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Sample records for radical prostatectomy techniques

  1. Evolution of endoscopic extraperitoneal radical prostatectomy (EERPE): technique and outcome

    Institute of Scientific and Technical Information of China (English)

    Jens-Uwe Stolzenburg; Odysseas Andrikopoulos; Panagiotis Kallidonis; Iason Kyriazis; Minh Do; Evangelos Liatsikos

    2012-01-01

    Endoscopic extraperitoneal radical prostatectomy (EERPE) is a well-established and standardized technique for treating patients with localized prostate cancer.Nevertheless,the procedure is continuously being refined with the expansion of anatomical knowledge.The development of a nerve-sparing approach and improvements in currently used equipment are expected to yield better results in cosmesis and convalescence without sacrificing the procedure's established benefits in terms of potency,continence and oncological management.In this study,the technique and its evolution are presented in detail,along with an analysis of its clinical efficacy.We also consult the literature to compare EERPE to transperitoneal laparoscopic radical prostatectomy,and we also discuss new technical advancements regarding the use of robotic assistance during EERPE.

  2. Robotic-assisted laparoscopic radical prostatectomy: The Ohio State University technique.

    Science.gov (United States)

    Patel, Vipul R; Shah, Ketul K; Thaly, Rahul K; Lavery, Hugh

    2007-03-01

    Robotic radical prostatectomy is a new innovation in the surgical treatment of prostate cancer. The technique is continuously evolving. In this article we demonstrate The Ohio State University technique for robotic radical prostatectomy. Robotic radical prostatectomy is performed using the da Vinci surgical system. The video demonstrates each step of the surgical procedure. Preliminary results with robotic prostatectomy demonstrate the benefits of minimally invasive surgery while also showing encouraging short-term outcomes in terms of continence, potency and cancer control. Robotic radical prostatectomy is an evolving technique that provides a minimally invasive alternative for the treatment of prostate cancer. Our experience with the procedure now stands at over 1,300 cases.

  3. Radical prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Sønksen, Jens; Jakobsen, Henrik

    2014-01-01

    OBJECTIVE: The aim of this study was to compare oncological and functional outcomes between robot-assisted laparoscopic radical prostatectomy (RALP) and retropubic radical prostatectomy (RRP) during the initial phase with RALP at a large university hospital. MATERIAL AND METHODS: Patient and tumour...... surgery and at follow-up and they were asked to report their use of pads/diapers. Potency was defined as an IIEF-5 score of at least 17 with or without phosphodiesterase-5 inhibitors. Patients using up to one pad daily for security reasons only were considered continent. Positive surgical margins, blood...... loss and functional outcomes were compared between groups. RESULTS: Overall, 453 patients were treated with RRP and 585 with RALP. On multivariate logistic regression analyses, the type of surgery did not affect surgical margins (p = 0.96) or potency at 12 months (p = 0.7). Patients who had undergone...

  4. Laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Lipke Michael

    2005-01-01

    Full Text Available Millions of men are diagnosed annually with prostate cancer worldwide. With the advent of PSA screening, there has been a shift in the detection of early prostate cancer, and there are increased numbers of men with asymptomatic, organ confined disease. Laparoscopic radical prostatectomy is the latest, well accepted treatment that patients can select. We review the surgical technique, and oncologic and functional outcomes of the most current, large series of laparoscopic radical prostatectomy published in English. Positive margin rates range from 2.1-6.9% for pT2a, 9.9-20.6% for pT2b, 24.5-42.3% for pT3a, and 22.6-54.5% for pT3b. Potency rates after bilateral nerve sparing laparoscopic radical prostatectomy range from 47.1 to 67%. Continence rates at 12 months range from 83.6 to 92%.

  5. Contemporary Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Qiang Fu

    2011-01-01

    Full Text Available Purpose. Patients diagnosed with clinically localized prostate cancer have more surgical treatment options than in the past. This paper focuses on the procedures' oncological or functional outcomes and perioperative morbidities of radical retropubic prostatectomy, radical perineal prostatectomy, and robotic-assisted laparoscopic radical prostatectomy. Materials and Methods. A MEDLINE/PubMed search of the literature on radical prostatectomy and other new management options was performed. Results. Compared to the open procedures, robotic-assisted radical prostatectomy has no confirmed significant difference in most literatures besides less blood loss and blood transfusion. Nerve sparing is a safe means of preserving potency on well-selected patients undergoing radical prostatectomy. Positive surgical margin rates of radical prostatectomy affect the recurrence and survival of prostate cancer. The urinary and sexual function outcomes have been vastly improved. Neoadjuvant treatment only affects the rate of positive surgical margin. Adjuvant therapy can delay and reduce the risk of recurrence and improve the survival of the high risk prostate cancer. Conclusions. For the majority of patients with organ-confined prostate cancer, radical prostatectomy remains a most effective approach. Radical perineal prostatectomy remains a viable approach for patients with morbid obesity, prior pelvic surgery, or prior pelvic radiation. Robot-assisted laparoscopic prostatectomy (RALP has become popular among surgeons but has not yet become the firmly established standard of care. Long-term data have confirmed the efficacy of radical retropubic prostatectomy with disease control rates and cancer-specific survival rates.

  6. [Radical prostatectomy - pro robotic].

    Science.gov (United States)

    Gillitzer, R

    2012-05-01

    Anatomical radical prostatectomy was introduced in the early 1980s by Walsh and Donker. Elucidation of key anatomical structures led to a significant reduction in the morbidity of this procedure. The strive to achieve similar oncological and functional results to this gold standard open procedure but with further reduction of morbidity through a minimally invasive access led to the establishment of laparoscopic prostatectomy. However, this procedure is complex and difficult and is associated with a long learning curve. The technical advantages of robotically assisted surgery coupled with the intuitive handling of the device led to increased precision and shortening of the learning curve. These main advantages, together with a massive internet presence and aggressive marketing, have resulted in a rapid dissemination of robotic radical prostatectomy and an increasing patient demand. However, superiority of robotic radical prostatectomy in comparison to the other surgical therapeutic options has not yet been proven on a scientific basis. Currently robotic-assisted surgery is an established technique and future technical improvements will certainly further define its role in urological surgery. In the end this technical innovation will have to be balanced against the very high purchase and running costs, which remain the main limitation of this technology.

  7. Orgasm after radical prostatectomy

    NARCIS (Netherlands)

    Koeman, M; VanDriel, MF; Schultz, WCMW; Mensink, HJA

    1996-01-01

    Objective To evaluate the ability to obtain and the quality of orgasm after radical prostatectomy, Patients and methods The orgasms experienced after undergoing radical prostatectomy were evaluated in 20 men (median age 65 years, range 56-76) using a semi-structured interview and a self-administered

  8. Salvage robotic radical prostatectomy

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    Samuel D Kaffenberger

    2014-01-01

    Full Text Available Failure of non-surgical primary treatment for localized prostate cancer is a common occurrence, with rates of disease recurrence ranging from 20% to 60%. In a large proportion of patients, disease recurrence is clinically localized and therefore potentially curable. Unfortunately, due to the complex and potentially morbid nature of salvage treatment, radical salvage surgery is uncommonly performed. In an attempt to decrease the morbidity of salvage therapy without sacrificing oncologic efficacy, a number of experienced centers have utilized robotic assistance to perform minimally invasive salvage radical prostatectomy. Herein, we critically evaluate the existing literature on salvage robotic radical prostatectomy with a focus on patient selection, perioperative complications and functional and early oncologic outcomes. These results are compared with contemporary and historical open salvage radical prostatectomy series and supplemented with insights we have gained from our experience with salvage robotic radical prostatectomy. The body of evidence by which conclusions regarding the efficacy and safety of robotic salvage radical prostatectomy can be drawn comprises fewer than 200 patients with limited follow-up. Preliminary results are promising and some outcomes have been favorable when compared with contemporary open salvage prostatectomy series. Advantages of the robotic platform in the performance of salvage radical prostatectomy include decreased blood loss, short length of stay and improved visualization. Greater experience is required to confirm the long-term oncologic efficacy and functional outcomes as well as the generalizability of results achieved at experienced centers.

  9. Novel technique to enhance bladder neck dissection with traction of Foley catheter during extraperitoneal laparoscopic radical prostatectomy

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    Henry Y. Lin

    2015-03-01

    Conclusion: Improved bladder neck enhancement provides a clearer vision during bladder neck dissection. Similar functional results and cancer control rates were also encountered during modified extraperitoneal radical prostatectomy. This novel technique is a feasible method for performing endoscopic radical prostatectomy using four ports instead of five.

  10. Radical prostatectomy - discharge

    Science.gov (United States)

    ... to 6 months. You will learn exercises (called Kegel exercises) that strengthen the muscles in your pelvis. ... Radical prostatectomy Retrograde ejaculation Urinary incontinence Patient Instructions Kegel exercises - self-care Suprapubic catheter care Urinary catheters - ...

  11. Sexuality Following Radical Prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Serefoglu, Ege C; Albersen, Maarten;

    2017-01-01

    INTRODUCTION: Radical prostatectomies can result in urinary incontinence and sexual dysfunction. Traditionally, these issues have been studied separately, and the sexual problem that has received the most focus has been erectile dysfunction. AIM: To summarize the literature on sexually related side...... effects and their consequences after radical prostatectomy and focus on the occurrence and management of problems beyond erectile dysfunction. METHODS: The literature on sexuality after radical prostatectomy was reviewed through a Medline search. Original research using quantitative and qualitative...... methodologies was considered. Priority was given to studies exploring aspects of sexuality other than erectile function. MAIN OUTCOME MEASURES: The prevalence, predictive factors, and management of post-prostatectomy sexual problems beyond erectile dysfunction. RESULTS: Most patients will develop urinary...

  12. Nerve-sparing techniques and results in robot-assisted radical prostatectomy

    OpenAIRE

    Tavukçu, Hasan Hüseyin; Aytac, Omer; Atug, Fatih

    2016-01-01

    Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative an...

  13. Preliminary experience with extraperitoneal endoscopic radical prostatectomy through duplication of the open technique

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    M. Tobias-Machado

    2005-06-01

    Full Text Available OBJECTIVE: To describe surgical and functional results with extraperitoneal laparoscopic radical prostatectomy with duplication of the open technique, from the experience obtained in the treatment of 28 initial cases. MATERIALS AND METHODS: In a 36-month period, we prospectively analyzed 28 patients diagnosed with localized prostate cancer undergoing extraperitoneal laparoscopic radical prostatectomy. RESULTS: Mean surgical time was 280 min, with mean blood loss of 320 mL. As intraoperative complications, there were 2 rectal lesions repaired with laparoscopic suture in 2 planes. There was no conversion to open surgery. Median hospital stay was 3 days, with return to oral diet in the first post-operative day in patients. As post-operative complications, there were 3 cases of extraperitoneal urinary fistula. Two of these cases were resolved by maintaining a Foley catheter for 21 days, and the other one by late endoscopic reintervention for repositioning the catheter. Five out of 18 previously potent patients evolved with erectile dysfunction. The diagnosis of prostate cancer was confirmed in all patients, with focal positive margin occurring in 3 cases. During a mean follow-up of 18 months, 2 patients presented increased PSA, with no clinical evidence of disease. CONCLUSION: Laparoscopic radical prostatectomy is a laborious and difficult procedure, with a long learning curve. Extraperitoneal access is feasible, and it is possible to practically duplicate the principles of open surgery. The present technique can possibly offer advantages in terms of decreased blood loss, preservation of erectile function and prevention of positive margins.

  14. Update on Robotic Laparoscopic Radical Prostatectomy

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    Garrett S. Matsunaga

    2006-01-01

    Full Text Available The da Vinci surgical robot has been shown to help shorten the learning curve for laparoscopic radical prostatectomy (LRP for both laparoscopically skilled and na surgeons[1,2]. This approach has shown equal or superior outcomes to conventional laparoscopic prostatectomy with regard to ease of learning, initial complication rates, conversion to open, blood loss, complications, continence, potency, and margin rates. Although the data are immature to compare oncologic and functional outcomes to open prostatectomy, preliminary data are promising.Herein, we review the technique and outcomes of robotic-assisted laparoscopic radical prostatectomy (RALP.

  15. Nerve-sparing techniques and results in robot-assisted radical prostatectomy

    Science.gov (United States)

    Aytac, Omer; Atug, Fatih

    2016-01-01

    Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative anatomic variations may affect the nerve-sparing technique, nerve-sparing degree and the approach. There is lack of randomized control trials for different nerve-sparing techniques and approaches in RARP, therefore accurate preoperative and intraoperative assessment of the patient is crucial. Current data shows that, performing the maximum possible nerve-sparing using athermal techniques have better functional outcomes. PMID:27995221

  16. Optimal pain management for radical prostatectomy surgery

    DEFF Research Database (Denmark)

    Joshi, Grish P; Jaschinski, Thomas; Bonnet, Francis;

    2015-01-01

    of evidence to develop an optimal pain management protocol in patients undergoing radical prostatectomy. Most studies assessed unimodal analgesic approaches rather than a multimodal technique. There is a need for more procedure-specific studies comparing pain and analgesic requirements for open and minimally......BACKGROUND: Increase in the diagnosis of prostate cancer has increased the incidence of radical prostatectomy. However, the literature assessing pain therapy for this procedure has not been systematically evaluated. Thus, optimal pain therapy for patients undergoing radical prostatectomy remains...... invasive surgical procedures. Finally, while we wait for appropriate procedure specific evidence from publication of adequate studies assessing optimal pain management after radical prostatectomy, we propose a basic analgesic guideline....

  17. A new technique of bladder neck reconstruction during radical prostatectomy in patients with prostate cancer

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    Yuri Tolkach

    2015-06-01

    Full Text Available ABSTRACTPurpose:To evaluate continence after radical prostatectomy in prostate cancer patients, in whom a new method of the bladder neck reconstruction (BNR using deep dorsal stitch was implemented (deep single stitch through all bladder layers directly dorsal to the bladder opening after “tennis racket” reconstruction and to provide justification for its use by means of anatomical study in cadavers.Material and Methods:Open radical retropubic prostatectomy was performed in 84 patients: 39 patients with a new BNR method used to improve continence and control group of 45 patients with standard “tennis racket” BNR. Median follow-up was 14 months in control group and 12 months in study group. Continence recovery was accessed early postoperatively and every 3 months thereafter. Anatomical study was performed on 2 male fresh cadavers reproducing two different BNR techniques to clarify any underlying continence related mechanisms.Results:Patients with new BNR achieved full continence significantly faster (p=0.041, but the continence rates after 12 months were similar between groups. The severity of incontinence up to month 9 was significantly reduced in BNR group. The anastomotic stricture rate was not affected. Applying new BNR to the cadaver model revealed effects on early continence, namely presence of proximal passive closure mechanism in area of bladder neck.Conclusions:Continence in patients with the new BNR method using deep dorsal stitch recovered significantly faster. Moreover, a reduced grade of residual incontinence was documented. The effect was non-significant at month 12 of follow-up, meaning that only early effect was present.

  18. CONTINENT RADICAL PROSTATECTOMY

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    Yu. P. Sernyak

    2014-07-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  19. CONTINENT RADICAL PROSTATECTOMY

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    Yu. P. Sernyak

    2013-01-01

    Full Text Available Objective: to evaluate the impact of dissection of the dorsal venous complex without pre-ligation, suturing, or coagulation during radical prostatectomy (RPE in patients with localized prostate cancer (PC on the quality of surgery and the function of urinary retention.Subjects and methods. The data of 42 patients who had undergone posterior and anterior anatomical repair and vesicourethral anastomosis using a V-lock suture after prostatectomy were analyzed. All the patients were divided into 2 groups. Group 1 consisted of 22 patients in whom the dorsal venous complex was closed using a 3-0 vicryl suture before urethral dissection. Group 2 included 20 patients in whom the urethra was dissected without suturing the venous complex.Results. In group 1, complete urinary retention after catheter removal was noted in 9 (40.9 % and 15 (68 % patients within 24 hours and after 3 months, respectively. Following 12 months, two (9 % patients were observed to have partial mild urinary incontinence (as many as 2 pads per day. Group 2 patients showed complete urinary retention in 17 (85 % cases on the first day after catheter removal; all the patients retained urine 3 months later.Conclusion. In patients with localized PC, dissection of the dorsal venous complex without presuturing during laparoscopic RPE exerts a considerable impact on the preservation of urinary retention, namely 45% more of the patients reported complete urinary retention in early periods and 10 % more did this in later periods. At the same time, there was no statistically significant increase in intraoperative blood loss (p > 0.05, the number of positive edges, or biochemical recurrences.

  20. A matched-pair comparison between bilateral intrafascial and interfascial nerve-sparing techniques in extraperitoneal laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Tao Zheng; Xu Zhang; Xin Ma; Hong-Zhao Li; Jiang-Pin Gao; Wei Cai; Jun Dong

    2013-01-01

    The aim of this study was to validate the advantages of the intrafascial nerve-sparing technique compared with the interfascial nerve-sparing technique in extraperitoneal laparoscopic radical prostatectomy.From March 2010 to August 2011,65 patients with localized prostate cancer (PCa) underwent bilateral intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy.These patients were matched in a 1:2 ratio to 130 patients with localized PCa who had undergone bilateral interfascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy between January 2008 and August 2011.Operative data and oncological and functional results of both groups were compared.There was no difference in operative data,pathological stages and overall rates of positive surgical margins between the groups.There were 9 and 13 patients lost to follow-up in the intrafascial group and interfascial group,respectively.The intrafascial technique provided earlier recovery of continence at both 3 and 6 months than the interfascial technique.Equal results in terms of continence were found in both groups at 12 months.Better rates of potency at 6 months and 12 months were found in younger patients (age ≤65 years) and overall patients who had undergone the intrafascial nerve-sparing extraperitoneal laparoscopic radical prostatectomy.Biochemical progression-free survival rates 1 year postoperatively were similar in both groups.Using strict indications,compared with the interfascial nerve-sparing technique,the intrafascial technique provided similar operative outcomes and short-term oncological results,quicker recovery of continence and better potency.The intrafascial nerve-sparing technique is recommended as a preferred approach for young PCa patients who are clinical stages cT1 to cT2a and have normal preoperative Potency.

  1. Salvage robot-assisted radical prostatectomy after brachytherapy: our experience

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    A. V. Govorov

    2014-01-01

    Full Text Available In case of recurrence of prostate cancer after radiation therapy patient may be offered salvage radical prostatectomy (both open and laparoscopic/robotic, hormone therapy, and a number of alternative techniques such as salvage cryoablation, HIFU-therapy and brachytherapy. Results of monitoring of patients for 10 years after salvage treatment of prostate cancer are known only after salvage prostatectomy. Technically radical prostatectomy after radiation therapy is associated with a large number of complications if compared with primary radical prostatectomy. The most frequent complications after salvage prostatectomy include incontinence, stricture formation of urethrovesical anastomosis, rectal injury, acute urinary retention and infectious complications.

  2. Incontinence and Erectile Dysfunction Following Radical Prostatectomy: A Review

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    Gerasimos Alivizatos

    2005-01-01

    Full Text Available Radical prostatectomy remains the treatment of choice for localized prostate cancer in age-appropriate and health-appropriate men. Although cancer control is the most important aspect of a radical prostatectomy, minimization of postoperative morbidity, especially urinary incontinence and erectile dysfunction, is becoming a greater concern. We reviewed recent data available on Medline regarding the incidence, pathophysiology, evaluation, and treatment of incontinence and sexual dysfunction after radical prostatectomy. Health-related quality of life issues have been specifically addressed. Although low incidences of incontinence and erectile dysfunction after radical prostatectomy have been reported in the hands of experienced surgeons, the literature review revealed a great variety, with incontinence rates ranging from 0.3–65.6% and potency rates ranging from 11–87%. Several factors contribute to this wide difference, the most important being the application of a meticulous surgical technique. General and cancer-specific health-related quality of life is not being affected after radical prostatectomy. The incidence of incontinence and erectile dysfunction is higher after radical prostatectomy when compared to the incidence observed when other therapies for localized prostate cancer are applied. However, the majority of the patients undergoing radical prostatectomy would vote for the operation again. Today, avoidance of major complications after radical prostatectomy depends mostly on a high-quality surgical technique. When incontinence or erectile dysfunction persists after radical prostatectomy, the majority of the treated patients can be managed effectively by various methods.

  3. Penile rehabilitation after radical prostatectomy

    DEFF Research Database (Denmark)

    Fode, Mikkel; Ohl, Dana A; Ralph, David

    2013-01-01

    The pathophysiology of erectile dysfunction after radical prostatectomy (RP) is believed to include neuropraxia, which leads to temporarily reduced oxygenation and subsequent structural changes in penile tissue. This results in veno-occlusive dysfunction, therefore, penile rehabilitation programmes...... rehabilitation improves erectile function after RP so many times that it becomes a truth even without the proper scientific backing....

  4. The Da Vinci Xi and robotic radical prostatectomy-an evolution in learning and technique.

    Science.gov (United States)

    Goonewardene, S S; Cahill, D

    2016-08-19

    The da Vinci Xi robot has been introduced as the successor to the Si platform. The promise of the Xi is to open the door to new surgical procedures. For robotic-assisted radical prostatectomy (RARP)/pelvic surgery, the potential is better vision and longer instruments. How has the Xi impacted on operative and pathological parameters as indicators of surgical performance? This is a comparison of an initial series of 42 RARPs with the Xi system in 2015 with a series using the Si system immediately before Xi uptake in the same calendar year, and an Si series by the same surgeon synchronously as the Xi series using operative time, blood loss, and positive margins as surrogates of surgical performance. Subjectively and objectively, there is a learning curve to Xi uptake in longer operative times but no impact on T2 positive margins which are the most reflective single measure of RARP outcomes. Subjectively, the vision of the Xi is inferior to the Si system, and the integrated diathermy system and automated setup are quirky. All require experience to overcome. There is a learning curve to progress from the Si to Xi da Vinci surgical platforms, but this does not negatively impact the outcome.

  5. Robotic Salvage Lymph Node Dissection After Radical Prostatectomy

    OpenAIRE

    Torricelli,Fabio C. M.; Arnaldo Cividanes; Guglielmetti,Giuliano B.; Coelho,Rafael F.

    2015-01-01

    ABSTRACT Introduction and objective: Radical prostatectomy is a first-line treatment for localized prostate cancer. However, in some cases, biochemical recurrence associated with imaging-detected nodal metastases may happen. Herein, we aim to present the surgical technique for salvage lymph node dissection after radical prostatectomy. Materials and Methods: A 70 year-old asymptomatic man presented with a prostate-specific antigen (PSA) of 7.45ng/ mL. Digital rectal examination was normal and ...

