardt
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | | | - Svenja Engels
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Holger Gerullis
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Friedhelm Wawroschek
- University Hospital for Urology, Klinikum Oldenburg, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, Germany
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van der Poel HG, Meershoek P, Grivas N, KleinJan G, van Leeuwen FWB, Horenblas S. Sentinel node biopsy and lymphatic mapping in penile and prostate cancer. Urologe A 2017; 56:13-17. [PMID: 27853841 DOI: 10.1007/s00120-016-0270-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Nodal metastases are linked to poor outcome in men with penile or prostate cancer. Early detection and resection are important for staging and for the prognosis. However, lymphadenectomy is associated with morbidity and may miss metastases when performed solely on the basis of anatomical templates. METHODS In this article we describe the technique and benefits of sentinel node biopsy (SNB) and provide a review of the literature. RESULTS Dynamic sentinel node techniques using both radioactive and optical (hybrid) tracers have been proven effective in penile cancer. For prostate cancer, SNB added to extended nodal dissection may further tailor dissection to the highly variable lymphatic drainage patterns in the pelvis. The sensitivity of SNB was found to be superior to conventional imaging methods; however, false-negative SNB procedures can occur and a complementary extensive lymphadenectomy is required to remove additional positive nodes that were not detected in the SNB template. CONCLUSION SNB is a standard method for early detection of nodal metastases in penile cancer and provides superior diagnostic accuracy to conventional imaging modalities in prostate cancer.
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Affiliation(s)
- H G van der Poel
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands.
| | - P Meershoek
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - N Grivas
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - G KleinJan
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
| | - F W B van Leeuwen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Horenblas
- Department of Urology, Netherlands Cancer Institute, Plesmanlaan 121, 1066CX, Amsterdam, The Netherlands
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32
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[Prostate gland - what would urologists like to know from radiologists?]. Radiologe 2017; 57:608-614. [PMID: 28660295 DOI: 10.1007/s00117-017-0273-4] [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: 10/19/2022]
Abstract
A more than 100-year period, where the prostate was only seen and treated as a whole is coming to an end right now. Finally, high resolution imaging is providing deep insights and detailed information so that new therapeutic procedures can aim for the smallest targets within the gland. The long-standing wish of patients for individual noninvasive diagnostics and treatment of prostate diseases can now be fulfilled by providing new tailored concepts; however, in order to transfer the enormous amount of new information into the specific clinical patient situation, a closely knit interdisciplinary approach is required. In this setting, the traditional outpatient consultation service is overstretched in every aspect. It is now the time for new innovative constructs. The current one-sided service concept for urologists, radiologists and radiation therapists is therefore behind the times and the development of a "prostate management team" with equally cooperating partners from each specialty is the task for the future.
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Cimino S, Reale G, Castelli T, Favilla V, Giardina R, Russo GI, Privitera S, Morgia G. Comparison between Briganti, Partin and MSKCC tools in predicting positive lymph nodes in prostate cancer: a systematic review and meta-analysis. Scand J Urol 2017. [DOI: 10.1080/21681805.2017.1332680] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Sebastiano Cimino
- Urology Section, Department of Urology, University of Catania, Catania, Italy
| | - Giulio Reale
- Urology Section, Department of Urology, University of Catania, Catania, Italy
| | - Tommaso Castelli
- Urology Section, Department of Urology, University of Catania, Catania, Italy
| | - Vincenzo Favilla
- Urology Section, Department of Urology, University of Catania, Catania, Italy
| | - Raimondo Giardina
- Urology Section, Department of Urology, University of Catania, Catania, Italy
| | - Giorgio Ivan Russo
- Urology Section, Department of Urology, University of Catania, Catania, Italy
| | - Salvatore Privitera
- Urology Section, Department of Urology, University of Catania, Catania, Italy
| | - Giuseppe Morgia
- Urology Section, Department of Urology, University of Catania, Catania, Italy
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Abstract
OBJECTIVES The purpose of the guidelines national committee CCAFU was to propose updated french guidelines for localized and metastatic prostate cancer (PCa). METHODS A Medline search was achieved between 2013 and 2016, as regards diagnosis, options of treatment and follow-up of PCa, to evaluate different references with levels of evidence. RESULTS Epidemiology, classification, staging systems, diagnostic evaluation are reported. Disease management options are detailed. Recommandations are reported according to the different clinical situations. Active surveillance is a major option in low risk PCa. Radical prostatectomy remains a standard of care of localized PCa. The three-dimensional conformal radiotherapy is the technical standard. A dose of > 74Gy is recommended. Moderate hypofractionation provides short-term biochemical control comparable to conventional fractionation. In case of intermediate risk PCa, radiotherapy can be combined with short-term androgen deprivation therapy (ADT). In case of high risk disease, long-term ADT remains the standard of care. ADT is the backbone therapy of metastatic disease. In men with metastases at first presentation, upfront chemotherapy combined with ADT should be considered as a new standard. In case of metastatic castration-resistant PCa (mCRPC), new hormonal treatments and chemotherapy provide a better control of tumor progression and increase survival. CONCLUSIONS These updated french guidelines will contribute to increase the level of urological care for the diagnosis and treatment for prostate cancer. © 2016 Elsevier Masson SAS. All rights reserved.
