Older versus younger patients in robot-assisted radical cystectomy with intracorporeal ileal conduit comparing safety and clinical outcomes

OBJECTIVE

To evaluate the safety and efficacy of robot-assisted radical cystectomy using an intracorporeal ileal conduit in older compared to younger patients.

METHODS

We retrospectively analyzed 122 patients who underwent robot-assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence-free survival, cancer-specific survival, and overall survival were compared between the cohorts.

RESULTS

The groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30-day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence-free survival, cancer-specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer-specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high-grade complications and cancer-specific survival.

CONCLUSIONS

Robot-assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients.

Real world data of recurrent and survival rates of penile cancer patients in Songklanagarind hospital: Tumor stage as a predictor for disease-free survival

OBJECTIVE

This study investigated disease-free survival and oncological outcomes in penile cancer patients treated surgically at a high-volume center and identified the prognostic factors for disease-free survival.

METHODS

A retrospective analysis was conducted on primary penile cancer patients diagnosed and treated at Songklanagarind Hospital, Thailand, between January 2001 and December 2021. Disease-free survival (DFS) was assessed using Kaplan-Meier survival curves, and Cox proportional hazard models were used for multivariate analysis.

RESULTS

The study included 188 patients with primary penile cancer. The majority (98.4%) were uncircumcised. Tumor staging revealed 40.6% with T1 tumors, 72.9% with well-differentiated tumors, and 23.5% diagnosed at stage IIIA. The recurrence rate was 19.1%, with a mean time to recurrence of 25.9 months. Disease-free survival rates at 1, 3, and 5 years were 81.1%, 70.9%, and 70.9%, respectively. Median overall survival was 16.43 months, with survival rates at 1, 3, and 5 years at 67.7%, 42.7%, and 35.4%, respectively. Cox proportional hazard models showed significant associations between disease-free survival and a higher T stage, a high level of CRP (>15 mg/L), delayed onset of symptoms, primary lesion location, groin node metastasis, lymphovascular invasion, and pelvic lymph node metastases. However, multivariate analysis revealed that a higher primary tumor stage (T) was the only independent prognostic factor for disease-free survival.

CONCLUSION

This study presents one of the largest cohorts investigating disease-free survival outcomes in penile cancer treatment at a single institution over a prolonged period. A higher pathologic T stage is a significant prognostic factor for disease-free survival. Further large-scale prospective studies are needed for validation.

Prostatic schwannoma discovered after laparoscopic radical prostatectomy: A case report with literature review

Background

Schwannomas originating in the prostate are extremely rare. We present a case of prostatic schwannoma in a 66-year-old male with lower urinary tract symptoms. Preoperative evaluation revealed a prostatic mass, and the definitive diagnosis was made through laparoscopic radical prostatectomy.

Case presentation

A 66-year-old male presented with persistent lower urinary tract symptoms for 5 years and a prostate-specific antigen level of 0.63 ng/mL. MRI showed a well-defined solid cystic mass in the posterolateral basal right peripheral zone, causing superior displacement of the right seminal vesicle. Laparoscopic radical prostatectomy was performed, confirming a periprostatic schwannoma.

Conclusion

This case highlights the rarity of prostatic schwannomas and their association with lower urinary tract symptoms. MRI plays a crucial role in identifying prostatic masses, while laparoscopic radical prostatectomy can serve as a diagnostic and therapeutic approach for prostatic schwannomas. Increased awareness of this rare entity is essential for accurate diagnosis and optimal management.

Prediction of biochemical recurrence after laparoscopic radical prostatectomy

BACKGROUND

Radical prostatectomy (RP) has been considered primary treatment for localized prostate cancer. Biochemical recurrence (BCR) occur approximately 20-30% in five year after RP. We aim to develop a novel nomogram to predict BCR-free survival (BCRFS) and performed external validation using a validation cohort that may help clinicians to make better decision for tailoring adjuvant treatment to specific group of patients.

MATERIALS AND METHODS

This retrospective cohort study included 370 localized and regional prostate cancer patients who underwent laparoscopic radical prostatectomy (LRP) in Songklanagarind hospital between January 2010 and December 2019, the patients were divided into two groups (primary cohort and validation cohort). BCR-free survival was created using Kaplan-Meier curve. Predictive factors for BCR were identified with univariable and multivariable analysis using Cox proportional hazards model. Predictive nomogram was created using these identified factors and developed for the prediction of biochemical recurrence free survival (BCRFS) at 1 and 5 years after LRP.

