1
|
Castelló A, Rodríguez-Barranco M, Pérez-Gómez B, Chirlaque MD, Bonet C, Amiano P, Ardanaz E, Huerta JM, Zamora-Ros R, Quirós JR, Barricarte-Gurrea A, Pollán M, Sanchez MJ. High adherence to Western dietary pattern and prostate cancer risk: findings from the EPIC-Spain cohort. BJU Int 2023; 132:272-282. [PMID: 37073612 DOI: 10.1111/bju.16001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
OBJECTIVE To explore the association between three previously identified dietary patterns (Western, Prudent and Mediterranean) and prostate cancer (PCa) risk by tumour aggressiveness. SUBJECTS AND METHODS The Spanish cohort of the European Prospective Investigation into Cancer and Nutrition study provided dietary and epidemiological information from 15 296 men recruited during the period 1992-1996. The associations between the adherence to the three dietary patterns and PCa risk (global, for Gleason grade groups 6 and >6, and for International Society of Urological Pathology [ISUP] grade 1 + 2 and ISUP grade 3 + 4 + 5) was explored with multivariable Cox proportional hazards regression models stratified by centre and age. RESULTS While no effect on PCa risk was detected for the Prudent and Mediterranean dietary patterns, a suggestion of a detrimental effect of the Western dietary pattern was found (hazard ratio [HR]Q4vsQ1 1.29 [95% confidence interval {CI} 0.96;1.72]). This effect was only observed for Gleason grade group >6 (HRQ3vsQ1 1.61 [95% CI 1.00; 2.59] and HRQ4vsQ1 1.60 [95% CI 0.96; 2.67]) and in particular ISUP grade 3 + 4 + 5 tumours (HRQ2vsQ1 1.97 [95% CI 0.98; 3.93]; HRQ3vsQ1 2.72 (95% CI 1.35; 5.51); HRQ4vsQ1 2.29 [95% CI 1.07; 4.92]). CONCLUSIONS Our results suggest that a high adherence to a healthy diet such as that represented by the Prudent and Mediterranean dietary patterns is not enough to prevent prostate cancer. Additionally, reducing adherence to a Western-type diet seems to be necessary.
Collapse
Affiliation(s)
- Adela Castelló
- School of Medicine, University of Alcalá, Madrid, Spain
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Beatriz Pérez-Gómez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - Maria Dolores Chirlaque
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Catalina Bonet
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Pilar Amiano
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Sub-Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, San Sebastian, Spain
- Epidemiology and Public Health Area, Biodonostia Health Research Institute, San Sebastian, Spain
| | - Eva Ardanaz
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - José María Huerta
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Department of Epidemiology, Murcia Regional Health Council, IMIB-Arrixaca, Murcia, Spain
| | - Raúl Zamora-Ros
- Unit of Nutrition and Cancer, Cancer Epidemiology Research Program, Catalan Institute of Oncology, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | | | - Aurelio Barricarte-Gurrea
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Instituto de Salud Pública de Navarra, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Marina Pollán
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Cancer and Environmental Epidemiology Unit, National Centre for Epidemiology, Carlos III Institute of Health, Madrid, Spain
| | - María-José Sanchez
- Consortium for Biomedical Research in Epidemiology & Public Health (CIBER Epidemiología y Salud Pública - CIBERESP), Madrid, Spain
- Andalusian School of Public Health, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| |
Collapse
|
2
|
Stroomberg HV, Andersen MC, Helgstrand JT, Larsen SB, Vickers AJ, Brasso K, Røder A. Standardized prostate cancer incidence and mortality rates following initial non-malignant biopsy result. BJU Int 2023; 132:181-187. [PMID: 36847603 PMCID: PMC10765343 DOI: 10.1111/bju.15997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVES To compare the incidence of subsequent prostate cancer diagnosis and death following an initial non-malignant systematic transrectal ultrasonography (TRUS) biopsy with that in an age- and calendar-year matched population over a 20-year period. SUBJECTS AND METHODS This population-based analysis compared a cohort of all men with initial non-malignant TRUS biopsy in Denmark between 1995 and 2016 (N = 37 231) with the Danish population matched by age and calendar year, obtained from the NORDCAN 9.1 database. Age- and calendar year-corrected standardized prostate cancer incidence (SIR) and prostate cancer-specific mortality ratios (SMRs) were calculated and heterogeneity among age groups was assessed with the Cochran's Q test. RESULTS The median time to censoring was 11 years, and 4434 men were followed for more than 15 years. The corrected SIR was 5.2 (95% confidence interval [CI] 5.1-5.4) and the corrected SMR was 0.74 (95% CI 0.67-0.81). Estimates differed among age groups (P < 0.001 for both), with a higher SIR and SMR among younger men. CONCLUSION Men with non-malignant TRUS biopsy have a much higher incidence of prostate cancer but a risk of prostate cancer death below the population average. This underlines that the oncological risk of cancers missed in the initial TRUS biopsy is low. Accordingly, attempts to increase the sensitivity of initial biopsy are unjustified. Moreover, current follow-up after non-malignant biopsy is likely to be overaggressive, particularly in men over the age of 60 years.
Collapse
Affiliation(s)
- Hein V. Stroomberg
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Marc C.M. Andersen
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - J. Thomas Helgstrand
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
| | - Signe Benzon Larsen
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Klaus Brasso
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Røder
- Copenhagen Prostate Cancer Center, Department of Urology, Copenhagen University Hospital – Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
3
|
Bryant RJ, Yamamoto H, Eddy B, Kommu S, Narahari K, Omer A, Leslie T, Catto JWF, Rosario DJ, Good DW, Gray R, Liew MPC, Lopez JF, Campbell T, Reynard JM, Tuck S, Barber VS, Medeghri N, Davies L, Parkes M, Hewitt A, Landeiro F, Wolstenholme J, Macpherson R, Verrill C, Marian IR, Williams R, Hamdy FC, Lamb AD. Protocol for the TRANSLATE prospective, multicentre, randomised clinical trial of prostate biopsy technique. BJU Int 2023; 131:694-704. [PMID: 36695816 DOI: 10.1111/bju.15978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Primary objectives: to determine whether local anaesthetic transperineal prostate (LATP) biopsy improves the detection of clinically significant prostate cancer (csPCa), defined as International Society of Urological Pathology (ISUP) Grade Group ≥2 disease (i.e., any Gleason pattern 4 disease), compared to transrectal ultrasound-guided (TRUS) prostate biopsy, in biopsy-naïve men undergoing biopsy based on suspicion of csPCa. SECONDARY OBJECTIVES to compare (i) infection rates, (ii) health-related quality of life, (iii) patient-reported procedure tolerability, (iv) patient-reported biopsy-related complications (including bleeding, bruising, pain, loss of erectile function), (v) number of subsequent prostate biopsy procedures required, (vi) cost-effectiveness, (vii) other histological parameters, and (viii) burden and rate of detection of clinically insignificant PCa (ISUP Grade Group 1 disease) in men undergoing these two types of prostate biopsy. PATIENTS AND METHODS The TRANSLATE trial is a UK-wide, multicentre, randomised clinical trial that meets the criteria for level-one evidence in diagnostic test evaluation. TRANSLATE is investigating whether LATP biopsy leads to a higher rate of detection of csPCa compared to TRUS prostate biopsy. Both biopsies are being performed with an average of 12 systematic cores in six sectors (depending on prostate size), plus three to five target cores per multiparametric/bi-parametric magnetic resonance imaging lesion. LATP biopsy is performed using an ultrasound probe-mounted needle-guidance device (either the 'Precision-Point' or BK UA1232 system). TRUS biopsy is performed according to each hospital's standard practice. The study is 90% powered to detect a 10% difference (LATP biopsy hypothesised at 55% detection rate for csPCa vs 45% for TRUS biopsy). A total of 1042 biopsy-naïve men referred with suspected PCa need to be recruited. CONCLUSIONS This trial will provide robust prospective data to determine the diagnostic ability of LATP biopsy vs TRUS biopsy in the primary diagnostic setting.
Collapse
Affiliation(s)
- Richard J Bryant
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Hide Yamamoto
- Department of Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone Hospital, Maidstone, UK
| | - Ben Eddy
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Sashi Kommu
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Kent and Canterbury Hospital, Canterbury, UK
| | - Krishna Narahari
- Department of Urology, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Altan Omer
- Department of Urology, University Hospitals Coventry and Warwickshire NHS Trust, University Hospital, Coventry, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Urology, Milton Keynes University Hospital NHS Foundation Trust, Milton Keynes Hospital, Milton Keynes, UK
| | - James W F Catto
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Derek J Rosario
- Academic Urology Unit, University of Sheffield and Department of Urology, Sheffield University Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Daniel W Good
- Department of Urology, NHS Lothian, Western General Hospital, Edinburgh, UK
| | - Rob Gray
- Department of Urology, Buckinghamshire Healthcare NHS Trust, Wycombe Hospital, High Wycombe, UK
| | - Matthew P C Liew
- Department of Urology, Wrightington, Wigan and Leigh Teaching Hospitals NHS Foundation Trust, Wigan, UK
| | - J Francisco Lopez
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Teresa Campbell
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - John M Reynard
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Steve Tuck
- Oxfordshire Prostate Cancer Support Group, Oxford, UK
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nadjat Medeghri
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Lucy Davies
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Matthew Parkes
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Aimi Hewitt
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Wolstenholme
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Ruth Macpherson
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Cellular Pathology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - Ioana R Marian
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Roxanne Williams
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Freddie C Hamdy
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Alastair D Lamb
- Department of Urology, Oxford University Hospitals NHS Foundation Trust, Churchill Hospital, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
4
|
Kanagarajah A, Hogan D, Yao HH, Dundee P, O'Connell HE. A systematic review on the outcomes of local anaesthetic transperineal prostate biopsy. BJU Int 2023; 131:408-423. [PMID: 36177521 DOI: 10.1111/bju.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To conduct a systematic review of the literature to assess the diagnostic ability, complication rate, patient tolerability, and cost of local anaesthetic (LA) transperineal prostate biopsy. METHODS Two reviewers searched Medline, the Cochrane Library, and Embase for publications on LA transperineal prostate biopsy up to March 2021. Outcomes of interest included cancer detection rates, complication rates, pain assessments and cost. RESULTS A total of 35 publications with 113 944 men were included in this review. The cancer detection rate for LA transperineal prostate biopsy in patients undergoing primary biopsy was 52% (95% confidence interval [CI] 0.45-0.60; I2 = 97) and the clinically significant cancer detection rate (Gleason≥3 + 4) was 37% (95% CI 0.24-0.52; I2 = 99%). The rate of infection-related complications in the included studies was 0.15% (95% CI 0.0000-0.0043; I2 = 86). The LA transperineal procedures had a low rate of procedural abandonment (26/6954, 0.37%), with the greatest pain scores measured during LA administration. No formal cost analyses on LA transperineal prostate biopsies were identified in the literature. The overall risk of bias in the included studies was high, with considerable study heterogeneity and publication bias. CONCLUSION Transperineal prostate biopsy performed under LA is a viable option for centres interested in avoiding the risk of infection associated with transrectal biopsy, and the logistical burden of general anaesthesia. Further investigation into LA transperineal prostate biopsy with comparative studies is warranted for its consideration as the standard in prostate biopsy technique.
Collapse
Affiliation(s)
- Abbie Kanagarajah
- Department of Urology, Western Health, Melbourne, Vic., Australia
- Austin Health, Melbourne, Vic., Australia
| | - Donnacha Hogan
- Department of Urology, Western Health, Melbourne, Vic., Australia
- University College Cork, Cork, Ireland
| | - Henry H Yao
- Department of Urology, Western Health, Melbourne, Vic., Australia
- Eastern Health Clinical School, Monash University, Melbourne, Australia
| | - Philip Dundee
- Department of Urology, Western Health, Melbourne, Vic., Australia
| | | |
Collapse
|
5
|
Orrason AW, Styrke J, Garmo H, Stattin P. Evidence of cancer progression as the cause of death in men with prostate cancer in Sweden. BJU Int 2023; 131:486-493. [PMID: 36088648 DOI: 10.1111/bju.15891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the strength of the evidence indicative of prostate cancer (PCa) progression as the adjudicated cause of death, according to age at death and PCa risk category. PATIENTS AND METHODS Using data from the Prostate Cancer data Base Sweden, we identified a study frame of 5543 men with PCa registered as the cause of death according to the Cause of Death Register. We assessed the evidence of PCa progression through a review of healthcare records for a stratified sample of 495/5543. We extracted data on prostate-specific antigen levels, presence of metastases on imaging, and PCa treatments, and quantified the evidence of disease progression using a points system. RESULTS Both no evidence and moderate evidence for PCa progression was more common in men aged >85 years at death than those aged <85 years (29% vs 14%). Among the latter, the proportion with no evidence or moderate evidence for PCa progression was 21% for low-risk, 14% for intermediate-risk, 8% for high-risk, and 0% for metastatic PCa. In contrast, in men aged >85 years, there was little difference in the proportion with no evidence or moderate evidence of PCa progression between PCa risk categories; 31% for low-risk, 29% for intermediate-risk, 29% for high-risk, and 21% for metastatic PCa. Of the 5543 men who died from PCa, 13% (95% confidence interval 5-19%) were estimated to have either no evidence or moderate evidence of PCa progression. CONCLUSIONS Weak evidence for PCa progression as cause of death was more common in older men with PCa and in those with low-risk PCa. This has implications for interpretation of mortality statistics especially when assessing screening and early treatment of PCa because the beneficial effect of earlier diagnosis could be masked by erroneous adjudication of PCa as cause of death in older men, particular those with localised disease at diagnosis.
Collapse
Affiliation(s)
| | - Johan Styrke
- Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University Hospital, Uppsala, Sweden
| |
Collapse
|
6
|
Eldred-Evans D, Connor MJ, Bertoncelli Tanaka M, Bass E, Reddy D, Walters U, Stroman L, Espinosa E, Das R, Khosla N, Tam H, Pegers E, Qazi H, Gordon S, Winkler M, Ahmed HU. The rapid assessment for prostate imaging and diagnosis (RAPID) prostate cancer diagnostic pathway. BJU Int 2023; 131:461-470. [PMID: 36134435 DOI: 10.1111/bju.15899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report outcomes within the Rapid Assessment for Prostate Imaging and Diagnosis (RAPID) diagnostic pathway, introduced to reduce patient and healthcare burdens and standardize delivery of pre-biopsy multiparametric magnetic resonance imaging (MRI) and transperineal biopsy. PATIENTS AND METHODS A total of 2130 patients from three centres who completed the RAPID pathway (3 April 2017 to 31 March 2020) were consecutively entered as a prospective registry. These patients were also compared to a pre-RAPID cohort of 2435 patients. Patients on the RAPID pathway with an MRI score 4 or 5 and those with PSA density ≥0.12 and an MRI score 3 were advised to undergo a biopsy. Primary outcomes were rates of biopsy and cancer detection. Secondary outcomes included comparison of transperineal biopsy techniques, patient acceptability and changes in time to diagnosis before and after the introduction of RAPID. RESULTS The median patient age and PSA level were 66 years and 6.6 ng/mL, respectively. Biopsy could be omitted in 43% of patients (920/2130). A further 7.9% of patients (168/2130) declined a recommendation for biopsy. The percentage of biopsies avoided among sites varied (45% vs 36% vs 51%; P < 0.001). In all, 30% (221/742) had a local anaesthetic (grid and stepper) transperineal biopsy. Clinically significant cancer detection (any Gleason score ≥3 + 4) was 26% (560/2130) and detection of Gleason score 3 + 3 alone constituted 5.8% (124/2130); detection of Gleason score 3 + 3 did not significantly vary among sites (P = 0.7). Among participants who received a transperineal targeted biopsy, there was no difference in cancer detection rates among local anaesthetic, sedation and general anaesthetic groups. In the 2435 patients from the pre-RAPID cohor, time to diagnosis was 32.1 days (95% confidence interval [CI] 29.3-34.9) compared to 15.9 days (95% CI 12.9-34.9) in the RAPID group. A total of 141 consecutive patient satisfaction surveys indicated a high satisfaction rate with the pathway; 50% indicated a preference for having all tests on a single day. CONCLUSIONS The RAPID prostate cancer diagnostic pathway allows 43% of men to avoid a biopsy while preserving good detection of clinically significant cancers and low detection of insignificant cancers, although there were some centre-level variations.