  6. Comparison of oncological results and functional outcomes of radical prostatectomy techniques – retropubic, laparoscopic and robot-assisted

    Directory of Open Access Journals (Sweden)

    E. A. Prilepskaya

    2015-01-01

    Full Text Available Radical prostatectomy (RP continues to be the «gold standard» in the treatment of localized prostate cancer (PC for patients with a life expectancy of 10 years.The purpose of this article is to review pertinent literature to the several surgical approaches for PC and compare both functional outcomes and oncological results of radical retropubic prostatectomy (RRP, laparoscopic radical prostatectomy (LRP and robot-assisted radical prostatectomy (RARP. We chose and systematically reviewed 44 articles published between 1999 and 2013. Comparison analysis showed that the mean blood loss during RRP, LRP and RARP was 935, 442 and 191 ml respectively. Intraoperative transfusion required 19,9; 6,3 and 4,6 % patients respectively. We’d like to outline in our functional outcomes that within the 6-months and 12-months period of follow-up acute urinary retention experienced 89,1 and 92,7 % patients undergoing RARP.However, lack of certain data and absence of standard assessment methods made objective evaluation of erectile function quite complex. Oncologic results revealed that positive surgical margin rates were higher for RARP in comparison to patients after RRP and LRP (the difference was statistically significant.Nevertheless, the absence of randomized approach in an overwhelming majority of cases, as well as the short follow-up period are serious deterrents limiting the number of such trials. Therefore it’s still impossible today to draw certain conclusions about the superiority of any surgical approach for RP

  7. Histopathologic Outcomes of Robotic Radical Prostatectomy

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    Vipul R. Patel

    2006-01-01

    Full Text Available Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and shortterm PSA outcomes of 500 robotic radical prostatectomies. Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM stage, Gleason’s grade, tumor location, volume, specimen weight, seminal vesicle involvement, and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data were collected every 3 months for the first year, then every 6 months for a year, then yearly. The average preoperative PSA was 6.9 (1–90 with Gleason’s score of 5 (2%, 6 (52%, 7 (40%, 8 (4%, and 9 (2%; postoperatively, histopathologic analysis showed Gleason's 6 (44%, 7 (42%, 8 (10%, and 9 (4%; 10, 5, 63, 15, 5, and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b, and T4, respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1–100, 8% (101–200, 13% (201–300, 5% (301–400, and 8% (401–500. By stage, it was 2, 4, and 2.5% for T2a, T2b, T2c tumors; 23% (T3a, 46% (T3b, and 53% (T4a. For organ-confined disease (T2, the margin rate was 2.5% and it was 31% for nonorgan-confined disease. There were a total of 47 positive margins, 26 (56% posterolateral, 4 (8.5% apical, 4 (8.5% bladder neck, 2 (4% seminal vesicle, and 11 (23% multifocal. Ninety-five percent of patients (n = 500 have undetectable PSA (<0.1 at average follow-up of 9.7 months. Recurrence has only been seen with nonorgan-confined tumors. Of those patients with a minimum follow-up of 1 year (average 15.7 months, 95% have undetectable PSA (<0.1. Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall, positive margin rate. Shortterm

  8. Initial Experience of Laparoendoscopic Single-Site Radical Prostatectomy Requiring Well-Equipped Appliances and a Skilled Technique

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    Joo Yong Lee

    2010-12-01

    Full Text Available We report an initial experience in laparoendoscopic single-site radical prostatectomy (LESSRP using a homemade single-port device for prostate cancer. A 63-year-old man was diagnosed with prostate cancer. The patient underwent LESSRP using an Alexis® wound retractor, which was inserted through an umbilical incision. A homemade single-port device was made by fixing a 61/2 surgical glove to the retractor’s outer ring and securing the glove finger to the end of 4 trocars with a tie. Using the flexible laparoscopic and rigid instruments, LESSRP was performed using a procedure similar to conventional laparoscopic radical prostatectomy (LRP. In the current case, we could not perform complete LESSRP, so we report our initial experience and consider the reason why laparoendoscopic single-site surgery was converted to conventional LRP.

  9. COMPLICATIONS OF EXTRAPERITONEOSCOPIC RADICAL PROSTATECTOMIES

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    I. V. Chernyshev

    2012-01-01

    Full Text Available Background. Radical prostatectomy (RPE is today the gold standard treatment option for locally advanced prostate cancer (PC. These operations are performed both openly and using video-assisted endosurgery. Since 2009, the Research Institute of Urology has been made 70 extraperitoneoscopic RPEs (ERPE.Objective: to assess the complications of ERPE with the validated Clavien complication scale.Materials and methods. The authors retrospectively analyzed the case histories of 70 patients with locally advanced PC who had undergone ERPE. The complications were allocated to 3 groups: intraoperative, early (within 1 month and late (over 1 month postoperative ones. All found complications were stratified using Clavien classification scale.Results. The total number of ERPE complications accounted for 35.7%. The most common complications, such as anastomotic incompetence and blood loss that required hemotransfusion, were 9.8 and 11.3%, respectively. Rectal damage was intraoperatively found in 2 cases. Obturator nerve damage was also recognized intraoperatively and did not result in the occurrence of neurological symptoms. The severest complication (Clavien scale grade V was pulmonary embolism causing death.Conclusion. Postoperative complications of ERPE were observed in a small percentage of the patients and posed no serious threat to their life. The analysis of the complications of ERPE suggests that this treatment for locally advanced PC is a current safe and low-traumatic method.

  10. COMPLICATIONS OF EXTRAPERITONEOSCOPIC RADICAL PROSTATECTOMIES

    Directory of Open Access Journals (Sweden)

    I. V. Chernyshev

    2014-08-01

    Full Text Available Background. Radical prostatectomy (RPE is today the gold standard treatment option for locally advanced prostate cancer (PC. These operations are performed both openly and using video-assisted endosurgery. Since 2009, the Research Institute of Urology has been made 70 extraperitoneoscopic RPEs (ERPE.Objective: to assess the complications of ERPE with the validated Clavien complication scale.Materials and methods. The authors retrospectively analyzed the case histories of 70 patients with locally advanced PC who had undergone ERPE. The complications were allocated to 3 groups: intraoperative, early (within 1 month and late (over 1 month postoperative ones. All found complications were stratified using Clavien classification scale.Results. The total number of ERPE complications accounted for 35.7%. The most common complications, such as anastomotic incompetence and blood loss that required hemotransfusion, were 9.8 and 11.3%, respectively. Rectal damage was intraoperatively found in 2 cases. Obturator nerve damage was also recognized intraoperatively and did not result in the occurrence of neurological symptoms. The severest complication (Clavien scale grade V was pulmonary embolism causing death.Conclusion. Postoperative complications of ERPE were observed in a small percentage of the patients and posed no serious threat to their life. The analysis of the complications of ERPE suggests that this treatment for locally advanced PC is a current safe and low-traumatic method.

  11. Single port radical prostatectomy: current status.

    Science.gov (United States)

    Martín, Oscar Darío; Azhar, Raed A; Clavijo, Rafael; Gidelman, Camilo; Medina, Luis; Troche, Nelson Ramirez; Brunacci, Leonardo; Sotelo, René

    2016-06-01

    The aim of this study is to analyze the current literature on single port radical prostatectomy (LESS-RP). Single port radical prostatectomy laparoendoscopic (LESS-RP) has established itself as a challenge for urological community, starting with the proposal of different approaches: extraperitoneal, transperitoneal and transvesical, initially described for laparoscopy and then laparoscopy robot-assisted. In order to improve the LESS-RP, new instruments, optical devices, trocars and retraction mechanisms have been developed. Advantages and disadvantages of LESS-RP are controversial, while some claim that it is a non-trustable approach, regarding the low cases number and technical difficulties, others acclaim that despite this facts some advantages have been shown and that previous described difficulties are being overcome, proving this is novel proposal of robotics platform, the Da Vinci SP, integrating the system into "Y". The LESS-RP approach gives us a new horizon and opens the door for rapid standardization of this technique. The few studies and short series available can be result of a low interest in the application of LESS-RP in prostate, probably because of the technical complexity that it requires. The new robotic platform, the da Vinci SP, shows that it is clear that the long awaited evolution of robotic technologies for laparoscopy has begun, and we must not lose this momentum.

  12. Robot-assisted Radical Prostatectomy: How I Do It

    Directory of Open Access Journals (Sweden)

    Cemil Uygur

    2016-06-01

    Full Text Available In this article, we describe surgical technique for robot assisted radical prostatectomy using the four-arm da Vinci robotic surgical system (SI, Intuitive Surgical, Sunnyvale, CA, USA. We have continually refined our technique to improve patient outcomes.

  13. Single plus one port laparoscopic radical prostatectomy:a report of 8 cases in one center

    Institute of Scientific and Technical Information of China (English)

    GAO Yi; XU Dan-feng; LIU Yu-shan; CUI Xin-gang; CHE Jian-ping; YAO Ya-cheng; YIN Lei

    2011-01-01

    Laparoscopic radical prostatectomy is considered the first treatment of choice for local prostate cancer due to its minimal invasion advantage. To further achieve the goal of minimal invasion, single port laparoscopic radical prostatectomy has been developed to minimize the complications associated with puncture tracks. The aim of this study was to illustrate the technique for single port laparoscopic radical prostatectomy and evaluate its efficacy and safety. We reported 8 cases of radical prostatectomy with excellent early outcome carried out in Shanghai Changzheng Hospital from June 2009 to August 2009 using a home-made multiple instrument access port and adding an additional small incision at McBumey point.

  14. [Radical prostatectomy--100 years of evolution].

    Science.gov (United States)

    Gofrit, Ofer N; Shalhav, Arieh L

    2008-07-01

    Prostate cancer is the most common malignant disease in men. The incidence of prostate cancer has been rising since the early 1990s. Not all men inflicted by prostate cancer will develop clinical disease. Therefore, sorting these cases is a great clinical challenge. Radical prostatectomy has undergone evolution in the last 100 years. Better understanding of the pelvic anatomy has led to a decrease in the blood loss during surgery and in the rate of urinary incontinence and erectile dysfunction following surgery. The introduction of laparoscopy in the late 1990s to this surgery provided the surgeon with a magnified multi-angle field of view and facilitated accurate dissection and suturing. Decreased damage to neighboring tissue made recovery hastier. Nevertheless, laparoscopic radical prostatectomy is a technically challenging surgery and did not become popular. The last step in the evolution of radical prostatectomy is the introduction of robotic systems for assistance in laparoscopic radical prostatectomy. A master-slave robotic system is composed of console and mechanical arms. The surgeon is provided with a magnified three dimensional view of the operative field and with two mechanical arms that accurately replicate its fingers movements. The initial results of robotic-assisted laparoscopic prostatectomy seem promising, however, long-term follow-up and comparison to open surgeries are lacking. Robotic systems were rapidly implemented in the American market and in the year 2006, 40% of all radical prostatectomies were robotic assisted. Future systems may reveal deep structures to the visualized surface by superimposing MRI images on the surgical field.

  15. Early Experience with Robot-assisted Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Hong Gee Sim

    2004-10-01

    Conclusions: rLRP is feasible in a practice with a low volume of radical prostatectomies. Significant improvement in perioperative parameters occurs after the first eight cases. This technique confers the benefits of enhanced precision and dexterity for complex laparoscopic work in the pelvic cavity.

  16. Combined radical retropubic prostatectomy and rectal resection.

    Science.gov (United States)

    Klee, L W; Grmoljez, P

    1999-10-01

    To present our experience with a small series of men who underwent simultaneous radical retropubic prostatectomy and rectal resection. Three men with newly diagnosed prostate cancer were found to have concurrent rectal tumors requiring resection. All three men underwent non-nerve-sparing radical retropubic prostatectomy and abdominoperineal resection (APR) or low anterior resection (LAR) of the rectum at the same operation. In the 2 patients undergoing APR, the levators were approximated posterior to the urethra, and the bladder was secured to the pubis. The patient undergoing LAR had urinary diversion stents placed and a diverting transverse loop colostomy. All 3 patients had excellent return of urinary continence. One patient required reoperation in the early postoperative period for small bowel adhesiolysis and stoma revision. Another patient had a mild rectal anastomotic stricture and a bladder neck stricture; both were successfully treated with a single dilation. No other significant complications occurred in these patients. Radical retropubic prostatectomy can safely be performed with partial or complete rectal resection in a single operation. A few minor modifications of the standard radical retropubic prostatectomy in this setting are suggested.

  17. The current status of robot-assisted radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Prokar Dasgupta; Roger S.Kirby

    2009-01-01

    Robot-assisted radical prostatectomy (RARP) is a rapidly evolving technique for the treatment of localized prostate cancer.In the United States,over 65% of radical prostatectomies are robot-assisted,although the acceptance of this technology in Europe and the rest of the world has been somewhat slower.This article reviews the current literature on RARP with regard to oncological,continence and potency outcomes-the so-called 'trifecta'.Preliminary data appear to show an advantage of RARP over open prostatectomy,with reduced blood loss,decreased pain,early mobilization,shorter hospital stay and lower margin rates.Most studies show good postoperative continence and potency with RARP;however,this needs to be viewed in the context of the paucity of randomized data available in the literature.There is no definitive evidence to show an advantage over standard laparoscopy,but the fact that this technique has reached parity with laparoscopy within 5 years is encouraging.Finally,evolving techniques of single-port robotic prostatectomy,laserguided robotics,catheter-free prostatectomy and image-guided robotics are discussed.

  18. Pain and quality of life following radical retropubic prostatectomy.

    Science.gov (United States)

    Haythornthwaite, J A; Raja, S N; Fisher, B; Frank, S M; Brendler, C B; Shir, Y

    1998-11-01

    We assess pain and quality of life following radical retropubic prostatectomy and determine whether intraoperative anesthetic management has any long-term effects on outcomes. A total of 110 patients undergoing radical retropubic prostatectomy were randomly assigned to receive epidural and/or general anesthesia. Patients responded to a questionnaire mailed 3 and 6 months following surgery that assessed prostate symptoms, pain related to surgery, quality of life and mood. No long-term effects of anesthesia were observed. Of the 103 respondents (94%) at 3 months 49% had some pain related to surgery. Although pain was not related to anesthesic technique, patients who had it at 3 months used significantly more pain medication on postoperative day 3. Pain at 3 months was mild, averaging 1.5 on a scale of 0 to 10, and associated with poor perceptions of overall health (p anesthesic technique were not apparent. Mild pain following radical retropubic prostatectomy was common and associated with reduced quality of life, particularly social functioning. Affective distress, particularly anxiety, before surgery and use of pain medications following surgery may be predictors of chronic pain following radical retropubic prostatectomy.

  19. Characteristics of positive surgical margins in robotic-assisted radical prostatectomy, open retropubic radical prostatectomy, and laparoscopic radical prostatectomy: a comparative histopathologic study from a single academic center.

    Science.gov (United States)

    Albadine, Roula; Hyndman, Matthew E; Chaux, Alcides; Jeong, J Y; Saab, Shahrazad; Tavora, Fabio; Epstein, Jonathan I; Gonzalgo, Mark L; Pavlovich, Christian P; Netto, George J

    2012-02-01

    Studies detailing differences in positive surgical margin among open retropubic radical prostatectomy, laparoscopic radical prostatectomy, and robotic-assisted laparoscopic radical prostatectomy are lacking. A retrospective review of all prostatectomies with positive surgical margin performed at our center in 2007 disclosed 99 cases, 6 (5%) of which were reinterpreted cases as having negative margins. Ninety-three cases were, therefore, included, corresponding to 37 retropubic radical prostatectomies, 19 laparoscopic radical prostatectomies, and 37 robotic-assisted laparoscopic radical prostatectomies. The relationship of positive surgical margin characteristics to clinicopathologic parameters and biochemical recurrence was assessed. The most commonly found positive surgical margin site was the apex/distal third in all groups (62% retropubic prostatectomies, 79% laparoscopic prostatectomies, 60% robotic-assisted prostatectomies). Total linear length of positive surgical margin sites was significantly correlated with preoperative prostate-specific antigen, preoperative prostate-specific antigen density, pT stage, and tumor volume (P ≤ .001). We found no significant differences among the 3 groups with respect to total linear length, number of foci, laterality, or location of positive surgical margin. The rate of biochemical recurrence was also comparable in the 3 groups. On univariate analyses, biochemical recurrence was significantly associated with preoperative prostate-specific antigen values, preoperative prostate-specific antigen density, Gleason score, number of positive surgical margins, and total linear length of positive surgical margin (P ≤ .02). Only preoperative prostate-specific antigen density and number of positive surgical margin foci were statistically significant (P ≤ .03) independent predictors of biochemical recurrence. We found no significant difference in positive surgical margin characteristics or biochemical recurrence among the 3

  20. Blunt apical dissection during anatomic radical retropubic prostatectomy

    Directory of Open Access Journals (Sweden)

    Yacoub Saif

    2009-02-01

    Full Text Available Abstract Background Meticulous apical dissection during a radical prostatectomy is imperative to achieve desirable pathologic and quality of life outcomes. Findings We describe a novel technique using careful blunt dissection to better delineate the apex of the prostate, providing a simple means to potentially lessen positive surgical margins at the apex and promote better continence and erectile function in men undergoing an anatomic radical prostatectomy. Median operative time and blood loss were 190 minutes and 675 mL, respectively. Only 10 percent of the patients with positive surgical margins were found to have apical positive surgical margins. Ninety-three percent of patients reported no urinary leakage. Conclusion We believe our technique of isolating the DVC with blunt dissection and then ligating and transecting the DVC to be feasible approach that requires larger studies to truly confirm its utility.

  1. Treatment of the positive surgical margin following radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Objective With increased incidence of prostate cancer and an increased number of patients undergoing radical prostatectomy in China,it will be necessary to elaborate the diagnosis,clinical significance and treatment of patients whose tumors have positive surgical margins following radical prostatectomy.Data sources Positive surgical margin,prostate cancer and radical prostatectomy were used as subject words and the medical literature in recent decades was searched using the PubMed database and the results are summarized.Study selection Using positive surgical margin,prostate cancer and radical prostatectomy as subject words the PubMed medical database produced 275 papers of pertinent literature.By further screening 28 papers were selected and they represent relatively large-scale clinical randomized and controlled clinical trials.Results A pertinent literature of 275 papers was identified and 28 papers on large clinical studies were obtained.Analysis of results indicated that the positive rate of surgical margin after radical prostatectomy is 20%-40%,and although most patients with positive surgical margins are stable for a considerable period,the data available now suggested that the presence of a positive surgical margin will have an impact on the patient's prognosis.The risk factors of positive surgical margin include preoperative prostate specific antigen level,Gleason's score and pelvic lymph node metastasis.The most common site with positive surgical margin is in apical areas of the prostate;therefore surgical technique is also a factor resulting in positive surgical margins.From data available now it appears that as long as the surgical technique is skilled,different surgical modes do not affect the rate of surgical margin.Adjuvant radiotherapy is mainly used to treat patients with positive surgical margin after radical prostatectomy,but combination with androgen deprivation therapy may increase the curative effect.Conclusion The current data indicated that

  2. Athermal bladder neck dissection during robot-assisted radical prostatectomy

    OpenAIRE

    Fabrizio Dal Moro

    2014-01-01

    Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP) have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN) serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at...

  3. [URINARY DISCOMFORTS IN PATIENTS AFTER RADICAL PROSTATECTOMY].

    Science.gov (United States)

    Al'-Shukri, S Kh; Ananiĭ, I A; Amdiĭ, R E; Kuz'min, I V

    2015-01-01

    The authors showed the result of complication treatment of lower urinary tracts in 128 patients with localized prostate cancer. The patients underwent radical prostatectomy. Urinary discomforts included enuresis, urinary incontinence in postoperative period. Abnormalities of urine outflow due to urethral stricture were revealed in 6 (4,6%) patients by the 6 month after operation. These complications required surgical treatment. Urinary incontinence was noted in 20 (15,6%) patients in this period. It was stressful urinary incontinence in 16 (12,6%) and urgent - in 4 (3%). Patents with stressful urinary difficulty were advised to use the conservative treatment (pelvic floor muscle training and electrostimulation), but in case of inefficiency - surgical treatment.

  4. Rehabilitation of erectile function following radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Andrew R. McCullough

    2008-01-01

    The concept of muscle rehabilitation after nerve injury is not a novel idea and is practiced in many branches of medicine, including urology. Bladder rehabilitation after spinal cord injury is universally practiced. The erectile dysfunction (ED) experienced after radical prostatectomy (RP) is increasingly recognized as being primarily neurogenic followed by secondary penile smooth muscle (SM) changes. There is unfortunately no standard approach to penile rehabilitation after RP because controlled prospective human studies are not available. This article reviews the epidemiology, experimental pathophysiological models, rationale for penile rehabilitation, and currently published rehabilitation strategies.

  5. Robot-assisted radical prostatectomy is a safe procedure

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebæk; Berg, Kasper Drimer; Hvarness, Helle

    2013-01-01

    We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients.......We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients....

  6. Robot-assisted radical prostatectomy is a safe procedure

    DEFF Research Database (Denmark)

    Thomsen, Frederik Birkebæk; Berg, Kasper Drimer; Hvarness, Helle

    2013-01-01

    We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients.......We present our departmental experience with robot-assisted radical prostatectomy and describe complications and early results for the first 239 consecutive patients....

  7. Evidence-Based Comparison of Robotic and Open Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    William T. Lowrance

    2010-01-01

    Full Text Available The rapid adoption of robotic-assisted laparoscopic radical prostatectomy (RALP has occurred despite a lack of high-quality evidence demonstrating its oncologic advantages, safety, or cost effectiveness compared with open radical retropubic prostatectomy (ORP. This review examines the current literature comparing ORP and RALP, focusing on perioperative, oncologic, functional, and economic outcomes.

  8. Obesity, prostate-specific antigen nadir, and biochemical recurrence after radical prostatectomy: biology or technique? Results from the SEARCH database.

    Science.gov (United States)

    Ho, Tammy; Gerber, Leah; Aronson, William J; Terris, Martha K; Presti, Joseph C; Kane, Christopher J; Amling, Christopher L; Freedland, Stephen J

    2012-11-01

    Obesity is associated with an increased risk of biochemical recurrence (BCR) after radical prostatectomy (RP). It is unclear whether this is due to technical challenges related to operating on obese men or other biologic factors. To examine whether obesity predicts higher prostate-specific antigen (PSA) nadir (as a measure of residual PSA-producing tissue) after RP and if this accounts for the greater BCR risk in obese men. A retrospective analysis of 1038 RP patients from 2001 to 2010 in the multicenter US Veterans Administration-based Shared Equal Access Regional Cancer Hospital database with median follow-up of 41 mo. All patients underwent RP. We evaluated the relationship between body mass index (BMI) and ultrasensitive PSA nadir within 6 mo after RP. Adjusted proportional hazards models were used to examine the association between BMI and BCR with and without PSA nadir. Mean BMI was 28.5 kg/m2. Higher BMI was associated with higher PSA nadir on both univariable (p=0.001) and multivariable analyses (pobesity only significantly predicted BCR in men with an undetectable nadir (p=0.006). Unfortunately, other clinically relevant end points such as metastasis or mortality were not available. Obese men are more likely to have a higher PSA nadir, suggesting that either more advanced disease or technical issues confound an ideal operation. However, even after adjusting for the increased PSA nadir, obesity remained predictive of BCR, suggesting that tumors in obese men are growing faster. This provides further support for the idea that obesity is biologically associated with prostate cancer progression. Published by Elsevier B.V.