RESULTS

For primary Songklanagarind cohort, BCR was found in 105 patients (44.7%). Overall 1-year BCR-free survival was 52.8%, and 5-year BCR-free survival was 45.7% with median time to BCR of 18.1 months. Multivariable analysis identified unfavorable factor to BCRRF which are high initial serum PSA (> 20) (p < 0.001; HR 3.2), ISUP Gleason grade group > = 3 (p 0.033; HR 2.2), positive surgical margins (p 0.046; HR 1.5), and seminal vesicle involvement (p < 0.001; HR 5.2) and using for develop a novel nomogram to predict BCR. Concordance index 0.78.

CONCLUSION

Prostate cancer patients with unfavorable factors, including high initial PSA (> 20), ISUP Gleason grade group > = 3, positive margin and extra-prostatic tumor extension are considered high risks and independent predictors of biochemical recurrence. This predictive models could potentially improve the 1 and 5-year BCR prediction after RP, according to the study's findings and will aid medical professionals in achieving the goal of clinical prediction and creating a proper management for the localized treatment of prostate cancer underwent laparoscopic radical prostatectomy.

Comparing pentafecta outcomes between nerve sparing and non nerve sparing robot-assisted radical prostatectomy in a propensity score-matched study

Pentafecta (continence, potency, cancer control, free surgical margins, and no complications) is an important outcome of prostatectomy. Our objective was to assess the pentafecta achievement between nerve-spring and non-nerve-sparing robot-assisted radical prostatectomy (RARP) in a large single-center cohort. The study included 1674 patients treated with RARP between August 2009 and November 2022 to assess the clinical outcomes. Cox regression analyses were performed to evaluate the prognostic significance of RARP for pentafecta achievement, and 1:1 propensity score matching (PSM) was performed between the nerve-sparing and non-nerve-sparing to test the validity of the results. Pentafecta definition included continence, which was defined as the use of zero pads; potency, which was defined as the ability to achieve and maintain satisfactory erections or ones firm enough for sexual activity and sexual intercourse. The biochemical recurrence rate was defined as two consecutive PSA levels > 0.2 ng/mL after RARP; 90-day Clavien-Dindo complications ≤ 3a; and a negative surgical pathologic margin. The median follow-up period was 61.3 months (IQR 6-159 months). A multivariate Cox regression analysis demonstrated that pentafecta achievement was significantly associated with nerve-sparing (NS) approach (1188 patients) (OR 4.16; 95% CI 2.51-6.9), p < 0.001), unilateral nerve preservation (983 patients) (OR 3.83; 95% CI 2.31-6.37, p < 0.001) and bilateral nerve preservation (205 patients) (OR 7.43; 95% CI 4.14-13.36, p < 0.001). After propensity matching, pentafecta achievement rates in the NS (476 patients) and non-NS (476 patients) groups were 72 (15.1%) and 19 (4%), respectively. (p < 0.001). NS in RARP offers a superior advantage in pentafecta achievement compared with non-NS RARP. This validation study provides the pentafecta outcome after RARP associated with nerve-sparing in clinical practice.

Comparison of the Y-pouch orthotopic neobladder and the Studer technique after radical cystectomy: surgical and functional outcomes from a single-center series

BACKGROUND

To explore a method of constructing an orthotopic ileal neobladder (ONB) in the Y-pouch configuration. We describe the steps followed to create the Y-pouch ileal orthotopic neobladder (ONB) and compared the perioperative, functional, and urodynamics outcomes with the Studer neobladder technique.

METHODS

A retrospective cohort study of 90 bladder cancer patients, who received open radical cystectomy with the ONB performed at a hospital from June 2009 to May 2020. These patients were divided into two groups-the Y-pouch and the Studer neobladder groups. Perioperative, functional outcome, complication, renal function data outcomes, and pressure-volume study were used to evaluate the treatment outcomes after a radical cystectomy.