Collapse
Affiliation(s)
- David Eldred-Evans
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Martin J Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Mariana Bertoncelli Tanaka
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Edward Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Deepika Reddy
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Uma Walters
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Luke Stroman
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Raj Das
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Nalin Khosla
- Epsom and St Helier University Hospitals, London, UK
| | - Henry Tam
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | | | - Hasan Qazi
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
7
|
Hill GT, Jeyanthi M, Coomer W, Bryant RJ, Colmsee MT, Tozer J, Cox AC, Wilson JR. Same-day discharge robot-assisted laparoscopic prostatectomy: feasibility, safety and patient experience. BJU Int 2023. [PMID: 36866941 DOI: 10.1111/bju.16002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
OBJECTIVES To report a single centre's experience of the feasibility, safety and patient acceptability of same-day discharge robot-assisted laparoscopic prostatectomy (RALP). SUBJECTS/PATIENTS AND METHODS Between June 2015 and December 2021, a total of 180 pre-selected consecutive patients underwent RALP with the intention to discharge on the same day as surgery. Cases were performed by two surgeons. An enhanced recovery after surgery (ERAS) programme was used. The feasibility of same-day discharge was analysed, along with the complication rate, oncological outcomes, and postoperative patient experience. RESULTS Of 180 patients, 169 (93.8%) were successfully discharged on the same day as surgery. The median (range) age was 63 ( 44-74) years. The median (range) console time was 97 (61-256) min and blood loss was 200 (20-800) mL. The resection specimen pathology results were: pT2 69.4%, pT3a 24.4% and pT3b 6.5%. With regard to Gleason Grade Group (GGG), 25.9% had GGG 1, 65.7% had GGG 2-3 and 8.4% had GGG 4-5 disease. Positive surgical margins were present in 25 cases (14.7%), 18 (15.5%) of which occurred in pT2 cases, and seven (13.4%) in pT3 cases. There were no early (<90 days) biochemical relapses (defined as prostate-specific antigen level >0.2 ng/mL). The 30-day readmission rate was 3%. A total of 13 early (0-30 days) complications were observed, five of which were Clavien-Dindo grade ≥3, however, none of these would have been avoided had the patient remained in hospital on the first postoperative night. Of 121 consecutive patients, 107 (88%) returned a satisfaction questionnaire, and 92% of responders stated they preferred recovery at home, with 94% stating they felt ready to go home. CONCLUSION Robot-assisted laparoscopic prostatectomy combined with an ERAS programme allows patients to be safely discharged home on the same day of their surgery. This is a feasible option, well-liked by patients, with morbidity and oncological outcomes similar to non-day-case or 23 h stay RALP.
Collapse
Affiliation(s)
| | - Mekha Jeyanthi
- Department of Urology, Royal Gwent Hospital, Newport, UK
| | - William Coomer
- Department of Urology, Royal Gwent Hospital, Newport, UK
| | - Richard J Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - James Tozer
- Department of Urology, Royal Gwent Hospital, Newport, UK
| | | | - Jim R Wilson
- Department of Urology, Royal Gwent Hospital, Newport, UK
| |
Collapse
|
8
|
Meijer D, Ettema RH, van Leeuwen PJ, van der Kwast TH, van der Poel HG, Donswijk ML, Oprea-Lager DE, Bekers EM, Vis AN. The prognostic value of lymph node staging with prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) and extended pelvic lymph node dissection in node-positive patients with prostate cancer. BJU Int 2023; 131:330-338. [PMID: 36069585 DOI: 10.1111/bju.15881] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate whether patients with suspected pelvic lymph node metastases (molecular imaging [mi] N1) on staging prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) had a different oncological outcome compared to those in whom the PSMA PET/CT did not reveal any pelvic lymph node metastases (miN0). PATIENTS AND METHODS All patients with pelvic lymph node metastatic (pN1) disease after robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND) between January 2017 and December 2020 were included. To assess predictors of biochemical progression of disease after RARP, a multivariable Cox regression analysis was performed, including number of tumour-positive lymph nodes, diameter of the largest nodal metastasis, and extranodal extension. RESULTS In total, 145 patients were diagnosed with pN1 disease after ePLND. The median biochemical progression-free survival in patients with miN0 on PSMA PET/CT was 13.7 months, compared to 7.9 months in patients with miN1 disease (P = 0.006). On multivariable Cox regression analysis, both number of tumour-positive lymph nodes (>2 vs 1-2: hazard ratio [HR] 1.97; P = 0.005) and diameter of the largest nodal metastasis (HR 1.12; P < 0.001) were significant independent predictors of biochemical progression of disease. CONCLUSION Patients in whom pelvic lymph node metastases were suspected on preoperative PSMA imaging (miN1), patients diagnosed with >2 tumour-positive lymph nodes, and patients with a larger diameter of the largest nodal metastasis had a significantly increased risk of biochemical disease progression after surgery.
Collapse
Affiliation(s)
- Dennie Meijer
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.,Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Rosemarijn H Ettema
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - Henk G van der Poel
- Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands
| | - Elise M Bekers
- Department of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Prostate Cancer Network Netherlands, Amsterdam University Medical Center, VU University, Amsterdam, The Netherlands.,Department of Urology, Prostate Cancer Network Netherlands, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Exterkate L, Wegelin O, Barentsz JO, van der Leest MG, Kummer JA, Vreuls W, de Bruin PC, Witjes JA, van Melick HHE, Somford DM. Incidence of significant prostate cancer after negative MRI and systematic biopsy in the FUTURE trial. BJU Int 2023; 131:313-320. [PMID: 35993590 DOI: 10.1111/bju.15876] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To assess the proportion of clinically significant (cs) prostate cancer (PCa) found during follow-up in patients with negative systematic biopsy (SB) followed by non-suspicious multiparametric magnetic resonance imaging (mpMRI) and persistent clinical suspicion of PCa compared to the general population. PATIENTS AND METHODS A prospective study in a subgroup of patients from a multicentre randomized controlled trial was conducted between 2014 and 2017, including 665 men with prior negative SB with a persistent elevated prostate-specific antigen and/or suspicious digital rectal examination undergoing mpMRI. All patients with negative SB and Prostate Imaging-Reporting and Data System (PI-RADS) ≤2 on mpMRI entered biochemical follow-up. Follow-up data until December 2021 were collected by reviewing institutional hospital records and the Dutch Pathology Registry (PALGA). The primary outcome was the observed number of csPCa (Gleason ≥3 + 4/International Society of Urological Pathology grade group ≥2) cases during follow-up compared to the expected number in the general population (standardized incidence ratio [SIR]). RESULTS In total, 431 patients had non-suspicious mpMRI and entered biochemical follow-up. After a median (interquartile range) follow-up of 41 (23-57) months, 38 patients were diagnosed with PCa, of whom 13 (3.0%) had csPCa. The SIR for csPCa was 4.3 (95% confidence interval 2.3-7.4; total excess of eight cases). A higher risk of a positive biopsy for (cs)PCa based on the European Randomized Study of Screening for Prostate Cancer risk calculator and a suspicious repeat MRI (PI-RADS ≥3) were significant predictive factors for csPCa. CONCLUSION After negative prior biopsy and non-suspicious mpMRI the risk of csPCa is low. However, compared to the general population, the risk of csPCa is increased despite the high negative predictive value of mpMRI. More research focusing on biochemical and image-guided risk-adapted diagnostic surveillance strategies is warranted.
Collapse
Affiliation(s)
- Leonie Exterkate
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Olivier Wegelin
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Jelle O Barentsz
- Department of Radiology and Nuclear Medicine, Radboudumc, Nijmegen, The Netherlands
| | | | - J Alain Kummer
- Department of Pathology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Peter C de Bruin
- Department of Pathology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboudumc, Nijmegen, The Netherlands
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Diederik M Somford
- Department of Urology, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Ma TM, Czernin J, Felix C, Alano R, Wilhalme H, Valle L, Steinberg ML, Dahlbom M, Reiter RE, Rettig MB, Cao M, Calais J, Kishan AU. LUNAR: a randomized Phase 2 study of 177 Lutetium-PSMA Neoadjuvant to Ablative Radiotherapy for Oligorecurrent Prostate Cancer (clinical trial protocol). BJU Int 2023. [PMID: 36797449 DOI: 10.1111/bju.15988] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE To assess the efficacy of 177 Lu-PNT2002, a novel radiolabelled small molecule that binds with high affinity to prostate-specific membrane antigen (PSMA), in combination with stereotactic body radiotherapy (SBRT) to all sites of metastasis, vs SBRT alone, in men with oligorecurrent metastatic hormone-sensitive prostate cancer (mHSPC). PATIENTS AND METHODS The 177 Lutetium-PSMA Neoadjuvant to Ablative Radiotherapy for Oligorecurrent Prostate Cancer (LUNAR) trial is an open-label, randomized, stratified, two-arm, single-centre, Phase 2 trial to compare the efficacy and safety of neoadjuvant 177 Lu-PNT2002 plus SBRT vs SBRT alone in men with oligorecurrent mHSPC. Key eligibility criteria include one to five lesions identified on a PSMA positron emission tomography (PET)/computed tomography (CT) scan centrally reviewed by a board-certified nuclear medicine physician. Key exclusion criteria include castrate-resistant disease, de novo oligometastatic disease and receipt of androgen deprivation therapy (ADT) within 6 months of trial enrolment. The trial aims to enrol 100 patients who will be centrally randomized to one of the two treatment arms, in a 1:1 ratio. Patients in the control arm receive SBRT to all sites of disease. Patients in the experimental arm receive two cycles of neoadjuvant 177 Lu-PNT2002 (6.8 GBq) 6-8 weeks apart, followed by an interval PSMA PET/CT in 4-6 weeks and dose-adapted SBRT to all sites of disease 1-2 weeks later. The primary endpoint is progression-free survival. Secondary endpoints are radiographic and prostate-specific antigen-based progression, acute and late physician-scored toxicity, patient-reported quality of life, ADT-free survival, time to progression, overall survival, locoregional control, and duration of response. Enrolment in the study commenced in September 2022. RESULTS AND CONCLUSIONS The addition of 177 Lu-PNT2002 to metastasis-directed therapy alone may potentially further forestall disease progression. The results of this Phase 2 trial will determine, for the first time in a randomized fashion, the added benefit of 177 Lu-PNT2002 to SBRT in patients with oligorecurrent mHSPC.
Collapse
Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine Interdepartmental Graduate Program, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Carol Felix
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Rejah Alano
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA
| | - Holly Wilhalme
- Department of Medicine Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Luca Valle
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Magnus Dahlbom
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine Interdepartmental Graduate Program, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Robert E Reiter
- Department of Urology, University of California, Los Angeles, CA, USA
| | - Matthew B Rettig
- Division of Hematology and Oncology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Minsong Cao
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California, Los Angeles, CA, USA.,Physics and Biology in Medicine Interdepartmental Graduate Program, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, CA, USA.,Department of Urology, University of California, Los Angeles, CA, USA
| |
Collapse
|
11
|
Patel HD, Koehne EL, Shea SM, Fang AM, Gerena M, Gorbonos A, Quek ML, Flanigan RC, Goldberg A, Rais-Bahrami S, Gupta GN. A prostate biopsy risk calculator based on MRI: development and comparison of the Prospective Loyola University multiparametric MRI (PLUM) and Prostate Biopsy Collaborative Group (PBCG) risk calculators. BJU Int 2023; 131:227-235. [PMID: 35733400 PMCID: PMC9772358 DOI: 10.1111/bju.15835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To develop and validate a prostate cancer (PCa) risk calculator (RC) incorporating multiparametric magnetic resonance imaging (mpMRI) and to compare its performance with that of the Prostate Biopsy Collaborative Group (PBCG) RC. PATIENTS AND METHODS Men without a PCa diagnosis receiving mpMRI before biopsy in the Prospective Loyola University mpMRI (PLUM) Prostate Biopsy Cohort (2015-2020) were included. Data from a separate institution were used for external validation. The primary outcome was diagnosis of no cancer, grade group (GG)1 PCa, and clinically significant (cs)PCa (≥GG2). Binary logistic regression was used to explore standard clinical and mpMRI variables (prostate volume, Prostate Imaging-Reporting Data System [PI-RADS] version 2.0 lesions) with the final PLUM RC, based on a multinomial logistic regression model. Receiver-operating characteristic curve, calibration curves, and decision-curve analysis were evaluated in the training and validation cohorts. RESULTS A total of 1010 patients were included for development (N = 674 training [47.8% PCa, 30.9% csPCa], N = 336 internal validation) and 371 for external validation. The PLUM RC outperformed the PBCG RC in the training (area under the curve [AUC] 85.9% vs 66.0%; P < 0.001), internal validation (AUC 88.2% vs 67.8%; P < 0.001) and external validation (AUC 83.9% vs 69.4%; P < 0.001) cohorts for csPCa detection. The PBCG RC was prone to overprediction while the PLUM RC was well calibrated. At a threshold probability of 15%, the PLUM RC vs the PBCG RC could avoid 13.8 vs 2.7 biopsies per 100 patients without missing any csPCa. At a cost level of missing 7.5% of csPCa, the PLUM RC could have avoided 41.0% (566/1381) of biopsies compared to 19.1% (264/1381) for the PBCG RC. The PLUM RC compared favourably with the Stanford Prostate Cancer Calculator (SPCC; AUC 84.1% vs 81.1%; P = 0.002) and the MRI-European Randomized Study of Screening for Prostate Cancer (ERSPC) RC (AUC 84.5% vs 82.6%; P = 0.05). CONCLUSIONS The mpMRI-based PLUM RC significantly outperformed the PBCG RC and compared favourably with other mpMRI-based RCs. A large proportion of biopsies could be avoided using the PLUM RC in shared decision making while maintaining optimal detection of csPCa.
Collapse
Affiliation(s)
- Hiten D. Patel
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | | | - Steven M. Shea
- Department of Radiology, Loyola University Medical Center, Maywood, IL
| | - Andrew M. Fang
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL
| | - Marielia Gerena
- Department of Radiology, Loyola University Medical Center, Maywood, IL
| | - Alex Gorbonos
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | - Marcus L. Quek
- Department of Urology, Loyola University Medical Center, Maywood, IL
| | | | - Ari Goldberg
- Department of Radiology, Loyola University Medical Center, Maywood, IL
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL,Department of Radiology, University of Alabama at Birmingham, Birmingham, AL,O’Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | - Gopal N. Gupta
- Department of Urology, Loyola University Medical Center, Maywood, IL,Department of Radiology, Loyola University Medical Center, Maywood, IL,Department of Surgery, Loyola University Medical Center, Maywood, IL
| |
Collapse
|
12
|
Rushworth LK, Loveridge C, Salji M, MacLeod M, Mui E, Sumpton D, Neilson M, Hedley A, Alexander L, McCartney E, Patel R, Wallace J, Delles C, Jones R, Leung HY. Phase II proof-of-concept study of atorvastatin in castration-resistant prostate cancer. BJU Int 2023; 131:236-243. [PMID: 35844167 PMCID: PMC10087532 DOI: 10.1111/bju.15851] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To test for evidence of statin-mediated effects in patients with castration-resistant prostate cancer (CRPC) as post-diagnosis use of statins in patients with prostate cancer is associated with favourable survival outcome. PATIENTS AND METHODS The SPECTRE trial was a 6-weeks-long proof-of-concept single-arm Phase II treatment trial, combining atorvastatin and androgen deprivation therapy in patients with CRPC (regardless of metastatic status), designed to test for evidence of statin-mediated effects in patients with CRPC. The primary study endpoint was the proportion of patients achieving a ≥50% drop from baseline in prostate-specific antigen (PSA) levels at any time over the 6-week period of atorvastatin medication (PSA response). Exploratory endpoints include PSA velocity and serum metabolites identified by mass spectrometry . RESULTS At the scheduled interim analysis, one of 12 patients experienced a ≥50% drop in PSA levels (primary endpoint), with ≥2 patients satisfying the primary endpoint required for further recruitment. All 12 patients experienced substantial falls in serum cholesterol levels following statin treatment. While all patients had comparable pre-study PSA velocities, six of 12 patients showed decreased PSA velocities after statin treatment, suggestive of disease stabilization. Unbiased metabolomics analysis on serial weekly blood samples identified tryptophan to be the dominant metabolite associated with patient response to statin. CONCLUSIONS Data from the SPECTRE study provide the first evidence of statin-mediated effects on CRPC and early sign of disease stabilization. Our data also highlight the possibility of altered tryptophan metabolism being associated with tumour response.