  9. Laparoscopic radical prostatectomy: omitting a pelvic drain

    Directory of Open Access Journals (Sweden)

    David Canes

    2008-03-01

    Full Text Available PURPOSE: Our goal was to assess outcomes of a selective drain placement strategy during laparoscopic radical prostatectomy (LRP with a running urethrovesical anastomosis (RUVA using cystographic imaging in all patients. Materials and Methods: A retrospective chart review was performed for all patients undergoing LRP between January 2003 and December 2004. The anastomosis was performed using a modified van Velthoven technique. A drain was placed at the discretion of the senior surgeon when a urinary leak was demonstrated with bladder irrigation, clinical suspicion for a urinary leak was high, or a complex bladder neck reconstruction was performed. Routine postoperative cystograms were obtained. RESULTS: 208 patients underwent LRP with a RUVA. Data including cystogram was available for 206 patients. The overall rate of cystographic urine leak was 5.8%. A drain was placed in 51 patients. Of these, 8 (15.6% had a postoperative leak on cystogram. Of the 157 undrained patients, urine leak was radiographically visible in 4 (2.5%. The higher leak rate in the drained vs. undrained cohort was statistically significant (p = 0.002. Twenty-four patients underwent pelvic lymph node dissection (8 drained, 16 undrained. Three undrained patients developed lymphoceles, which presented clinically on average 3 weeks postoperatively. There were no urinomas or hematomas in either group. CONCLUSIONS: Routine placement of a pelvic drain after LRP with a RUVA is not necessary, unless the anastomotic integrity is suboptimal intraoperatively. Experienced clinical judgment is essential and accurate in identifying patients at risk for postoperative leakage. When suspicion is low, omitting a drain does not increase morbidity.

  10. HYDRODISSECTION FOR PRESERVATION OF NEUROVASCULAR BUNDLE DURING RADICAL PROSTATECTOMY

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    H. S. Gevorgyan

    2016-01-01

    Full Text Available Nerve-sparing radical prostatectomy is one of the high-tech operations in urology, and the challenge of the surgeon is not only to remove the prostate tumor, but also to provide a high quality of life. The fact that most questions devoted from patients in a conversation with the surgeon before the operation are devoted to this issue, shows the importance and relevance. At present, the diagnostic methods allow significantly more likely to detect early  prostate cancer, making finding and treatment of these patients more affordable and allows to apply this operation.Lately, it seems urgent to explore the possibility of water jet dissection in the field of urology, in particular, for nerve-sparing prostatectomy. Preservation of erectile function depends largely on the quality of separating the neurovascular bundle. Standard use of electrocautery is associated with damage to the neurovascular bundle.  When performing operations using water-jet mobilization of prostate the selective dissection of tissue is performed. This avoids injury of neurovascular bundle and further postoperative complications. The use of this technique may allow the surgeon to provide a more accurate mobilization prostate and selectively controlled intersection vessels heading to the prostate from the neurovascular bundle, reduce intraoperative blood loss,  maintaining continence, erectile function.This literature review is considered by the experience of using nerve-sparing radical prostatectomy using a water-jet dissector, estimated intraoperative parameters using this method.However, we have the lack of extensive research capabilities of this technique when performing nerve-preserving radical prostatectomy, that does not allow to make a comprehensive presentation on the benefits of this technique and its effects on erectile function and quality of urination, further study of this issue in such a difficult category of patients.

  11. Robotic Salvage Lymph Node Dissection After Radical Prostatectomy.

    Science.gov (United States)

    Torricelli, Fabio C M; Cividanes, Arnaldo; Guglielmetti, Giuliano B; Coelho, Rafael F

    2015-01-01

    Radical prostatectomy is a first-line treatment for localized prostate cancer. However, in some cases, biochemical recurrence associated with imaging-detected nodal metastases may happen. Herein, we aim to present the surgical technique for salvage lymph node dissection after radical prostatectomy. A 70 year-old asymptomatic man presented with a prostate-specific antigen (PSA) of 7.45 ng/mL. Digital rectal examination was normal and trans-rectal prostate biopsy revealed a prostate adenocarcinoma Gleason 7 (3+4). Pre-operative computed tomography scan and bone scintigraphy showed no metastatic disease. In other service, the patient underwent a robotic-assisted radical prostatectomy plus obturador lymphadenectomy. Pathologic examination showed a pT3aN0 tumor. After 6 months of follow-up, serum PSA was 1.45 ng/mL. Further investigation with 11C--Choline PET/CT revealed only a 2-cm lymph node close to the left internal iliac artery. The patient was counseled for salvage lymph node dissection. Salvage lymph node dissection was uneventfully performed. Operative time was 1.5 hour, blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. After 12 months of follow-up, his PSA was undetectable with no other adjuvant therapy. Robotic salvage pelvic lymph node dissection is an effective option for treatment of patients with biochemical recurrence after radical prostatectomy and only pelvic lymph node metastasis detected by C11-Choline PET/CT.

  12. Robotic Salvage Lymph Node Dissection After Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Fabio C. M. Torricelli

    2015-08-01

    Full Text Available ABSTRACTIntroduction and objective:Radical prostatectomy is a first-line treatment for localized prostate cancer. However, in some cases, biochemical recurrence associated with imaging-detected nodal metastases may happen. Herein, we aim to present the surgical technique for salvage lymph node dissection after radical prostatectomy.Materials and Methods:A 70 year-old asymptomatic man presented with a prostate-specific antigen (PSA of 7.45ng/ mL. Digital rectal examination was normal and trans-rectal prostate biopsy revealed a prostate adenocarcinoma Gleason 7 (3+4. Pre-operative computed tomography scan and bone scintigraphy showed no metastatic disease. In other service, the patient underwent a robotic-assisted radical prostatectomy plus obturador lymphadenectomy. Pathologic examination showed a pT3aN0 tumor. After 6 months of follow-up, serum PSA was 1.45ng/mL. Further investigation with 11C–Choline PET/CT revealed only a 2-cm lymph node close to the left internal iliac artery. The patient was counseled for salvage lymph node dissection.Results:Salvage lymph node dissection was uneventfully performed. Operative time was 1.5 hour, blood loss was minimal, and there were no intra- or postoperative complications. The patient was discharged from hospital in the 1st postoperative day. After 12 months of follow-up, his PSA was undetectable with no other adjuvant therapy.Conclusion:Robotic salvage pelvic lymph node dissection is an effective option for treatment of patients with biochemical recurrence after radical prostatectomy and only pelvic lymph node metastasis detected by C11-Choline PET/CT.

  13. Neglected Side Effects After Radical Prostatectomy

    DEFF Research Database (Denmark)

    Frey, Anders Ullmann; Sønksen, Jens; Fode, Mikkel

    2014-01-01

    INTRODUCTION: A series of previously neglected sexually related side effects to radical prostatectomy (RP) has been identified over the recent years. These include orgasm-associated incontinence (OAI), urinary incontinence in relation to sexual stimulation (UISS), altered perception of orgasm....... Alterations of orgasmic function are experienced by approximately 80% after RP. Erectile dysfunction seems to play an important role in waning orgasmic function. OAP is only experienced by a subset of the patients with reported rates varying between 3% and 19%. Sparing of the tips of the seminal vesicles has...... been shown to double the risk of OAP. PS occurs in 15-68% of RP patients. Nerve sparing and preservation of erectile function may help preserve penile length. With regard to all side effects, studies indicate that they are reduced over time. CONCLUSIONS: The sexually related side effects summarized...

  14. Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step–by-step technique description of this first brazilian experience

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    Full Text Available Abstract Introduction: Retzus-sparing robotic-assisted radical prostatectomy(RARP is a newly approach that preserve the Retzus structures and provide better recovery of continence and erectile function. In Brazil, this approach has not yet been previously reported. Objective: Our goal is to describe Step-by-Step the Retzus-sparing RARP surgical technique and report our first Brazilian experience. Methods: We present a case of a 60-year-old white man with low risk prostate cancer. Surgical materials were four arms Da Vinci robotic platform system, six transperitoneal portals, two prolene wires and Polymer Clips. This surgical technique was step-by-step described according to Galfano et al. One additional step was added as a modification of Galfano et al. Primary technique description: The closure of the Denovellier fascia. Results: We have operated one patient with this technique. The operative time was 180minutes, console time was135 min, the blood loss was 150ml, none perioperative or postoperative complications was found, hospital stay of 01 day. The anatomopathological classification revealed a pT2aN0M0 specimen with free surgical margins. The patient achieved continence immediately after bladder stent retrieval. Full erection reported after 30 days of surgery. Conclusion: Retzus-sparing RARP approach is feasible and reproducible. However, further comparative studies are necessary to demonstrate potential benefits in continence and sexual outcomes over the standard approaches.

  15. Radical prostatectomy. Results and indications; Indications et resultats de la prostatectomie radicale

    Energy Technology Data Exchange (ETDEWEB)

    Jacqmin, D. [Hopitaux universitaires de Strasbourg, 67 - Strasbourg (France)

    1997-12-31

    Radical prostatectomy is the surgical curative treatment of localized prostate cancer. The survival is good in young patients (<70) with T2 N0M0 tumors and more than 10 year`s life expectancy. Side-effects are urinary incontinence, impotence and anastomosis stricture. Quality of life should be considered as an important factor for the choice of the patient between radical prostatectomy, radiotherapy and follow-up. (author)

  16. Robotic Surgical System for Radical Prostatectomy: A Health Technology Assessment

    Science.gov (United States)

    Wang, Myra; Xie, Xuanqian; Wells, David; Higgins, Caroline

    2017-01-01

    Background Prostate cancer is the second most common type of cancer in Canadian men. Radical prostatectomy is one of the treatment options available, and involves removing the prostate gland and surrounding tissues. In recent years, surgeons have begun to use robot-assisted radical prostatectomy more frequently. We aimed to determine the clinical benefits and harms of the robotic surgical system for radical prostatectomy (robot-assisted radical prostatectomy) compared with the open and laparoscopic surgical methods. We also assessed the cost-effectiveness of robot-assisted versus open radical prostatectomy in patients with clinically localized prostate cancer in Ontario. Methods We performed a literature search and included prospective comparative studies that examined robot-assisted versus open or laparoscopic radical prostatectomy for prostate cancer. The outcomes of interest were perioperative, functional, and oncological. The quality of the body of evidence was examined according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. We also conducted a cost–utility analysis with a 1-year time horizon. The potential long-term benefits of robot-assisted radical prostatectomy for functional and oncological outcomes were also evaluated in a 10-year Markov model in scenario analyses. In addition, we conducted a budget impact analysis to estimate the additional costs to the provincial budget if the adoption of robot-assisted radical prostatectomy were to increase in the next 5 years. A needs assessment determined that the published literature on patient perspectives was relatively well developed, and that direct patient engagement would add relatively little new information. Results Compared with the open approach, we found robot-assisted radical prostatectomy reduced length of stay and blood loss (moderate quality evidence) but had no difference or inconclusive results for functional and oncological outcomes

  17. Robotic assisted radical prostatectomy: a different treatment for prostate cancer?

    OpenAIRE

    Julio,Alexandre Den; Ahlering,Thomas Edward; Korkes, Fernando; Lopes Neto,Antonio Correa; Tobias-Machado,Marcos; Pompeo, Antonio Carlos Lima; Wroclawski,Eric Roger

    2010-01-01

    ABSTRACTConsidering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with redu...

  18. FUNCTIONAL RESULTS OF ENDOSCOPIC EXTRAPERITONEAL RADICAL INTRAFASCIAL PROSTATECTOMY

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    D. V. Perlin

    2014-01-01

    Full Text Available Introduction. Endoscopic radical prostatectomy is a highly effective treatment for localized prostate cancer. Intrafascial prostate dissection ensures early recovery of urine continence function and erectile function. This article sums up our own experience of performing intrafascial endoscopic prostatectomy.Materials and methods. 25 patients have undergone this procedure. 12 months after surgery 88.2 % of the patients were fully continent, 11.7 % had symptoms of minimal stress urinary incontinence. We encountered no cases of positive surgical margins and one case of bio-chemical recurrence of the disease.Conclusion. Oncologically, intrafascial endoscopic radical prostatectomy is as effective as other modifications of radical prostatectomy and has the benefits of early recovery of urine continence function and erectile function. 

  19. Learning curve for radical retropubic prostatectomy

    Directory of Open Access Journals (Sweden)

    Fernando J. A. Saito

    2011-02-01

    Full Text Available PURPOSE: The learning curve is a period in which the surgical procedure is performed with difficulty and slowness, leading to a higher risk of complications and reduced effectiveness due the surgeon's inexperience. We sought to analyze the residents' learning curve for open radical prostatectomy (RP in a training program. MATERIALS AND METHODS: We conducted a prospective study from June 2006 to January 2008 in the academic environment of the University of São Paulo. Five residents operated on 184 patients during a four-month rotation in the urologic oncology division, mentored by the same physician assistants. We performed sequential analyses according to the number of surgeries, as follows: = 10, 11 to 19, 20 to 28, and = 29. RESULTS: The residents performed an average of 37 RP each. The average psa was 9.3 ng/mL and clinical stage T1c in 71% of the patients. The pathological stage was pT2 (73%, pT3 (23%, pT4 (4%, and 46% of the patients had a Gleason score 7 or higher. In all surgeries, the average operative time and estimated blood loss was 140 minutes and 488 mL. Overall, 7.2% of patients required blood transfusion, and 23% had positive surgical margins. CONCLUSION: During the initial RP learning curve, we found a significant reduction in the operative time; blood transfusion during the procedures and positive surgical margin rate were stable in our series.

  20. REHABILITATION OF PATIENTS AFTER RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    V. N. Pavlov

    2009-01-01

    Full Text Available According to the data obtained by Russian and foreign investigators, the major complication after radical prostatectomy (RPE is urinaryincontinence that is recorded in 20-30% of cases.Objective. To improve the results of surgical treatment in patients with prostate cancer, by developing and introducing a well-rounded post-operative rehabilitation program.Subjects and methods. Seventy-four patients who were treated at the urology clinic, Bashkir State Medical University, and underwent RPEin 2005 to 2007 have been examined; 27 of them were diagnosed as having urinary incontinence (UI. After discharge from the clinic, acontrol group received rehabilitative treatment at the sanatorium “Krasnousolsk” of the Republic of Bashkortostan. Results and discussion. Therapeutic exercises and pelvic floor electrostimulation halve the number of day urinations and paddings used inpatients with UI, by increasing the bladder capacity from 138.2±12.7 to 196±11.2 ml and improving the trophism of the bladder neck andurethra in the sphincteral area. 

  1. Radical prostatectomy in oligometastatic prostate cancer.

    Science.gov (United States)

    Mandel, Philipp; Steuber, Thomas; Graefen, Markus

    2017-11-01

    Although cytoreductive surgery is accompanied with prolonged survival in many other malignancies in a metastatic stage, its role in oligometastatic prostate cancer is unclear. Radical prostatectomy (RP) in patients with oligometastatic prostate cancer seems to be feasible. Perioperative complication rates vary between 20 and 50% (Clavien 1-3) and are comparable to patients with locally advanced tumors. Postoperative functional outcomes (urinary continence and erectile function) can be slightly worse than in patients with locally advanced tumor. In literature, an oncological benefit of surgery is so far only described for retrospective multiinstitutional databases and a case-control study but not for prospective studies. Still, men undergoing RP clearly seem to develop severe local complications less frequently than patients receiving best systemic therapy (up to more than 50% versus less than10%). Patients should be counseled about the potential significant reduction of local complications whenever undergoing RP for oligometastatic prostate cancer. Nevertheless, as complication rates are relatively high, functional outcome can be slightly worse compared with RP with curative intent and especially as oncological benefit so far is shown using retrospective but not prospective data, patients should only undergo surgery within the ongoing prospective, randomized trials.

  2. REHABILITATION OF PATIENTS AFTER RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    V. N. Pavlov

    2014-07-01

    Full Text Available According to the data obtained by Russian and foreign investigators, the major complication after radical prostatectomy (RPE is urinaryincontinence that is recorded in 20-30% of cases.Objective. To improve the results of surgical treatment in patients with prostate cancer, by developing and introducing a well-rounded post-operative rehabilitation program.Subjects and methods. Seventy-four patients who were treated at the urology clinic, Bashkir State Medical University, and underwent RPEin 2005 to 2007 have been examined; 27 of them were diagnosed as having urinary incontinence (UI. After discharge from the clinic, acontrol group received rehabilitative treatment at the sanatorium “Krasnousolsk” of the Republic of Bashkortostan. Results and discussion. Therapeutic exercises and pelvic floor electrostimulation halve the number of day urinations and paddings used inpatients with UI, by increasing the bladder capacity from 138.2±12.7 to 196±11.2 ml and improving the trophism of the bladder neck andurethra in the sphincteral area. 

  3. Iatrogenic Rectal Injury During Radical Prostatectomy: Is Colostomy Inevitable End?

    Directory of Open Access Journals (Sweden)

    Ramazan Topaktas

    2014-12-01

    Full Text Available Aim: Radical prostatectomy (RP is the gold standard treatment method for localized prostate cancer, because of its high oncological success. Iatrogenic rectal injury (IRI during RP is rarely seen, but it may causes serious complications because of the close anatomic relationship between the prostate and rectum. Aim is to present our series about management of IRI without colostomy. Material and Method: Between June 1999 and June 2013, radical retropubic prostatectomy (RRP was performed to 372 patients by a single surgeon. 10 cases (%2,6 were complicated by a rectal injury during RRP. Instant rectal closure was performed in 3 layers without a diverting colostomy, at the time of surgery. Omental vascular flap was placed between rectum and vesicourethral anastomosis. Results: The clinical stages of IRI cases were T1c, T2a and T2c in 2, 3 and 5 patients, respectively. Their preoperative Gleason scores were 6, 7 and 8 in 3, 5 and 2 patient, respectively. None of the 10 had undergone previous prostatic or rectal surgery, or received preoperative radiotherapy or hormonal therapy. Discussion: Instant diagnosis and rectal wall closures by three layers are essential for successful repair. Our technique seems as a safe, minimal invasive and highly effective option for the management of IRI.

  4. Anatomical basis for carrying out a state-of-the-art radical prostatectomy.

    Science.gov (United States)

    Takenaka, Atsushi; Tewari, Ashutosh K

    2012-01-01

    Robotic-assisted laparoscopic prostatectomy has consolidated the position of surgical treatment for localized prostate cancer in the USA. In a few years, it is expected to spread rapidly worldwide. However, surgical anatomy has trailed the advance in surgical techniques of robotic-assisted laparoscopic prostatectomy. Therefore, we reviewed the recent literature, which sometimes refutes the established consensus on pelvic anatomy, for the state-of-the-art technique. We also describe the anatomical findings for each basic step during robotic-assisted laparoscopic prostatectomy, and show evidence-based surgical techniques. Of course, these findings will also be useful for radical retropubic, perineal and conventional laparoscopic prostatectomy. Surgical anatomy should always be developing and changing with advances in surgical approaches.

  5. Neoadjuvant hormonal deprivation for patients undergoing radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Xu Gao; Tie Zhou; Yuan-Jie Tang; Xin Lu; Ying-Hao Sun

    2009-01-01

    The purpose of this study is to evaluate the therapeutic effect of radical prostatectomy combined with preoperative neoadjuvant hormonal ablation therapy for prostate cancer (PCa).In this study,a total of 31 patients with local PCa underwent radical prostatectomy;of these,12 patients underwent preoperative hormonal deprivation with a combination of goserelin and flutamide for a period of 5.6 months.Data regarding clinical characteristics were compared between the neoadjuvant therapy and radical prostatectomy groups.A total of 31 patients received pelvic lymph node clearance,and the rate of positive lymph nodes was 12.9% (4/31).Serum prostate-specific antigen (PSA) was 8.9±1.2μg L-1 after the neoadjuvant therapy and 0.4±0.3μg L-1 one month after the radical prostatectomy.There were significant differences in the positive surgical margins,seminal vesicle invasion and lymph node metastasis between the neoadjuvant therapy group (n=12) and the radical prostatectomy group (n=19,P<0.01).The resulsts indicates that preoperative hormonal deprivation induced by goserelin and flutamide can decrease clinical and pathological staging,but assessment of its influence on long-term prognosis requires further study.

  6. Advances in Robotic-Assisted Radical Prostatectomy over Time

    Directory of Open Access Journals (Sweden)

    Emma F. P. Jacobs

    2013-01-01

    Full Text Available Since the introduction of robot-assisted radical prostatectomy (RALP, robotics has become increasingly more commonplace in the armamentarium of the urologic surgeon. Robotic utilization has exploded across surgical disciplines well beyond the fields of urology and prostate surgery. The literature detailing technical steps, comparison of large surgical series, and even robotically focused randomized control trials are available for review. RALP, the first robot-assisted surgical procedure to achieve widespread use, has recently become the primary approach for the surgical management of localized prostate cancer. As a result, surgeons are constantly trying to refine and improve upon current technical aspects of the operation. Recent areas of published modifications include bladder neck anastomosis and reconstruction, bladder drainage, nerve sparing approaches and techniques, and perioperative and postoperative management including penile rehabilitation. In this review, we summarize recent advances in perioperative management and surgical technique for RALP.

  7. Anastomotic complications after robot-assisted laparoscopic and open radical prostatectomy

    DEFF Research Database (Denmark)

    Jacobsen, André; Berg, Kasper Drimer; Iversen, Peter

    2016-01-01

    Objective Anastomotic complications are well known after radical prostatectomy (RP). The vesicourethral anastomotic technique is handled differently between open and robotic RP. The aim of the study was to investigate whether the frequency of anastomotic leakages and strictures differed between...... patients undergoing retropubic radical prostatectomy (RRP) and robot-assisted radical prostatectomy (RARP) and to identify risk factors associated with these complications. Materials and methods The study included 735 consecutive patients who underwent RRP (n = 499) or RARP (236) at the Department...... of Urology, Rigshospitalet, Denmark, in a complete 3 year period from 2010 to 2012. Univariate and multivariate logistic regression analysis was used to analyse associations between surgical procedure (RRP vs RARP) and anastomotic complications. Analyses included age, smoking status, diabetes, hypertension...