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Vagnoni V, Bianchi L, Borghesi M, Pultrone CV, Dababneh H, Chessa F, La Manna G, Rizzi S, Porreca A, Brunocilla E, Martorana G, Schiavina R. Adverse Features and Competing Risk Mortality in Patients With High-Risk Prostate Cancer. Clin Genitourin Cancer 2017; 15:e239-e248. [DOI: 10.1016/j.clgc.2016.08.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Revised: 08/10/2016] [Accepted: 08/14/2016] [Indexed: 11/27/2022]
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Srougi V, Tourinho-Barbosa RR, Nunes-Silva I, Baghdadi M, Garcia-Barreras S, Rembeyo G, Eiffel SS, Barret E, Rozet F, Galiano M, Sanchez-Salas R, Cathelineau X. The Role of Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer. J Endourol 2017; 31:229-237. [DOI: 10.1089/end.2016.0659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Victor Srougi
- Department of Urology, Institut Montsouris, Paris, France
- Division of Urology, University of Sao Paulo, Sao Paulo, Brazil
| | - Rafael R. Tourinho-Barbosa
- Department of Urology, Institut Montsouris, Paris, France
- Division of Urology, ABC Medical School, Sao Paulo, Brazil
| | | | | | | | | | | | - Eric Barret
- Department of Urology, Institut Montsouris, Paris, France
| | - Francois Rozet
- Department of Urology, Institut Montsouris, Paris, France
| | - Marc Galiano
- Department of Urology, Institut Montsouris, Paris, France
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Abstract
Conventional anatomical imaging with CT and MRI has limitations in the evaluation of prostate cancer. PET is a powerful imaging technique, which can be directed toward molecular targets as diverse as glucose metabolism, density of prostate-specific membrane antigen receptors, and skeletal osteoblastic activity. Although 2-deoxy-2-18F-FDG-PET is the mainstay of molecular imaging, FDG has limitations in typically indolent prostate cancer. Yet, there are many useful and emerging PET tracers beyond FDG, which provide added value. These include radiotracers interrogating prostate cancer via molecular mechanisms related to the biology of choline, acetate, amino acids, bombesin, and dihydrotestosterone, among others. Choline is used for cell membrane synthesis and its metabolism is upregulated in prostate cancer. 11C-choline and 18F-choline are in wide clinical use outside the United States, and they have proven most beneficial for detection of recurrent prostate cancer. 11C-acetate is an indirect biomarker of fatty acid synthesis, which is also upregulated in prostate cancer. Imaging of prostate cancer with 11C-acetate is overall similar to the choline radiotracers yet is not as widely used. Upregulation of amino acid transport in prostate cancer provides the biologic basis for amino acid-based radiotracers. Most recent progress has been made with the nonnatural alicyclic amino acid analogue radiotracer anti-1-amino-3-18F-fluorocyclobutane-1-carboxylic acid (FACBC or fluciclovine) also proven most useful for the detection of recurrent prostate cancer. Other emerging PET radiotracers for prostate cancer include the bombesin group directed to the gastrin-releasing peptide receptor, 16β-18F-fluoro-5α-dihydrotestosterone (FDHT) that binds to the androgen receptor, and those targeting the vasoactive intestinal polypeptide receptor 1 (VPAC-1) and urokinase plasminogen activator receptor (uPAR), which are also overexpressed in prostate cancer.