Collapse
Affiliation(s)
- Linda K. Rushworth
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | - Carolyn Loveridge
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | - Mark Salji
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | - Martin MacLeod
- Beatson West of Scotland Cancer CentreGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | - Ernest Mui
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| | | | | | | | - Laura Alexander
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | - Elaine McCartney
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | | | - Jan Wallace
- Beatson West of Scotland Cancer CentreGlasgowUK
| | - Christian Delles
- Institute of Cardiovascular and Medical Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
| | - Rob Jones
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- Beatson West of Scotland Cancer CentreGlasgowUK
- CRUK West of Scotland Clinical Trials UnitGlasgowUK
| | - Hing Y. Leung
- Institute of Cancer Sciences, College of Medical, Veterinary and Life SciencesUniversity of GlasgowGlasgowUK
- CRUK Beatson InstituteGlasgowUK
| |
Collapse
|
13
|
Aggarwal A, Han L, Tree A, Lewis D, Roques T, Sangar V, van der Meulen J. Impact of centralization of prostate cancer services on the choice of radical treatment. BJU Int 2023; 131:53-62. [PMID: 35726400 PMCID: PMC10084068 DOI: 10.1111/bju.15830] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess the impact of centralization of prostate cancer surgery and radiotherapy services on the choice of prostate cancer treatment. PATIENTS AND METHODS This national population-based study used linked cancer registry data and administrative hospital-level data for all 16 621 patients who were diagnosed between 1 January 2017 and 31 December 2018 with intermediate-risk prostate cancer and who underwent radical prostatectomy (RP) or radical radiation therapy (RT) in the English National Health Service (NHS). Travel times by car to treating centres were estimated using a geographic information system. We used logistic regression to assess the impact of the relative proximity of alternative treatment options on the type of treatment received, with adjustment for patient characteristics. RESULTS Of the 78 NHS hospitals that provide RT or RP for prostate cancer, 41% provide both, 36% provide RT and 23% provide RP. Compared to patients who had both treatment options available at their nearest centre where overall 57% of patients received RT and 43% RP, patients were less likely to receive RT if their nearest centre offered RP only and the extra travel time to a hospital providing RT was >15 min (52% of patients received RT and 48% RP%, odds ratio [OR] 0.70 (0.58-0.85); P < 0.001). Conversely, patients were more likely to receive RT if their nearest centre offered RT and the extra travel time to a hospital providing RP was >15 min (63% of patients received RT and 37% RP, OR 1.23 (1.08-1.40); P < 0.001). There was a negligible impact on the type of treatment received if centres providing alternative treatment options were ≤15-min travel time from each other. CONCLUSION The relative proximity of prostate cancer treatment options to a patient's residence is an independent predictor for the type of radical treatment received. Centralization policies for prostate cancer should not focus on one treatment modality but should consider all treatments to avoid a negative impact on treatment choice.
Collapse
Affiliation(s)
- Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.,Department of Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Lu Han
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Alison Tree
- Royal Marsden Hospital and The Institute for Cancer Research, London, UK
| | - Daniel Lewis
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Tom Roques
- Norfolk and Norwich NHS Foundation Trust, Norwich, UK
| | - Vijay Sangar
- The Christie NHS Trust and Manchester University NHS Foundation Trust, Manchester, UK.,Manchester University, Manchester, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
14
|
Djurhuus SS, Simonsen C, Toft BG, Thomsen SN, Wielsøe S, Røder MA, Hasselager T, Østergren PB, Jakobsen H, Pedersen BK, Hojman P, Brasso K, Christensen JF. Exercise training to increase tumour natural killer-cell infiltration in men with localised prostate cancer: a randomised controlled trial. BJU Int 2023; 131:116-124. [PMID: 35753072 PMCID: PMC10084118 DOI: 10.1111/bju.15842] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To explore the effects of preoperative high-intensity interval training (HIIT) compared to usual care on tumour natural killer (NK)-cell infiltration in men with localised prostate cancer (PCa), as NK-cell infiltration has been proposed as one of the key mechanisms whereby exercise can modulate human tumours. PATIENTS AND METHODS A total of 30 patients with localised PCa undergoing radical prostatectomy (RP) were randomised (2:1) to either preoperative aerobic HIIT four-times weekly (EX; n = 20) or usual care (CON; n = 10) from time of inclusion until scheduled surgery. Tumour NK-cell infiltration was assessed by immunohistochemistry (CD56+ ) in diagnostic core needle biopsies and corresponding prostatic tissue from the RP. Changes in cardiorespiratory fitness, body composition, blood biochemistry, and health-related quality of life were also evaluated. RESULTS The change in tumour NK-cell infiltration did not differ between the EX and CON groups (between-group difference: -0.09 cells/mm2 , 95% confidence interval [CI] -1.85 to 1.66; P = 0.913) in the intention-to-treat analysis. The total number of exercise sessions varied considerably from four to 30 sessions. The per-protocol analysis showed a significant increase in tumour NK-cell infiltration of 1.60 cells/mm2 (95% CI 0.59 to 2.62; P = 0.004) in the EX group. Further, the total number of training sessions was positively correlated with the change in NK-cell infiltration (r = 0.526, P = 0.021), peak oxygen uptake (r = 0.514, P = 0.035) and peak power output (r = 0.506, P = 0.038). CONCLUSION Preoperative HIIT did not result in between-group differences in tumour NK-cell infiltration. Per-protocol and exploratory analyses demonstrate an enhanced NK-cell infiltration in PCa. Future studies are needed to test the capability of exercise to increase tumour immune cell infiltration.
Collapse
Affiliation(s)
| | - Casper Simonsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Birgitte Grønkaer Toft
- Department of Pathology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Simon Nørskov Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Sabrina Wielsøe
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Hasselager
- Department of Pathology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Peter Busch Østergren
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Henrik Jakobsen
- Department of Urology, Copenhagen University Hospital - Herlev and Gentofte, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Hojman
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Copenhagen Prostate Cancer Center, Copenhagen University Hospital -Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Frank Christensen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.,Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
| |
Collapse
|
15
|
Jia Z, Chen Z, Chang Y, Wu C, Qu M, Nian X, Shen X, Zhang Y, Tang S, Wang Y, Gao X. Sustainable functional urethral reconstruction improves early urinary continence after robot-assisted radical prostatectomy: a randomised controlled trial. BJU Int 2022; 131:720-728. [PMID: 36545839 DOI: 10.1111/bju.15956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate the impact of sustainable functional urethral reconstruction (SFUR) on early recovery of urinary continence (UC) after robot-assisted radical prostatectomy. PATIENTS AND METHODS Overall, 96 patients with primary prostate cancer were randomised into the SFUR or standard group (n = 48 each). The primary outcome was the 1-month UC recovery. Secondary outcomes included short-term (≤3 months) UC recovery, urinary function, micturition-related bother, perioperative complications, and oncological outcomes. Kaplan-Meier curves and Cox proportional hazard models were used to assess the 3-month UC recovery. Generalised estimating equations were used to compare postoperative urinary function and micturition-related bother. RESULTS The 1-month UC recovery rates, median 24-h pad weights, and median operative time in the SFUR and standard groups were 73% and 49% (P = 0.017), 0 and 47 g (P = 0.001), and 125 and 103 min (P = 0.025), respectively. The UC recovery rates in the SFUR vs standard groups were 53% vs 23% at 1 week (P = 0.003), 53% vs 32% at 2 weeks (P = 0.038), and 93% vs 77% at 3 months (P = 0.025). The median time to UC recovery in the SFUR and standard groups was 5 and 34 days, respectively (log-rank P = 0.006); multivariable Cox regression supported this result (hazard ratio 1.73, 95% confidence interval 1.08-2.79, P = 0.024). Similar results were observed when UC was defined as 0 pads/day. Urinary function (P = 0.2) and micturition-related bother (P = 0.8) were similar at all follow-up intervals. The perioperative complication rates, positive surgical margin rates, and 1-year biochemical recurrence-free survival were comparable between both groups (all P > 0.05). CONCLUSION SFUR resulted in earlier UC recovery without compromising postoperative urinary function. Long-term validation and multicentre studies are required to confirm the results of this novel technique.
Collapse
Affiliation(s)
- Zepeng Jia
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zeyu Chen
- Department of Urology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Yifan Chang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Cheng Wu
- Department of Health Statistics, Naval Medical University, Shanghai, China
| | - Min Qu
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xinwen Nian
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xianqi Shen
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yun Zhang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Shouyan Tang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Yan Wang
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
16
|
Meissner VH, Simson BW, Dinkel A, Schiele S, Ankerst DP, Lunger L, Gschwend JE, Herkommer K. Treatment decision regret in long-term survivors after radical prostatectomy: a longitudinal study. BJU Int 2022; 131:623-630. [PMID: 36545828 DOI: 10.1111/bju.15955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate prevalence, course, and predictors of longitudinal decision regret in long-term prostate cancer (PCa) survivors treated by radical prostatectomy (RP). PATIENTS AND METHODS A total of 1003 PCa survivors from the multicentre German Familial PCa Database completed questionnaires on average 7 years after RP in 2007 and at follow-up 13 years later in 2020. Patients completed standardised patient-reported outcome measures on decision regret, decision-making, health-related quality of life, and psychosocial factors. Hierarchical multivariable logistic regression was used to assess predictors of longitudinal decision regret. RESULTS Decision regret increased significantly over time (9.0% after 6.9 years in 2007 and 12% after 19 years in 2020; P = 0.009). Favourable localised PCa (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.05-3.68), decision regret in 2007 (OR 6.38, 95% CI 3.55-11.47), and a higher depression score (OR 1.37, 95% CI 1.03-1.83) were associated with decision regret in 2020. Shared decision-making (OR 0.55, 95% CI 0.33-0.93) was associated with less decision regret. CONCLUSION The findings of the present study underline the perseverance of decision regret in long-term PCa survivors and the definitive need for involving patients in the decision-making process to mitigate regret over the long term.
Collapse
Affiliation(s)
- Valentin H Meissner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Barbara W Simson
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Schiele
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Donna P Ankerst
- Departments of Mathematics and Life Science Systems, Munich Data Science Institute, Technical University of Munich, Garching, Germany
| | - Lukas Lunger
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| |
Collapse
|
17
|
Hansen RS, Biørn SH, Birk-Korch JB, Sheikh SP, Poulsen MH, Vinholt PJ. Prevalence of prostate cancer in men with haematuria: a systematic review and meta-analysis. BJU Int 2022; 131:530-539. [PMID: 36522728 DOI: 10.1111/bju.15950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the prevalence of prostate cancer in men attending evaluation for haematuria, as this could help healthcare providers to determine whether men with haematuria should have prostate examinations performed. METHODS The study was performed according to a pre-specified protocol uploaded to the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022299383). A systematic search of MEDLINE, Ovid and Google Scholar was performed in December 2021. Two independent researchers evaluated all titles, available abstracts, and full texts. We included studies on adult men (aged ≥18 years) describing haematuria and prostate cancer. RESULTS We screened 4252 titles and abstracts when available and assessed 350 studies in full text. In total, 65 studies were included and 42 was summarised in a meta-analysis. In total, 18 752 men with haematuria were included, and the pooled prevalence (95% confidence interval [CI]) of prostate cancer was 3.0% (2.0-4.1%). In men with macroscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 5.9% (2.9-9.9%; n = 265/5373). In men with microscopic haematuria, the pooled prevalence (95% CI) of prostate cancer was 1.4% (0.8-2.2%; n = 71/6642). CONCLUSION Our findings indicate that the prevalence of prostate cancer is considerable in men attending evaluation for haematuria. Therefore, digital rectal examination and prostate-specific antigen measurement should become a standard procedure for all men with haematuria, especially for men with macroscopic haematuria.
Collapse
Affiliation(s)
- Rasmus Søgaard Hansen
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Signe Hedengran Biørn
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | | | - Søren Paludan Sheikh
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Mads Hvid Poulsen
- Department of Urology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| | - Pernille Just Vinholt
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark (SDU), Odense, Denmark
| |
Collapse
|
18
|
Veerman H, Donswijk M, Bekers E, Bodar YJ, Meijer D, van Moorselaar RA, Oprea‐Lager DE, van der Noort V, van Leeuwen PJ, Vis AN, van der Poel HG. The oncological characteristics of non-prostate-specific membrane antigen (PSMA)-expressing primary prostate cancer on preoperative PSMA positron emission tomography/computed tomography. BJU Int 2022; 130:750-753. [PMID: 36117468 PMCID: PMC9828411 DOI: 10.1111/bju.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Hans Veerman
- Department of UrologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands,Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Maarten Donswijk
- Department of Nuclear MedicineNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands
| | - Elise Bekers
- Department of PathologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands
| | - Yves J.L. Bodar
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Dennie Meijer
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - R. Jeroen A. van Moorselaar
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Daniela E. Oprea‐Lager
- Department of Radiology and Nuclear Medicine, Cancer Center AmsterdamAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands
| | - Vincent van der Noort
- Department of BiometricsNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands
| | - Pim J. van Leeuwen
- Department of UrologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - André N. Vis
- Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| | - Henk G. van der Poel
- Department of UrologyNetherlands Cancer Institute‐Antoni van Leeuwenhoek HospitalAmsterdamthe Netherlands,Department of UrologyAmsterdam University Medical Centres, Location VU Medical CentreAmsterdamthe Netherlands,Prostate Cancer Network NetherlandsAmsterdamthe Netherlands
| |
Collapse
|
19
|
van Riel LA, Geboers B, Kabaktepe E, Blazevski A, Reesink DJ, Stijns P, Stricker PD, Casanova J, Dominguez‐Escrig JL, de Reijke TM, Scheltema MJ, Oddens JR. Outcomes of salvage radical prostatectomy after initial irreversible electroporation treatment for recurrent prostate cancer. BJU Int 2022; 130:611-618. [PMID: 35474600 PMCID: PMC9790506 DOI: 10.1111/bju.15759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To evaluate: (i) safety, (ii) feasibility, and medium-term (iii) oncological and (iv) functional outcomes of salvage radical prostatectomy (sRP) for recurrent localised prostate cancer (PCa) following initial focal therapy using irreversible electroporation (IRE). PATIENTS AND METHODS An international, multicentre and retrospective analysis of prospectively collected data of patients that underwent sRP for recurrent localised PCa after initial primary IRE treatment. Data were reported on (i) surgical complications, (ii) feasibility of sRP reported by surgeons, (iii) time interval between IRE and sRP and pathology results, and (iv) urinary continence, erectile function, and quality of life. RESULTS In four participating centres, a total of 39 patients with a median (interquartile range [IQR]) age 64 (60-67) years were identified. No serious adverse events occurred during or following sRP and surgery was deemed feasible without difficulties. The median (IQR) time to recurrence following IRE was 14.3 (9.1-38.8) months. Pathology results showed localised disease in 21 patients (53.8%) and locally-advanced disease in 18 (46.2%). Positive surgical margins (PSMs) were observed in 10 patients (25.6%), of which six (15.4%) had significant PSMs. A persistent detectable prostate-specific antigen level was found in one case after sRP, caused by metastatic disease. One patient had a biochemical recurrence 6 months after sRP. These two cases, together with a PSM case, required additional therapy after sRP. After a median (IQR) follow-up of 17.7 (11.8-26.4) months, urinary continence and erectile function were preserved in 34 (94.4%) and 18 patients (52.9%), respectively, while quality of life remained stable. CONCLUSIONS Salvage RP is safe and feasible for patients with recurrent localised PCa following initial IRE treatment. The medium-term oncological and functional outcomes are similar to primary RP. Strict patient selection for focal therapy and standardised follow-up is needed as some patients developed high-grade disease.