  8. Hemodynamic changes during robotic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Vanlal Darlong

    2012-01-01

    Full Text Available Background: Effect on hemodynamic changes and experience of robot-assisted laparoscopic radical prostatectomy (RALRP in steep Trendelenburg position (45° with high-pressure CO 2 pneumoperitoneum is very limited. Therefore, we planned this prospective clinical trial to study the effect of steep Tredelenburg position with high-pressure CO 2 pneumoperitoneum on hemodynamic parameters in a patient undergoing RALRP using FloTrac/Vigileo™1.10. Methods: After ethical approval and informed consent, 15 patients scheduled for RALRP were included in the study. In the operation room, after attaching standard monitors, the radial artery was cannulated. Anesthesia was induced with fentanyl (2 μg/kg and thiopentone (4-7 mg/kg, and tracheal intubation was facilitated by vecuronium bromide (0.1 mg/kg. The patient′s right internal jugular vein was cannulated and the Pre Sep™ central venous oximetry catheter was connected to it. Anesthesia was maintained with isoflurane in oxygen and nitrous oxide and intermittent boluses of vecuronium. Intermittent positive-pressure ventilation was provided to maintain normocapnea. After CO 2 pneumoperitoneum, position of the patient was gradually changed to 45° Trendelenburg over 5 min. The robot was then docked and the robot-assisted surgery started. Intraoperative monitoring included central venous pressure (CVP, stroke volume (SV, stroke volume variation (SVV, cardiac output (CO, cardiac index (CI and central venous oxygen saturation (ScvO 2 . Results: After induction of anesthesia, heart rate (HR, SV, CO and CI were decreased significantly from the baseline value (P>0.05. SV, CO and CI further decreased significantly after creating pneumoperitoneum (P>0.05. At the 45° Trendelenburg position, HR, SV, CO and CI were significantly decreased compared with baseline. Thereafter, CO and CI were persistently low throughout the 45° Trendelenburg position (P=0.001. HR at 20 min and 1 h, SV and mean arterial blood pressure

  9. Intra-operative prostate motion tracking using surface markers for robot-assisted laparoscopic radical prostatectomy

    Science.gov (United States)

    Esteghamatian, Mehdi; Sarkar, Kripasindhu; Pautler, Stephen E.; Chen, Elvis C. S.; Peters, Terry M.

    2012-02-01

    Radical prostatectomy surgery (RP) is the gold standard for treatment of localized prostate cancer (PCa). Recently, emergence of minimally invasive techniques such as Laparoscopic Radical Prostatectomy (LRP) and Robot-Assisted Laparoscopic Radical Prostatectomy (RARP) has improved the outcomes for prostatectomy. However, it remains difficult for the surgeons to make informed decisions regarding resection margins and nerve sparing since the location of the tumor within the organ is not usually visible in a laparoscopic view. While MRI enables visualization of the salient structures and cancer foci, its efficacy in LRP is reduced unless it is fused into a stereoscopic view such that homologous structures overlap. Registration of the MRI image and peri-operative ultrasound image using a tracked probe can potentially be exploited to bring the pre-operative information into alignment with the patient coordinate system during the procedure. While doing so, prostate motion needs to be compensated in real-time to synchronize the stereoscopic view with the pre-operative MRI during the prostatectomy procedure. In this study, a point-based stereoscopic tracking technique is investigated to compensate for rigid prostate motion so that the same motion can be applied to the pre-operative images. This method benefits from stereoscopic tracking of the surface markers implanted over the surface of the prostate phantom. The average target registration error using this approach was 3.25+/-1.43mm.

  10. Effect of a risk-stratified grade of nerve-sparing technique on early return of continence after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Srivastava, Abhishek; Chopra, Sameer; Pham, Anthony; Sooriakumaran, Prasanna; Durand, Matthieu; Chughtai, Bilal; Gruschow, Siobhan; Peyser, Alexandra; Harneja, Niyati; Leung, Robert; Lee, Richard; Herman, Michael; Robinson, Brian; Shevchuk, Maria; Tewari, Ashutosh

    2013-03-01

    The impact of nerve sparing (NS) on urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RALP) has yet to be defined. To evaluate the effect of a risk-stratified grade of NS technique on early return of urinary continence. Data were collected from 1546 patients who underwent RALP by a single surgeon at a tertiary care center from December 2008 to October 2011. Patients were categorized preoperatively by a risk-stratified approach into risk grades 1-4, with risk grade 1 patients more likely to receive NS grade 1 or complete hammock preservation. This categorization was also conducted for risk grades 2-4, with grade 4 patients receiving a non-NS procedure. Risk-stratified grading of NS RALP. Univariate and multivariate analysis identified predictors of early return of urinary continence, defined as no pad use at ≤ 12 wk postoperatively. Early return of continence was achieved by 791 of 1417 men (55.8%); of those, 199 of 277 (71.8%) were in NS grade 1, 440 of 805 (54.7%) were in NS grade 2, 132 of 289 (45.7%) were in NS grade 3, and 20 of 46 (43.5%) were in NS grade 4 (preturn of urinary continence when NS grade 1 was the reference variable compared with NS grade 2 (preturn of urinary continence. Positive surgical margin rates were 7.2% (20 of 277) of grade 1 cases, 7.6% (61 of 805) of grade 2 cases, 7.6% (22 of 289) of grade 3 cases, and 17.4% (8 of 46) of grade 4 cases (p=0.111). Extraprostatic extension occurred in 6.1% (17 of 277) of NS grade 1 cases, 17.5% (141 of 805) of NS grade 2 cases, 42.5% (123 of 289) of NS grade 3 cases, and 63% (29 of 46) of NS grade 4 cases (prisk-stratified grade of NS technique and early return of urinary continence as patients with a lower grade (higher degree) of NS achieved an early return of urinary continence without compromising oncologic safety. Copyright © 2012 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  11. [Organisation and early outcome after radical prostatectomy in Denmark 2004-2007

    DEFF Research Database (Denmark)

    Borre, M.; Iversen, P.; Bendixen, A.

    2008-01-01

    .2%. CONCLUSION: There is an increasing rate of radical prostatectomies in Denmark. It is proposed that a national database be established to monitor early and long-term outcomes, including the role of surgical technique (nerve sparing, laparoscopic/robotic surgery, etc.) in order to ensure optimal organisation...

  12. [Organisation and early outcome after radical prostatectomy in Denmark 2004-2007

    DEFF Research Database (Denmark)

    Borre, M.; Iversen, P.; Bendixen, A.

    2008-01-01

    .2%. CONCLUSION: There is an increasing rate of radical prostatectomies in Denmark. It is proposed that a national database be established to monitor early and long-term outcomes, including the role of surgical technique (nerve sparing, laparoscopic/robotic surgery, etc.) in order to ensure optimal organisation...

  13. ProACT for stress urinary incontinence after radical prostatectomy.

    NARCIS (Netherlands)

    Martens, F.M.J.; Lampe, M.; Heesakkers, J.P.F.A.

    2009-01-01

    INTRODUCTION: Stress urinary incontinence is a bothersome complication of radical prostatectomy. Surgical treatment consists of the artificial urinary sphincter (AUS), the male sling and bulk injections. This study presents the results of the first series of implantations of ProACT in the Netherland

  14. Impact of obesity on surgical outcomes following open radical prostatectomy.

    NARCIS (Netherlands)

    Roermund, J.G. van; Basten, J.P. van; Kiemeney, L.A.L.M.; Karthaus, H.F.M.; Witjes, J.A.

    2009-01-01

    OBJECTIVE: The increasing incidence of both obesity and prostate cancer (PCa) detection will confront the urologist more often with obese men having PCa. It is unknown whether obesity affects the surgical and oncological outcomes following open radical retropubic prostatectomy (RRP). Knowledge

  15. ProACT for stress urinary incontinence after radical prostatectomy.

    NARCIS (Netherlands)

    Martens, F.M.J.; Lampe, M.; Heesakkers, J.P.F.A.

    2009-01-01

    INTRODUCTION: Stress urinary incontinence is a bothersome complication of radical prostatectomy. Surgical treatment consists of the artificial urinary sphincter (AUS), the male sling and bulk injections. This study presents the results of the first series of implantations of ProACT in the Netherland

  16. Cystectomy with orthotopic reconstruction following radical retropubic prostatectomy

    Directory of Open Access Journals (Sweden)

    Ari Miotto Jr

    2004-04-01

    Full Text Available The development of infiltrative bladder carcinoma in patients previously treated with radical prostatectomy due to prostate adenocarcinoma represents a challenging perspective. Radical cystectomy remains the best option for invasive bladder cancer, however, there are few reports about the best approach to such individuals. Nevertheless, despite possible technical difficulties found during surgery, the orthotopic urinary shunt is a reasonable option in selected cases.

  17. Initial consecutive 125 cases of robotic assisted laparoscopic radical prostatectomy performed in Ireland's first robotic radical prostatectomy centre.

    LENUS (Irish Health Repository)

    Bouchier-Hayes, D M

    2012-03-01

    We examined the patient characteristics, operative proceedings and the outcomes of the initial series of 125 cases of robot-assisted laparoscopic radical prostatectomy (RALRP) in an independent hospital in Ireland, performed by two surgeons using the da Vinci(®) surgical system.

  18. Surgical complications of radical retropubic prostatectomy: A single institutional experience of seven years

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    Neeraj K Goyal

    2007-01-01

    Full Text Available Aim: To determine the surgical complications of open retropubic radical prostatectomy. Materials and Methods: Fifty-nine cases of localized prostate cancer underwent retropubic radical prostatectomy in our department in the last seven years. Standard technique of open retropubic radical prostatectomy as described by Walsh was used. During follow-up cancer control and quality of life indices (potency and urinary continence were noted. Result: Postoperative recovery of all patients except one was excellent. This patient required cardio-respiratory support and nine units of blood transfusion. Forty-nine out of 52 patients were continent, two had stress incontinence and one was totally incontinent at one year. Bladder neck contracture was present in eight out of 52 patients at one year. Forty-five patients were impotent at one year with or without oral tablet sildenafil. Cancer control was present in 45 out of 52 cases. Seven cases had biochemical failure at one year. Conclusion: Though retropubic radical prostatectomy is the standard treatment for early prostate cancer it is not without complications. It has a steep learning curve. More number of cases and refinement in technique is required to achieve world-class results.

  19. Open radical retropubic prostatectomy 2007: the true minimally invasive surgery for localized prostate cancer?

    Science.gov (United States)

    Nosnik, Israel P; Gan, Tong J; Moul, Judd W

    2007-09-01

    The introduction of robotic laparoscopic assisted prostatectomy at our institution and nationwide has been a great advancement and has caused us to focus and fine-tune our goal for improvements in prostate cancer outcomes whether the patient elects for robotic laparoscopic assisted prostatectomy or open minimally invasive radical retropubic prostatectomy. While these authors favor the open technique performed by highly skilled urologic surgical oncologists, the lessons we have learned to date suggest that it is the skill of the surgeon that determines outcome, regardless of whether or not the operation is performed by an open or robotic laparoscopic technique. The concepts we have articulated here are related to resection and avoidance of positive margins, limited intraoperative blood loss and pain control, which allow equivalence in these outcome areas, regardless of technique.

  20. MRI-derived Restriction Spectrum Imaging Cellularity Index is Associated with High Grade Prostate Cancer on Radical Prostatectomy Specimens

    OpenAIRE

    Michael Andre Liss; White, Nathan S.; J. Kellogg Parsons; Schenker-Ahmed, Natalie M.; Rebecca eRakow-Penner; Kuperman, Joshua M.; Hauke eBartsch; Choi, Hyung W.; Mattrey, Robert F.; Bradley, William G.; Ahmed eShabaik; Jiaoti eHuang; Daniel J. A. Margolis; Raman, Steven S.; Marks, Leonard S.

    2015-01-01

    Objectives: We evaluate a novel magnetic resonance imaging (MRI) technique to improve detection of aggressive prostate cancer. Methods: We performed a retrospective analysis of presurgical prostate MRI scans using an advanced diffusion weighted imaging technique called Restriction Spectrum Imaging (RSI), which can be presented as a normalized z-score statistic (RSI z-score). Scans were acquired prior to radical prostatectomy. Prostatectomy specimens were processed using whole mount sectioning...

  1. MRI-Derived Restriction Spectrum Imaging Cellularity Index is Associated with High Grade Prostate Cancer on Radical Prostatectomy Specimens

    OpenAIRE

    Liss, Michael A.; White, Nathan S.; Parsons, J. Kellogg; Schenker-Ahmed, Natalie M.; Rakow-Penner, Rebecca; Kuperman, Joshua M.; Bartsch, Hauke; Choi, Hyung W.; Mattrey, Robert F.; Bradley, William G.; Shabaik, Ahmed; Huang, Jiaoti; Daniel J. A. Margolis; Raman, Steven S.; Marks, Leonard S.

    2015-01-01

    Purpose: We evaluate a novel magnetic resonance imaging (MRI) technique to improve detection of aggressive prostate cancer (PCa). Materials and Methods: We performed a retrospective analysis of pre-surgical prostate MRI scans using an advanced diffusion-weighted imaging technique called restriction spectrum imaging (RSI), which can be presented as a normalized z-score statistic. Scans were acquired prior to radical prostatectomy. Prostatectomy specimens were processed using whole-mount sec...

  2. Radical perineal prostatectomy - the contemporary resurgence of a genuinely minimally invasive procedure: Procedure outline. Comparison of the advantages, disadvantages, and outcomes of different surgical techniques of treating organ-confined prostate cancer (PCa). A literature review with special focus on perineal prostatectomy.

    Science.gov (United States)

    Wroński, Stanisław

    2012-01-01

    Surgery plays a central role in the management of organ-confined prostate cancer (PCa). Four types of prostatectomy are currently practiced: perineal, retropubic, laparoscopic, and robot-assisted. The qualification criteria for all types are similar. Radical perineal prostatectomy (RPP) was the first method introduced into clinical practice, however, it has been neglected in favor of other procedures. Its resurgence has been facilitated by a multitude of advantages. Unfortunately, nowadays most urologists are not familiar with the perineal approach though many centers have begun to implement it. This manuscript presents the technique of RPP used in the author's institution. It also reviews a vast body of literature on the four techniques of prostatectomy including their advantages and outcomes. The data was collected from the literature and medical databases. RPP proves to be a very efficacious, cost-effective treatment option for localized PCa. The outcomes of RPP, as defined by continence, potency, and complication rate, are equivalent to those accomplished by other methods.

  3. Outcomes after robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Declan G.Murphy; Benjamin J.Challacombe; Anthony J.Costello

    2009-01-01

    Robot-assisted laparoscopic radical prostatectomy (RALRP) using the da Vinci surgical system is now in widespread use in many countries where economic conditions allow the installation of this expensive technology.Controversy has surrounded the procedure since it was first performed in 2000,with many critics highlighting the lack of evidence to support its use.However,despite the lack of level I evidence,many large studies of patients have confirmed that the procedure is feasible and safe,with low morbidity.Available longer-term oncological data seem to show that outcomes from the robotic approach at least match those of traditional open radical prostatectomy.Functional outcomes also seem satisfactory,although randomized controlled trials are lacking.This paper reviews the current status of RALRP with respect to perioperative data and complications and oncologic and functional outcomes.

  4. Overactive bladder is a negative predictor of achieving continence after robot-assisted radical prostatectomy.

    Science.gov (United States)

    Yamada, Yuta; Fujimura, Tetsuya; Fukuhara, Hiroshi; Sugihara, Toru; Miyazaki, Hideyo; Nakagawa, Tohru; Kume, Haruki; Igawa, Yasuhiko; Homma, Yukio

    2017-10-01

    To investigate predictors of continence outcomes after robot-assisted radical prostatectomy. Clinical records of 272 patients who underwent robot-assisted radical prostatectomy were investigated. Preoperative Overactive Bladder Symptom Score, International Prostate Symptom Score and clinicopathological factors were investigated, and relationships between factors and recovery of continence after robot-assisted radical prostatectomy were assessed. The presence of overactive bladder was defined as having urgency for more than once a week and having ≥3 points according to the Overactive Bladder Symptom Score. Age (≤66 years) was significantly associated with continence within 6 months after robot-assisted radical prostatectomy (P = 0.033). The absence of overactive bladder and lower Overactive Bladder Symptom Score (robot-assisted radical prostatectomy, Kaplan-Meier curves showed earlier recovery in "age ≤66 years," "prostate weight ≤40 g" and "overactive bladder symptom score robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  5. Editor’s Pick: Recent Developments in Minimally Invasive Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Jarno Riikonen

    2015-01-01

    Full Text Available Minimally invasive surgery has gained a dominant status in prostate cancer surgery during the last decade. The benefits of minimally invasive prostatectomy were demonstrated by pioneers of conventional laparoscopic prostatectomy, however, the real domination of laparoscopy in radical prostatectomy (RP started after the dissemination of robotic surgery. Robot-assisted surgery still remains the most widespread method to perform minimally invasive RP, although the recent evolution of laparoscopic technology and instruments has evoked interest in conventional laparoscopy again. The recent developments in the technique of RP are focused on decreasing invasiveness and complications. The recent methods to improve postoperative functional outcome of RP can be utilised without compromising the oncological results.

  6. Laparoscopic Radical Prostatectomy in the ERA of Robot-Assisted Technology

    Directory of Open Access Journals (Sweden)

    Iason Kyriazis

    2014-05-01

    Full Text Available In this work the outcomes of laparoscopic radical prostatectomy (LRP with regard to perioperative morbidity, oncological effectiveness, as well as postoperative continence and potency preservation are being reviewed and compared with the gold standard open radical prostatectomy. In addition, the limitations of LRP are being presented in contrast to the advancement offered by the emerging robotic assisted radical prostatectomy in an attempt to reveal whether laparoscopic approach still has a role in the era of robot-assisted technology.

  7. Extended lymph node dissection in robotic radical prostatectomy: Current status

    Directory of Open Access Journals (Sweden)

    Sameer Chopra

    2016-01-01

    Full Text Available Introduction: The role and extent of extended pelvic lymph node dissection (ePLND during radical prostatectomy (RP for prostate cancer patients remains unclear. Materials and Methods: A PubMed literature search was performed for studies reporting on treatment regimens and outcomes in patients with prostate cancer treated by RP and extended lymph node dissection between 1999 and 2013. Results: Studies have shown that RP can improve progression-free and overall survival in patients with lymph node-positive prostate cancer. While this finding requires further validation, it does allow urologists to question the former treatment paradigm of aborting surgery when lymph node invasion from prostate cancer occurred, especially in patients with limited lymph node tumor infiltration. Studies show that intermediate- and high-risk patients should undergo ePLND up to the common iliac arteries in order to improve nodal staging. Conclusions: Evidence from the literature suggests that RP with ePLND improves survival in lymph node-positive prostate cancer. While studies have shown promising results, further improvements and understanding of the surgical technique and post-operative treatment are required to improve treatment for prostate cancer patients with lymph node involvement.

  8. Complications of radical retropubic prostatectomy – our experience

    Directory of Open Access Journals (Sweden)

    Ovidiu Bratu

    2015-12-01

    Full Text Available Introduction: Radical retropubic prostatectomy represents in its various forms (open, laparoscopic and robotic the "gold standard" treatment for adenocarcinoma of the prostate. Unfortunately like al treatment solutions it has its shortcomings. Retropubic radical prostatectomy, external beam radiation therapy and brachytherapy are the curative options. Materials and Method: The experience of Clinic of Urology from Central Military Hospital representing more than 100 cases was analyzed . Classical open retropubic prostatectomy was performed in all cases. We focused in this paper on intraoperative complications and also precocious and late postoperative complications. Results: Our results are matching the other centers in terms of intraoperative complications (blood loss, early postoperative complications (hematuria, urinary tract infection, lymphatic drainage or late postoperative complications (erectile dysfunction and urinary incontinence. However none of these complications are to be underestimated Conclusions: The limits of this intervention can be pushed a litle bit further, in our opinion the age factor is a relative one, some of these patients having a longer than 10 years life expectancy. It provides good oncological outcome with manageable complications most of the times.

  9. Robot-assisted radical prostatectomy in Brazil: preliminary results

    Directory of Open Access Journals (Sweden)

    Jose Roberto Colombo Junior

    2009-12-01

    Full Text Available Purpose: To report the initial experience on robot-assisted radical prostatectomy in Brazil. Methods: From March 2008 to March 2009, a hundred patients were treated with robot-assisted radical prostatectomy. Patient’s demographic data, as well as perioperative results of the procedures, are described in this study. Rresults: Patients’ mean age and mean PSA were 58 years and 7.58 ng/ml, respectively. All procedures were performed through transperitoneal approach, with a mean bleeding of 480 mL and surgical time of 298 minutes. A surgical margin affected by cancer was present in 16% of the cases. There were four complications: bleeding requiring transfusion (two cases, rectal perforation corrected on the spot and inadequate functioning of the robot. There was no conversion to another access or obit occurrences in this caseload. Cconclusions: Robot-assisted prostatectomy is a reality in Brazil and the results herein presented demonstrate that this procedure can be safely performed. Long-term follow-up is still necessary to assess the oncological and functional outcomes.

  10. Management of erectile dysfunction post-radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Saleh A

    2015-02-01

    Full Text Available Alan Saleh, Hamid Abboudi, MB Ghazal-Aswad, Erik K Mayer, Justin A Vale Division of Surgery and Cancer, Imperial College Healthcare NHS Trust, St Mary's Hospital, London, UK Abstract: Radical prostatectomy is a commonly performed procedure for the treatment of localized prostate cancer. One of the long-term complications is erectile dysfunction. There is little consensus on the optimal management; however, it is agreed that treatment must be prompt to prevent fibrosis and increase oxygenation of penile tissue. It is vital that patient expectations are discussed, a realistic time frame of treatment provided, and treatment started as close to the prostatectomy as possible. Current treatment regimens rely on phosphodiesterase 5 inhibitors as a first-line therapy, with vacuum erection devices and intraurethral suppositories of alprostadil as possible treatment combination options. With nonresponders to these therapies, intracavernosal injections are resorted to. As a final measure, patients undergo the highly invasive penile prosthesis implantation. There is no uniform, objective treatment program for erectile dysfunction post-radical prostatectomy. Management plans are based on poorly conducted and often underpowered studies in combination with physician and patient preferences. They involve the aforementioned drugs and treatment methods in different sequences and doses. Prospective treatments include dietary supplements and gene therapy, which have shown promise with there proposed mechanisms of improving erectile function but are yet to be applied successfully in human patients. Keywords: erectile dysfunction, phosphodiesterase 5 inhibitors, vacuum erection devices, intraurethral suppositories, intracavernosal injections

  11. Level of education and mortality after radical prostatectomy.

    Science.gov (United States)

    Froehner, Michael; Koch, Rainer; Propping, Stefan; Liebeheim, Dorothea; Hübler, Matthias; Baretton, Gustavo B; Hakenberg, Oliver W; Wirth, Manfred P

    2017-01-01

    Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62-0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40-0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55-0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79-1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.