RESULTS

Ninety patients (54 Studer and 36 Y-pouch neobladder) were enrolled. The median patient age was 62.6 (± 11) years. The mean operative time for the Studer technique was 290 (242.5-350) min, and the Y-pouch technique was 300 (271.2-335) min) (p = 0.826). At 30 days postoperatively, the Clavien-Dindo classification of surgical complications revealed grade-2 urinary infections in two patients (5.6%) and six patients (11.1%) for the Y-pouch and Studer techniques, respectively. Intermediate complications (30-90 days) were reported in 4 (11.1%) and 18 patients (44.4%) in the Y-pouch and the Studer techniques, respectively (p = 0.062). In the urodynamics study (UDS), the Y-pouch group had a mean postvoid residual volume of 20 mL and Studer of 40 ml (p = 0.06). A mean capacity of 462 (380-600) mL compares to the Studer neobladder group with 495 (400-628) mL. The average mean compliance of the Studer group was 35.5 (28-52) ml/cm H₂O and 33 (30-43) ml/cm H₂O for Y pouch, and most patients had > 30 ml/cm H₂O compliance (80/90 patients).

CONCLUSIONS

The Y-pouch neobladder technique in an RC with an orthotopic neobladder provides perioperative and functional outcomes compared to those of the Studer orthotopic neobladder resulting in similar intermediate-term. Therefore, the Y-pouch ileal neobladder is both feasible and safe to be used as a standard neobladder technique for urinary diversion in patients with bladder cancer undergoing radical cystectomy and needs confirmation with long-term results.

The changing composition of urinary calculi in Southern Thailand over the past 14 years

Objective

A worldwide increased incidence of urolithiasis has been observed over the past few decades. Insight into the composition of these stones can lead to enhanced medical treatment and outcomes. The objective of this study was to examine the distribution and chemical composition of urinary calculi in Southern Thailand over the past decade.

Materials and Methods

An analysis was conducted on 2611 urinary calculi submitted to the Stone Analysis Laboratory, Songklanagarind Hospital, a single stone analysis laboratory in Southern Thailand. The analysis was performed from 2007 to 2020 using Fourier-transform infrared spectroscopy. The demographic results were described using descriptive statistical analyses, and the Chi-square test for trends was performed to identify changes in urinary calculi composition.

Results

The patients' demographic data revealed a male-to-female ratio of 2.2:1; the most common age group of affected men was 50-69 years, whereas the most common age group of affected women was 40-59 years. The most common components found in the calculi were uric acid (30.6%), mixed calcium oxalate with calcium phosphate (29.2%), and calcium oxalate (26.7%). We noted a trend of increasing uric acid calculi for 14 years (P = 0.00493), whereas the trend for the other major components was decreasing.

Conclusion

The most common component of urinary calculi analyzed in Southern Thailand was uric acid, with a significant rising trend in proportion in the past decade; the trend of other major components, such as mixed calcium oxalate-calcium phosphate and calcium oxalate, decreased.

Urogenital dysfunction after laparoscopic surgery for rectal or sigmoid colon cancer

BACKGROUND/OBJECTIVE

Urogenital dysfunction is a common complication after surgery for sigmoid colon or rectal cancers and may result from various causes. Herein, we evaluated urogenital dysfunction and the associated factors after laparoscopic surgery at different follow-up times.

METHODS

We conducted a prospective study on 91 patients who were diagnosed with sigmoid colon and rectal cancers and underwent laparoscopic surgery during 2014-2016. Voiding and male and female sexual dysfunctions following surgery were evaluated by the International Prostate Symptom Score (IPSS), International Index of Erectile Function-5 (IIEF-5), and Female Sexual Function Index-6 (FSFI-6), respectively. Urogenital function was compared at pre-surgery and 3 and 12 months postoperatively, and factors associated with urogenital dysfunction were identified.

RESULTS

The overall urinary function after surgery was better when compared to that at pre-surgery; however, there was deterioration in both male and female sexual functions. The mean preoperative IPSS, IIEF-5, and FSFI-6 scores were 9.35, 12.18, and 6.09, respectively. The mean differences among IPSS, IIEF-5, and FSFI-6 at 12 months postoperatively and pre-surgery were -3.08 (95% confidence interval [CI] -4.77 to -1.40), -2.57 (95% CI -4.33 to -0.80), and -2.58 (95% CI -4.73 to 0.42), respectively. Multivariate analysis demonstrated that age ≤60 years (odds ratio 4.22) and postoperative complications (odds ratio 2.77) were correlated with erectile dysfunction.

CONCLUSION

Voiding function improved after laparoscopic surgery in both sigmoid colon and rectal cancer patients. However, sexual function in both male and female patients was worse. Age ≤60 years and postoperative complications were strongly associated with male sexual dysfunction.