Collapse
Affiliation(s)
- Luigi A.M.J.G. van Riel
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Bart Geboers
- Department of Radiology and Nuclear MedicineAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands,Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Ertunc Kabaktepe
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Alexander Blazevski
- Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Daan J. Reesink
- Department of UrologySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Pascal Stijns
- St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Phillip D. Stricker
- Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,Department of UrologySt. Antonius HospitalNieuwegeinThe Netherlands
| | - Juan Casanova
- Department of UrologyInstituto Valenciano de OncologiaValènciaSpain
| | | | - Theo M. de Reijke
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Matthijs J. Scheltema
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands,Garvan Institute of Medical ResearchKinghorn Cancer CentreDarlinghurstNSWAustralia,St. Vincent's Prostate Cancer Research CentreSydneyNSWAustralia
| | - Jorg R. Oddens
- Department of UrologyAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
20
|
Cussenot O, Cancel-Tassin G, Comperat E, Benbouzid S, Lamb A. Total pelvic exenteration surgery for loco-regionally advanced prostate cancer, is it justifiable? BJU Int 2022; 130:582-585. [PMID: 36263588 DOI: 10.1111/bju.15841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Olivier Cussenot
- GRC 5 Predictive Onco-Urology, Sorbonne University, APHP, Paris, France
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- CeRePP, Paris, France
| | - Geraldine Cancel-Tassin
- GRC 5 Predictive Onco-Urology, Sorbonne University, APHP, Paris, France
- CeRePP, Paris, France
| | - Eva Comperat
- GRC 5 Predictive Onco-Urology, Sorbonne University, APHP, Paris, France
- CeRePP, Paris, France
| | - Sabrina Benbouzid
- GRC 5 Predictive Onco-Urology, Sorbonne University, APHP, Paris, France
| | - Alastair Lamb
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
21
|
Sooriakumaran P, Wilson C, Rombach I, Hassanali N, Aning J, D Lamb A, Cathcart P, Eden C, Ahmad I, Rajan P, Sridhar A, Bryant RJ, Elhage O, Cook J, Leung H, Soomro N, Kelly J, Nathan S, Donovan JL, Hamdy FC. Feasibility and safety of radical prostatectomy for oligo-metastatic prostate cancer: the Testing Radical prostatectomy in men with prostate cancer and oligo-Metastases to the bone (TRoMbone) trial. BJU Int 2022; 130:43-53. [PMID: 34878715 DOI: 10.1111/bju.15669] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To test the feasibility of randomisation to radical prostatectomy (RP) plus pelvic lymphadenectomy in addition to standard-of-care (SOC) systemic therapy in men with newly diagnosed oligo-metastatic prostate cancer. PATIENTS AND METHODS A prospective, randomised, non-blinded, feasibility clinical trial with an embedded QuinteT Recruitment Intervention (QRI) to optimise recruitment was conducted in nine nationwide tertiary care centres undertaking high-volume robotic surgery. We aimed to randomise 50 men with synchronous oligo-metastatic prostate cancer within an 18-month recruitment period to SOC systemic therapy vs SOC plus RP (intervention arm). The main outcome measures were: ability to randomise patients, optimised by a QRI; EuroQoL five Dimensions five Levels (EQ-5D-5L) questionnaires to capture quality-of-life (QoL) data at baseline and 3 months post-randomisation; routine clinicopathological assessment to capture adverse events and prostate-specific antigen in both arms, plus standard perioperative parameters in the surgical arm. RESULTS A total of 51 men were randomised within 14 months (one was subsequently deemed ineligible), with 60-83% accrual rate in centres that recruited at least two patients. All patients completed the trial follow-up; one patient in the intervention arm subsequently did not undergo the surgical intervention and one in the SOC arm refused all therapies. The QRI positively impacted recruitment. QoL data showed similarly high functioning in both study arms. Surgery for men with oligo-metastatic prostate cancer was found to be safe and had similar impact on early functional outcomes as surgery for standard indication. CONCLUSION It is feasible to randomise men with synchronous oligo-metastatic prostate cancer to a surgical intervention in addition to standard systemic therapies. While surgery appeared safe with no substantial impact on QoL in this feasibility study, a large randomised controlled trial is now warranted to examine treatment effectiveness of this additional component in the multimodality management of oligo-metastatic prostate cancer.
Collapse
Affiliation(s)
- Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Caroline Wilson
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Ines Rombach
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Neelam Hassanali
- Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK
| | - Jonathan Aning
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Alastair D Lamb
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Paul Cathcart
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Imran Ahmad
- The Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - Prabhakar Rajan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ashwin Sridhar
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Richard J Bryant
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - Jonathan Cook
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Hing Leung
- The Queen Elizabeth University Hospital Glasgow, Glasgow, UK
| | - Naeem Soomro
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - John Kelly
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Senthil Nathan
- Department of Uro-oncology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jenny L Donovan
- Department of Population Health Sciences, University of Bristol, Bristol, UK
| | - Freddie C Hamdy
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
22
|
Leonard AJ, Garg N, Chen TT, Monga M. Case of the Month from UCSD, San Diego, USA: Treatment of giant dystrophic prostatic calcification using MOSES holmium laser. BJU Int 2022; 129:306-308. [PMID: 35297157 DOI: 10.1111/bju.15695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Austin J Leonard
- San Diego School of Medicine, University of California, San Diego, CA, USA
| | - Nishant Garg
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Tony T Chen
- Department of Urology, University of California San Diego, San Diego, CA, USA
| | - Manoj Monga
- Department of Urology, University of California San Diego, San Diego, CA, USA
| |
Collapse
|
23
|
Rahota RG, Salin A, Gautier JR, Almeras C, Garnault V, Tollon C, Loison G, Beauval JB, Ploussard G. A prehabilitation programme implemented before robot-assisted radical prostatectomy improves peri-operative outcomes and continence recovery. BJU Int 2021; 130:357-363. [PMID: 34854212 DOI: 10.1111/bju.15666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the impact of a routine, on-site, 1-day prehabilitation (PreHab) programme on peri-operative and continence recovery after robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS All 303 consecutive RARPs performed between March 2018 and February 2020 since the routine implementation of PreHab were included in our study. PreHab was carried out according to the availability of the 1-day programme before the planned date of surgery (two sessions per month including four patients per session). The PreHab programme was implemented in 165 patients (54.5%). The primary endpoint was continence recovery, strictly defined as no safety pad use at 1 and 6 months. Secondary endpoints were peri-operative variables (blood loss, operating time, length of stay, transfusion, complications, and readmission rates). Comparisons were made according to whether the PreHab pathway was applied or not (PreHab+ vs PreHab-) in univariable and multivariable models. RESULTS The PreHab pathway was implemented for a stable proportion of patients over time (54.5%). The two cohorts were comparable in terms of preoperative and pathological features (P > 0.05). Length of stay was significantly shorter in the PreHab+ group (1.3 vs 1.9 days; P = 0.001). There was a trend towards fewer complications in the PreHab+ group (P = 0.061). Use of the PreHab pathway was independently correlated with higher continence rates at 1 month (37% vs 60%; P < 0.001) and 6 months (67.4% vs 87.3%; P < 0.001), even after controlling for age, body mass index, prostate volume, type of apical reconstruction, nerve-sparing surgery and lymph node dissection. The main limitation of the study was the absence of randomization. CONCLUSIONS Our experience demonstrates that the PreHab programme is the major predictor of improved peri-operative outcomes and continence recovery after RARP, with sustainable benefits 6 months after surgery.
Collapse
Affiliation(s)
| | - Ambroise Salin
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | | | - Valérie Garnault
- Public Health Department, PMSI, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Christophe Tollon
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - Guillaume Loison
- Urology Department, La Croix du Sud Hospital, Quint Fonsegrives, France
| | | | | |
Collapse
|
24
|
Lee V, An Y, Park HS, Yu JB, Kim SP, Jairam V. Emergency department visits for radiation cystitis among patients with a prostate cancer history. BJU Int 2021; 130:208-216. [PMID: 34806813 DOI: 10.1111/bju.15650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 08/31/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To elucidate the national burden of emergency department (ED) visits for radiation cystitis (RC), a known complication of radiation therapy (RT) to the pelvic area, among patients with a prostate cancer history, and identify those who are at increased risk of requiring invasive measures. PATIENTS AND METHODS This study queried the Nationwide Emergency Department Sample for all ED visits from January 2006 to December 2015 with a primary diagnosis of RC and secondary diagnosis of prostate cancer. ED visits were characterised by demographic factors, socioeconomic factors, and hospital characteristics. Weighted frequencies were used to create national estimates for all data analysis. RESULTS A weighted total of 17 382 ED visits occurred for RC among patients with a prostate cancer history, of which 9655 (55.5%) were treated with an invasive procedure. Notable factors associated with undergoing an invasive procedure included having a prior prostatectomy (odds ratio [OR] 5.48, 95% confidence interval [CI] 2.62-11.46), urinary retention (OR 1.35, 95% CI 1.12-1.64), haematuria (OR 1.20, 95% CI 1.01-1.42), and undergoing a blood transfusion (OR 2.12, 95% CI 1.72-2.62). ED visits that were associated with invasive procedures had a higher median total charge ($34 707.53 vs $15 632.53) and an increased median length of stay (5 vs 3 days) compared to visits without an invasive procedure. CONCLUSIONS Among ED visits for RC in prostate cancer, approximately one half required an invasive procedure for treatment. While RT remains an effective modality for patients with prostate cancer, providers should be mindful of RC as a potential complication.
Collapse
Affiliation(s)
- Victor Lee
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Yi An
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA
| | - Henry S Park
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - James B Yu
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| | - Simon P Kim
- Division of Urology, University of Colorado Anschutz Medical Center, Aurora, CO, USA
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, CT, USA.,Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven, CT, USA
| |
Collapse
|
25
|
Hofbauer SL, Luger F, Harland N, Plage H, Reimann M, Hollenbach M, Gusenleitner A, Stenzl A, Schlomm T, Wiemer L, Cash H. A non-inferiority comparative analysis of micro-ultrasonography and MRI-targeted biopsy in men at risk of prostate cancer. BJU Int 2021; 129:648-654. [PMID: 34773679 DOI: 10.1111/bju.15635] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To compare the efficacy of multiparametric magnetic resonance imaging (mpMRI)-directed and micro-ultrasonography (micro-US)-directed biopsy for detecting clinically significant (Grade Group >1) prostate cancer (csPCa). MATERIALS AND METHODS A total of 203 patients were prospectively enrolled at three institutions across Germany and Austria in the period from January 2019 to December 2019. During each biopsy, the urologist was blinded to the mpMRI report until after the micro-US targets had been assessed. After unblinding, targets were then sampled using software-assisted fusion, followed by systematic samples. The primary outcome measure was non-inferiority of micro-US to detect csPCa, with a detection ratio of at least 80% that of mpMRI. RESULTS A total of 79 csPCa cases were detected overall (39%). Micro-US-targeted biopsy detected 58/79 cases (73%), while mpMRI-targeted biopsy detected 60/79 (76%) and non-targeted (completion sampling) samples detected 45/79 cases (57%). mpMRI-targeted samples alone detected 7/79 (9%) csPCa cases which were missed by micro-US-targeted and non-targeted samples. Three of these seven were anterior lesions with 2/7 in the transition zone. Micro-US-targeted samples alone detected 5/79 (6%) and completion sampling alone detected 4/79 cases (5%). Micro-US was non-inferior to mpMRI and detected 97% of the csPCa cases detected by mpMRI-targeted biopsy (95% CI 80-116%; P = 0.023). CONCLUSIONS This is the first multicentre prospective study comparing micro-US-targeted biopsy with mpMRI-targeted biopsy. The study provides further evidence that micro-US can reliably detect cancer lesions and suggests that micro-US biopsy might be as effective as mpMRI for detection of csPCA. This result has significant implications for increasing accessibility, reducing costs and expediting diagnosis.
Collapse
Affiliation(s)
| | - Ferdinand Luger
- Department of Urology, Ordensklinikum Linz, Elisabethinen, Austria
| | - Niklas Harland
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Henning Plage
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Maximillian Reimann
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Markus Hollenbach
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Arnulf Stenzl
- Department of Urology, Eberhard-Karls-University, Tübingen, Germany
| | - Thorsten Schlomm
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Laura Wiemer
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Prouro, Urology Berlin, Berlin, Germany.,Department of Urology, University of Magdeburg, Magdeburg, Germany
| |
Collapse
|
26
|
Heesterman BL, van der Poel HG, Schoots IG, Mehra N, Aben KKH. Prognostic importance of concomitant non-regional lymph node and bone metastases in men with newly diagnosed metastatic prostate cancer. BJU Int 2021; 130:217-225. [PMID: 34741789 DOI: 10.1111/bju.15632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 09/09/2021] [Accepted: 11/04/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate the prognostic importance of concomitant non-regional lymph node (NRLN) and bone metastases in men with synchronous metastatic hormone-sensitive prostate cancer (mHSPC), and to determine whether M1b/M1c is the most appropriate M-stage and evaluate the additional importance to the distinction in low/high volume disease. PATIENTS AND METHODS All men diagnosed with synchronous mHSPC from 2010 to 2018 in the Netherlands were identified in the Netherlands Cancer Registry. Men were categorised as having NRLN (M1a), bone (M1b), NRLN and bone (M1c), or visceral metastases (M1c). For men diagnosed since October 2015 disease volume could be determined. Analyses were performed in this cohort (>5600 men) and repeated in the 2010-2018 cohort (>14 000 men). The primary outcome measure in this observational cohort study was overall survival (OS) and Cox regression was used to calculate hazard ratios (HRs). RESULTS Compared to men with NRLN and bone metastases (reference group), OS of men with only NRLN (HR 0.70, 95% confidence interval [CI] 0.55-0.88) was better. This was also true for men with only bone metastases in the low-volume subgroup (HR 0.75, 95% CI0.58-0.98), but not in the high-volume subgroup (HR 0.99, 95% CI 0.84-1.18). In contrast, the OS of men with visceral metastases was worse (HR 2.20, 95% CI 1.75-2.77 + 0.97/month, 95% CI 0.96-0.98). CONCLUSION In men with low-volume synchronous mHSPC, presence of concomitant NRLN and bone metastases (currently classified as M1c), is a poor prognostic sign. However, survival of men with visceral metastases (M1c) is worse. Implying that classifying concomitant NRLN and bone metastases as M1c or M1b is not appropriate. Adding a fourth M1-category to the ninth edition of the Tumour-Node-Metastasis classification should be contemplated. Furthermore, definitions of metastatic burden need to be re-evaluated.
Collapse
Affiliation(s)
| | - Henk G van der Poel
- Department of Urology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ivo G Schoots
- Department of Radiology, Netherlands Cancer Institute, Amsterdam, the Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Niven Mehra
- Department of Medical Oncology, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands
| |
Collapse
|
27
|
Luzzago S, Piccinelli ML, Mistretta FA, Bianchi R, Cozzi G, Di Trapani E, Cioffi A, Catellani M, Fontana M, Jannello LMI, Botticelli FMG, Marvaso G, Alessi S, Pricolo P, Ferro M, Matei DV, Jereczek-Fossa BA, Fusco N, Petralia G, de Cobelli O, Musi G. Repeat MRI during active surveillance: natural history of prostatic lesions and upgrading rates. BJU Int 2021; 129:524-533. [PMID: 34687137 DOI: 10.1111/bju.15623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess upgrading rates in patients on active surveillance (AS) for prostate cancer (PCa) after serial multiparametric magnetic resonance imaging (mpMRI). METHODS We conducted a retrospective analysis of 558 patients. Five different criteria for mpMRI progression were used: 1) a Prostate Imaging Reporting and Data System (PI-RADS) score increase; 2) a lesion size increase; 3) an extraprostatic extension score increase; 4) overall mpMRI progression; and 5) the number of criteria met for mpMRI progression (0 vs 1 vs 2-3). In addition, two definitions of PCa upgrading were evaluated: 1) International Society of Urological Pathology Grade Group (ISUP GG) ≥2 with >10% of pattern 4 and 2) ISUP GG ≥ 3. Estimated annual percent changes methodology was used to show the temporal trends of mpMRI progression criteria. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of mpMRI progression criteria were also analysed. Multivariable logistic regression models tested PCa upgrading rates. RESULTS Lower rates over time for all mpMRI progression criteria were observed. The NPV of serial mpMRI scans ranged from 90.5% to 93.5% (ISUP GG≥2 with >10% of pattern 4 PCa upgrading) and from 98% to 99% (ISUP GG≥3 PCa upgrading), depending on the criteria used for mpMRI progression. A prostate-specific antigen density (PSAD) threshold of 0.15 ng/mL/mL was used to substratify those patients who would be able to skip a prostate biopsy. In multivariable logistic regression models assessing PCa upgrading rates, all five mpMRI progression criteria achieved independent predictor status. CONCLUSION During AS, approximately 27% of patients experience mpMRI progression at first repeat MRI. However, the rates of mpMRI progression decrease over time at subsequent mpMRI scans. Patients with stable mpMRI findings and with PSAD < 0.15 ng/mL/mL could safely skip surveillance biopsies. Conversely, patients who experience mpMRI progression should undergo a prostate biopsy.