  12. Athermal bladder neck dissection during robot-assisted radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Fabrizio Dal Moro

    2014-06-01

    Full Text Available Introduction With improved understanding of the precise anatomy, surgical techniques during robot-assisted radical prostatectomy (RARP have been refined, with the aim of improving functional outcomes without compromising oncological adequacy and results. Nevertheless, postoperative urinary incontinence remains a frustrating side-effect. Anatomically, bladder neck (BN serves as an internal sphincter. The longitudinal fibres of BN may be identified and isolated with a meticulous dissection at the prostato-vesical junction, contributing to earlier return of urinary continence. The purpose of this video is to show an anatomical athermal dissection of BN during RARP.Materials and Methods After incision of endopelvic fascia and anterior defatting, the morphology of prostate not only laterally, but also at the level of bladder-prostatic junction is well visualized. With an athermal dissection of the plane between prostate and bladder we can minimize the traumatic effects on the longitudinal fibres of BN. A cold section of the preserved BN permits the complete preservation of integrity of this sphincteric structure.Results With this technique we preserve the longitudinal fibres of BN, allowing the sparing of the sphincteric mechanism of BN. The finding of a difficult athermal dissection of these plans may make you suspect the presence of an infiltration, suggesting to sacrifice BN in order to avoid a positive surgical margin. In our series no increase of PSM has been recorded using this technique.Conclusions This surgical technique preserving the natural BN mechanism appears to improve urinary continence, allowing at the same time an easy identification of a neoplastic infiltration.

  13. Selective indication for check cystogram before catheter removal following robot assisted radical prostatectomy

    OpenAIRE

    Rajiv Yadav; Somendra Bansal; Narmada P Gupta

    2016-01-01

    Introduction: With the improvement in anastomotic technique, it is rare to find anastomotic site leak after robot-assisted radical prostatectomy (RARP). It may not always be necessary to do regular check cystogram before catheter removal. We evaluated our 230 consecutive RARP patients and their cystograms to determine the indications for selective use of cystogram before catheter removal. Materials and Methods: We reviewed our prospectively collected RARP database of 230 consecutive patie...

  14. Total pelvic floor reconstruction during non-nerve-sparing laparoscopic radical prostatectomy: impact on early recovery of urinary continence.

    Science.gov (United States)

    Hoshi, Akio; Nitta, Masahiro; Shimizu, Yuuki; Higure, Taro; Kawakami, Masayoshi; Nakajima, Nobuyuki; Hanai, Kazuya; Nomoto, Takeshi; Usui, Yukio; Terachi, Toshiro

    2014-11-01

    To develop a modified technique of "total pelvic floor reconstruction" during non-nerve-sparing laparoscopic radical prostatectomy, and to determine its effect on postoperative urinary outcomes. A total of 128 patients who underwent non-nerve-sparing laparoscopic radical prostatectomy were evaluated, including 81 with total pelvic floor reconstruction and 47 with non-total pelvic floor reconstruction. Nerve-sparing cases were excluded. Urinary outcomes were assessed with self-administrated questionnaires (Expanded Prostate Cancer Index Composite) at 1, 3, 6 and 12 months after laparoscopic radical prostatectomy. The total pelvic floor reconstruction technique included two concepts involving posterior and anterior reconstructions. In posterior reconstruction, Denonvilliers' fascia was approximated to the bladder neck and the median dorsal raphe by slipknot. The anterior surface of the bladder-neck was approximated to the anterior detrusor apron and the puboprostatic ligament collar for anterior reconstruction. There were no significant differences between the two groups in the patients' characteristics, and in perioperative and oncological outcomes. In the total pelvic floor reconstruction group, the continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy were 45.7%, 71.4%, and 84.6%, respectively. In the non-total pelvic floor reconstruction group, the continence rates were 26.1%, 46.8% and 60.9%, respectively. The total pelvic floor reconstruction technique resulted in significantly higher continence rates at 3, 6 and 12 months after laparoscopic radical prostatectomy, respectively (all P floor reconstruction group (mean 7.7 months) than in the non-total pelvic floor reconstruction group (mean 9.8 months; P = 0.0003). The total pelvic floor reconstruction technique allows preservation of the blood supply to the urethra and physical reinforcement of the pelvic floor. Therefore, this technique is likely to improve urinary continence

  15. Recent neuroanatomical studies on the neurovascular bundle of the prostate and cavernosal nerves: clinical reflections on radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    Selcuk Yucel; Tibet Erdogru; Mehmet Baykara

    2005-01-01

    The neurovascular bundle of the prostate and cavernosal nerves have been used to describe the same structure ever since the publication of the first studies on the neuroanatomy of the lower urogenital tract of men, studies that were prompted by postoperative complications arising from radical prostatectomy. In urological surgery every effort is made to preserve or restore the neurovascular bundle of the prostate to avoid erectile dysfunction (ED). However,the postoperative potency rates are yet to be satisfactory despite all advancements in radical prostatectomy technique.As the technology associated with urological surgery develops and topographical studies on neuroanatomy are cultivated,new observations seriously challenge the classical teachings on the topography of the neurovascular bundle of the prostate and the cavernosal nerves. The present review revisits the classical and most recent data on the topographical anatomy of the neurovascular bundle of the prostate and cavernosal nerves and their implications on radical prostatectomy techniques.

  16. [Current status and future prospect of robot-assisted radical prostatectomy].

    Science.gov (United States)

    Miyake, Hideaki; Fujisawa, Masato

    2016-01-01

    Although radical retropubic prostatectomy had long been the mainstay as the surgical treatment for patients with localized prostate cancer, robot-assisted radical prostatectomy (RARP) has recently been achieving increasing acceptance, resulting in the leading option for treating such patients in the United States, and it has been progressively expanding in other countries, including Japan. To date, however, there have been limited data concerning prospective studies or randomized trials showing the superiority of RARP over other surgical approaches. In this review, we attempted to summarize the current status of RARP based on available evidence as well as the experience at our institution, and to discuss the future prospect of this novel system as a major surgical technique for localized prostate cancer.

  17. 达芬奇机器人辅助腹腔镜前列腺癌根治术的手术要点(附光盘)%Surgical techniques of Da Vinci robot-assisted laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进; 何威; 王晓晶; 钟山

    2013-01-01

    达芬奇机器人手术系统在泌尿外科领域的广泛应用和发展是当今世界临床医学发展的里程碑.达芬奇机器人辅助腹腔镜前列腺癌根治术(robot-assisted laparoscopic radical prostatectomy,RLRP)是所有泌尿外科机器人手术中,与开放和传统腹腔镜手术相比最具明显优势的微创手术.目前在前列腺癌高发的欧美国家,RLRP几乎成为治疗局限性前列腺癌的金标准,在国内RLRP也已取得快速发展.本文就机器人手术系统的国内外发展状况和发展趋势,RLRP的适应证和禁忌证、手术步骤和技巧、优缺点等做一概述.%The wide application and development of Da Vinci surgical system in the urology is a milestone in the development of clinical medicine. Da Vinci robot-assisted laparoscopic radical prostatectomy(RLRP)has the most obvious advantages of minimally invasive surgery among all robotic surgeries in urology compared to the laparoscopic surgeries. In the developed regions with high incidence of prostate cancer,RLRP has almost become the gold standard for the treatment of localized prostate cancer. Rapid development of RLRP has also been achieved in China. This review gives a brief account of the current situation and development trend of robotic surgical system and summarizes the main aspects of RLRP including the indications and contraindications, surgical procedures and techniques, ad vantages and disadvantages and so on.

  18. TECHNICAL CHARACTERISTICS OF RADICAL PROSTATECTOMY FOR EARLY CONTINENCE RECOVERY

    Directory of Open Access Journals (Sweden)

    V. A. Perepechay

    2014-07-01

    Full Text Available The paper presents the technical characteristics of radical prostatectomy (RPE for early continence recovery in patients with prostate cancer. Restoration of the fascial structures of the small pelvis after RPE has been found to promote early urinary continence recovery. A method for total restoration of the fascial structures of the small pelvis (an operation after A. Tewari and a procedure for performing posterior suspension of urethrocystic neoanastomosis in Denonvilliers’ fascia length deficit are considered, which show the similar results in the time of continence recovery.

  19. Prediction of biochemical failure in localized carcinoma of prostate after radical prostatectomy by neuro-fuzzy

    Directory of Open Access Journals (Sweden)

    Neeraj Kumar Goyal

    2007-01-01

    Full Text Available Objective: To predict biochemical failure in localized prostate cancer after radical prostatectomy using preoperative variables. Materials and Methods: Twenty-six patients of early carcinoma of prostate underwent open retropubic radical prostatectomy from June 2002 to June 2006. Preoperative variables included age, family history, digital rectal examination, serum prostatic specific antigen (S. PSA, prostate biopsy Gleason score, MRI of pelvis variables like periprostatic extension, seminal vesical invasion, weight of gland and pathological stage. With application of neuro-fuzzy, these variables were fed into system as input and output, that is S. PSA at six months (predicted value was calculated. Neuro-fuzzy system is a system to combine fuzzy system with learning techniques derived from neural networks. Here, we applied Takagi Sugeno Kang model (TSK due to its close solution to our aim. All the patients were followed up for a minimum of six months. At six month S. PSA of all patients was done (observed value. Predicted and observed values were compared. Result: Predicted and observed values were plotted on 1:1 slop line. Coefficient of correlation was 0.9935. Conclusion: Coefficient of correlation is close to one. It indicates that the neuro-fuzzy is accurate in predicting biochemical failure in localized carcinoma of prostate after radical prostatectomy.

  20. Radical prostatectomy in clinically localized high-risk prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Berg, Kasper Drimer; Christensen, Ib Jarle;

    2013-01-01

    Abstract Objective. The optimal therapeutic strategy for high-risk localized prostate cancer (PCa) is controversial. Supported by randomized trials, the combination of external beam radiation therapy (EBRT) and endocrine therapy (ET) is advocated by many, while radical prostatectomy (RP) is regar......Abstract Objective. The optimal therapeutic strategy for high-risk localized prostate cancer (PCa) is controversial. Supported by randomized trials, the combination of external beam radiation therapy (EBRT) and endocrine therapy (ET) is advocated by many, while radical prostatectomy (RP......) is regarded as primary therapy by others. This study examined the outcome for high-risk localized PCa patients treated with RP. Material and methods. Of 1300 patients who underwent RP, 231 were identified as high-risk. Patients were followed for biochemical recurrence (BCR) (defined as prostate......-specific antigen ≥ 0.2 ng/ml), metastatic disease and survival. Excluding node-positive patients, none of the patients received adjuvant therapy before BCR was confirmed. Univariate and multivariate analysis was performed with Kaplan-Meier and Cox proportional hazard models. Results. Median follow-up was 4.4 years...

  1. Anatomic and technical considerations for optimizing recovery of urinary function during robotic-assisted radical prostatectomy.

    Science.gov (United States)

    Vora, Anup A; Dajani, Daoud; Lynch, John H; Kowalczyk, Keith J

    2013-01-01

    The advent of robotic-assisted radical prostatectomy purported fewer complications including postprostatectomy incontinence (PPI). PPI is associated with worse quality of life. We evaluate recently reported robot-assisted radical prostatectomy surgical techniques aimed at limiting PPI, describe their anatomic basis and summarize their outcomes. RARP techniques to reduce PPI include bladder neck preservation, bladder neck reconstruction, urethral length preservation, periurethral suspension stitch, posterior reconstruction, combined anterior and posterior reconstruction, preservation of the endopelvic fascia, complete anterior preservation, selective suturing of dorsal venous complex and nerve sparing approach. Outcomes of reconstructive techniques seem to be conflicting, whereas outcomes of techniques aiming to preserve the native urinary continence system seem to hasten urinary function recovery. However, few of these techniques have been shown to affect long-term urinary continence. Surgical techniques preserving the natural urinary continence mechanism appear to improve short-term urinary continence, whereas techniques reconstructing pelvic anatomy have mixed results. The search for the ideal technique to minimize PPI remains hampered by the lack of prospective multi-institutional studies and the long-term follow up. Although reconstructive techniques are safe with few drawbacks, meticulous surgical technique and preservation of the natural continence mechanism should remain the mainstay of PPI prevention.

  2. First case of 18F-FACBC PET/CT-guided salvage radiotherapy for local relapse after radical prostatectomy with negative 11C-Choline PET/CT and multiparametric MRI: New imaging techniques may improve patient selection

    Directory of Open Access Journals (Sweden)

    Eugenio Brunocilla

    2014-09-01

    Full Text Available We present the first case of salvage radiotherapy based on the results of 18F-FACBC PET/CT performed for a PSA relapse after radical prostatectomy. The patients underwent 11CCholine PET/CT and multiparametric MRI that were negative while 18F-FACBC PET/CT visualized a suspected local relapse confirmed by transrectal ultrasound-guided biopsy. No distant relapse was detected. Thus the patient was submitted to salvage radiotherapy in the prostatic fossa. After 20 months of follow-up, the PSA was undetectable and 18F-FACBC PET/CT was negative. Salvage radiotherapy after surgery, provided that it is administered at the earliest evidence of the biochemical relapse, may improve cancer control and favourably influence the course of disease as well as the adjuvant approach. New imaging techniques may increase the efficacy of the salvage radiotherapy thus helping in the selection of the patients. Preliminary clinical reports showed an improvement in the detection rate of 20-40% of 18F-FACBC in comparison with 11C-Choline for the detection of disease relapse after radical prostatecomy, rendering the 18F-FACBC the potential radiotracer of the future for prostate cancer.

  3. First case of 18F-FACBC PET/CT-guided salvage radiotherapy for local relapse after radical prostatectomy with negative 11C-Choline PET/CT and multiparametric MRI: New imaging techniques may improve patient selection.

    Science.gov (United States)

    Brunocilla, Eugenio; Schiavina, Riccardo; Nanni, Cristina; Borghesi, Marco; Cevenini, Matteo; Molinaroli, Enrico; Vagnoni, Valerio; Castellucci, Paolo; Ceci, Francesco; Fanti, Stefano; Gaudiano, Caterina; Golfieri, Rita; Martorana, Giuseppe

    2014-09-30

    We present the first case of salvage radiotherapy based on the results of 18F-FACBC PET/CT performed for a PSA relapse after radical prostatectomy. The patients underwent 11CCholine PET/CT and multiparametric MRI that were negative while 18F-FACBC PET/CT visualized a suspected local relapse confirmed by transrectal ultrasound-guided biopsy. No distant relapse was detected. Thus the patient was submitted to salvage radiotherapy in the prostatic fossa. After 20 months of follow-up, the PSA was undetectable and 18F-FACBC PET/CT was negative. Salvage radiotherapy after surgery, provided that it is administered at the earliest evidence of the biochemical relapse, may improve cancer control and favourably influence the course of disease as well as the adjuvant approach. New imaging techniques may increase the efficacy of the salvage radiotherapy thus helping in the selection of the patients. Preliminary clinical reports showed an improvement in the detection rate of 20-40% of 18F-FACBC in comparison with 11C-Choline for the detection of disease relapse after radical prostatecomy, rendering the 18F-FACBC the potential radiotracer of the future for prostate cancer.

  4. Anatomic Considerations for Radical Retropubic Prostatectomy in an Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Dennis Gyomber

    2009-01-01

    Full Text Available This is the first report of a radical retropubic prostatectomy (RRP in an achondroplastic dwarf. We highlight the pelvic anatomy, precluding laparoscopic or robotic prostatectomy, and making open surgery extremely difficult. We review relevant literature regarding general, urological, and orthopedic abnormalities of achondroplasia (ACH and present a clinical case. No reports of RRP in achondroplastic dwarfs exist, with only one case of an abandoned RRP due to similar pelvic anatomy in a patient with osteogenesis imperfecta. Significant lumbar lordosis found in ACH results in a short anteroposterior dimension, severely limiting access to the prostate. We present a case of a 62-year-old achondroplastic dwarf who had Gleason 3+4 disease on transrectal ultrasound-guided biopsy in four from 12 cores. Surgery was difficult due to narrow anteroposterior pelvic dimension, but achievable. Histological analysis revealed multifocal prostate cancer, with negative surgical margins and no extraprostatic extension. RRP in ACH patients, although possible, should be approached with caution due to the abnormal pelvic dimensions, and discussions regarding potential abandonment of surgery should be included during informed consent. This case highlights the preoperative use of computed tomography to assist in the surgical planning for patients with difficult pelvic anatomy.

  5. Survival after radical prostatectomy for clinically localised prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Brasso, Klaus; Christensen, Ib Jarle

    2013-01-01

    hazard of all-cause and prostate cancer-specific mortality after 10 years was 15.4% (95% confide3nce interval [CI] 13.2-17.7) and 6.6% (95% CI 4.9-8.2) respectively. CONCLUSIONS: We present the first survival analysis of a complete, nationwide cohort of men undergoing RP for localised prostate cancer......OBJECTIVES: To describe survival and cause of death in a nationwide cohort of Danish patients with prostate cancer undergoing radical prostatectomy (RP). To describe risk factors associated with prostate cancer mortality. PATIENTS AND METHODS: Observational study of 6489 men with localised prostate...... cancer treated with RP at six different hospitals in Denmark between 1995 and 2011. Survival was described using Kaplan-Meier estimates. Causes of death were obtained from the national registry and cross-checked with patient files. Cumulative incidence of death, any cause and prostate cancer...

  6. First Danish single-institution experience with radical prostatectomy

    DEFF Research Database (Denmark)

    Vrang, Marie-Louise; Røder, Martin Andreas; Vainer, Ben

    2012-01-01

    OBJECTIVE: This study aimed to investigate the impact of positive surgical margins (PSMs), stratified by location and extension, on biochemical outcome after radical retropubic prostatectomy (RRP). MATERIAL AND METHODS: The study included data from 605 consecutive patients treated with RRP...... for localized prostate cancer. Patients with node-positive disease were excluded. Biochemical recurrence-free survival was calculated using the Kaplan-Meier method. Univariate and multivariate analysis was used to assess risk factors. RESULTS: The overall PSM rate was 35.4%. Eighty-three per cent (82.......7%) of these had a single PSM, whereas 17.3% of patients had two or more PSMs. Apical PSMs were present in 42.5% and non-apical in 57.5%. The presence of any PSM had a significant impact on the risk of biochemical recurrence (BR) [hazard ratio (HR) = 3.3, p

  7. The Metabolic Syndrome and Biochemical Recurrence following Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Jennifer M. Post

    2011-01-01

    Full Text Available Metabolic syndrome refers to a set of conditions that increases the risk of cardiovascular disease and has been associated with an increased risk of prostate cancer, particularly among African American men. This study aimed to estimate the association of metabolic syndrome with biochemical recurrence (BCR in a racially diverse population. Among 383 radical prostatectomy patients, 67 patients had documented biochemical recurrence. Hypertension was significantly, positively associated with the rate of BCR (hazard ratio (HR = 2.1; 95%  CI = 1.1, 3.8. There were distinct racial differences in the prevalence of individual metabolic syndrome components; however, the observed associations with BCR did not differ appreciably by race. We conclude that hypertension may contribute to a poorer prognosis in surgically treated prostate cancer patients. Our findings suggest that targeting components of the metabolic syndrome which are potentially modifiable through lifestyle interventions may be a viable strategy to reduce risk of BCR in prostate cancer.

  8. A new nomogram to predict pathologic outcome following radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Alexandre Crippa

    2006-04-01

    Full Text Available OBJECTIVE: To develop a preoperative nomogram to predict pathologic outcome in patients submitted to radical prostatectomy for clinical localized prostate cancer. MATERIALS AND METHODS: Nine hundred and sixty patients with clinical stage T1 and T2 prostate cancer were evaluated following radical prostatectomy, and 898 were included in the study. Following a multivariate analysis, nomograms were developed incorporating serum PSA, biopsy Gleason score, and percentage of positive biopsy cores in order to predict the risks of extraprostatic tumor extension, and seminal vesicle involvement. RESULTS: In univariate analysis there was a significant association between percentage of positive biopsy cores (p < 0.001, serum PSA (p = 0.001 and biopsy Gleason score (p < 0.001 with extraprostatic tumor extension. A similar pathologic outcome was seen among tumors with Gleason score 7, and Gleason score 8 to 10. In multivariate analysis, the 3 preoperative variables showed independent significance to predict tumor extension. This allowed the development of nomogram-1 (using Gleason scores in 3 categories - 2 to 6, 7 and 8 to 10 and nomogram-2 (using Gleason scores in 2 categories - 2 to 6 and 7 to 10 to predict disease extension based on these 3 parameters. In the validation analysis, 87% and 91.1% of the time the nomograms-1 and 2, correctly predicted the probability of a pathological stage to within 10% respectively. CONCLUSION: Incorporating percent of positive biopsy cores to a nomogram that includes preoperative serum PSA and biopsy Gleason score, can accurately predict the presence of extraprostatic disease extension in patients with clinical localized prostate cancer.

  9. Comparison of Robot-Assisted Radical Prostatectomy and Open Radical Prostatectomy Outcomes: A Systematic Review and Meta-Analysis

    Science.gov (United States)

    Seo, Hyun-Ju; Lee, Na Rae; Son, Soo Kyung; Kim, Dae Keun

    2016-01-01

    Purpose To systematically update evidence on the clinical efficacy and safety of robot-assisted radical prostatectomy (RARP) versus retropubic radical prostatectomy (RRP) in patients with prostate cancer. Materials and Methods Electronic databases, including ovidMEDLINE, ovidEMBASE, the Cochrane Library, KoreaMed, KMbase, and others, were searched, collecting data from January 1980 to August 2013. The quality of selected systematic reviews was assessed using the revised assessment of multiple systematic reviews and the modified Cochrane Risk of Bias tool for non-randomized studies. Results A total of 61 studies were included, including 38 from two previous systematic reviews rated as best available evidence and 23 additional studies that were more recent. There were no randomized controlled trials. Regarding safety, the risk of complications was lower for RARP than for RRP. Among functional outcomes, the risk of urinary incontinence was lower and potency rate was significantly higher for RARP than for RRP. Regarding oncologic outcomes, positive margin rates were comparable between groups, and although biochemical recurrence (BCR) rates were lower for RARP than for RRP, recurrence-free survival was similar after long-term follow up. Conclusion RARP might be favorable to RRP in regards to post-operative complications, peri-operative outcomes, and functional outcomes. Positive margin and BCR rates were comparable between the two procedures. As most of studies were of low quality, the results presented should be interpreted with caution, and further high quality studies controlling for selection, confounding, and selective reporting biases with longer-term follow-up are needed to determine the clinical efficacy and safety of RARP. PMID:27401648

  10. Learning Curve of Robotic-assisted Radical Prostatectomy With 60 Initial Cases by a Single Surgeon

    Directory of Open Access Journals (Sweden)

    Yen-Chuan Ou

    2011-04-01

    Conclusion: After gaining experience by performing an initial 30 robotic-assisted laparoscopic radical prostatectomies, the subsequent 30 surgeries established proficiency as determined by vesicourethral anastomosis time and early continence rate.

  11. Impact of obesity on early erectile function recovery after robotic radical prostatectomy

    National Research Council Canada - National Science Library

    Uffort, Ekong E; Jensen, James C

    2011-01-01

    .... International Index of Erectile Function (IIEF-6) scores were prospectively collected with institutional review board approval, for patients who underwent robotic radical prostatectomy with bilateral nerve sparing from February 2007 to October 2009...

  12. Natural orifice transendoluminal surgery and laparoendoscopic single-site surgery: the future of laparoscopic radical prostatectomy.