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Affiliation(s)
- David M Schuster
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA.
| | - Cristina Nanni
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, University of Bologna, Bologna, Italy
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Brouwer OR, van der Poel HG, Bevers RF, van Gennep EJ, Horenblas S. Beyond penile cancer, is there a role for sentinel node biopsy in urological malignancies? Clin Transl Imaging 2016; 4:395-410. [PMID: 27738628 PMCID: PMC5037151 DOI: 10.1007/s40336-016-0189-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 05/30/2016] [Indexed: 11/30/2022]
Abstract
This review aims to discuss the current state-of-the-art of sentinel node (SN) mapping in urological malignancies. The principles and methodological aspects of lymphatic mapping and SN biopsy in urological malignancies are reviewed. Literature search was restricted to English language. The references of the retrieved articles were examined to identify additional articles. The review also includes meta-analyses published in the past 5 years. SN biopsy for penile cancer is recommended by the European Association of Urology as the preferred staging tool for clinically node-negative patients with at least T1G2 tumours (level of evidence 2a, Grade B). The feasibility of SN biopsy in prostate cancer has been repeatedly demonstrated and its potential value is increasingly being recognised. However, conclusive prospective clinical data as well as consensus on methodology and patient selection are still lacking. For bladder, renal and testicular cancer, only few studies have been published, and concerns around high false-negative rates remain. Throughout the years, the uro-oncological field has portrayed a pivotal role in the development of the SN concept. Recent advances such as hybrid tracers and novel intraoperative detection tools such as fluorescence and portable gamma imaging will hopefully encourage prospectively designed clinical trials which can further substantiate the potential of the SN approach in becoming an integral part of staging in urological malignancies beyond penile cancer.
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Affiliation(s)
- O R Brouwer
- Department of Urologyand Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands ; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - H G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - R F Bevers
- Department of Urologyand Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - E J van Gennep
- Department of Urologyand Interventional Molecular Imaging Laboratory, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - S Horenblas
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
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Yadav R, Arora S, Sachdeva M, Gupta NP. Assessment of the performance of Partin's nomogram (2007) in contemporary Indian cohort. Indian J Urol 2016; 32:199-203. [PMID: 27555677 PMCID: PMC4970390 DOI: 10.4103/0970-1591.185096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction: Partin's nomogram is an important prognostic tool to predict adverse pathological features for clinically localized prostate carcinoma. This tool is widely used by both radiation and surgical oncologists for pre-intervention counseling, treatment planning, and predicting the possible need for adjuvant treatment. However, the model is derived from a Western population with typical characteristics of prostate cancer in a prostate-specific antigen (PSA) screened population. Therefore, this study was conducted to assess the performance of the Partin's nomogram as applied to an Indian cohort by assessing the discrimination and calibration properties. Methods: A retrospective review of 282 patients treated with robotic radical prostatectomy from 2010 to 2015 was conducted. Partin tables (year 2007) were used to calculate the predicted probabilities for lymph node invasion (LNI), seminal vesicle invasion (SVI), and extraprostatic extension (EPE). The discrimination properties were assessed using the receiver operating characteristic (ROC) curves. Calibration of the model was done to show the relationship between predicted and observed values. Results: The mean age of the patients was 64.3 years. Most (59.4%) were clinical T2 disease. Patients with PSA >10 ng/ml comprised 60% of the population. ECE, SVI, and LNI were present in 39.2%, 22%, and 11% of cases, respectively. ROC analysis revealed area under curve values for EPE, SVI, and LNI of 68%, 67.5%, and 71.2%, respectively. Calibration plot suggested that the Partin tables under-predicted the risk whenever the values of predicted risk were more than 26%, 3%, and 1% for EPE, SVI, and LNI, respectively, and over predicted when the risk was lower. Conclusion: Our data show that Partin's tables, despite having fair discrimination properties, do not accurately predict LNI, SVI, and ECE across the entire range of predicted values in a contemporary Indian cohort.