Collapse
Affiliation(s)
- Stefano Luzzago
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Mattia Luca Piccinelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | | | - Roberto Bianchi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Gabriele Cozzi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Ettore Di Trapani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Antonio Cioffi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Michele Catellani
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Matteo Fontana
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | - Letizia Maria Ippolita Jannello
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Università degli Studi di Milano, Milan, Italy
| | | | - Giulia Marvaso
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Sarah Alessi
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Pricolo
- Division of Radiology, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Deliu-Victor Matei
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Barbara A Jereczek-Fossa
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Radiotherapy, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Nicola Fusco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Department of Pathology, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Giuseppe Petralia
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Precision Imaging and Research Unit, Department of Medical Imaging and Radiation Sciences, IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Ottavio de Cobelli
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Gennaro Musi
- Department of Urology, IEO European Institute of Oncology, IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| |
Collapse
|
28
|
Pouliot F, Beauregard JM, Saad F, Trudel D, Richard PO, Turcotte É, Rousseau É, Probst S, Kassouf W, Anidjar M, Camirand Lemyre F, Bouvet GF, Neveu B, Tétu A, Guérin B. The Triple-Tracer strategy against Metastatic PrOstate cancer (3TMPO) study protocol. BJU Int 2021; 130:314-322. [PMID: 34674367 PMCID: PMC9546087 DOI: 10.1111/bju.15621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the prevalence of intra-patient inter-metastatic heterogeneity based on positron emission tomography (PET)/computed tomography (CT) in patients with metastatic castration-resistant prostate cancer (mCRPC) and to determine the prevalence of neuroendocrine disease in these patients and their eligibility for radioligand therapies (RLTs). PATIENTS AND METHODS This multicentre observational prospective clinical study will include 100 patients with mCRPC from five Canadian academic centres. Patients with radiological or biochemical progression and harbouring at least three metastases by conventional imaging will be accrued. Intra-patient inter-metastatic heterogeneity will be determined with triple-tracer imaging using fluorine-18 fluorodeoxyglucose (18 F-FDG), gallium-68-(68 Ga)-prostate-specific membrane antigen (PSMA)-617 and 68 Ga-DOTATATE, which are a glucose analogue, a PSMA receptor ligand and a somatostatin receptor ligand, respectively. The 68 Ga-PSMA-617 and 18 F-FDG PET/CT scans will be performed first. If at least one PSMA-negative/FDG-positive lesion is observed, an additional PET/CT scan with 68 Ga-DOTATATE will be performed. The tracer uptake of individual lesions will be assessed for each PET tracer and patients with lesions presenting discordant uptake profiles will be considered as having inter-metastatic heterogeneous disease and may be offered a biopsy. EXPECTED RESULTS The proposed triple-tracer approach will allow whole-body mCRPC characterisation, investigating the inter-metastatic heterogeneity in order to better understand the phenotypic plasticity of prostate cancer, including the neuroendocrine transdifferentiation that occurs during mCRPC progression. Based on 68 Ga-PSMA-617 or 68 Ga-DOTATATE PET positivity, the potential eligibility of patients for PSMA and DOTATATE-based RLT will be assessed. Non-invasive whole-body determination of mCRPC heterogeneity and transdifferentiation is highly innovative and might establish the basis for new therapeutic strategies. Comparison of molecular imaging findings with biopsies will also link metastasis biology to radiomic features. CONCLUSION This study will add novel, biologically relevant dimensions to molecular imaging: the non-invasive detection of inter-metastatic heterogeneity and transdifferentiation to neuroendocrine prostate cancer by using a multi-tracer PET/CT strategy to further personalise the care of patients with mCRPC.
Collapse
Affiliation(s)
- Frédéric Pouliot
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada.,Urology Division, Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Jean-Mathieu Beauregard
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada.,Department of Radiology and Nuclear Medicine, Cancer Research Centre, Université Laval, Quebec City, QC, Canada.,Department of Medical Imaging, CHUQc-UL, Quebec City, QC, Canada
| | - Fred Saad
- CHU de Montréal, Montréal, QC, Canada
| | - Dominique Trudel
- Institut du Cancer de Montréal, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Pathology and Cellular Biology, Université de Montréal, Montréal, QC, Canada
| | - Patrick O Richard
- Division of Urology, Department of Surgery, Centre Hospitalier Universitaire de Sherbrooke, Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, QC, Canada
| | - Éric Turcotte
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Sherbrooke Molecular Imaging Centre (CIMS), CRCHUS, Sherbrooke, QC, Canada
| | - Étienne Rousseau
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Sherbrooke Molecular Imaging Centre (CIMS), CRCHUS, Sherbrooke, QC, Canada
| | - Stephan Probst
- Department of Radiology, Division of Nuclear Medicine, Faculty of Medicine, Sir Mortimer B. Davis - Jewish General Hospital, McGill University, Montréal, QC, Canada
| | - Wassim Kassouf
- Division of Urology, Department of Surgery, McGill University Health Center, Montréal, QC, Canada
| | - Maurice Anidjar
- Department of Urology, McGill University Health Centre, Jewish General Hospital, Montréal, QC, Canada
| | - Félix Camirand Lemyre
- Health, Populations, Organization, Practices Axis, CRCHUS, Sherbrooke, QC, Canada.,Department of Mathematics, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Guillaume F Bouvet
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada
| | - Bertrand Neveu
- Oncology Axis, (CHU) de Québec - Université Laval (CHUQc-UL) Research Centre, Quebec City, QC, Canada
| | - Amélie Tétu
- Unité de Recherche Clinique et Épidémiologique (URCE), CRCHUS, Sherbrooke, QC, Canada
| | - Brigitte Guérin
- Department of Nuclear Medicine and Radiobiology, Université de Sherbrooke, Sherbrooke, QC, Canada.,Sherbrooke Molecular Imaging Centre (CIMS), CRCHUS, Sherbrooke, QC, Canada
| |
Collapse
|
29
|
Witt JH, Friedrich M, Jandrig B, Porsch M, Baumunk D, Liehr UB, Wendler JJ, Schostak M. Molecular margin status after radical prostatectomy using glutathione S-transferase P1 (GSTP1) promoter hypermethylation. BJU Int 2021; 130:454-462. [PMID: 34657365 DOI: 10.1111/bju.15618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the potential for molecular staging in biopsies of the prostatic fossa after radical prostatectomy (RP) by searching for occult tumour cells through analysis of glutathione S-transferase P1 (GSTP1) methylation status. PATIENTS AND METHODS We analysed 2446 biopsies: 2286 biopsies from a group of 254 patients with clinically organ-confined prostate cancer who underwent RP and 160 biopsies from a control group of 32 patients. After prostate gland excision, biopsies were obtained from defined areas of the prostatic fossa and bisected for histopathological and molecular genetics analyses. Results were related to clinicopathological data including tumour stage, lymph node status, resection status, tumour grading, initial PSA level, and biochemical recurrence. RESULTS In total, 34 patients (13.4%) had at least one core positive for the GSTP1 promoter hypermethylation, six of whom (17.6%) were characterised as having a clinically localised tumour stage (pT2, pN0) and 28 (82.4%) as an advanced tumour stage (≥pT3 and/or pN1). GSTP1 promoter hypermethylation significantly correlated with tumour stage (P < 0.001), International Society of Urological Pathology grading (P = 0.001), lymph node status (P < 0.001), surgical margin status (P < 0.001), and biochemical recurrence (P = 0.001). Furthermore, in 46 patients (18.1%) further analysis led to a down- or upgrading of conventional surgical margin status. Classical R-status (margins of the specimen) is significantly superior to histological sampling from the fossa (P = 0.006) but not to GSTP1 analysis from the fossa (P = 0.227). CONCLUSION For the detection of residual tumour in the fossa after RP in order to better predict recurrence, molecular GSTP1 promoter hypermethylation has some value; however, the classical R-status (margins of the specimen) is simpler and more widely applicable with similar results.
Collapse
Affiliation(s)
- Jörn H Witt
- Department of Urology, St. Antonius-Hospital, Gronau, Germany
| | - Maria Friedrich
- Clinic of Urology, Uro-Oncology, Robot-assisted and Focal Therapy, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany.,Department of Urology, University Hospital, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Burkhard Jandrig
- Department of Urology, University Hospital, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | | | | | - Uwe-B Liehr
- Department of Urology, University Hospital, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Johann J Wendler
- Department of Urology, University Hospital, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Martin Schostak
- Clinic of Urology, Uro-Oncology, Robot-assisted and Focal Therapy, University Hospital, Otto-von-Guericke-University, Magdeburg, Germany.,Department of Urology, University Hospital, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| |
Collapse
|
30
|
Kelly R, Anton A, Wong S, Shapiro J, Weickhardt A, Azad A, Kwan EM, Spain L, Muthusamy A, Torres J, Parente P, Parnis F, Goh J, Joshua A, Pook D, Baenziger O, Gibbs P, Tran B. Real-world use of first-generation antiandrogens: impact on patient outcomes and subsequent therapies in metastatic castration-resistant prostate cancer. BJU Int 2021; 128 Suppl 1:18-26. [PMID: 34622543 DOI: 10.1111/bju.15364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To investigate the recent real-world use of first-generation antiandrogens (FGAs) in metastatic castration-resistant prostate cancer (mCRPC) using a retrospective multicentre cohort study. PATIENTS AND METHODS The electronic CRPC Australian Database (ePAD) was interrogated to identify patients with mCRPC. Clinicopathological features, treatment and outcome data, stratified by FGA use, were retrieved and reported through descriptive statistics. Survival analyses were calculated using the Kaplan-Meier method and groups compared using log-rank tests. Factors influencing overall survival (OS) were analysed using Cox proportional hazards regression model. RESULTS We identified 634 patients with mCRPC, enrolled in ePAD between January 2016 and March 2019, including 322 (51%) who received FGAs. The median follow-up was 21.9 months. Patients treated with FGAs were more likely to have lower International Society of Urological Pathologists (ISUP) grade group (P = 0.04), longer median time to CRPC (25.6 vs 16.0 months, P < 0.001), and were less likely to have visceral metastases (5.0% vs 11.2%, P = 0.005) or to have received upfront docetaxel (P < 0.001). A ≥50% reduction from pre-treatment prostate-specific antigen (PSA) level (PSA50 response) during FGA treatment occurred in 119 (37%) patients and was independently associated with improved OS (hazard ratio 0.233, P < 0.001). Prior FGA treatment did not significantly influence the selection of subsequent life-prolonging treatments for mCRPC or their PSA50 response rates. CONCLUSION In our present cohort, FGAs were commonly used in lower-risk mCRPC and their use did not significantly influence the choice or duration of subsequent systemic therapy. A PSA50 response to FGA therapy was an independent favourable prognostic marker associated with improved OS.
Collapse
Affiliation(s)
- Richard Kelly
- Walter and Eliza Hall Institute, Melbourne, Vic., Australia
| | - Angelyn Anton
- Walter and Eliza Hall Institute, Melbourne, Vic., Australia.,Eastern Health, Melbourne, Vic., Australia.,Monash University, Melbourne, Vic., Australia
| | | | | | - Andrew Weickhardt
- Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Vic., Australia
| | - Arun Azad
- Monash University, Melbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Edmond Michael Kwan
- Monash University, Melbourne, Vic., Australia.,Monash Health, Melbourne, Vic., Australia
| | - Lavinia Spain
- Eastern Health, Melbourne, Vic., Australia.,Monash University, Melbourne, Vic., Australia
| | - Arun Muthusamy
- Olivia Newton-John Cancer Wellness and Research Centre, Melbourne, Vic., Australia
| | | | - Phillip Parente
- Eastern Health, Melbourne, Vic., Australia.,Monash University, Melbourne, Vic., Australia
| | - Francis Parnis
- Adelaide Cancer Centre, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Jeffrey Goh
- Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | | | - David Pook
- Monash University, Melbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | | | - Peter Gibbs
- Walter and Eliza Hall Institute, Melbourne, Vic., Australia.,Western Health, Melbourne, Vic., Australia
| | - Ben Tran
- Walter and Eliza Hall Institute, Melbourne, Vic., Australia.,Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| |
Collapse
|
31
|
Marshall CH, Tunacao J, Danda V, Tsai HL, Barber J, Gawande R, Weiss CR, Denmeade SR, Joshu C. Reversing the effects of androgen-deprivation therapy in men with metastatic castration-resistant prostate cancer. BJU Int 2021; 128:366-373. [PMID: 33765326 PMCID: PMC9844547 DOI: 10.1111/bju.15408] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To investigate whether bipolar androgen therapy (BAT), involving rapid cyclic administration of high-dose testosterone, as a novel treatment for metastatic castration-resistant prostate cancer (mCRPC) promotes improvements in body composition and associated improvements in lipid profiles and quality of life. PATIENTS AND METHODS Men from two completed trials with computed tomography imaging at baseline and after three cycles of BAT were included. Cross-sectional areas of psoas muscle, visceral and subcutaneous fat were measured at the L3 vertebral level. Functional Assessment of Chronic Illness Therapy - Fatigue questionnaire and 36-item short-form health survey were used to assess quality of life. RESULTS The 60 included patients lost a mean (sd) of 7.8 (8.2)% of subcutaneous fat, 9.8 (18.2)% of visceral fat, and gained 12.2 (6.7)% muscle mass. Changes in subcutaneous and visceral fat were positively correlated with each other (Spearman's correlation coefficient 0.58, 95% confidence interval 0.35-0.71) independent of the effects of age, body mass index, and duration of androgen-deprivation therapy. Energy, physical function, and measures of limitations due to physical health were all significantly improved at 3 months. The improvements in body composition were not correlated with decreases in lipid levels or observed improvements in quality of life. CONCLUSIONS In the present study, BAT was associated with significant improvements in body composition, lipid parameters, and quality of life. This has promising implications for the long-term health of men with mCRPC.
Collapse
Affiliation(s)
| | - Jessa Tunacao
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Varun Danda
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Hua-Ling Tsai
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - John Barber
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rakhee Gawande
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Clifford R. Weiss
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Samuel R. Denmeade
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Corinne Joshu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
32
|
Lopez JF, Campbell A, Omer A, Stroman L, Bondad J, Austin T, Reeves T, Phelan C, Leiblich A, Philippou Y, Lovegrove CE, Ranasinha N, Bryant RJ, Leslie T, Hamdy FC, Brewster S, Bell CR, Popert R, Hodgson D, Elsaghir M, Eddy B, Bolomytis S, Persad R, Reddy UD, Foley C, van Rij S, Lam W, Lamb AD. Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis. BJU Int 2021; 128:311-318. [PMID: 33448607 DOI: 10.1111/bju.15337] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability. PATIENTS AND METHODS Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint™ TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs). RESULTS Some 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'. CONCLUSION Our data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.
Collapse
Affiliation(s)
| | | | - Altan Omer
- Churchill Hospital Cancer Centre, Oxford, UK
| | | | | | - Tom Austin
- Queen Alexandra Hospital, Portsmouth, UK
| | | | | | - Aaron Leiblich
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Yiannis Philippou
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Catherine E Lovegrove
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Nithesh Ranasinha
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Richard J Bryant
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Tom Leslie
- Churchill Hospital Cancer Centre, Oxford, UK
| | - Freddie C Hamdy
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | | | | | | | | | - Ben Eddy
- Kent and Canterbury Hospital, Canterbury, UK
| | | | | | - Utsav D Reddy
- Norfolk and Norwich University Hospital, Norwich, UK
| | | | | | - Wayne Lam
- Department of Surgery, University of Hong Kong, Hong Kong SAR, China
| | - Alastair D Lamb
- Churchill Hospital Cancer Centre, Oxford, UK
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
33
|
Lonergan PE, Vertosick EA, Assel M, Sjoberg DD, Haese A, Graefen M, Boorjian SA, Klee GG, Cooperberg MR, Pettersson K, Routila E, Vickers AJ, Lilja H. Prospective validation of microseminoprotein-β added to the 4Kscore in predicting high-grade prostate cancer in an international multicentre cohort. BJU Int 2021; 128:218-224. [PMID: 33306251 PMCID: PMC8279428 DOI: 10.1111/bju.15320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To prospectively evaluate the performance of a pre-specified statistical model based on four kallikrein markers in blood (total prostate-specific antigen [PSA], free PSA, intact PSA, and human kallikrein-related peptidase 2), commercially available as the 4Kscore, in predicting Gleason Grade Group (GG) ≥2 prostate cancer at biopsy in an international multicentre study at three academic medical centres, and whether microseminoprotein-β (MSP) adds predictive value. PATIENTS AND METHODS A total of 984 men were prospectively enrolled at three academic centres. The primary outcome was GG ≥2 on prostate biopsy. Three pre-specified statistical models were used: a base model including PSA, age, digital rectal examination and prior negative biopsy; a model that added free PSA to the base model; and the 4Kscore. RESULTS A total of 947 men were included in the final analysis and 273 (29%) had GG ≥2 on prostate biopsy. The base model area under the receiver operating characteristic curve of 0.775 increased to 0.802 with the addition of free PSA, and to 0.824 for the 4Kscore. Adding MSP to the 4Kscore model yielded an increase (0.014-0.019) in discrimination. In decision-curve analysis of clinical utility, the 4Kscore showed a benefit starting at a 7.5% threshold. CONCLUSION A prospective multicentre evaluation of a pre-specified model based on four kallikrein markers (4Kscore) with the addition of MSP improves the predictive discrimination for GG ≥2 prostate cancer on biopsy and could be used to inform biopsy decision-making.