    Science.gov (United States)

    Barret, Eric; Sanchez-Salas, Rafael; Ercolani, Matthew C; Rozet, Francois; Galiano, Marc; Cathelineau, Xavier

    2011-03-01

    Techniques for minimally invasive radical prostatectomy (RP) have been carefully reviewed by surgical teams worldwide in order to identify possible weaknesses and facilitate further improvement in their overall performance. The initial plan of action has been to carefully study the best-practice techniques for open RP in order to reproduce and standardize performance from the laparoscopic perspective. Similar to open surgery, the learning curve of minimally invasive RP has been well documented in terms of objective evaluation of outcomes for cancer control and functional results. Natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have recently gained momentum as feasible techniques for minimal access urological surgery. NOTES-LESS drastically limit the surgeon's ability to choose the site of entry for operative instruments; therefore, the advantages of NOTES-LESS are gained with the understanding that the surgical procedure is more technically challenging. There are several key elements in RP techniques (in particular, dorsal vein control, apex exposure and cavernosal nerve sparing) that can have significant implications on oncologic and functional results. These steps are hard to perform in a limited working field. LESS radical prostatectomy can clearly be facilitated by using robotic technology.

  13. Surgeon and Hospital Level Variation in the Costs of Robot-Assisted Radical Prostatectomy.

    Science.gov (United States)

    Cole, Alexander P; Leow, Jeffrey J; Chang, Steven L; Chung, Benjamin I; Meyer, Christian P; Kibel, Adam S; Menon, Mani; Nguyen, Paul L; Choueiri, Toni K; Reznor, Gally; Lipsitz, Stuart R; Sammon, Jesse D; Sun, Maxine; Trinh, Quoc-Dien

    2016-10-01

    We assessed surgeon and hospital level variation in robot-assisted radical prostatectomy costs and predictors of high and low cost surgery. The study population consisted of a weighted sample of 291,015 men who underwent robot-assisted radical prostatectomy for prostate cancer by 667 surgeons at 197 U.S. hospitals from 2003 to 2013. We evaluated 90-day direct hospital costs (2014 USD) in the Premier Hospital Database. High costs per robot-assisted radical prostatectomy were those above the 90th percentile and low costs were those below the 10th percentile. Mean hospital cost per robot-assisted radical prostatectomy was $11,878 (95% CI $11,804-$11,952). Mean cost was $2,837 (95% CI $2,805-$2,869) in the low cost group vs $25,906 (95% CI $24,702-$25,490) in the high cost group. Nearly a third of the variation in robot-assisted radical prostatectomy cost was attributable to hospital characteristics and more than a fifth was attributable to surgeon characteristics (R-squared 30.43% and 21.25%, respectively). High volume surgeons and hospitals (90th percentile or greater) had decreased odds of high cost surgery (surgeons: OR 0.24, 95% CI 0.11-0.54; hospitals: OR 0.105, 95% CI 0.02-0.46). The performance of robot-assisted radical prostatectomy at a high volume hospital was associated with increased odds of low cost robot-assisted radical prostatectomy (OR 839, 95% CI 122-greater than 999). This study provides insight into the role of surgeons and hospitals in robot-assisted radical prostatectomy costs. Given the substantial variability, identifying and remedying the root cause of outlier costs may yield substantial benefits. Copyright © 2016 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  14. [International Society of Urological Pathology (ISUP) Consensus Conference on handling and staging of radical prostatectomy specimens].

    Science.gov (United States)

    Compérat, Eva; Camparo, Philippe; Srigley, John; Delahunt, Brett; Egevad, Lars

    2013-06-01

    The 2009 International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens issued recommendations for standardization of pathology reporting of radical prostatectomy specimens. The conference addressed specimen handling, T2 substaging, prostate cancer volume, extraprostatic extension, lymphovascular invasion, seminal vesicle invasion, lymph node metastases and surgical margins. This review summarizes the conclusions and recommendations resulting from the consensus process. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  15. Prostatic fascia and recovery of sexual function after radical prostatectomy: Is it a "Veil of Aphrodite" or "Veil of mystery"!

    Science.gov (United States)

    Mandhani, Anil

    2009-01-01

    Sexual dysfunction is one of the most controversial aspects associated with radical prostatectomy. Since Walsh's description of neurovascular bundle there have been number of articles describing various modification to the technique of bilateral nerve sparing to augment the recovery of sexual function. There is a very thin line between performing an ideal nerve sparing and giving equally good oncological outcome in terms of negative surgical margin. "Veil of Aphrodite" nerve sparing technique was conceptualized by Menon et al. Lately other related terms have emerged in the literature e.g., "high anterior release, "curtain dissection," or "incremental nerve sparing. Does veil technique of radical prostatectomy help improve recovery of sexual function? Do mere presence of nerves in veil account for potency? Are these nerve parasympathetic? This short review tries to find the answer of these questions in contemporary world literature.

  16. Prostatic fascia and recovery of sexual function after radical prostatectomy: Is it a "Veil of Aphrodite" or "Veil of mystery"!

    Directory of Open Access Journals (Sweden)

    Anil Mandhani

    2009-01-01

    Full Text Available Sexual dysfunction is one of the most controversial aspects associated with radical prostatectomy. Since Walsh′s description of neurovascular bundle there have been number of articles describing various modification to the technique of bilateral nerve sparing to augment the recovery of sexual function. There is a very thin line between performing an ideal nerve sparing and giving equally good oncological outcome in terms of negative surgical margin. ′′Veil of Aphrodite′′ nerve sparing technique was conceptualized by Menon et al. Lately other related terms have emerged in the literature e.g., ′′high anterior release, ′′curtain dissection,′′ or ′′incremental nerve sparing. Does veil technique of radical prostatectomy help improve recovery of sexual function? Do mere presence of nerves in veil account for potency? Are these nerve parasympathetic? This short review tries to find the answer of these questions in contemporary world literature.

  17. [Positive surgical margin status after minimally invasive radical prostatectomy: a multicenter study].

    Science.gov (United States)

    Tafa, Ardit; Grasso, Angelica; Antonelli, Alessandro; Bove, Pierluigi; Celia, Antonio; Ceruti, Carlo; Crivellaro, Simone; Falsaperla, Mario; Minervini, Andrea; Parma, Paolo; Porreca, Angelo; Zaramella, Stefano; De Lorenzis, Elisa; Cozzi, Gabriele; Rocco, Bernardo

    2015-01-01

    UNLABELLED: The aim of our study is to evaluate the status of positive margins (PSMs) comparing their incidence between aparoscopic radical prostatectomy (LRP) and robot assisted radical prostatectomy (RARP) in centers with medium case-load (50-150 cases/year). We also analyzed the correlations between surgical technique, nerve-sparing approach (NS), and incidence of PSMs, stratifying our results by pathological stage. We analyzed 1992 patients who underwent RP in various urologic centers. We evaluated the incidence of PSMs, and then we compared the stage-related incidence of PSMs, for both the techniques. We did not find a statistically significant difference between the two surgical modalities in the study regarding the overall incidence of PSMs. In our retrospective study, we did not find any difference in terms of PSMs in RARP versus LRP. Our PSMs were not negligible, particularly in pT3 stages, compared with high-volume centers; surgical experience and patients' selection can be a possible explanation.

  18. Comparative Effectiveness of Cancer Control and Survival after Robot-Assisted versus Open Radical Prostatectomy.

    Science.gov (United States)

    Hu, Jim C; O'Malley, Padraic; Chughtai, Bilal; Isaacs, Abby; Mao, Jialin; Wright, Jason D; Hershman, Dawn; Sedrakyan, Art

    2017-01-01

    Robot-assisted surgery has been rapidly adopted in the U.S. for prostate cancer. Its adoption has been driven by market forces and patient preference, and debate continues regarding whether it offers improved outcomes to justify the higher cost relative to open surgery. We examined the comparative effectiveness of robot-assisted vs open radical prostatectomy in cancer control and survival in a nationally representative population. This population based observational cohort study of patients with prostate cancer undergoing robot-assisted radical prostatectomy and open radical prostatectomy during 2003 to 2012 used data captured in the SEER (Surveillance, Epidemiology, and End Results)-Medicare linked database. Propensity score matching and time to event analysis were used to compare all cause mortality, prostate cancer specific mortality and use of additional treatment after surgery. A total of 6,430 robot-assisted radical prostatectomies and 9,161 open radical prostatectomies performed during 2003 to 2012 were identified. The use of robot-assisted radical prostatectomy increased from 13.6% in 2003 to 2004 to 72.6% in 2011 to 2012. After a median followup of 6.5 years (IQR 5.2-7.9) robot-assisted radical prostatectomy was associated with an equivalent risk of all cause mortality (HR 0.85, 0.72-1.01) and similar cancer specific mortality (HR 0.85, 0.50-1.43) vs open radical prostatectomy. Robot-assisted radical prostatectomy was also associated with less use of additional treatment (HR 0.78, 0.70-0.86). Robot-assisted radical prostatectomy has comparable intermediate cancer control as evidenced by less use of additional postoperative cancer therapies and equivalent cancer specific and overall survival. Longer term followup is needed to assess for differences in prostate cancer specific survival, which was similar during intermediate followup. Our findings have significant quality and cost implications, and provide reassurance regarding the adoption of more

  19. Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence

    OpenAIRE

    Eugenio Brunocilla; Riccardo Schiavina; Marco Borghesi; Cristian Pultrone; Matteo Cevenini; Valerio Vagnoni; Giuseppe Martorana

    2014-01-01

    Objective: We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy (RRP) and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard RRP, while for the final phases the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prosta...

  20. Radiation therapy after radical prostatectomy: Implications for clinicians

    Directory of Open Access Journals (Sweden)

    Fernanda G Herrera

    2016-05-01

    Full Text Available Depending on the pathological findings, up to 60% of prostate cancer patients who undergo radical prostatectomy (RP will develop biochemical relapse and require further local treatment. Radiotherapy (RT immediately after RP may potentially eradicate any residual localized microscopic disease in the prostate bed, and it is associated with improved biochemical, clinical progression free survival, and overall survival in patients with high-risk pathological features according to published randomized trials. Offering immediate adjuvant RT to all men with high-risk pathological factors we are over-treating around 50% of patients who would anyway be cancer-free, exposing them to unnecessary toxicity and adding costs to the health care system. The current dilemma is, thus, whether to deliver adjuvant immediate RT solely on the basis of high-risk pathology, but in the absence of measurable prostate-specific antigen, or whether early salvage radiotherapy would yield equivalent outcomes. Randomized trials are ongoing to definitely answer this question. Retrospective analyses suggest that there is a dose–response favoring doses >70 Gy to the prostate bed. The evidence regarding the role of androgen deprivation therapy is emerging, and ongoing randomized trials are underway.

  1. Radiotherapy after radical prostatectomy. Immediate or early delayed?

    Energy Technology Data Exchange (ETDEWEB)

    Bottke, D.; Bartkowiak, D.; Schrader, M.; Wiegel, T. [University Hospital Ulm (Germany)

    2012-12-15

    Background: Biochemical recurrence after radical prostatectomy (RP) is associated with risk indicators, including Gleason score, preoperative PSA level, tumor stage, seminal vesicle invasion, and positive surgical margins. The 5-year biochemical progression rate among predisposed patients is as high as 50-70%. Post-RP treatment options include adjuvant radiotherapy (ART, for men with undetectable PSA) or salvage radiotherapy (SRT, for PSA persisting or re-rising above detection threshold). Presently, there are no published randomized trials evaluating ART vs. SRT directly. Methods: Published data on ART and SRT were reviewed to allow a comparison of the two treatment approaches. Results: Three randomized phase III trials demonstrated an almost 20% absolute benefit for biochemical progression-free survival after ART (60-64 Gy) compared to a 'wait and see' policy. The greatest benefit was achieved in patients with positive margins and pT3 tumors. SRT can be offered to patients with elevated PSA after RP. In 30-70% of SRT patients, PSA will decrease to an undetectable level, thus giving a second curative chance. The rate of side effects for both treatments is comparably low. The role of irradiation of pelvic lymph nodes and the additional use of hormone therapy and radiation dose are discussed. Conclusion: It remains unclear whether early SRT initiated after PSA failure is equivalent to ART. Where SRT is indicated, it should be started as early as possible. (orig.)

  2. PROGNOSTIC FACTORS OF PROSTATE CANCER BEFORE AND AFTER RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    E. I. Veliev

    2011-01-01

    Full Text Available Objective: to assess a correlation between the preoperative prognostic characteristics and the pathologic stage and to determine whether a positive surgical margin is present after radical prostatectomy (RPE.Materials and methods. The materials of 224 patients with prostate cancer (PC who had undergone RPE at the Clinic of Urology and Surgical Andrology, Russian Medical Academy of Postgraduate Education, were analyzed.Results. The patients’ median age was 62 (43–78 years. Sixty-seven (29.9 %, 46 (20.5%, and 111 (49.6 % patients were referred to as low-, moderate-, and high-risk groups, respectively. A positive surgical margin was observed in 11.9, 28.3, and 38.7 % of the patients in the low-, moderate-, and high-risk groups, respectively (р = 0.0003. The predictors of a positive surgical margin were the percent of involved biopsy specimens (R = 0.34 and Gleason score (R = 0.31 and perineural invasion. According to multivariate analysis, neither the preoperative level of prostate-specific antigen, nor the clinical stage showed any correlation with the positive surgical margin and the pathologic stage after RPE.

  3. PROGNOSTIC FACTORS OF PROSTATE CANCER BEFORE AND AFTER RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    E. I. Veliev

    2014-07-01

    Full Text Available Objective: to assess a correlation between the preoperative prognostic characteristics and the pathologic stage and to determine whether a positive surgical margin is present after radical prostatectomy (RPE.Materials and methods. The materials of 224 patients with prostate cancer (PC who had undergone RPE at the Clinic of Urology and Surgical Andrology, Russian Medical Academy of Postgraduate Education, were analyzed.Results. The patients’ median age was 62 (43–78 years. Sixty-seven (29.9 %, 46 (20.5%, and 111 (49.6 % patients were referred to as low-, moderate-, and high-risk groups, respectively. A positive surgical margin was observed in 11.9, 28.3, and 38.7 % of the patients in the low-, moderate-, and high-risk groups, respectively (р = 0.0003. The predictors of a positive surgical margin were the percent of involved biopsy specimens (R = 0.34 and Gleason score (R = 0.31 and perineural invasion. According to multivariate analysis, neither the preoperative level of prostate-specific antigen, nor the clinical stage showed any correlation with the positive surgical margin and the pathologic stage after RPE.

  4. [Risk factors of ISUP Modified Gleason score upgrading after radical prostatectomy].

    Science.gov (United States)

    Li, Xiao-dong; Qu, Gen-yi; Xu, Ning; Xue, Xue-yi; Wei, Yong; Zheng, Qing-shui; Li, Jun-feng; Cai, Hai; Lin, Yun-zhi

    2016-05-01

    To investigate the factors upgrading the International Society of Urological Pathology (ISUP) Gleason score using the specimens from preoperative prostatic biopsy and radical prostatectomy. A total of 164 patients diagnosed with prostate cancer by biopsy underwent radical prostatectomy. We retrospectively analyzed their age, prostate volume, preoperative PSA level, PSA density (PSAD) , the time interval between biopsy and surgery, the number of positive punctures, positive surgical margin, seminal vesicle invasion, lymphatic invasion, and Gleason scores from biopsy and prostatectomy. We also determined the predictors of Gleason score upgrading by logistic regression analysis. Of the 164 cases analyzed, 95 (57.93% ) showed a consistency between the Gleason score of preoperative prostatic biopsy and that after radical prostatectomy, 55 (33.54% ) increased and 14 (8.52%) decreased after prostatectomy as compared with preoperative biopsy. The prostate volume (P 60 ml group (P < 0.05). Low Gleason score of biopsy (≤ 6) and small prostate volume (≤ 40 ml) may be the predictors of Gleason score upgrading after radical prostatectomy.

  5. Oncological results at 2 years after robotic radical prostatectomy – the Romanian experience

    Science.gov (United States)

    Andras, Iulia; Coman, Radu-Tudor; Logigan, Horia; Epure, Flavia; Stanca, Dan Vasile; Coman, Ioan

    2016-01-01

    Introduction To assess the oncological outcomes of robotic radical prostatectomy in a country where there are no on-going national screening programs for prostate cancer. Material and methods Between November 2009 and November 2014, 220 robotic radical prostatectomies were performed at our Robotic Surgery Center. We already have the complete data for the 2-year follow-up of the first 105 patients, who were therefore included in the study group. Pre-operative (age, prostate-specific antigen, body-mass index, prostate volume, clinical staging, biopsy characteristics), post-operative (surgical technique, surgical margin status, lymph node status, pathological stage, Gleason score) and follow-up parameters (biochemical recurrence) were assessed. Results The global rate of positive surgical margins was 34.3%, with rates of 17.2% in stage pT2 and 55.3% in stage pT3. The most frequent localization for positive surgical margins was at the base and apex of the prostate. The positive surgical margins rate was correlated with the pre-operative prostate-specific antigen, clinical and pathological Gleason score, lymph node status and the number of positive biopsy cores. The rate of biochemical recurrence at the 2-year follow-up was 11.8%. The most important predictors for the biochemical recurrence were the positive surgical margins, pathological staging and Gleason score on the prostatectomy specimen. Conclusions Robotic surgery is validated by the oncological results at medium follow-up (2 years) for localized and locally advanced prostate cancer, even in countries where there is no on-going national screening program. PMID:27123326

  6. Hypertension, obesity and prostate cancer biochemical recurrence after radical prostatectomy.

    Science.gov (United States)

    Asmar, R; Beebe-Dimmer, J L; Korgavkar, K; Keele, G R; Cooney, K A

    2013-03-01

    The metabolic syndrome (MetS) comprises a constellation of risk factors associated with an increased risk for cardiovascular disease. Components of MetS have emerged as putative risk factors for prostate carcinoma. In this study, we examine the association between three features of the MetS (obesity, hypertension and diabetes) and the risk of biochemical recurrence (BCR) after radical prostatectomy (RP). We examined data from 1428 men in the University of Michigan Prostate Cancer Data Bank who elected to have RP as their primary treatment. We calculated body mass index from patients' weight and height measured at the time of prostate cancer diagnosis. We used the University of Michigan's Electronic Medical Record Search Engine to identify subjects with hypertension and/or diabetes before their prostate cancer diagnosis. Of 1428 men who underwent RP, 107 (8%) subsequently developed BCR with a median length of follow-up post-surgery of 3.6 years. Obesity and hypertension were each associated with an increased risk of BCR (adjusted hazard ratio (aHR) = 1.37; 95% CI 0.92-2.09 and aHR = 1.51, 95% CI 1.01-2.26), whereas no association was observed between diabetes and BCR (aHR = 0.73; 95% CI 0.40-1.33). Obesity and hypertension were each associated with an increased risk for BCR of prostate cancer after RP, independent of age at diagnosis and tumor pathological features. Given the increasing rates of obesity, hypertension and prostate cancer, a better understanding of the relationship between these entities is of significant public health importance. Elucidation of the involved pathogenic mechanisms will be needed to establish causality.

  7. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease.

    NARCIS (Netherlands)

    Magi-Galluzzi, C.; Evans, A.J.; Delahunt, B.; Epstein, J.I.; Griffiths, D.F.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Srigley, J.R.; Egevad, L.L.; Humphrey, P.A.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The International Society of Urological Pathology Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to extraprostatic extension (pT3a

  8. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling.

    NARCIS (Netherlands)

    Samaratunga, H.; Montironi, R.; True, L.; Epstein, J.I.; Griffiths, D.F.; Humphrey, P.A.; Kwast, T. van der; Wheeler, T.M.; Srigley, J.R.; Delahunt, B.; Egevad, L.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the handling and processing of radical prostatectomy specimens were coordinated by wo

  9. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease.

    NARCIS (Netherlands)

    Magi-Galluzzi, C.; Evans, A.J.; Delahunt, B.; Epstein, J.I.; Griffiths, D.F.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Srigley, J.R.; Egevad, L.L.; Humphrey, P.A.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The International Society of Urological Pathology Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to extraprostatic extension (pT3a

  10. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling.

    NARCIS (Netherlands)

    Samaratunga, H.; Montironi, R.; True, L.; Epstein, J.I.; Griffiths, D.F.; Humphrey, P.A.; Kwast, T. van der; Wheeler, T.M.; Srigley, J.R.; Delahunt, B.; Egevad, L.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the handling and processing of radical prostatectomy specimens were coordinated by wo

  11. Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Christensen, Ib Jarle

    2014-01-01

    OBJECTIVE: The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. MATERIAL AND METHODS: A prospective...... consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage...... positive biopsies for cancer (PPB), surgeon and surgical technique. RESULTS: The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Wald χ(2)) on PSA (p PSM...

  12. Comparative cost-effectiveness of robot-assisted and standard laparoscopic prostatectomy as alternatives to open radical prostatectomy for treatment of men with localised prostate cancer: a health technology assessment from the perspective of the UK National Health Service.

    Science.gov (United States)

    Close, Andrew; Robertson, Clare; Rushton, Stephen; Shirley, Mark; Vale, Luke; Ramsay, Craig; Pickard, Robert

    2013-09-01

    Robot-assisted laparoscopic prostatectomy is increasingly used compared with a standard laparoscopic technique, but it remains uncertain whether potential benefits offset higher costs. To determine the cost-effectiveness of robotic prostatectomy. We conducted a care pathway description and model-based cost-utility analysis. We studied men with localised prostate cancer able to undergo either robotic or laparoscopic prostatectomy for cure. We used data from a meta-analysis, other published literature, and costs from the UK National Health Service and commercial sources. Care received by men for 10 yr following radical prostatectomy was modelled. Clinical events, their effect on quality of life, and associated costs were synthesised assuming 200 procedures were performed annually. Over 10 yr, robotic prostatectomy was on average (95% confidence interval [CI]) £1412 (€1595) (£1304 [€1473] to £1516 [€1713]) more costly than laparoscopic prostatectomy but more effective with mean (95% CI) gain in quality-adjusted life-years (QALYs) of 0.08 (0.01-0.15). The incremental cost-effectiveness ratio (ICER) was £18 329 (€20 708) with an 80% probability that robotic prostatectomy was cost effective at a threshold of £30 000 (€33 894)/QALY. The ICER was sensitive to the throughput of cases and the relative positive margin rate favouring robotic prostatectomy. Higher costs of robotic prostatectomy may be offset by modest health gain resulting from lower risk of early harms and positive margin, provided >150 cases are performed each year. Considerable uncertainty persists in the absence of directly comparative randomised data. Copyright © 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  13. Impact of metabolic syndrome on early recovery of continence after robot-assisted radical prostatectomy.