Molecular Subtyping in Muscle-Invasive Bladder Cancer on Predicting Survival and Response of Treatment

Molecular classifications for urothelial bladder cancer appear to be promising in disease prognostication and prediction. This study investigated the novel molecular subtypes of muscle invasive bladder cancer (MIBC). Tumor samples and normal tissues of MIBC patients were submitted for transcriptome sequencing. Expression profiles were clustered using K-means clustering and principal component analysis. The molecular subtypes were also applied to The Cancer Genome Atlas (TCGA) dataset and analyzed for clinical outcome correlation. Three molecular subtypes of MIBC were discovered, clusters A, B, and C. The most differentially upregulated genes in cluster A were BDKRB1, EDNRA, AVPR1A, PDGFRB, and TNC, while the most upregulated genes in cluster C were collagen-related genes, PDGFRB, and PRKG1. For cluster B, COL6A3, COL1A2, COL6A2, tenascin C, and fibroblast growth factor 2 were statistically suppressed. When the centroids of clustering on PCA were applied to TCGA data, the clustering significantly predicted survival outcomes. Cluster B had the best overall survival (OS), and cluster C was associated with poor OS but exhibited the best response to perioperative chemotherapy. Among all groups, cluster B had a better pathologic response to neoadjuvant chemotherapy (40%). Based on the results of the present study, the novel clusters of subtype MIBC appear potentially suitable for integration into clinical practice.

Dynamic Indices for the Prediction of Fluid Responsiveness in Laparoscopic Urologic Surgery under General Anaesthesia: An Interventional Study

Objective: This study aims to evaluate the ability of stroke volume variation (SVV), pulse pressure variation (PPV), and change in PVV and SVV after tidal volume challenge testing (ΔPPV and ΔSVV) aiming to predict fluid responsiveness in patients undergoing laparoscopic urologic surgery. Material and Methods: A prospective interventional study was performed with 23 patients undergoing urologic surgery while they were placed in Trendelenburg positions. A Vigileo/FloTrac system was used for the analysis. Hemodynamic data such as: arterial pressure (MAP), heart rate (HR), peak airway pressure (PIP), stroke volume (SV), cardiac output (CO), SVV, and PPV were recorded at the tidal volume settings of 8 mL/kg and 12 mL/kg before, and after a fluid challenge (FC). Fluid responsiveness was defined as an increase in SV(ΔSV) ≥15.0%. Results: After tidal volume challenge tests, there were significant increases in PIP in both groups. PPV increased only in the responders, as opposed to SVV, which increased significantly only in non-responders after tidal volume challenge test. After fluid challenge, PVV and SVV decreased gradually and significantly in both groups. The area under the ROC curves of patients undergoing laparoscopic urologic surgery was 0.872 (95% CI: 0.57-0.96) for ΔPPV, this change was the highest compared to other parameters. The threshold of the ΔPPV of patients undergoing laparoscopic urologic surgery was 4% with a sensitivity at 0.75 and specificity at 0.93. Conclusion: Change in PPV after the tidal volume challenge test from 8 mL/kg to 12 mL/kg can be used as an effective indicator to monitor fluid responsiveness in regards to patients undergoing urologic surgery.

Eucalyptus-Mediated Synthesized Silver Nanoparticles-Coated Urinary Catheter Inhibits Microbial Migration and Biofilm Formation

Catheter-associated urinary tract infections (CAUTIs) are significant complications among catheterized patients, resulting in increased morbidity, mortality rates, and healthcare costs. Foley urinary catheters coated with synthesized silver nanoparticles (AgNPs) using Eucalyptus camaldulensis leaf extract were developed using a green chemistry principle. In situ-deposited AgNPs with particle size ranging between 20 and 120 nm on the catheter surface were illustrated by scanning electron microscopy. Atomic force microscopy revealed the changes in surface roughness after coating with nanoparticles. The coated catheter could significantly inhibit microbial adhesion and biofilm formation performed in pooled human urine-supplemented media to mimic a microenvironment during infections (p 0.05). AgNPs-coated catheter exhibited broad-spectrum antimicrobial activity against important pathogens, causing CAUTIs with no cytotoxic effects on HeLa cells. A reduction in microbial viability in biofilms was observed under confocal laser scanning microscopy. A catheter bridge model demonstrated complete prevention of Proteus mirabilis migration by the coated catheter. Significant inhibition of ascending motility of Escherichia coli and P. mirabilis along the AgNPs-coated catheter was demonstrated in an in vitro bladder model (p 0.05). The results suggested that the AgNPs-coated urinary catheter could be applied as an alternative strategy to minimize the risk of CAUTIs by preventing bacterial colonization and biofilm formation.