Collapse
Affiliation(s)
- Peter E Lonergan
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| | - Emily A Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Melissa Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Daniel D Sjoberg
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Alexander Haese
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | | | - George G Klee
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Matthew R Cooperberg
- Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kim Pettersson
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Erica Routila
- Departments of Biochemistry/Biotechnology, University of Turku, Turku, Finland
| | - Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
| |
Collapse
|
34
|
Buelens S, Poelaert F, Claeys T, De Bleser E, Dhondt B, Verla W, Ost P, Rappe B, De Troyer B, Verbaeys C, Kimpe B, Billiet I, Plancke H, Fransis K, Willemen P, Ameye F, Decaestecker K, Lumen N. Multicentre, prospective study on local treatment of metastatic prostate cancer (LoMP study). BJU Int 2021; 129:699-707. [PMID: 34289231 DOI: 10.1111/bju.15553] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the role of cytoreductive radical prostatectomy in addition to standard of care for patients with newly diagnosed metastatic prostate cancer. MATERIALS AND METHODS This multicentre, prospective study included asymptomatic patients from 2014 to 2018 (NCT02138721). Cytoreductive radical prostatectomy was offered to all fit patients with resectable tumours, resulting in 40 patients. Standard of care was administered to 40 patients who were ineligible or unwilling to undergo surgery. The primary endpoint was castration resistant cancer-free survival at the time point of ≥50% events. The secondary endpoint was local event-free survival. Kaplan-Meier and Cox regression analyses with propensity-score analysis were applied. RESULTS After a median (quartiles) follow-up of 35 (24-47) months, 42 patients became castration-resistant or died. The median castration resistant cancer-free survival was 53 (95% confidence interval [CI] 14-92) vs 21 (95% CI 15-27) months for cytoreductive radical prostatectomy compared to standard of care (P = 0.017). The 3-year estimates for local event-free survival were 83% (95% CI 71-95) vs 59% (95% CI 51-67) for cytoreductive radical prostatectomy compared to standard of care (P = 0.012). However, treatment group showed no significance in the multivariable models for castration resistant cancer-free survival (P = 0.5) or local event-free survival (P = 0.3), adjusted for propensity-score analysis. Complications were similar to the non-metastatic setting. Patients undergoing surgery were younger, with lower baseline prostate-specific antigen levels, alkaline phosphatase levels and metastatic burden. CONCLUSION The present LoMP study was unable to show a difference between the two inclusion groups regarding castration resistant cancer-free survival for asymptomatic patients with newly diagnosed metastatic prostate cancer. These results validate previous evidence that, in well-selected and informed patients, cytoreductive radical prostatectomy is feasible and safe, with corresponding continence rates compared to the non-metastatic, high-risk setting. Whether cytoreductive radical prostatectomy could be a valuable option to achieve good local palliation needs to be further researched. Overall, the role of cytoreductive radical prostatectomy needs to be further explored in randomized studies to correct for potential bias.
Collapse
Affiliation(s)
- Sarah Buelens
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Filip Poelaert
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Tom Claeys
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Elise De Bleser
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Bert Dhondt
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| | - Wesley Verla
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Bart De Troyer
- Department of Urology, AZ Nikolaas, Sint-Niklaas, Belgium
| | | | - Bart Kimpe
- Department of Urology, Sint-Lucas Hospital, Bruges, Belgium
| | | | | | - Karen Fransis
- Department of Urology, University Hospital Antwerp, Antwerp, Belgium
| | | | - Filip Ameye
- Department of Urology, AZ Maria Middelares, Ghent, Belgium
| | | | - Nicolaas Lumen
- Department of Urology, Ghent University Hospital, Ghent, Belgium.,Cancer Research Institute Ghent, Ghent University, Ghent, Belgium
| |
Collapse
|
35
|
Abstract
OBJECTIVES To present an overview of radiation therapy (RT) for prostate cancer over the past decade. METHODS The literature on prostate cancer radiation therapy was reviewed and summarised. Radiation therapy (RT) for prostate cancer has dramatically evolved in the past decade, with superior techniques and exciting advances, pushing the role of the radiation oncologist to new frontiers. RESULTS Innovations in imaging, treatment delivery, and a deeper understanding of biology has resulted in more tailored RT for individuals. In the present review, we summarise the changing landscape and broadly discuss new developments in prostate RT. CONCLUSIONS Questions and challenges remain in the field, however there are multiple opportunities to further improve upon RT for our patients with prostate cancer.
Collapse
Affiliation(s)
- Sophia C Kamran
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anthony L Zietman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
36
|
Hayne D, Grummet J, Espinoza D, McCombie SP, Chalasani V, Ford KS, Frydenberg M, Gilling P, Gordon B, Hawks C, Konstantatos A, Martin AJ, Nixon A, O'Brien C, Patel MI, Sengupta S, Shahbaz S, Subramaniam S, Williams S, Woo HH, Stockler MR, Davis ID, Buchan N. 'Pain-free TRUS B': a phase 3 double-blind placebo-controlled randomized trial of methoxyflurane with periprostatic local anaesthesia to reduce the discomfort of transrectal ultrasonography-guided prostate biopsy (ANZUP 1501). BJU Int 2021; 129:591-600. [PMID: 34273231 PMCID: PMC9291594 DOI: 10.1111/bju.15552] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective To determine whether the addition of inhaled methoxyflurane to periprostatic infiltration of local anaesthetic (PILA) during transrectal ultrasonography‐guided prostate biopsies (TRUSBs) improved pain and other aspects of the experience. Patients and Methods We conducted a multicentre, placebo‐controlled, double‐blind, randomized phase 3 trial, involving 420 men undergoing their first TRUSB. The intervention was PILA plus a patient‐controlled device containing either 3 mL methoxyflurane, or 3 mL 0.9% saline plus one drop of methoxyflurane to preserve blinding. The primary outcome was the pain score (0–10) reported by the participant after 15 min. Secondary outcomes included ratings of other aspects of the biopsy experience, willingness to undergo future biopsies, urologists’ ratings, biopsy completion, and adverse events. Results The mean (SE) pain scores 15 min after TRUSB were 2.51 (0.22) in those assigned methoxyflurane vs 2.82 (0.22) for placebo (difference 0.31, 95% confidence interval [CI] −0.75 to 0.14; P = 0.18). Methoxyflurane was associated with better scores for discomfort (difference −0.48, 95% CI −0.92 to −0.03; P = 0.035, adjusted [adj.] P = 0.076), whole experience (difference −0.50, 95% CI −0.92 to −0.08; P = 0.021, adj. P = 0.053), and willingness to undergo repeat biopsies (odds ratio 1.67, 95% CI 1.12–2.49; P = 0.01) than placebo. Methoxyflurane resulted in higher scores for drowsiness (difference +1.64, 95% CI 1.21–2.07; P < 0.001, adj. P < 0.001) and dizziness (difference +1.78, 95% CI 1.31–2.24; P < 0.001, adj. P < 0.001) than placebo. There was no significant difference in the number of ≥ grade 3 adverse events. Conclusions We found no evidence that methoxyflurane improved pain scores at 15 min, however, improvements were seen in patient‐reported discomfort, overall experience, and willingness to undergo repeat biopsies.
Collapse
Affiliation(s)
- Dickon Hayne
- UWA Medical School, University of Western Australia, Perth, WA, Australia.,Fiona Stanley Hospital, Perth, WA, Australia
| | - Jeremy Grummet
- Alfred Health, Central Clinical School, Monash University, Melbourne, Vic., Australia.,Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | | | - Steve P McCombie
- UWA Medical School, University of Western Australia, Perth, WA, Australia.,Fiona Stanley Hospital, Perth, WA, Australia
| | | | - Kate S Ford
- NHMRC Clinical Trials Centre, Sydney, NSW, Australia
| | - Mark Frydenberg
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.,Cabrini Institute, Cabrini Health, Melbourne, Vic., Australia
| | | | - Barbara Gordon
- Canterbury Urology Research Trust, Christchurch, New Zealand
| | - Cynthia Hawks
- UWA Medical School, University of Western Australia, Perth, WA, Australia.,Fiona Stanley Hospital, Perth, WA, Australia
| | - Alex Konstantatos
- Alfred Health, Central Clinical School, Monash University, Melbourne, Vic., Australia
| | - Andrew J Martin
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | | | - Colin O'Brien
- Consumer Advisory Panel, Australian and New Zealand Urogenital and Prostate Cancer Trials Group (ANZUP), Sydney, NSW, Australia
| | - Manish I Patel
- Discipline of Surgery, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
| | - Shomik Sengupta
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.,Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia
| | - Shekib Shahbaz
- Monash Health, Casey Hospital, Melbourne, Vic., Australia
| | - Shalini Subramaniam
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Scott Williams
- Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
| | - Henry H Woo
- Sydney Adventist Hospital, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia
| | - Martin R Stockler
- Department of Surgery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Ian D Davis
- Eastern Health Clinical School, Monash University, Melbourne, Vic., Australia.,Cancer Services, Eastern Health, Melbourne, Vic., Australia
| | - Nick Buchan
- Canterbury Urology Research Trust, Christchurch, New Zealand
| | | |
Collapse
|
37
|
Björklund J, Stattin P, Rönmark E, Aly M, Akre O. The 90-day cause-specific mortality after radical prostatectomy: a nationwide population-based study. BJU Int 2021; 129:318-324. [PMID: 34191407 DOI: 10.1111/bju.15533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the cause-specific mortality in the postoperative period after radical prostatectomy (RP) for prostate cancer (PCa). METHODS In the National Prostate Cancer Register of Sweden (NPCR), we identified all men who died within 90 days after RP performed 1998-2018 and we assessed cause of death in a chart review. We compared the adjudications of death from our medical record review with those in in the Swedish Cause of Death Registry (CDR). RESULTS Out of 44 635, 58 (0.13%) men who had undergone RP from 1998 through 2018 died within 90 days after RP. Per medical record review the most common causes of death were cardiac disease (30%) and venous thromboembolic events (VTE; 21%). No men died of metastatic PCa as was first indicated in the CDR. After robot-assisted RP (RARP) or open retropubic RP (RRP), the postoperative mortality was 0.09% (19/21 520) and 0.19% (37/19 635), respectively. The effect off modality was confounded mainly by year of surgery, age at surgery, Charlson Comorbidity Index score and the concomitant pelvic lymph node dissection. CONCLUSION The validated absolute 90-day mortality after RP was 1.3/1000 during the 21-year study period. Cardiovascular diseases were the most common causes of death after RP. Our validation of the CDR refuted the occurrence of postoperative deaths from metastatic PCa. There were differences in rates and type of mortality between RRP and RARP, but the RARP cohort was more recent than the RRP cohort, which likely explain the differences.
Collapse
Affiliation(s)
- Johan Björklund
- Urology, The Institution for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Erik Rönmark
- Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Markus Aly
- Urology, The Institution for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Akre
- Urology, The Institution for Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
38
|
Mori K, Mostafaei H, Sari Motlagh R, Pradere B, Quhal F, Laukhtina E, Schuettfort VM, Kramer G, Abufaraj M, Karakiewicz PI, Kimura T, Egawa S, Shariat SF. Systemic therapies for metastatic hormone-sensitive prostate cancer: network meta-analysis. BJU Int 2021; 129:423-433. [PMID: 34171173 PMCID: PMC9291853 DOI: 10.1111/bju.15507] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objectives To perform a systematic review and network meta‐analysis to compare the efficacy and safety of currently available treatments for the management of metastatic hormone‐sensitive prostate cancer (mHSPC), as there has been a paradigm shift with the use of next‐generation androgen receptor inhibitors (ARIs) and docetaxel. Methods Multiple databases were searched for articles published before May 2020 according to the Preferred Reporting Items for Systematic Review and Meta‐analysis extension statement for network meta‐analysis. Studies comparing overall/progression‐free survival (OS/PFS) and/or adverse events (AEs) in patients with mHSPC were eligible. Results Nine studies (N = 9960) were selected, and formal network meta‐analyses were conducted. Abiraterone (hazard ratio [HR] 0.83, 95% credible interval [CrI] 0.76–0.90), docetaxel (HR 0.90, 95% CrI 0.82–0.98), and enzalutamide (HR 0.85, 95% CrI 0.73–0.99) were associated with significantly better OS than androgen‐deprivation therapy (ADT), and abiraterone emerged as the best option. Abiraterone (HR 0.71, 95% CrI 0.67–0.76), apalutamide (HR 0.73, 95% CrI 0.65–0.81), docetaxel (HR 0.84, 95% CrI 0.78–0.90), and enzalutamide (HR 0.67, 95% CrI 0.63–0.71) were associated with significantly better PFS than ADT, and enzalutamide emerged as the best option. Abiraterone (HR 0.85, 95% CrI 0.78–0.93), apalutamide (HR 0.87, 95% CrI 0.77–0.98), and enzalutamide (HR 0.80, 95% CrI 0.73–0.88) were significantly more effective than docetaxel. Regarding AEs, apalutamide was the likely best option among the three ARIs. In patients with low‐volume mHSPC, enzalutamide was the best option in terms of OS and PFS. Conclusions All three ARIs are effective therapies for mHSPC; apalutamide was the best tolerated. All three seemed more effective than docetaxel. These findings may facilitate individualised treatment strategies and inform future comparative trials.
Collapse
Affiliation(s)
- Keiichiro Mori
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Hadi Mostafaei
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Sari Motlagh
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Benjamin Pradere
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Fahad Quhal
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | - Ekaterina Laukhtina
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia
| | - Victor M Schuettfort
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Canada
| | - Takahiro Kimura
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shin Egawa
- Department of Urology, The Jikei University School of Medicine, Tokyo, Japan
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Vienna, Austria.,Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia.,Division of Urology, Department of Special Surgery, The University of Jordan, Amman, Jordan.,Department of Urology, Weill Cornell Medical College, New York, NY, USA.,Department of Urology, University of Texas Southwestern, Dallas, TX, USA.,Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,European Association of Urology Research Foundation, Arnhem, Netherlands
| |
Collapse
|
39
|
Gray WK, Day J, Briggs TWR, Harrison S. An observational study of volume-outcome effects for robot-assisted radical prostatectomy in England. BJU Int 2021; 129:93-103. [PMID: 34133832 DOI: 10.1111/bju.15516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To investigate volume-outcome relationships in robot-assisted radical prostatectomy (RARP) for cancer using data from the Hospital Episodes Statistics (HES) database for England. MATERIALS AND METHODS Data for all adult, elective RPs for cancer during the period January 2013-December 2018 (inclusive) were extracted from the HES database. The HES database records data on all National Health Service (NHS) hospital admissions in England. Data were extracted for the NHS trust and surgeon undertaking the procedure, the surgical technique used (laparoscopic, open or robot-assisted), hospital length of stay (LOS), emergency readmissions, and deaths. Multilevel modelling was used to adjust for hierarchy and covariates. RESULTS Data were available for 35 629 RPs (27 945 RARPs). The proportion of procedures conducted as RARPs increased from 53.2% in 2013 to 92.6% in 2018. For RARP, there was a significant relationship between 90-day emergency hospital readmission (primary outcome) and trust volume (odds ratio [OR] for volume decrease of 10 procedures: 0.99, 95% confidence interval [CI] 0.99-1.00; P = 0.037) and surgeon volume (OR for volume decrease of 10 procedures: 0.99, 95% CI 0.99-1.00; P = 0.013) in the previous year. From lowest to highest volume category there was a decline in the adjusted proportion of patients readmitted as an emergency at 90 days from 10.6% (0-49 procedures) to 7.0% (≥300 procedures) for trusts and from 9.4% (0-9 procedures) to 8.3% (≥100 procedures) for surgeons. LOS was also significantly associated with surgeon and trust volume, although 1-year mortality was associated with neither. CONCLUSIONS There is evidence of a volume-outcome relationship for RARP in England and minimising low-volume RARP will improve patient outcomes. Nevertheless, the observed effect size was relatively modest, and stakeholders should be realistic when evaluating the likely impact of further centralisation at a population level.