    Science.gov (United States)

    Nishikawa, Masatomo; Watanabe, Hiromitsu; Kurahashi, Toshifumi

    2017-09-01

    To evaluate the impact of metabolic syndrome on the early recovery of urinary continence after robot-assisted radical prostatectomy. The present study included a total of 302 consecutive Japanese patients with clinically localized prostate cancer who underwent robot-assisted radical prostatectomy. In this study, postoperative urinary continence was defined as no leak or the use of a security pad. The continence status was assessed by interviews before and 1 and 3 months after robot-assisted radical prostatectomy. Metabolic syndrome was defined as follows: body mass index ≥25 kg/m(2) and two or more of the following: hypertension, diabetes mellitus and dyslipidemia. The effect of the presence of metabolic syndrome on the continence status of these patients was retrospectively examined. A total of 116 (38.4%) and 203 (67.2%) of the 302 patients were continent at 1 and 3 months after robot-assisted radical prostatectomy, respectively. A total of 31 (10.3%) patients were judged to have metabolic syndrome. Despite the operative time being longer in patients with metabolic syndrome, no significant differences were observed in the remaining preoperative, intraoperative or postoperative variables between patients with or without metabolic syndrome. On multivariate logistic regression analysis, metabolic syndrome and the duration of hospitalization were significantly correlated with the 1-month continence status. Similarly, metabolic syndrome and estimated blood loss during surgery were independent predictors of continence rates at 3 months after robot-assisted radical prostatectomy. These findings suggest that the presence of metabolic syndrome could have a significant impact on the early recovery of urinary continence after robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  14. Avoiding and managing vascular injury during robotic-assisted radical prostatectomy.

    Science.gov (United States)

    Sotelo, René; Nunez Bragayrac, Luciano A; Machuca, Victor; Garza Cortes, Roberto; Azhar, Raed A

    2015-02-01

    There has been an increase in the number of urologic procedures performed robotically assisted; this is the case for radical prostatectomy. Currently, in the USA, 67% of prostatectomies are performed robotically assisted. With this increase in robotic urologic surgery it is clear that there are more surgeons in their learning curve, where most of the complications occur. Among the complications that can occur are vascular injuries. These can occur in the initial stages of surgery, such as in accessing the abdominal cavity, as well as in the intraoperative or postoperative setting. We present the most common vascular injuries in robot-assisted radical prostatectomy, as well as their management and prevention. We believe that it is of vital importance to be able to recognize these injuries so that they can be prevented.

  15. Technical Note: Method to correlate whole-specimen histopathology of radical prostatectomy with diagnostic MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    McGrath, Deirdre M., E-mail: d.mcgrath@sheffield.ac.uk; Lee, Jenny; Foltz, Warren D. [Radiation Medicine Program, Princess Margaret Hospital, University Health Network, Toronto, Ontario M5G 2M9 (Canada); Samavati, Navid [Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9 (Canada); Jewett, Michael A. S. [Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Centre, University Health Network and University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Kwast, Theo van der [Pathology Department, University Health Network, Toronto, Ontario M5G 2C4 (Canada); Chung, Peter [Radiation Medicine Program, Princess Margaret Hospital, University Health Network and the University of Toronto, Toronto, Ontario M5G 2M9 (Canada); Ménard, Cynthia [Radiation Medicine Program, Princess Margaret Hospital, University Health Network and the University of Toronto, Toronto, Ontario M5G 2M9, Canada and Centre Hospitalier de l’Université de Montréal, 1058 Rue Saint-Denis, Montréal, Québec H2X 3J4 (Canada); Brock, Kristy K. [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan 48108 (United States)

    2016-03-15

    Purpose: Validation of MRI-guided tumor boundary delineation for targeted prostate cancer therapy is achieved via correlation with gold-standard histopathology of radical prostatectomy specimens. Challenges to accurate correlation include matching the pathology sectioning plane with the in vivo imaging slice plane and correction for the deformation that occurs between in vivo imaging and histology. A methodology is presented for matching of the histological sectioning angle and position to the in vivo imaging slices. Methods: Patients (n = 4) with biochemical failure following external beam radiotherapy underwent diagnostic MRI to confirm localized recurrence of prostate cancer, followed by salvage radical prostatectomy. High-resolution 3-D MRI of the ex vivo specimens was acquired to determine the pathology sectioning angle that best matched the in vivo imaging slice plane, using matching anatomical features and implanted fiducials. A novel sectioning device was developed to guide sectioning at the correct angle, and to assist the insertion of reference dye marks to aid in histopathology reconstruction. Results: The percentage difference in the positioning of the urethra in the ex vivo pathology sections compared to the positioning in in vivo images was reduced from 34% to 7% through slicing at the best match angle. Reference dye marks were generated, which were visible in ex vivo imaging, in the tissue sections before and after processing, and in histology sections. Conclusions: The method achieved an almost fivefold reduction in the slice-matching error and is readily implementable in combination with standard MRI technology. The technique will be employed to generate datasets for correlation of whole-specimen prostate histopathology with in vivo diagnostic MRI using 3-D deformable registration, allowing assessment of the sensitivity and specificity of MRI parameters for prostate cancer. Although developed specifically for prostate, the method is readily

  16. A Literature-Based Analysis of the Learning Curves of Laparoscopic Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Daniel W. Good

    2014-05-01

    Full Text Available There is a trend for the increased adoption of minimally invasive techniques of radical prostatectomy (RP – laparoscopic (LRP and robotic assisted (RARP – from the traditional open radical retropubic prostatectomy (ORP, popularised by Partin et al. Recently there has been a dramatic expansion in the rates of RARP being performed, and there have been many early reports postulating that the learning curve for RARP is shorter than for LRP. The aim of this study was to review the literature and analyse the length of the LRP learning curves for the various outcome measures: perioperative, oncologic, and functional outcomes. A broad search of the literature was performed in November 2013 using the PubMed database. Only studies of real patients and those from 2004 until 2013 were included; those on simulators were excluded. In total, 239 studies were identified after which 13 were included. The learning curve is a heterogeneous entity, depending entirely on the criteria used to define it. There is evidence of multiple learning curves; however the length of these is dependent on the definitions used by the authors. Few studies use the more rigorous definition of plateauing of the curve. Perioperative learning curve takes approximately 150-200 cases to plateau, oncologic curve approximately 200 cases, and the functional learning curve up to 700 cases to plateau (700 for potency, 200 cases for continence. In this review, we have analysed the literature with respect to the learning curve for LRP. It is clear that the learning curve is long. This necessitates centralising LRP to high volume centres such that surgeons, trainees, and patients are able to utilise the benefits of LRP.

  17. Effect of the modified nerve-sparing technique in open antegrade radical prostatectomy for 30 patients with prostate cancer%改良的保留神经根治性前列腺癌切除术30例

    Institute of Scientific and Technical Information of China (English)

    朱再生; 付强; 徐礼臻; 罗荣利; 张春霆; 刘全启; 陈良佑

    2015-01-01

    目的 探讨改良的保留神经根治性前列腺癌切除术的临床疗效.方法 30例前列腺癌患者采用改良根治性保留神经的前列腺切除术.改良的关键点:采用注水分离前列腺周围筋膜的方法,将Veil保留神经技术应用于开放手术中(即改良Veil保留神经技术);扩大分区(9区5组)盆腔淋巴结清扫;完整保留膀胱颈;集束捆扎背深静脉复合体;跳针套叠技术行膀胱与尿道的吻合.术后行控尿及勃起功能国际问卷-5(IIEF-5)随访.结果 患者平均年龄62岁,前列腺特异性抗原(PSA)水平平均11.9 ng/ml,手术时间平均150 min(75~240 min),术中出血量平均350 ml(100~1 600 ml),术前IIEF-5评分平均为21分,病理分期pT18例、pT2a 15例、pT2b4例、pT3a 3例.Gleason评分5分2例、6分7例、7分20例、8分1例.手术切缘阳性4例,其中2例为T2期,占T2期的10.5%(2/19),2例为T3期.无围手术期严重并发症.平均随访19个月(6-48个月),术后1个月完全控尿27例(90%),3个月达100%.术后3个月和6个月IIEF-5评分分别为13、19分,分别恢复到术前水平的40%和70%.结论 对选择性的前列腺癌患者,改良的保留神经根治性前列腺切除术较完整保留了前列腺周围所有的筋膜神经,使术后控尿及性功能得到早期、快速恢复,切缘阳性发生率低,疗效可靠.%Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy (MNS-ORP).Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer.The modified technique included: endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally;using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology;pelvic lymph node dissections (9 regions and 5 groups) were extended;bladder neck

  18. Intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: an observational study

    Directory of Open Access Journals (Sweden)

    Joaquim de Almeida Claro

    Full Text Available CONTEXT: Despite the recent improvements in performing radical retropubic prostatectomy that have led to a considerable decrease in the complication rate, erectile dysfunction still represents a major problem. Moreover, less invasive treatment options that are emerging for erectile dysfunction have not shown satisfactory results in managing these patients. OBJECTIVE: To study the efficacy and side effects of self-injection therapy in the treatment of men who had become impotent after undergoing radical prostatectomy due to prostate cancer, over a study period of 96 months. DESIGN: Observational study. SETTING: University Referral Center. PARTICIPANTS: 168 patients with erectile dysfunction, aged 43 to 78 years old, who underwent radical retropubic prostatectomy due to localized prostate cancer. PROCEDURES: The patients were treated with self-injection therapy using papaverine, phentolamine and prostaglandin E1, at home. RESULTS: This study showed an acceptable 94.6% success rate, with no life-threatening complications. In addition to this, our series presented a 13.1% cure rate with this therapy. CONCLUSION: Self-injection therapy with papaverine, phentolamine and prostaglandin E1 is effective and safe in the treatment of erectile dysfunction after radical prostatectomy.

  19. Quantification of extraprostatic extension in prostate cancer: different parameters correlated to biochemical recurrence after radical prostatectomy

    NARCIS (Netherlands)

    Veggel, B.A. van; Oort, I.M. van; Witjes, J.A.; Kiemeney, L.A.L.M.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    AIMS: Different methods to substage extraprostatic extension (EPE) were correlated with biochemical recurrence (BCR) after radical prostatectomy (RP). Methods and results: A total of 157 consecutive RP specimens with EPE were completely embedded. Twenty-three patients with adjuvant therapy or detect

  20. Prognostic relevance of number and bilaterality of positive surgical margins after radical prostatectomy.

    NARCIS (Netherlands)

    Somford, D.M.; Oort, I.M. van; Cosyns, J.P.; Witjes, J.A.; Kiemeney, L.A.L.M.; Tombal, B.

    2012-01-01

    PURPOSE: Positive surgical margin (PSM) status following radical prostatectomy (RP) is a well-established prognostic factor. The aim of the present study is to evaluate whether number of PSMs or bilaterality of PSMs might have prognostic significance for biochemical recurrence (BCR) in the populatio

  1. Identifying the Best Candidate for Radical Prostatectomy Among Patients with High-Risk Prostate Cancer

    NARCIS (Netherlands)

    Briganti, Alberto; Joniau, Steven; Gontero, Paolo; Abdollah, Firas; Passoni, Niccolo M.; Tombal, Bertrand; Marchioro, Giansilvio; Kneitz, Burkhard; Walz, Jochen; Frohneberg, Detlef; Bangma, Chris H.; Graefen, Markus; Tizzani, Alessandro; Frea, Bruno; Karnes, R. Jeffrey; Montorsi, Francesco; Van Poppel, Hein; Spahn, Martin

    2012-01-01

    Background: The current role of radical prostatectomy (RP) in patients with high-risk disease remains controversial. Objective: To identify which high-risk prostate cancer (PCa) patients might have favorable pathologic outcomes when surgically treated. Design, setting, and participants: We evaluated

  2. Combined radical prostatectomy and abdominoperineal resection for locally invasive rectal cancer

    Directory of Open Access Journals (Sweden)

    Daniel Fernández-Martínez

    2014-01-01

    CONCLUSION: En bloc radical prostatectomy and proctosigmoidectomy is feasible in selected patients with rectal cancer and invasion limited to the prostate or seminal vesicles because it provides good local tumor control and significantly improves the patient's quality of life in comparison to total pelvic exenteration.

  3. Optic Nerve Sheath Diameter Remains Constant during Robot Assisted Laparoscopic Radical Prostatectomy

    NARCIS (Netherlands)

    Verdonck, Philip; Kalmar, Alain F.; Suy, Koen; Geeraerts, Thomas; Vercauteren, Marcel; Mottrie, Alex; De Wolf, Andre M.; Hendrickx, Jan F. A.

    2014-01-01

    Background: During robot assisted laparoscopic radical prostatectomy (RALRP), a CO2 pneumoperitoneum (CO2PP) is applied and the patient is placed in a head-down position. Intracranial pressure (ICP) is expected to acutely increase under these conditions. A non-invasive method, the optic nerve sheath

  4. The value of cystography in the prediction of early urinary continence after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Yi-Huei Chang

    2016-12-01

    Conclusion: Postoperative cystography can provide information on VUAL and bladder neck condition which can predict recovery of urinary continence after radical prostatectomy. A higher VUAL and bladder neck closure were associated with a higher rate of early recovery of urinary continence.

  5. Evaluation of Clinical and MRI Staging for Prostate Cancer before Radical Prostatectomy

    Institute of Scientific and Technical Information of China (English)

    ZHONGChenyang; ZOUEnze; CHENMin; WANGWenchao; ZHAOWeifeng; WANBen; DENGShuming; YANGJianye

    2004-01-01

    To evaluate the clinical significance of clinical staging and magnetic resonance imaging (MRI) staging for prostate cancer before radical prostatectomy. Methods: Thirty-two patients with organ confined prostate cancer were reviewed to assess the accuracy of clinical staging and MRI staging to correlate with pathological staging results after radical prostatectomy. Results: 33.3% (10/30) prostate cancer patients with staging C and 3.3% (1/30) prostate cancer patients with staging D were diagnosed by pathology after radical prostatectomy in 30 patients with prostate cancer with clinical staging B, and 36.7% (11/30) under staging; Only one patient was over staging in clinical staging C. 19.1% (4/21) prostate cancer patients with staging C were diagnosed in 21 patients with prostate cancer and under staging with MRI staging B; 11.1% (1/9) was over staging with MRI staging C. The clinical staging and MRI staging had more correlation with pathological staging results (P=0.002), and PPV of the organ confined prostate cancer by clinical staging and MRI staging were 63.3% and 80.9% respectively, and NPV of nonorgan confined prostate cancer by clinical staging and MRI staging were 50% and 88.9% respectively. MRI staging was more specificity and accuracy than that of clinical staging to predict pathological staging results before radical prostatectomy (P=0.023). Conclusion: The MRI staging was more accuracy than that of clinical staging to predict pathological staging results in organ confined and nonorgan confined prostate cancer before radical prostatectomy.

  6. Management of pelvic lymphoceles following robot-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Omer A Raheem

    2012-01-01

    Full Text Available Pelvic lymphocele is a potential complication of radical prostatectomy. Although lymphoceles often regress spontaneously, many may progress, precipitate clinical symptoms, and ultimately require intervention. To date, the best treatment of pelvic lymphoceles has not yet been fully defined. However, laparoscopic marsupialization is a definitive and efficacious surgical alternative to percutaneous drainage. It is effective, results in minimal patient morbidity, and allows for rapid recovery. We report our experience with management of clinically symptomatic pelvic lymphoceles following robotic-assisted prostatectomy using laparoscopic marsupialization.

  7. Patients undergoing radical prostatectomy have a better survival than the background population

    DEFF Research Database (Denmark)

    Andreas Røder, Martin; Brasso, Klaus; Drimer Berg, Kasper;

    2013-01-01

    INTRODUCTION: The objective of this study was to investigate standardised relative survival and mortality ratio for patients undergoing radical prostatectomy for localized prostate cancer at our institution. MATERIAL AND METHODS: Between 1995 and 2010, a total of 1,350 consecutive patients underw...... better than expected in the age-matched background population. This finding is likely explained by selection bias. Although the results indicate an excellent outcome in terms of cancer control, the efficacy of prostatectomy for localized prostate cancer remains at debate....

  8. Impact of obesity on early erectile function recovery after robotic radical prostatectomy.

    Science.gov (United States)

    Uffort, Ekong E; Jensen, James C

    2011-01-01

    Studies are limited regarding the impact of obesity on early erectile functional outcomes after robotic radical prostatectomy. Our goal was to determine this impact using patient-reported validated questionnaires. International Index of Erectile Function (IIEF-6) scores were prospectively collected with institutional review board approval, for patients who underwent robotic radical prostatectomy with bilateral nerve sparing from February 2007 to October 2009. The data were categorized into nonobese and obese groups and subsequently into 2 subgroups based on risk for postprostatectomy erectile dysfunction. Low risk is preoperative IIEF-6 ≥19 and high risk is IIEF-6 function recovery rates between the groups (P=0.755). In both groups, patients with low risk of postoperative erectile dysfunction had statistically similar postoperative mean IIEF-6 scores at 6 and 12 months (P=0.580 and P=0.389, respectively), and no difference in erectile function recovery rates existed at 12 months (P=0.735). Obesity has no major contribution to the rate of early erectile function recovery after robotic radical prostatectomy. Preoperative erectile function remains the determining factor in postradical prostatectomy erectile dysfunction.

  9. Robotic Prostatectomy: Soon Number 1 in Europe?

    Directory of Open Access Journals (Sweden)

    Iselin CE

    2008-01-01

    Full Text Available Since 1990, laparoscopic surgery has undergone a tremendous evolution, pushed forward by the minimally invasive trend driven by our patients. Complex laparoscopic procedures, such as laparoscopic prostatectomy, have nevertheless faced significant difficulties, rendering them difficult to enter standard practice. However, robotic radical prostatectomy is expanding rapidly since the year 2000 especially in the USA, where actually approximately 70 % of radical prostatectomies are performed laparoscopically with the da Vinci system. This development is related to the facilitation the robot has brought to perform the difficult steps of laparoscopic prostatectomy. The functional outcome of robotic prostatectomy appears similar to the gold standard retropubic radical prostatectomy. This is also the case oncologically, although long-term data are needed for its final validation. The main problem of robotic prostatectomy is its high material cost, significantly superior to that of the conventional laparoscopic or retropubic technique. The near future will tell how European health systems will react to the American robotic epidemy.

  10. Robot-assisted laparoscopic radical prostatectomy with early retrograde release of the neurovascular bundle and endopelvic fascia sparing

    Science.gov (United States)

    de Albuquerque, George Augusto Monteiro Lins; Guglielmetti, Giuliano Betoni; Cordeiro, Maurício Dener; Nahas, William Carlos; Coelho, Rafael Ferreira

    2017-01-01

    ABSTRACT Introduction Robotic-assisted radical prostatectomy (RAP) is the dominant minimally invasive surgical treatment for patients with localized prostate cancer. The introduction of robotic assistance has the potential to improve surgical outcomes and reduce the steep learning curve associated with conventional laparoscopic radical prostatectomy. The purpose of this video is to demonstrate the early retrograde release of the neurovascular bundle without open the endopelvic fascia during RAP. Materials and Methods A 51-year old male, presenting histological diagnosis of prostate adenocarcinoma, Gleason 6 (3+3), in 4 cores of 12, with an initial PSA=3.41ng/dl and the digital rectal examination demonstrating a prostate with hardened nodule in the right lobe of the prostate base (clinical stage T2a). Surgical treatment with the robot-assisted technique was offered as initial therapeutic option and the critical technical point was the early retrograde release of the neurovascular bundle with endopelvic fascia preservation, during radical prostatectomy. Results The operative time was of 89 minutes, blood loss was 100ml. No drain was left in the peritoneal cavity. The patient was discharged within 24 hours. There were no intraoperative or immediate postoperative complications. The pathological evaluation revealed prostate adenocarcinoma, Gleason 6, with free surgical margins and seminal vesicles free of neoplastic involvement (pathologic stage T2a). At 3-month-follow-up, the patient lies with undetectable PSA, continent and potent. Conclusion This is a feasible technique combining the benefits of retrograde release of the neurovascular bundle, the preservation of the pubo-prostatic collar and the preservation of the antero-lateral cavernous nerves. PMID:27802002

  11. A robotic needle driver to facilitate vescico-urethral anastomosis during laparoscopic radical prostatectomy.

    Science.gov (United States)

    Varca, Virginia; Benelli, Andrea; Pietrantuono, Francesco; Suardi, Nazareno; Gregori, Andrea; Gaboardi, Franco

    2017-06-19

    The completion of the vescico-urethral anastomosis (VUA) represents the most critical step of laparoscopic radical prostatectomy (LRP), and it can often discourage the use of minimally invasive surgery in less experienced laparoscopic surgeons. The aim of this paper is to evaluate the usefulness of a new robotic needle driver named Dextérité in performing the VUA after LRP. This prospective randomized clinical study enrolled 40 consecutive patients eligible for LRP, which were randomized into four groups: group A, patients undergoing LRP done by an expert surgeon; group B, patients undergoing robotic-assisted radical prostatectomy (RARP) performed by the same expert surgeon; group C, patients undergoing LRP performed by a young surgeon at the beginning of the learning curve; group D, patients undergoing LRP performed by another young surgeon at the beginning of the learning curve with the aid of Dextérité needle driver for completion of the VUA. The two young urologists performed the same steps of LRP so that they are at the same step of the learning curve. All the anastomosis were performed with the same technique in order to be comparable. We use interrupted sutures with Vicryl 2/0 and a 5/8 needle; we performed the Rocco stitch technique before all the anastomosis (6) and we applied bladder neck sparing technique. All patients underwent an ultrasound control of the anastomosis on the seventh postoperative day, as we usually do (9, 10). We consider continent who utilised no pad. Operative VUA completion time was 24.9 vs. 25 vs. 86.7 vs. 61 minutes, respectively. When comparing VUA completion time in group 3 and 4, the use of the Dextérité needle driver resulted in a reduction in VUA time. Urinary leakage was seen in zero out of 10 patients in groups 1 and 2 and in three out of 10 and one in 10 patients, respectively, in groups 3 and 4. All urinary leakages were managed conservatively. One-year continence rates were 95%, 97%, 93% and 95%, respectively. Only

  12. PELVIC FLOOR MUSCLE TRAINING IN THE TREATMENT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Yu. L. Demidko

    2014-07-01

    Full Text Available The incidence of urinary incontinence after radical prostatectomy is 0.8 to 87%. This category of patients has pelvic floor muscle weakness and reduced perineal reflex. The treatment of these patients uses a pelvic floor exercise system that is to enhance muscle tone and to develop strong reflex contraction in response to a sudden rise in intraabdominal pressure. Pelvic floor muscle training belongs to first-line therapy for urinary incontinence occurring within 6 to 12 months after prostatectomy. The ability to control pelvic floor muscle knowingly and to train them allows one not only to increase the closing capability of sphincter mechanisms, but also to suppress involuntary detrusor contractions. We used this method in 9 patients who had undergone radical prostatectomy. The duration of pelvic floor muscle training under control was up to 25 weeks. During this period, the symptoms of incontinence were relieved. No contraindications or adverse reactions have put this method in first-line therapy for post-prostatectomy urinary incontinence.