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Affiliation(s)
- Rajiv Yadav
- Department of Urology, Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Sohrab Arora
- Department of Urology, Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Manish Sachdeva
- Department of Urology, Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India
| | - Narmada Prasad Gupta
- Department of Urology, Institute of Kidney and Urology, Medanta - The Medicity, Gurgaon, Haryana, India
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Yang Y, Luo Y, Hou GL, Huang QX, Pang J, Gao X. Laparoscopic Radical Prostatectomy Plus Extended Lymph Node Dissection in Combination With Immediate Androgen Deprivation Therapy for Cases of pT3-4N0-1M0 Prostate Cancer: A Multimodal Study of 8 Years' Follow-up. Clin Genitourin Cancer 2016; 14:e321-7. [DOI: 10.1016/j.clgc.2015.11.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 10/22/2015] [Accepted: 11/11/2015] [Indexed: 11/27/2022]
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von Below C, Daouacher G, Wassberg C, Grzegorek R, Gestblom C, Sörensen J, Ahlström H, Waldén M. Validation of 3 T MRI including diffusion-weighted imaging for nodal staging of newly diagnosed intermediate- and high-risk prostate cancer. Clin Radiol 2016; 71:328-34. [PMID: 26774372 DOI: 10.1016/j.crad.2015.12.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 11/13/2015] [Accepted: 12/02/2015] [Indexed: 12/14/2022]
Abstract
AIM To prospectively validate 3 T magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI) for preoperative lymph node (LN) staging in a clinical setting, in intermediate- and high-risk prostate cancer (PCa) patients using laparoscopic extended LN dissection (ePLND) as the reference standard. MATERIALS AND METHODS Between August 2011 and May 2013, 40 newly diagnosed intermediate and high-risk PCa patients underwent preoperative LN staging with 3 T MRI DWI using histopathology of ePLND as the reference standard. The sensitivity, specificity, and accuracy of MRI DWI were calculated. A subgroup analysis of proven LN-positive patients was made to investigate differences in PSA, Gleason score, number, and size of LN metastases, estimated risk of LN involvement, and if curative treatment was indicated, between the true-positive and the false-negative groups. RESULTS A total of 728 LN were harvested from six anatomical regions per patient (external, obturator, internal) with a mean number of 18 LNs per patient (range 11-40). Twenty patients had histologically proven LN-positive disease. MRI DWI was true positive in 11 patients, false negative in nine patients, false positive in two patients, and true negative in 18 patients, resulting in 90% specificity, 55% sensitivity, and 72.5% accuracy. The true-positive patients had significantly more involved LNs (mean 6.9 versus 2.7, p=0.017), with larger diameter (mean 12.3 versus 5.2 mm, p=0.048) and fewer were treated with curative intent (six versus nine, p=0.03), compared with the false-negative group. CONCLUSION MRI DWI LN staging has a low sensitivity but high specificity. The true-positive patients have a considerably higher burden of LN metastases compared to false-negative patients.
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Affiliation(s)
- C von Below
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden.
| | - G Daouacher
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
| | - C Wassberg
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - R Grzegorek
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
| | - C Gestblom
- Department of Pathology, Central Hospital of Karlstad, Karlstad, Sweden
| | - J Sörensen
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - H Ahlström
- Department of Surgical Sciences/Radiology, Uppsala University, Uppsala, Sweden
| | - M Waldén
- Department of Urology, Central Hospital of Karlstad, Karlstad, Sweden
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Raman JD, Gherezghihir A. Indications for Pelvic Lymphadenectomy. Prostate Cancer 2016. [DOI: 10.1016/b978-0-12-800077-9.00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Pelvic lymph node dissection in prostate cancer: indications, extent and tailored approaches. Urologia 2015; 84:9-19. [PMID: 26689534 DOI: 10.5301/uro.5000139] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE The purpose of this study is to review the current literature concerning the indication of pelvic lymph node dissection (PLND), its extent and complications in prostate cancer (PCa) staging, the available tools, and the future perspectives to assess the risk of lymph node invasion (LNI). METHODS A literature review was performed using the Medline, Embase, and Web of Science databases. The search strategy included the terms pelvic lymph nodes, PLND, radical prostatectomy, prostate cancer, lymph node invasion, biochemical recurrence, staging, sentinel lymph node dissection, imaging, and molecular markers. RESULTS PLND currently represents the gold standard for nodal staging in PCa patients. Available imaging techniques are characterized by poor accuracy in the prediction of LNI before surgery. On the contrary, an extended PLND (ePLND) would result into proper staging in the majority of the cases. Several models based on preoperative disease characteristics are available to assess the risk of LNI. Although ePLND is not associated with a substantial risk of severe complications, up to 10% of the men undergoing this procedure experience lymphoceles. Concerns over potential morbidity of ePLND led many authors to investigate the role of sentinel lymph node dissection in order to prevent unnecessary ePLND. Finally, the incorporation of novel biomarkers in currently available tools would improve our ability to identify men who should receive an ePLND. CONCLUSIONS Nowadays, the most informative tools predicting LNI in PCa patients consist in preoperative clinical nomograms. Sentinel lymph node dissection still remains experimental and novel biomarkers are needed to identify patients at a higher risk of LNI.