Neoadjuvant versus Adjuvant Chemotherapy in Patients with Resectable Muscle-Invasive Bladder Cancer

INTRODUCTION

In regards to resectable muscle-invasive bladder cancer (MIBC) patients, contemporary guidelines recommend treatment with radical cystectomy and perioperative chemotherapy (neoadjuvant or adjuvant). In addition, the 5-year survival rate ranges from 36% to 48% in connection to T3 or T4 staged tumors or lymph node metastatic tumors. Perioperative treatment can improve overall survival, and the most robust evidence are in favor of neoadjuvant chemotherapy. The purpose of this study was to assess the impact of perioperative chemotherapy on the survival of patients with muscle-invasive bladder cancer (MIBC) who underwent radical cystectomy (RC).

METHODS

The medical records of ninety-four patients with muscle-invasive bladder cancer (MIBC) that were treated with radical cystectomy and perioperative chemotherapy from 2008 to 2018 were retrospectively analyzed at Songklanagarind hospital. Neoadjuvant and adjuvant chemotherapy groups were classified. Univariable and multivariable regression analyses were used to predict overall survival (OS) after treatment. The survival rates for each group were estimated and compared using long-rank testing.

RESULTS

Overall, we identified 94 eligible patients of whom 20 patients (21.2%) received neoadjuvant and 74 patients (78.8%) received adjuvant chemotherapy. The 5-year survival rate of the neoadjuvant group was 55.7%, and in regards to the adjuvant group it was 30.4%. A multivariable analysis yielded that, patients treated with neoadjuvant chemotherapy had longer survival than those treated with adjuvant chemotherapy (p =0.039).  The median survival here as log rank compares median survival.

CONCLUSION

The overall survival of neoadjuvant chemotherapy (NAC) was better than adjuvant chemotherapy (AC) in regards to muscle-invasive bladder cancer. These data could support the use of neoadjuvant chemotherapy in MIBC prior to radical cystectomy.

Primary Malignant Melanoma of the Bladder: A Rare Case Report in Asia and Review of the Literature

Background

Primary malignant melanoma (PMM) of the bladder is extremely rare and has a poor prognosis; just 40 cases of PMM of the bladder have been recorded in the literature. We described a case of PMM of the bladder, treatment, and a review of the literature because the recommended treatment choices are not widely known.

Case Presentation

An 80-year-old Thai female came in with a three-month history of pelvic pain and dysuria without extensive hematuria. She underwent transurethral excision of the bladder tumor and histologically reported malignant melanoma with no further primary sites of melanoma after computed tomography indicated a big heterogeneous enhancing mass on the posterior wall of the bladder. The patient eventually underwent anterior pelvic exenteration with ileal conduit, but metastatic disease occurred one year later.

Conclusion

Bladder melanoma has a fatal aggressive nature. Certain diagnostic features can be obtained through histopathological investigation, immunohistochemistry, clinical history, and endoscopic evaluation. Despite a wide range of treatments, people with PMM still have a bad prognosis.

Impact of immunohistochemistry-based subtyping of GATA3, CK20, CK5/6, and CK14 expression on survival after radical cystectomy for muscle-invasive bladder cancer

Molecular subtyping of muscle-invasive bladder cancer (MIBC) predicts disease progression and treatment response. However, standard subtyping based on transcriptomic analysis is relatively expensive. This study tried to use immunohistochemistry (IHC) to subtype MIBC based on GATA3, CK20, CK5/6, and CK14 protein expression. The IHC-based subtypes in MIBC subtypes were classified as luminal (GATA3⁺ CK5/6⁻, 38.6%), basal (GATA3⁻CK5/6⁺, 12.9%), mixed (GATA3⁺ CK5/6⁺, 37.9%), and double-negative (GATA3⁻CK5/6⁻, 10.6%) in 132 MIBC patients. All individual markers and clinicopathological parameters were analyzed against treatment outcomes after radical cystectomy. The mean patient age was 65.6 years, and the male to female ratio was 6.8:1. Positive IHC expression of GATA3, CK20, CK5/6, and CK14 were 80.3%, 50.8%, 42.4%, and 28.0%, respectively. Only GATA3 and CK5/6 were significantly associated with survival outcome (p values = 0.004 and 0.02). The mixed subtype was significantly better in 5-year OS at 42.8%, whereas the double-negative subtype had the worst prognosis (5-year OS 7.14%). The double-negative subtype had a hazard ratio of 3.29 (95% CI 1.71–6.32). Subtyping using GATA3 and CK5/6 was applicable in MIBCs, and patients with the double-negative subtype were at the highest risk and may require more intensive therapy.