Collapse
Affiliation(s)
- William K Gray
- Getting It Right First Time programme, NHS England and NHS Improvement, London, UK
| | - Jamie Day
- Getting It Right First Time programme, NHS England and NHS Improvement, London, UK
| | - Tim W R Briggs
- Getting It Right First Time programme, NHS England and NHS Improvement, London, UK.,Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - Simon Harrison
- Getting It Right First Time programme, NHS England and NHS Improvement, London, UK.,Pinderfields Hospital, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| |
Collapse
|
40
|
Dinneen E, Haider A, Grierson J, Freeman A, Oxley J, Briggs T, Nathan S, Williams NR, Brew-Graves C, Persad R, Aning J, Jameson C, Ratynska M, Ben-Salha I, Ball R, Clow R, Allen C, Heffernan-Ho D, Kelly J, Shaw G. NeuroSAFE frozen section during robot-assisted radical prostatectomy: peri-operative and histopathological outcomes from the NeuroSAFE PROOF feasibility randomized controlled trial. BJU Int 2021; 127:676-686. [PMID: 32985121 DOI: 10.1111/bju.15256] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To report on the methods, peri-operative outcomes and histopathological concordance between frozen and final section from the NeuroSAFE PROOF feasibility study (NCT03317990). PATIENTS AND METHODS Between May 2018 and March 2019, 49 patients at two UK centres underwent robot-assisted radical prostatectomy (RARP). Twenty-five patient were randomized to NeuroSAFE RARP (intervention arm) and 24 to standard RARP (control arm). Frozen section was compared to final paraffin section margin assessment in the 25 patients in the NeuroSAFE arm. Operation timings and complications were collected prospectively in both arms. RESULTS Fifty neurovascular bundles (NVBs) from 25 patients in the NeuroSAFE arm were analysed. When analysed by each pathological section (n = 250, average five per side), we noted a sensitivity of 100%, a specificity of 99.2%, and an area under the curve (AUC) of 0.994 (95% confidence interval [CI] 0.985 to 1; P ≤0.001). On an NVB basis (n = 50), sensitivity was 100%, specificity was 92.7%, and the AUC was 0.963 (95% CI 0.914 to 1; P ≤0.001). NeuroSAFE RARP lasted a mean of 3 h 16 min (knife to skin to off table, 95% CI 3 h 2 min-3 h 30 min) compared to 2 h 4 min (95% CI 2 h 2 min-2 h 25 min; P ≤0.001) for standard RARP. There was no morbidity associated with the additional length of operating time on in the NeuroSAFE arm. CONCLUSION This feasibility study demonstrates the safety, reproducibility and excellent histopathological concordance of the NeuroSAFE technique in the NeuroSAFE PROOF trial. Although the technique increases the duration of RARP, this does not cause short-term harm. Confirmation of feasibility has led to the opening of the fully powered NeuroSAFE PROOF randomized controlled trial, which is currently under way at four sites in the UK.
Collapse
Affiliation(s)
- Eoin Dinneen
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Aiman Haider
- Department of Histopathology, University College Hospital London, London, UK
| | - Jack Grierson
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Alex Freeman
- Department of Histopathology, University College Hospital London, London, UK
| | - Jon Oxley
- Department of Histopathology, North Bristol Hospitals Trust, Southmead Hospital, Bristol, UK
| | - Tim Briggs
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Senthil Nathan
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Norman R Williams
- Division of Surgery and Interventional Science, University College London, London, UK
| | | | - Raj Persad
- Department of Urology, North Bristol Hospitals Trust, Southmead Hospital, Bristol, UK
| | - Jon Aning
- Department of Urology, North Bristol Hospitals Trust, Southmead Hospital, Bristol, UK
| | - Charles Jameson
- Department of Histopathology, University College Hospital London, London, UK
| | - Marzena Ratynska
- Department of Histopathology, University College Hospital London, London, UK
| | - Imen Ben-Salha
- Department of Histopathology, University College Hospital London, London, UK
| | - Rhys Ball
- Department of Histopathology, University College Hospital London, London, UK
| | - Rosie Clow
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Clare Allen
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Daniel Heffernan-Ho
- Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - John Kelly
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| | - Greg Shaw
- Division of Surgery and Interventional Science, University College London, London, UK.,Department of Urology, Westmoreland Street Hospital, University College Hospital London, London, UK
| |
Collapse
|
41
|
Meijer D, van Leeuwen PJ, Donswijk ML, Boellaard TN, Schoots IG, van der Poel HG, Hendrikse HN, Oprea-Lager DE, Vis AN. Predicting early outcomes in patients with intermediate- and high-risk prostate cancer using prostate-specific membrane antigen positron emission tomography and magnetic resonance imaging. BJU Int 2021; 129:54-62. [PMID: 34028165 PMCID: PMC9290881 DOI: 10.1111/bju.15492] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/20/2021] [Accepted: 05/18/2021] [Indexed: 11/30/2022]
Abstract
Objectives To identify predictors of early oncological outcomes in patients who opt for robot‐assisted laparoscopic radical prostatectomy (RARP) for localized prostate cancer (PCa), including conventional prognostic variables as well as multiparametric magnetic resonance imaging (mpMRI) and prostate‐specific membrane antigen (PSMA) positron emission tomography (PET). Patients and Methods This observational study included 493 patients who underwent RARP and extended pelvic lymph node dissection (ePLND) for unfavourable intermediate‐ or high‐risk PCa. Outcome measurement was biochemical progression of disease, defined as any postoperative prostate‐specific antigen (PSA) value ≥0.2 ng/mL, or the start of additional treatment. Cox regression analysis was performed to assess predictors for biochemical progression, including initial PSA value, biopsy Grade Group (GG), T‐stage on mpMRI, and lymph node status on PSMA PET imaging (miN0 vs miN1). Results The median (interquartile range) total follow‐up of all included patients without biochemical progression was 12.6 (7.5–22.7) months. When assessing biochemical progression after surgery, initial PSA value (per doubling; odds ratio [OR] 1.22, 95% confidence interval [CI] 1.07–1.40; P = 0.004), biopsy GG ≥4 vs GG 1–2 (OR 1.83, 95% CI 1.18–2.85; P = 0.007), T‐stage on mpMRI (rT3a vs rT2: OR 2.13, 95% CI 1.39–3.27; P = 0.001; ≥rT3b vs rT2: OR 4.78, 95% CI 3.20–7.16; P < 0.001) and miN1 on PSMA PET imaging (OR 2.94, 95% CI 2.02–4.27; P < 0.001) were independent predictors of early biochemical progression of disease. Conclusion Initial PSA value, biopsy GG ≥4, ≥rT3 disease on mpMRI and miN1 disease on PSMA PET were predictors of early biochemical progression after RARP. Identifying these patients with an increased risk of early biochemical progression after surgery may have major implications for patient counselling in radical treatment decisions and on patient selection for modern (neo‐)adjuvant and systematic treatments.
Collapse
Affiliation(s)
- Dennie Meijer
- Department of Urology, Prostate Cancer Network Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Prostate Cancer Network Amsterdam, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maarten L Donswijk
- Department of Nuclear Medicine, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Ivo G Schoots
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, Prostate Cancer Network Amsterdam, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Harry N Hendrikse
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands
| | - Daniela E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Cancer Centre Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands
| | - André N Vis
- Department of Urology, Prostate Cancer Network Amsterdam, Amsterdam University Medical Centre, VU University, Amsterdam, The Netherlands.,Department of Urology, Prostate Cancer Network Amsterdam, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| |
Collapse
|
42
|
Soeterik TFW, Hueting TA, Israel B, van Melick HHE, Dijksman LM, Stomps S, Biesma DH, Koffijberg H, Sedelaar M, Witjes JA, van Basten JPA. External validation of the Memorial Sloan Kettering Cancer Centre and Briganti nomograms for the prediction of lymph node involvement of prostate cancer using clinical stage assessed by magnetic resonance imaging. BJU Int 2021; 128:236-243. [PMID: 33630398 DOI: 10.1111/bju.15376] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To evaluate the impact of using clinical stage assessed by multiparametric magnetic resonance imaging (mpMRI) on the performance of two established nomograms for the prediction of pelvic lymph node involvement (LNI) in patients with prostate cancer. PATIENTS AND METHODS Patients undergoing robot-assisted extended pelvic lymph node dissection (ePLND) from 2015 to 2019 at three teaching hospitals were retrospectively evaluated. Risk of LNI was calculated four times for each patient, using clinical tumour stage (T-stage) assessed by digital rectal examination (DRE) and by mpMRI, in the Memorial Sloan Kettering Cancer Centre (MSKCC; 2018) and Briganti (2012) nomograms. Discrimination (area under the curve [AUC]), calibration, and the net benefit of these four strategies were assessed and compared. RESULTS A total of 1062 patients were included, of whom 301 (28%) had histologically proven LNI. Using DRE T-stage resulted in AUCs of 0.71 (95% confidence interval [CI] 0.70-0.72) for the MSKCC and 0.73 (95% CI 0.72-0.74) for the Briganti nomogram. Using mpMRI T-stage, the AUCs were 0.72 (95% CI 0.71-0.73) for the MSKCC and 0.75 (95% CI 0.74-0.76) for the Briganti nomogram. mpMRI T-stage resulted in equivalent calibration compared with DRE T-stage. Combined use of mpMRI T-stage and the Briganti 2012 nomogram was shown to be superior in terms of AUC, calibration, and net benefit. Use of mpMRI T-stage led to increased sensitivity for the detection of LNI for all risk thresholds in both models, countered by a decreased specificity, compared with DRE T-stage. CONCLUSION T-stage as assessed by mpMRI is an appropriate alternative for T-stage assessed by DRE to determine nomogram-based risk of LNI in patients with prostate cancer, and was associated with improved model performance of both the MSKCC 2018 and Briganti 2012 nomograms.
Collapse
Affiliation(s)
- Timo F W Soeterik
- Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands.,Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Tom A Hueting
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Bas Israel
- Department of Radiology and Nuclear Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.,Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Harm H E van Melick
- Department of Urology, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Lea M Dijksman
- Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands.,Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Saskia Stomps
- Department of Urology, Hospital Group Twente, Hengelo/Almelo, The Netherlands
| | - Douwe H Biesma
- Department of Value-Based Healthcare, Santeon, Utrecht, The Netherlands.,Department of Value-Based Healthcare, St. Antonius Hospital, Nieuwegein/Utrecht, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michiel Sedelaar
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - J Alfred Witjes
- Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | |
Collapse
|
43
|
O'Callaghan M, Papa N, Pase M, Frydenberg M, Mark S, Moretti K, Maqsood S, Smith D, Walker T, White C, Millar J. Patterns of care for prostate cancer treatment and improving outcomes - are national registries the answer? BJU Int 2021; 128 Suppl 1:6-8. [PMID: 33977631 DOI: 10.1111/bju.15366] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Michael O'Callaghan
- Flinders Medical Centre, Flinders University, University of Adelaide, Adelaide, SA, Australia
| | - Nathan Papa
- Department of Epidemiology and Preventative Medicine School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
| | - Marie Pase
- Department of Epidemiology and Preventative Medicine School of Public Health and Preventative Medicine, Monash University, Melbourne, Vic., Australia
| | - Mark Frydenberg
- Department of Surgery, Cabrini Institute, Cabrini Health, Monash University, Melbourne, Vic., Australia
| | - Stephen Mark
- Department of Urology, Christchurch Hospital, Christchurch, New Zealand
| | - Kim Moretti
- Cancer Research Institute, School of Health Sciences, Discipline of Surgery, University of South Australia, University of Adelaide, Adelaide, SA, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia
| | - Saad Maqsood
- Alan Walker Cancer Care Centre, Northern Territory Radiation Oncology, Tiwi, NT, Australia
| | - David Smith
- Cancer Research Division, Cancer Council NSW, Sydney, NSW, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Tony Walker
- College of Health and Biomedicine, Victoria University, Melbourne, Vic., Australia
| | - Craig White
- Prostate Cancer Outcomes Registry of Australia and New Zealand (PCOR-ANZ), Monash University, Melbourne, Vic., Australia
| | - Jeremy Millar
- Department of Surgery, Alfred Health, Monash University, Melbourne, Vic., Australia
| | | |
Collapse
|
44
|
Rosenberg JE, Jung JH, Edgerton Z, Lee H, Lee S, Bakker CJ, Dahm P. Retzius-sparing versus standard robot-assisted laparoscopic prostatectomy for the treatment of clinically localized prostate cancer. BJU Int 2021; 128:12-20. [PMID: 33686742 DOI: 10.1111/bju.15385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To assess the effects of Retzius-sparing (RS) robotic-assisted laparoscopic prostatectomy (RALP) compared to standard RALP for the treatment of clinically localized prostate cancer. METHODS We performed a systematic search of multiple databases and the grey literature with no restrictions on the language of publication or publication status, up until June 2020. We included randomized controlled trials (RCTs) comparing RS-RALP with standard RALP. We performed a meta-analysis using a random-effect model. The quality of evidence was assessed on an outcome basis according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach. RESULTS Our search identified six records of five unique RCTs, of which two were published studies, one was in press, and two were abstract proceedings. There were 571 randomized participants, of whom 502 completed the trials. The mean age of participants was 64.6 years and the mean prostate-specific antigen level was 6.9 ng/mL. Approximately 54.2% of participants had cT1c disease, 38.6% had cT2a-b disease, and 7.1% had cT2c disease. RS-RALP probably improves continence within 1 week after catheter removal (risk ratio [RR] 1.74, 95% confidence interval [CI] 1.41-2.14; I2 = 0%; studies = 4; participants = 410; moderate-certainty evidence). Assuming 335 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 248 more men per 1000 (137 more to 382 more) reporting continence recovery. RS-RALP may increase continence at 3 months after surgery compared to standard RALP (RR 1.33, 95% CI 1.06-1.68; I2 = 86%; studies = 5; participants = 526; low-certainty evidence). Assuming 750 per 1000 men undergoing standard RALP are continent at this time point, this corresponds to 224 more men per 1000 (41 more to 462 more) reporting continence recovery. We are very uncertain about the effects of RS-RALP on serious adverse events compared to standard RALP (RR 1.40, 95% CI 0.47-4.17; studies = 2; participants = 230; very low-certainty evidence). CONCLUSIONS The findings of this review indicate that RS-RALP may result in better continence outcomes than standard RALP up to 6 months after surgery. Continence outcomes at 12 months may be similar. The disadvantages of RS-RALP may be higher positive surgical margin rates. We are very uncertain about the effect on biochemical recurrence-free survival and potency outcomes. Longer-term oncological and functional outcomes are lacking, and no preplanned subgroup analyses could be performed to explore the observed heterogeneity. Surgeons should discuss these trade-offs and the limitations of the evidence with their patients when considering this approach.
Collapse
Affiliation(s)
- Joel E Rosenberg
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Jae Hung Jung
- Department of Urology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Zach Edgerton
- University of Minnesota Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Hunju Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Solam Lee
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Caitlin J Bakker
- Health Sciences Libraries, University of Minnesota, Minneapolis, MN, USA
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.,Urology Section, Minneapolis VA Health Care System, Minneapolis, MN, USA
| |
Collapse
|
45
|
Wessels F, Schmitt M, Krieghoff-Henning E, Jutzi T, Worst TS, Waldbillig F, Neuberger M, Maron RC, Steeg M, Gaiser T, Hekler A, Utikal JS, von Kalle C, Fröhling S, Michel MS, Nuhn P, Brinker TJ. Deep learning approach to predict lymph node metastasis directly from primary tumour histology in prostate cancer. BJU Int 2021; 128:352-360. [PMID: 33706408 DOI: 10.1111/bju.15386] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop a new digital biomarker based on the analysis of primary tumour tissue by a convolutional neural network (CNN) to predict lymph node metastasis (LNM) in a cohort matched for already established risk factors. PATIENTS AND METHODS Haematoxylin and eosin (H&E) stained primary tumour slides from 218 patients (102 N+; 116 N0), matched for Gleason score, tumour size, venous invasion, perineural invasion and age, who underwent radical prostatectomy were selected to train a CNN and evaluate its ability to predict LN status. RESULTS With 10 models trained with the same data, a mean area under the receiver operating characteristic curve (AUROC) of 0.68 (95% confidence interval [CI] 0.678-0.682) and a mean balanced accuracy of 61.37% (95% CI 60.05-62.69%) was achieved. The mean sensitivity and specificity was 53.09% (95% CI 49.77-56.41%) and 69.65% (95% CI 68.21-71.1%), respectively. These results were confirmed via cross-validation. The probability score for LNM prediction was significantly higher on image sections from N+ samples (mean [SD] N+ probability score 0.58 [0.17] vs 0.47 [0.15] N0 probability score, P = 0.002). In multivariable analysis, the probability score of the CNN (odds ratio [OR] 1.04 per percentage probability, 95% CI 1.02-1.08; P = 0.04) and lymphovascular invasion (OR 11.73, 95% CI 3.96-35.7; P < 0.001) proved to be independent predictors for LNM. CONCLUSION In our present study, CNN-based image analyses showed promising results as a potential novel low-cost method to extract relevant prognostic information directly from H&E histology to predict the LN status of patients with prostate cancer. Our ubiquitously available technique might contribute to an improved LN status prediction.