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van der Poel HG, van den Berg NS, KleinJan GH, van Leeuwen FWB. Reply from authors re: Francesco Montorsi, Giorgio Gandaglia. Sentinel node biopsy for prostate cancer: a useless surgical exercise? Eur urol 2014;66:999-1000: Removing nodes that count rather than counting nodes that don't. Eur Urol 2014; 66:1000-1. [PMID: 25440526 DOI: 10.1016/j.eururo.2014.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 10/01/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Nynke S van den Berg
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gijs H KleinJan
- Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Fijs W B van Leeuwen
- Department of Urology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Interventional Molecular Imaging Laboratory, Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Clinical nodal staging scores for prostate cancer: a proposal for preoperative risk assessment. Br J Cancer 2014; 111:213-9. [PMID: 25003663 PMCID: PMC4102948 DOI: 10.1038/bjc.2014.311] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 05/05/2014] [Accepted: 05/12/2014] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Pelvic lymph node dissection in patients undergoing radical prostatectomy for clinically localised prostate cancer is not without morbidity and its therapeutical benefit is still a matter of debate. The objective of this study was to develop a model that allows preoperative determination of the minimum number of lymph nodes needed to be removed at radical prostatectomy to ensure true nodal status. METHODS We analysed data from 4770 patients treated with radical prostatectomy and pelvic lymph node dissection between 2000 and 2011 from eight academic centres. For external validation of our model, we used data from a cohort of 3595 patients who underwent an anatomically defined extended pelvic lymph node dissection. We estimated the sensitivity of pathological nodal staging using a beta-binomial model and developed a novel clinical (preoperative) nodal staging score (cNSS), which represents the probability that a patient has lymph node metastasis as a function of the number of examined nodes. RESULTS In the development and validation cohorts, the probability of missing a positive lymph node decreases with increase in the number of nodes examined. A 90% cNSS can be achieved in the development and validation cohorts by examining 1-6 nodes in cT1 and 6-8 nodes in cT2 tumours. With 11 nodes examined, patients in the development and validation cohorts achieved a cNSS of 90% and 80% with cT3 tumours, respectively. CONCLUSIONS Pelvic lymph node dissection is the only reliable technique to ensure accurate nodal staging in patients treated with radical prostatectomy for clinically localised prostate cancer. The minimum number of examined lymph nodes needed for accurate nodal staging may be predictable, being strongly dependent on prostate cancer characteristics at diagnosis.
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Bach C, Pisipati S, Daneshwar D, Wright M, Rowe E, Gillatt D, Persad R, Koupparis A. The status of surgery in the management of high-risk prostate cancer. Nat Rev Urol 2014; 11:342-51. [DOI: 10.1038/nrurol.2014.100] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Spernat D, Sofield D, Moon D, Louie-Johnsun M, Woo H. Implications of laparoscopic inguinal hernia repair on open, laparoscopic, and robotic radical prostatectomy. Prostate Int 2014; 2:8-11. [PMID: 24693528 PMCID: PMC3970989 DOI: 10.12954/pi.13032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 12/30/2013] [Indexed: 11/21/2022] Open
Abstract
Purpose: There have been anecdotal reports of surgeons having to abandon radical prostatectomy (RP) after laparoscopic inguinal hernia repair (LIHR) due to obliteration of tissue planes by mesh. Nodal dissection may also be compromised. We prospectively collected data from four experienced prostate surgeons from separate institutions. Our objective was to evaluate the success rate of performing open RP (ORP), laparoscopic RP (LRP) and robotic assisted RP (RALRP) and pelvic lymph node dissection (PLND) after LIHR, and the frequency of complications. Methods: A retrospective analysis of prospectively maintained databases of men who underwent RP after LIHR between 2004 and 2010 at four institutions was undertaken. The data recorded included age, preoperative prostate-specific antigen, preoperative Gleason score, and clinical stage. The operative approach, success or failure to perform RP, success or failure to perform PLND, pathological stage, and complications were also recorded. Results: A total of 1,181 men underwent RP between 2004 and 2010. Fifty-seven patients (4.8%) underwent RP after LIHR. An ORP was attempted in 19 patients, LRP in 33, and RALRP in 5. All 57 cases were able to be successfully completed. Ten of the 18 open PLND were able to be completed (55.6%). Four of the 22 laparoscopic LND were able to be completed (18.2%). Robotic LND was possible in 5 of 5 cases (100%). Therefore, it was not possible to complete a LND 56.8% of patients. Complications were limited to ten patients. These complications included one LRP converted to ORP due to failure to progress, and one rectourethral fistula in a salvage procedure post failed high intensity focused ultrasound. Conclusions: LIHR is an increasingly common method of treating inguinal hernias. LIHR is not a contra-indication to RP. However PLND may not be possible in over 50% of patients who have had LIHR. Therefore, these patients may be under-staged and under treated.