Successful transitional cell carcinoma of bladder underwent laparoscopic radical cystectomy with orthotopic intracorporeal Y pouch neobladder using a 3D digital printing model for surgical post op pouch evaluation

A 48-year-old-male diagnosed transitional cell carcinoma of bladder was underwent laparoscopic radical cystectomy with intracorporeal Y pouch neobladder. The patient's Y pouch neobladder was described in three-dimensional printing for follow-up and in order to help the surgeon understand the morphology and capacity after surgery. Laparospcopic radical cystectomy with intracorporeal neobladder is challenging. In this case, we performed the first case of intracorporeal orthotopic Y pouch neobladder and investigated an early postoperatively using a three-dimensional digital printing model in order to help with pouch after surgery.

Oncological Outcomes of Radical Cystectomy for Transitional Cell Carcinoma of Bladder

OBJECTIVE

To investigate the oncological outcome of radical cystectomy for muscle invasive bladder (MIBC) on cancerspecific survival.

MATERIAL AND METHOD

A consecutive series of patients undergoing radical cystectomy from 2004 to 2012 were recorded. The prognostic significance of several clinicopathologic factors in these patients were analyzed. The endpoint of oncological outcome was cancer-specific survival (CSS). The effect of clinical variables on CSS were statistically analysed by a log-rank test or Cox regression with hazard ratios. All analyses were performed using a 0.05 level of significance.

RESULTS

One hundred eleven patients were analyzed. The average patient age when cystectomy was carried out was 65 (35 - 84) years. The 5-year cancer-specific survival rate was 36% for all 111 patients. The 5-year cancers-specific survival rates for patients with clinical T1, T2, T3 and T4 were 89%, 32%, 30% and 11.6%, respectively. Positive lymph nodes were found in 26 patients (23.4%) who had a 5-year cancer-specific survival 12.9%. Of several factors examined, univariate analysis identified tumor stage, nodal status, metastasis, margin positive and lymphovascular invasion (LVI) as significant predictors of OS, of which tumor stage and nodal status appeared to be independently related to overall survival on multivariate analysis.

CONCLUSION

Radical cystectomy is a standard treatment for muscle invasive bladder cancer. Oncologic outcomes of radical cystectomy is generally favorable, however, surgery alone had no more potential to prolong survival of patients with invasive cancer, multimodal treatment approaches might need.

Oncological Outcome of Docetaxel-Based Chemotherapy for Men with Metastatic Castration-Resistant Prostate Cancer

OBJECTIVE

To retrospectively review the oncological outcome of docetaxel-based chemotherapy in men with metastatic castration-resistant prostate cancer (mCRPC).

MATERIAL AND METHOD

The present study included 68 patients with mCRPC who were treated with 3-weekly docetaxel (75 mg/m2) plus prednisone between 2010 and 2014. The prognostic significance of several clinicopathologic factors in these patients were analyzed. The endpoints of oncological outcome were overall survival (OS). The effect of clinical variables on OS was statistically analyzed by a log-rank test or Cox regression with hazard ratios. All analyses were performed using a 0.05 level of significance.

RESULTS

In these 68 patients, the median age and serum value of prostate-specific antigen (PSA) prior to docetaxel-based chemotherapy were 69 years and 173 ng/ml, respectively. Of these patients, PSA decline ≥50% was observed in 46 patients (67.6%). The OS and progression-free survival were 25.4 and 11.7 months, respectively. Of several factors examined, univariate analysis identified PSA at diagnosis mCRPC, PSA at diagnosis of mCRPC, PSA at first cycle of CMT ≥150 ng/mL, number of CMT response ≤2 cycle as significant predictors of OS, of which only PSA at first cycle of CMT ≥150 ng/mL appeared to be independently related to poor OS on multivariate analysis.

CONCLUSION

Oncologic outcomes in mCRPC patients receiving docetaxel-based chemotherapy is generally favorable and only PSA at first cycle of CMT more than 150 ng/mL appeared to be independently related to poor OS on multivariate analysis.