Collapse
Affiliation(s)
- Frederik Wessels
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Max Schmitt
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Eva Krieghoff-Henning
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Tanja Jutzi
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Thomas S Worst
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Frank Waldbillig
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Manuel Neuberger
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Roman C Maron
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Matthias Steeg
- Institute of Pathology, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Timo Gaiser
- Institute of Pathology, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Achim Hekler
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Jochen S Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Christof von Kalle
- Department of Clinical-Translational Sciences, Berlin Institute of Health (BIH), Charité University Medicine, Berlin, Germany
| | - Stefan Fröhling
- National Center for Tumor Diseases, German Cancer Research Center, Heidelberg, Germany
| | - Maurice S Michel
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Philipp Nuhn
- Department of Urology and Urological Surgery, Medical Faculty Mannheim of Heidelberg University, University Medical Center Mannheim, Mannheim, Germany
| | - Titus J Brinker
- Digital Biomarkers for Oncology Group, National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), Heidelberg, Germany
| |
Collapse
|
46
|
Cathcart P, Ribeiro L, Moore C, Ahmed HU, Leslie T, Arya M, Orczyk C, Hindley RG, Cahill F, Prendergast A, Coetzee C, Yogeswaran Y, Tunna K, Sooriakumaran P, Emberton M. Outcomes of the RAFT trial: robotic surgery after focal therapy. BJU Int 2021; 128:504-510. [PMID: 33891378 DOI: 10.1111/bju.15432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To report toxicity of treatment observed in men participating in the Robotic surgery After Focal Therapy (RAFT) clinical trial. PATIENTS AND METHODS Men were eligible for this prospective single group interventional study if they had histologically confirmed recurrent/residual prostate adenocarcinoma following primary FT. The short-form Expanded Prostate Cancer Index Composite (EPIC-26) measured prior to salvage robotic prostatectomy (S-RARP) and 3-monthly post-operatively together with Clavien-Dindo complications (I-IV). Secondary outcomes included biochemical recurrence-free survival (BCFS) following surgery and need for salvage treatment after surgery. This study is registered with ClinicalTrials.gov NCT03011606. RESULTS Twenty-four men were recruited between February 2016 and September 2018. 1 patient withdrew from the trial after consenting and before S-RARP. 23 men completed 12-month post S-RARP follow-up. Median EPIC-26 urinary continence scores initially deteriorated after 3 months (82.4 vs 100) but there was no statistically significant difference from baseline at 12 months (100 vs 100, P = 0.31). Median lower urinary tract symptom scores improved after 12 months compared to baseline (93.8 vs 87.5, P = 0.01). At 12 months, 19/23 (83%) were pad-free and 22/23 (96%) required 0/1 pads. Median sexual function subscale scores deteriorated and remained low at 12 months (22.2 vs 58.3, P < 0.001). Utilising a minimally important difference of nine points, at 12 months after surgery 17/23 (74%) reported urinary continence to be 'better' or 'not different' to pre-operative baseline. The corresponding figure for sexual function (utilising a minimally important difference of 12 points) was 7/23 (30%). There was no statistically significant difference on median bowel/hormonal subscale scores. Only a single patient had a post-operative complication (Clavien-Dindo Grade I). BCFS at 12 months after surgery was 82.6% (95% confidence interval [CI]: 60.1-93.1%) while 4/23 (17%) received salvage radiation. CONCLUSIONS The RAFT clinical trial suggests toxicity of surgery after FT is low, with good urinary function outcomes, albeit sexual function deteriorated overall. Oncological outcomes at 12 months appear acceptable.
Collapse
Affiliation(s)
- Paul Cathcart
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Luis Ribeiro
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Caroline Moore
- Department of Urology, University College Hospital London, London, UK
| | - Hashim U Ahmed
- Imperial Prostate, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Tom Leslie
- Department of Urology, Oxford University Hospitals, Oxford, UK
| | - Manit Arya
- Department of Urology, University College Hospital London, London, UK.,Imperial Urology, Imperial College Healthcare NHS Trust, London, UK
| | - Clement Orczyk
- Department of Urology, University College Hospital London, London, UK
| | - Richard G Hindley
- Department of Urology, Basingstoke and North Hampshire Hospital, Basingstoke, UK
| | - Fidelma Cahill
- Department of Urology, Guys & St. Thomas' Hospital, London, UK
| | - Aaron Prendergast
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Carike Coetzee
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Yathushan Yogeswaran
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Kirsty Tunna
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
| | | | - Mark Emberton
- Department of Urology, University College Hospital London, London, UK
| |
Collapse
|
47
|
Dhiantravan N, Emmett L, Joshua AM, Pattison DA, Francis RJ, Williams S, Sandhu S, Davis ID, Vela I, Neha N, Bressel M, Murphy DG, Hofman MS, Azad AA. UpFrontPSMA: a randomized phase 2 study of sequential 177 Lu-PSMA-617 and docetaxel vs docetaxel in metastatic hormone-naïve prostate cancer (clinical trial protocol). BJU Int 2021; 128:331-342. [PMID: 33682320 DOI: 10.1111/bju.15384] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To assess the activity and safety of sequential lutetium-177 (177 Lu)-PSMA-617 and docetaxel vs docetaxel on a background of androgen deprivation therapy (ADT) in men with de novo metastatic hormone-naïve prostate cancer (mHNPC). PATIENTS AND METHODS UpFrontPSMA (NCT04343885) is an open-label, randomized, multicentre, phase 2 trial, recruiting 140 patients at 12 Australian centres. Key eligibility criteria include: prostate cancer with a histological diagnosis within 12 weeks of screening commencement; prostate-specific antigen (PSA) >10 ng/mL at diagnosis; ≤4 weeks on ADT; evidence of metastatic disease on computed tomography (CT) and/or bone scan; high-volume prostate-specific membrane antigen (PSMA)-avid disease with a maximum standardized uptake value >15; and absence of extensive discordant fluorodeoxyglcuose (FDG)-positive, PSMA-negative disease. 68 Ga-PSMA-11 and 18 F-FDG positron-emission tomography (PET)/CT undergo central review to determine eligibility. Patients are randomized 1:1 to experimental treatment, Arm A (177 Lu-PSMA-617 7.5GBq q6w × 2 cycles followed by docetaxel 75 mg/m2 q3w × 6 cycles), or standard-of-care treatment, Arm B (docetaxel 75 mg/m2 q3w × 6 cycles). All patients receive continuous ADT. Patients are stratified based on disease volume on conventional imaging and duration of ADT at time of registration. The primary endpoint is the proportion of patients with undetectable PSA (≤0.2 ng/L) at 12 months after study treatment commencement. Secondary endpoints include safety, time to castration resistance, overall survival, PSA and radiographic progression-free survival, objective tumour response rate, early PSMA PET response, health-related quality of life, and frequency and severity of adverse events. Enrolment commenced in April 2020. RESULTS AND CONCLUSIONS The results of this trial will generate data on the activity and safety of 177 Lu-PSMA-617 in men with de novo mHNPC in a randomized phase 2 design.
Collapse
Affiliation(s)
- Nattakorn Dhiantravan
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Louise Emmett
- Department of Theranostics, St Vincent's Hospital, Sydney, NSW, Australia.,Garvan Institute of Medical Research, Sydney, NSW, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia
| | - Anthony M Joshua
- Garvan Institute of Medical Research, Sydney, NSW, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia.,Department of Medical Oncology, The Kinghorn Cancer Centre, St Vincent's Hospital, Sydney, NSW, Australia
| | - David A Pattison
- Department of Nuclear Medicine & Specialised PET Services, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia.,School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Roslyn J Francis
- Department of Nuclear Medicine, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Medical School, University of Western Australia, Perth, WA, Australia.,The Australasian Radiopharmaceutical Trial network (ARTnet), Sydney, NSW, Australia
| | - Scott Williams
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia.,Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Shahneen Sandhu
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Ian D Davis
- Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia.,Eastern Health, Melbourne, VIC, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Ian Vela
- Department of Urology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Prostate Cancer Research Centre-Queensland, Translational Research Institute, Queensland University of Technology, Brisbane, QLD, Australia
| | - Nitika Neha
- Centre for Biostatistics and Clinical Trials (BaCT), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials (BaCT), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Declan G Murphy
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Michael S Hofman
- Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia
| | - Arun A Azad
- Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.,Australian and New Zealand Urogenital and Prostate (ANZUP) Cancer Trials Group, Sydney, NSW, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| |
Collapse
|
48
|
Lundgren PO, Kjellman A, Norming U, Gustafsson O. Association between one-time prostate-specific antigen (PSA) test with free/total PSA ratio and prostate cancer mortality: A 30-year prospective cohort study. BJU Int 2021; 128:490-496. [PMID: 33811738 DOI: 10.1111/bju.15417] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 03/01/2021] [Accepted: 03/17/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore if there is a long-term association between baseline prostate-specific antigen (PSA), including free/total PSA ratio and long-term (30-year) risk for prostate cancer death. SUBJECTS AND METHODS In all, 1782 men were screened for prostate cancer through PSA analysis. Some years later, frozen plasma samples were used to calculate the ratio of free to total PSA (f/t PSA). At 30-year follow-up, baseline PSA and f/t PSA were compared with recent data extracts from the Swedish Cause of Death Registry and Swedish Cancer Registry. PSA values and f/t PSA values were treated as continuous variables in a multivariable analysis and also stratified according to their distribution and useful clinical thresholds. RESULTS Risk of death from prostate cancer after 30 years of follow-up was significantly increased with a higher baseline PSA level, with the hazard ratio being 1.04 (95% confidence interval 1.03-1.09) per increase of one unit of PSA. Adding f/t PSA increased the model's ability to discriminate (concordance index 0.84-0.88). Men with PSA levels <1.0 ng/mL had a very low long-term risk of prostate cancer death (1.2% risk). An f/t PSA ≥ 0.25 extended the low-risk range to PSA < 2.0 ng/mL (1.5% risk). CONCLUSION Prostate-specific antigen testing can be carried out less frequently or can be discontinued in men aged 55-70 years if their PSA levels are <2.0 ng/mL and the f/t PSA is ≥0.25.
Collapse
Affiliation(s)
- Per-Olof Lundgren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Anders Kjellman
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ulf Norming
- Department of Clinical Science and Education, Karolinska Institutet and Södersjukhuset, Stockholm, Sweden
| | - Ove Gustafsson
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
49
|
Aning JJ, Parry MG, van der Meulen J, Fowler S, Payne H, McGrath JS, Challacombe B, Clarke NW. How reliable are surgeon-reported data? A comparison of the British Association of Urological Surgeons radical prostatectomy audit with the National Prostate Cancer Audit Hospital Episode Statistics-linked database. BJU Int 2021; 128:482-489. [PMID: 33752249 DOI: 10.1111/bju.15399] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the accuracy and completeness of surgeon-reported radical prostatectomy outcome data across a national health system by comparison with a national dataset gathered independently from clinicians directly involved in patient care. PATIENTS AND METHODS Data submitted by surgeons to the British Association of Urological Surgeons (BAUS) radical prostatectomy audit for all men undergoing radical prostatectomy between 2015 and 2016 were assessed by cross linkage to the National Prostate Cancer Audit (NPCA) database. Specific data items collected in both databases were selected for comparison analysis. Data completeness and agreement were assessed by percentages and Cohen's kappa statistic. RESULTS Data from 4707 men in the BAUS and NPCA databases were matched for comparison. Compared with the NPCA, dataset completeness was higher in the BAUS dataset for type of nerve-sparing procedure (92% vs 42%) and postoperative margin status (89% vs 48%) but lower for readmission (87% vs 100%) and Charlson score (80% vs 100%). For all other variables assessed completeness was comparable. Agreement and data reliability were high for most variables. However, despite good agreement, the inter-cohort reliability was poor for readmission, M stage and Charlson score (κ < 0.30). CONCLUSIONS For the first time in urology we show that surgeon-reported data from the BAUS radical prostatectomy audit can reliably be used to benchmark peri-operative radical prostatectomy outcomes. For comorbidity data, to assist with risk analysis, and longer-term outcomes, NPCA routinely collected data provide a more comprehensive source.
Collapse
Affiliation(s)
- Jonathan J Aning
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Matthew G Parry
- London School of Hygiene and Tropical Medicine, London, UK.,Royal College of Surgeons of England, London, UK
| | | | - Sarah Fowler
- British Association of Urological Surgeons, London, UK
| | | | - John S McGrath
- Exeter Surgical Health Services Research Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, Devon, UK
| | - Ben Challacombe
- Urology Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Noel W Clarke
- Christie and Salford Royal NHS Foundation Trusts, Manchester, UK
| | | |
Collapse
|
50
|
Aslim EJ, Law YXT, Fook-Chong SMC, Ho HSS, Yuen JSP, Lau WKO, Lee LS, Cheng CWS, Ngo NT, Law YM, Tay KJ. Defining prostate cancer size and treatment margin for focal therapy: does intralesional heterogeneity impact the performance of multiparametric MRI? BJU Int 2021; 128:178-186. [PMID: 33539650 PMCID: PMC8360156 DOI: 10.1111/bju.15355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer. PATIENTS AND METHODS We identified men who underwent primary radical prostatectomy for organ- confined prostate cancer over a 3-year period. Cancer foci on whole-mount histology were marked out, coding low-grade (LG; Gleason 3) and high-grade (HG; Gleason 4-5) components separately. Measurements of entire tumours were grouped according to intralesional proportion of HG cancer: 0%, <50% and ≥50%; the readings were corrected for specimen shrinkage and correlated with matching lesions on mpMRI. Separate measurements were also taken of HG cancer components only, and correlated against entire lesions on mpMRI. Size discrepancies were used to derive the optimal tumour size and treatment margins for FT. RESULTS There were 122 MRI-detected cancer lesions in 70 men. The mean linear specimen shrinkage was 8.4%. The overall correlation between histology and MRI dimensions was r = 0.79 (P < 0.001). Size correlation was superior for tumours with high burden (≥50%) compared to low burden (<50%) of HG cancer (r = 0.84 vs r = 0.63; P = 0.007). Size underestimation by mpMRI was more likely for larger tumours (51% for >12 mm vs 26% for ≤12 mm) and those containing HG cancer (44%, vs 20% for LG only). Size discrepancy analysis suggests an optimal tumour size of ≤12 mm and treatment margins of 5-6 mm for FT. For tumours ≤12 mm in diameter, applying 5- and 6-mm treatment margins would achieve 98.6% and 100% complete tumour ablation, respectively. For tumours of all sizes, using the same margins would ablate >95% of the HG cancer components. CONCLUSIONS Multiparametric MRI performance in estimating prostate cancer size, and consequently the treatment margin for FT, is impacted by tumour size and the intralesional heterogeneity of cancer grades.
Collapse
Affiliation(s)
| | - Yu Xi Terence Law
- Department of Urology, National University Hospital, Singapore City, Singapore
| | | | - Henry Sun Sien Ho
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - John Shyi Peng Yuen
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Weber Kam On Lau
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| | - Lui Shiong Lee
- Department of Urology, Sengkang General Hospital, Singapore City, Singapore
| | | | - Nye Thane Ngo
- Department of Anatomical Pathology, Singapore General Hospital, Singapore City, Singapore
| | - Yan Mee Law
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore City, Singapore
| | - Kae Jack Tay
- Department of Urology, Singapore General Hospital, Singapore City, Singapore
| |
Collapse
|