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Affiliation(s)
- Dan Spernat
- Department of Urology, The Queen Elizabeth Hospital, Adelaide University, South Australia, Australia
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[Comparison of ventral and dorsal lymph node metastases of obturator nerve in radical prostatectomy]. Nihon Hinyokika Gakkai Zasshi 2014; 105:3-9. [PMID: 24605580 DOI: 10.5980/jpnjurol.105.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In this study, we assessed the significance of complete dissection of the dorsal lymph node of the obturator nerve during radical prostatectomy. PATIENTS AND METHODS Fifty-six patients undergoing open radical prostatectomy and pelvic lymph node dissection for treatment of prostate cancer were included in this study. Neoadjuvant hormonal therapy and radiation therapy were not performed in any of the patients. First, pelvic lymph node dissection was performed between the external iliac vein and obturator nerve and classified as "ventral lymph node of the obturator nerve". Then, the tissue located in the area between the obturator nerve and the surface of the obturator internus muscle was removed and classified as "dorsal lymph node of the obturator nerve". Both lymph nodes were meticulously examined by identical pathologist. Lymph node yields, lymph node positive rate, and the factors associated with lymph node metastasis were studied. RESULTS Eight of the 56 patients had pelvic lymph node metastases (6 were high risk and 2 were intermediate risk according to the D'Amico's criteria). In the 8 node-positive patients, only 1 patient had positive lymph node in "ventral lymph node of the obturator nerve" exclusively. Four patients had positive lymph node exclusively in "dorsal lymph node of the obturator nerve" and 3 patients had in both "ventral and dorsal lymph nodes of the obturator nerve". The total lymph node yields from "ventral lymph node of the obturator nerve" and "dorsal lymph node of the obturator nerve" were 459 (8.2 per patient) and 117 (2.1 per patient), respectively. The total numbers of positive lymph nodes from "ventral lymph node of the obturator nerve" and "dorsal lymph node of the obturator nerve" were 6 and 12, respectively. Lymph node positive rate was significantly higher in "dorsal lymph node of the obturator nerve" (10%) than "ventral lymph node of the obturator nerve" (1.3%) (P < 0.0001). The level of prostate-specific antigen (> or = 20 ng ml), Gleason score sum at prostate biopsy (> or = 9), and lymph node yield (> or = 16) were associated with lymph node status on univariate analysis. In multivariate analysis, only lymph node yield was associated with lymph node status. CONCLUSIONS Dorsal lymph nodes of the obturator nerve should be dissected completely during radical prostatectomy.
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Dirix P, Joniau S, Van den Bergh L, Isebaert S, Oyen R, Deroose CM, Lerut E, Haustermans K. The role of elective pelvic radiotherapy in clinically node-negative prostate cancer: A systematic review. Radiother Oncol 2014; 110:45-54. [DOI: 10.1016/j.radonc.2013.06.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/19/2013] [Accepted: 06/23/2013] [Indexed: 01/18/2023]
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Hinev AI, Anakievski D, Kolev NH, Hadjiev VI. Validation of Nomograms Predicting Lymph Node Involvement in Patients with Prostate Cancer Undergoing Extended Pelvic Lymph Node Dissection. Urol Int 2014; 92:300-5. [DOI: 10.1159/000354323] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 07/09/2013] [Indexed: 11/19/2022]
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