  13. PELVIC FLOOR MUSCLE TRAINING IN THE TREATMENT OF URINARY INCONTINENCE AFTER RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Yu. L. Demidko

    2010-01-01

    Full Text Available The incidence of urinary incontinence after radical prostatectomy is 0.8 to 87%. This category of patients has pelvic floor muscle weakness and reduced perineal reflex. The treatment of these patients uses a pelvic floor exercise system that is to enhance muscle tone and to develop strong reflex contraction in response to a sudden rise in intraabdominal pressure. Pelvic floor muscle training belongs to first-line therapy for urinary incontinence occurring within 6 to 12 months after prostatectomy. The ability to control pelvic floor muscle knowingly and to train them allows one not only to increase the closing capability of sphincter mechanisms, but also to suppress involuntary detrusor contractions. We used this method in 9 patients who had undergone radical prostatectomy. The duration of pelvic floor muscle training under control was up to 25 weeks. During this period, the symptoms of incontinence were relieved. No contraindications or adverse reactions have put this method in first-line therapy for post-prostatectomy urinary incontinence.

  14. Robot-assisted radical prostatectomy: histopathologic and biochemical recurrence data at one-year follow-up

    Science.gov (United States)

    Patel, Vipul; Thaly, Rahul; Shah, Ketul

    2007-02-01

    Introduction: Robotically assisted laparoscopic radical prostatectomy is a minimally invasive alternative for the treatment of prostate cancer. We report the histopathologic and short term PSA outcomes of 500 robotic prostatectomies. Materials and Methods: Five hundred patients underwent robotic radical prostatectomy. The procedure was performed via a six trocar transperitoneal technique. Prostatectomy specimens were analyzed for TNM Stage, Gleason's grade, tumor location, volume, specimen weight, seminal vesicle involvement and margin status. A positive margin was reported if cancer cells were found at the inked specimen margin. PSA data was collected every three months for the first year, then every six months for a year, then yearly. Results: Average pre-operative PSA was 6.9 (1-90) with Gleason's score of 5 (2%), 6 (52%), 7 (40%), 8 (4%), 9(2%). Post operatively histopathologic analysis showed Gleason's 6 (44%), 7(42%), 8(10%), 9(4%). 10%, 5%, 63%, 15%, 5% and 2% had pathologic stage T2a, T2b, T2c, T3a, T3b and T4 respectively. Positive margin rate was 9.4% for the entire series. The positive margin rate per 100 cases was: 13% (1-100), 8% (101-200), 13% (201-300), 5% (301-400) and 8% (401-500). By stage it was 2%, 4%, 2.5% for T2a, T2b, T2c tumors, 23% (T3a), 46% (T3b) and 53% (T4a). For organ confined disease (T2) the margin rate was 2.5% and 31% for non organ confined disease. There were a total of 47 positive margins, 26 (56%) posterolateral, 4 (8.5%) apical, 4 (8.5%) bladder neck, 2 (4%) seminal vesicle and 11 (23%) multifocally. Ninety five percent of patients (n=500) have undetectable PSA (<0.1) at average follow up of 9.7 months. Recurrence has only been seen with non organ confined tumors. Those patients with a minimum follow up of 1 year (average 15.7 months) 95% have undetectable PSA (<.1). Conclusion: Our initial experience with robotic radical prostatectomy is promising. Histopathologic outcomes are acceptable with a low overall margin positive rate

  15. Salvage external beam radiotherapy for prostate cancer after radical prostatectomy: current status and controversy.

    Science.gov (United States)

    Raldow, Ann; Hamstra, Daniel A; Kim, Sung; Yu, James B

    2010-07-01

    Prostate cancer is the second most common cause of cancer death in American men. What to do when prostate cancer recurs months or years after a patient undergoes radical prostatectomy is an area of active research. Patients who underwent radical prostatectomy without immediate adjuvant radiation therapy (ART) but subsequently have evidence of recurrent disease are candidates for Salvage Radiation Therapy (SRT). Though there are three prospective randomized trials illustrating the efficacy of post-operative ART for selected patients, similarly strong evidence is lacking for SRT. In this article, we define the biochemical recurrence of prostate cancer, distinguish SRT from ART, outline the evidence for SRT, and make recommendations with regard to radiotherapy volume and dose. We discuss the known side effects from SRT, weigh the cost and benefit of SRT, and discuss possible tools that may improve the cost/benefit ratio for SRT by helping to select patients whom SRT may be more likely to benefit.

  16. The Role of Robot-Assisted Radical Prostatectomy in High-Risk Prostate Cancer.

    Science.gov (United States)

    Srougi, Victor; Tourinho-Barbosa, Rafael R; Nunes-Silva, Igor; Baghdadi, Mohammed; Garcia-Barreras, Silvia; Rembeyo, Gregory; Eiffel, Sophie S; Barret, Eric; Rozet, Francois; Galiano, Marc; Sanchez-Salas, Rafael; Cathelineau, Xavier

    2017-03-01

    Prostate cancer (PCa) is stratified into different risk categories based on the patient's prognosis. High-risk disease was formerly characterized by an increased risk of metastasis and lethality, requiring complex treatments. Surgery was recently highlighted to have a pivotal role for the treatment of such cases, even as monotherapy. In the past, open radical prostatectomy was performed for most patients with high-risk PCa; however, robot-assisted radical prostatectomy (RARP) emerged as a reasonable option because it provided optimal outcomes for low- and intermediate-risk PCa. Robust studies are lacking to properly assess the role of RARP for high-risk PCa. We summarize this knowledge and present a literature review on the perioperative recovery and functional and oncologic outcomes of RARP for the treatment of patients with high-risk PCa.

  17. Erectile function post robotic radical prostatectomy: technical tips to improve outcomes?

    Science.gov (United States)

    Goonewardene, S S; Persad, R; Gillatt, D

    2016-09-01

    Robotic surgery is becoming more and more commonplace. At the same time, so are complications, especially related to erectile function. The population being diagnosed with cancer is younger, with more aggressive cancers and higher expectations for good erectile function postoperatively. We conduct a retrospective analysis of literature over 20 years for Embase and Medline. Search terms used include (Robotic) AND (prostatectomy) AND (erectile function). There are a variety of multifactorial causes, resulting in worsening ED post-robotic radical prostatectomy; however, there are a number of treatments that can support this. There is much we can do to help prevent patients getting postoperative erectile dysfunction post-radical surgery. However, part of this is management of realistic patient expectations.

  18. Intracavernous injection in the treatment of erectile dysfunction after radical prostatectomy: an observational study

    OpenAIRE

    Joaquim de Almeida Claro; José Elêrton de Aboim; Marcelo Maríngolo; Enrico Andrade; Wilson Aguiar; Marcos Nogueira; Archimedes Nardozza Júnior; Miguel Srougi

    2001-01-01

    CONTEXT: Despite the recent improvements in performing radical retropubic prostatectomy that have led to a considerable decrease in the complication rate, erectile dysfunction still represents a major problem. Moreover, less invasive treatment options that are emerging for erectile dysfunction have not shown satisfactory results in managing these patients. OBJECTIVE: To study the efficacy and side effects of self-injection therapy in the treatment of men who had become impotent after undergoi...

  19. RESULTS OF PREOPERATIVE DETECTION OF LOCALLY ADVANCED PROSTATE CANCER IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Z. N. Shavladze

    2014-07-01

    Full Text Available The values of the diagnostic efficiency and consistency of preoperative evaluations of locally advanced prostate cancer (PC by magnetic resonance imaging (MRI with a matrix coil were estimated in 37 patients with PC who had undergone radical prostatectomy. The accuracy of differentiation of T3 and T2 stages in prospective and retrospective assessments was 59 and 73 %; the sensitivity was 7 and 40 %, and the specificity was 96 and 9 %, respectively; with the moderate consistency of evaluations.

  20. RESULTS OF PREOPERATIVE DETECTION OF LOCALLY ADVANCED PROSTATE CANCER IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY

    Directory of Open Access Journals (Sweden)

    Z. N. Shavladze

    2011-01-01

    Full Text Available The values of the diagnostic efficiency and consistency of preoperative evaluations of locally advanced prostate cancer (PC by magnetic resonance imaging (MRI with a matrix coil were estimated in 37 patients with PC who had undergone radical prostatectomy. The accuracy of differentiation of T3 and T2 stages in prospective and retrospective assessments was 59 and 73 %; the sensitivity was 7 and 40 %, and the specificity was 96 and 9 %, respectively; with the moderate consistency of evaluations.

  1. Robotic Radical Prostatectomy in Patients with Previous Prostate Surgery and Radiotherapy

    Directory of Open Access Journals (Sweden)

    Ömer Acar

    2014-01-01

    Full Text Available Herein, we will review the available literature about robot-assisted radical prostatectomy in patients who have undergone prostate surgery or radiotherapy. Current data about this topic consists of small case series with limited follow-up. Despite being technically demanding, robot-assisted radical prostatectomy (RARP can be considered feasible in either setting. Prostate surgery or prostatic irradiation should not be considered as a contraindication for robot-assisted radical prostatectomy. Nevertheless, patient counseling about the possible complications and the need for reintervention is of extreme importance in this patient population. Early oncologic and functional results of RARP performed in case of radiorecurrent prostate cancer look promising. Regarding postprostate surgery RARP, some series have reported comparable results, while some have demonstrated more inferior outcomes than those of naive cases. In order to assess the exact functional and oncologic outcome of RARP in patients with previous prostate surgery and radiotherapy, studies enrolling higher number of patients and providing longer follow-up data are needed.

  2. Anatomic and technical considerations for optimizing recovery of sexual function during robotic-assisted radical prostatectomy.

    Science.gov (United States)

    Carter, Stacey; Le, Jesse D; Hu, Jim C

    2013-01-01

    Although cure of prostate cancer is the primary goal of radical prostatectomy, preserving erectile function is also tantamount, given the indolent clinical course of most prostate cancers, particularly low-risk disease. In order to optimize postprostatectomy erectile function during a robotic-assisted radical prostatectomy, there must be a detailed understanding of pelvic anatomy to recognize the optimal nerve-sparing plane and technical finesse to minimize stretch injury to the neurovascular bundle. The magnified, well illuminated robotic-operative field coupled with less blood loss has paralleled greater understanding of the periprostatic 'fascial' planes, leading to differentiation of intrafascial versus interfascial nerve-sparing approaches. However, refinement of tissue handling during nerve-sparing to minimize lateral displacement of the neurovascular bundle and attenuate neurapraxia enables earlier and better recovery of erectile function. The critical maneuvers to preserving erectile function are atraumatic dissection of the prostate away from the optimal nerve-sparing plane to maximally preserve nerve fibers while minimizing neurapraxia. Therefore, attaining these principles involves a conceptual paradigm shift from 'radical' prostatectomy to neurosurgery of the prostate.

  3. The role of radical prostatectomy as an initial approach for the treatment of high-risk prostate cancer.

    Science.gov (United States)

    Jaunarena, J H; Villamil, W; Martínez, P F; Gueglio, G; Giudice, C R

    2016-01-01

    The treatment of high-risk prostate cancer requires a multimodal approach to improve control of the disease. There is still no consensus as to the initial strategy of choice. The aim of this study is to review the results of radical prostatectomy as first step in management of patients with high-risk disease. A search was conducted on PubMed of English and Spanish texts. We included those studies that reported the results of radical prostatectomy in patients with high-risk prostate cancer, as well as those that compared radical prostatectomy with other treatment alternatives. The last search was conducted in November 2015. The advantages of radical prostatectomy include a better pathological analysis, more accurate staging, better local control of the disease and better follow-up and adjuvant therapy strategies. When compared with external radiation therapy plus hormonal blockade, the patients who underwent prostatectomy had greater chances of healing and longer cancer-specific survival. The patients who most benefit from this approach are younger, have fewer comorbidities and no evidence of organ metastases. The available scientific evidence to date is not without bias and confounders; however, they appear to favour radical prostatectomy as the initial approach of choice for high-risk prostate cancer. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. A NEW METHOD OF BLADDER NECK RECONSTRUCTION DURING THE RADICAL PROSTATECTOMY IN PATIENTS WITH LOCALIZED PROSTATE CANCER

    Directory of Open Access Journals (Sweden)

    Yu. V. Tolkach

    2014-08-01

    Full Text Available Radical prostatectomy is a «gold standard» for treatment of the patients with a localized prostate cancer. Urinary incontinence is one of the two most common complications of this operation. In this article we report a study aimed to compare the efficacy parameters linked to postoperative continence in 39 patients with new technique for reconstruction of the bladder neck during the radical prostatectomy using a deep suture of the bladder wall dorsally to the neck aperture with 45 patients in control group with a standard type of reconstruction in the form of tennis racket. According to the results, application of the new technique leads to a significant improvement in continence during the first 6 months after the operation with no difference among groups during follow-up later on. Given the results of the anatomical study, the efficacy of the new method of reconstruction is linked to passive closure mechanism created in the area of the bladder neck.

  5. A pilot randomized trial of conventional versus advanced pelvic floor exercises to treat urinary incontinence after radical prostatectomy: a study protocol

    OpenAIRE

    Santa Mina, Daniel; Au, Darren; Alibhai, Shabbir M.H.; Jamnicky, Leah; Faghani, Nelly; Hilton, William J.; Stefanyk, Leslie E.; Ritvo, Paul; Jones, Jennifer; Elterman, Dean; Neil E. Fleshner; Finelli, Antonio; Singal, Rajiv K.; Trachtenberg, John; Matthew, Andrew G.

    2015-01-01

    Background Radical prostatectomy is the most common and effective treatment for localized prostate cancer. Unfortunately, radical prostatectomy is associated with urinary incontinence and has a significant negative impact on quality of life. Pelvic floor exercises are the most common non-invasive management strategy for urinary incontinence following radical prostatectomy; however, studies provide inconsistent findings regarding their efficacy. One potential reason for sub-optimal efficacy of...

  6. Side docking of the da Vinci robotic system for radical prostatectomy: advantages over traditional docking.

    Science.gov (United States)

    Cestari, Andrea; Ferrari, Matteo; Zanoni, Matteo; Sangalli, Mattia; Ghezzi, Massimo; Fabbri, Fabio; Sozzi, Francesco; Rigatti, Patrizio

    2015-09-01

    The standard low lithotomic position, used during robot-assisted radical prostatectomy (RARP), with prolonged positioning in stirrups together with steep Trendelenburg may expose the patient to neurapraxia phenomena of the lower limbs and can rarely be used in patients with problems of hip abduction. To overcome these hurdles, we evaluated the clinical benefits of "side docking" (SD) of the da Vinci(®) robotic system in comparison to "traditional docking" (TD). A cohort of 120 patients submitted to RARP were prospectively randomized into two groups by docking approach: SD with the patient supine with lower limbs slightly abducted on the operating table, and TD docking time, intraoperative number of collisions between the robotic arms and postoperative neurological problems in the lower limbs were noted. Descriptive statistics was used to analyze outcomes. Docking time was shorter for the SD group [SD: median 13 min (range 10-18); TD: median 21 min (range 15-34)]. None in the SD group and six of 60 patients (10%) in the TD group suffered from temporary (<30 days) unilateral neurological deficits of the lower limbs. In both groups no collisions between the robotic arms occurred. The SD approach is technically feasible. It does not cause collisions between the robotic arms, and is a reliable method for reducing the setup time of RARP. The supine position of the patient may prevent neurological complications of the lower limbs. Based on these results, SD has become the standard docking technique used by our department.

  7. Retropubic radical prostatectomy: Clinicopathological observations and outcome analysis of 428 consecutive patients

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    Jagdeesh N Kulkarni

    2011-01-01

    Full Text Available Aim : We report the outcome analysis of retropubic radical prostatectomy (RRP performed in 428 patients in terms of pathological findings, complications, and survival. Materials and Methods : Systematically recorded case reports forms of consecutive 428 RRPs done over a 14-year period were analyzed using the SPSS 14 software. Secondary analysis was done to evaluate era specific (pre and post 2002 changes in clinical features and survivals. Results : Seven-year overall survival (OAS, cancer-specific survival (CSS, and event-free survival (EFS was 83.2%, 82.8%, and 69.8% respectively in our series. Era-specific survival showed higher CSS post 2002, and there was an increase in presentation with organ-confined disease. Univariate and multivariate analysis showed statistically significant impact on era specific outcome. With the improvement in techniques decrease in complications rate and increase in quality of life was noted. Conclusions : Our series spanning over decade demonstrates that RRP is viable option to offer cure to organ-confined carcinoma prostate. Further, there is evidence of stage migration and improvements in outcome in post 2002 patients. Although our series is modest in number, the success rates and outcome data matches those reported in the literature.

  8. Significance and management of positive surgical margins at the time of radical prostatectomy.

    Science.gov (United States)

    Silberstein, Jonathan L; Eastham, James A

    2014-10-01

    Positive surgical margins (PSM) at the time of radical prostatectomy (RP) result in an increased risk of biochemical recurrence (BCR) and secondary treatment. We review current literature with a focus on stratifying the characteristics of the PSM that may define its significance, the impact of modern imaging and surgical approaches in avoidance of PSM, and management strategies when PSM do occur. We performed a review of the available literature to identify factors associated with PSM and their management. PSM have been repeatedly demonstrated to be associated with an increased risk of BCR following RP. The specific characteristics (size, number, location, Gleason score at the margin) of the PSM may influence the risk of recurrence. Novel imaging and surgical approaches are being investigated and may allow for reductions of PSM in the future. The use of adjuvant treatment for a PSM remains controversial and should be decided on an individual basis after a discussion about the risks and benefits. The goal of RP is complete resection of the tumor. PSM are associated with increased risk of BCR and secondary treatments. Of the risk factors associated with BCR after RP, a PSM is directly influenced by surgical technique.

  9. Advanced Imaging for the Early Diagnosis of Local Recurrence Prostate Cancer after Radical Prostatectomy

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    Valeria Panebianco

    2014-01-01

    Full Text Available Currently the diagnosis of local recurrence of prostate cancer (PCa after radical prostatectomy (RT is based on the onset of biochemical failure which is defined by two consecutive values of prostate-specific antigen (PSA higher than 0.2 ng/mL. The aim of this paper was to review the current roles of advanced imaging in the detection of locoregional recurrence. A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of PET/CT in the restaging of PCa after RP; the second part is intended to provide the impact of multiparametric-MRI (mp-MRI in the depiction of locoregional recurrence. Published data indicate an emerging role for mp-MRI in the depiction of locoregional recurrence, while the performance of PET/CT still remains unclear. Moreover Mp-MRI, thanks to functional techniques, allows to distinguish between residual glandular healthy tissue, scar/fibrotic tissue, granulation tissue, and tumour recurrence and it may also be able to assess the aggressiveness of nodule recurrence.

  10. Advanced imaging for the early diagnosis of local recurrence prostate cancer after radical prostatectomy.

    Science.gov (United States)

    Panebianco, Valeria; Barchetti, Flavio; Musio, Daniela; De Felice, Francesca; Proietti, Camilla; Indino, Elena Lucia; Megna, Valentina; Schillaci, Orazio; Catalano, Carlo; Tombolini, Vincenzo

    2014-01-01

    Currently the diagnosis of local recurrence of prostate cancer (PCa) after radical prostatectomy (RT) is based on the onset of biochemical failure which is defined by two consecutive values of prostate-specific antigen (PSA) higher than 0.2 ng/mL. The aim of this paper was to review the current roles of advanced imaging in the detection of locoregional recurrence. A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of PET/CT in the restaging of PCa after RP; the second part is intended to provide the impact of multiparametric-MRI (mp-MRI) in the depiction of locoregional recurrence. Published data indicate an emerging role for mp-MRI in the depiction of locoregional recurrence, while the performance of PET/CT still remains unclear. Moreover Mp-MRI, thanks to functional techniques, allows to distinguish between residual glandular healthy tissue, scar/fibrotic tissue, granulation tissue, and tumour recurrence and it may also be able to assess the aggressiveness of nodule recurrence.

  11. Reality of nerve sparing and surgical margins in surgeons' early experience with robot-assisted radical prostatectomy in Japan.

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    Tatsugami, Katsunori; Yoshioka, Kunihiko; Shiroki, Ryoichi; Eto, Masatoshi; Yoshino, Yasushi; Tozawa, Keiichi; Fukasawa, Satoshi; Fujisawa, Masato; Takenaka, Atsushi; Nasu, Yasutomo; Kashiwagi, Akira; Gotoh, Momokazu; Terachi, Toshiro

    2017-03-01

    To analyze nerve sparing performance at an early stage of robot-assisted radical prostatectomy, and the correlation between the surgeons' experience and the risk of a positive surgical margin in patients treated with robot-assisted radical prostatectomy. Patients' records from January 2009 to March 2013 were retrospectively reviewed, and 3469 patients with localized prostate cancer were identified at 45 institutions. Individual surgeon's experience with nerve sparing was recorded as the number of nerve sparing cases among total robot-assisted radical prostatectomies beginning with the first case during which nerve sparing was carried out. Patients were selected by propensity score matching for nerve sparing, and predictive factors of positive surgical margins were analyzed in patients with and without positive surgical margins. A total of 152 surgeons were studied, and the median number of robot-assisted radical prostatectomy cases for all surgeons was 21 (range 1-511). In all, 54 surgeons (35.5%) undertook nerve sparing during their first robot-assisted radical prostatectomy case. For 2388 patients selected with (1194) and without (1194) nerve sparing, predictive factors for positive surgical margin were high initial prostate-specific antigen level (P 100 cases (P = 0.0058). Thus, nerve sparing was not associated with positive surgical margins. The surgeon's experience influences the occurrence of positive surgical margins, although a considerable number of surgeons carried out nerve sparing during their early robot-assisted radical prostatectomy cases. Surgeons should consider their own experience and prostate cancer characteristics before carrying out a nerve sparing robot-assisted radical prostatectomy. © 2017 The Japanese Urological Association.

  12. Urinary Bother as a Predictor of Postsurgical Changes in Urinary Function After Robotic Radical Prostatectomy.

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    Murphy, Gregory; Haddock, Peter; Doak, Hoyt; Jackson, Max; Dorin, Ryan; Meraney, Anoop; Kesler, Stuart; Staff, Ilene; Wagner, Joseph R

    2015-10-01

    To characterize changes in indices of urinary function in prostatectomy patients with presurgical voiding symptoms. A retrospective analysis of our prostate cancer database identified robot-assisted radical prostatectomy patients between April 2007 and December 2011 who completed pre- and postsurgical (24 months) Expanded Prostate Cancer Index Composite-26 surveys. Gleason score, margins, D'Amico risk, prostate-specific antigen, radiotherapy, and nerve-sparing status were tabulated. Survey questions addressed urinary irritation/obstruction, incontinence, and overall bother. Responses were averaged to calculate a urinary sum (US) score. Patients were stratified according to the severity of their baseline urinary bother (UB), and changes in urinary indices determined at 24 months. A total of 737 patients were included. Postsurgical improvement in urinary obstruction, bother, and sum score was related to baseline UB (P function. These data are helpful when counseling a subset of robot-assisted laparoscopic radical prostatectomy patients with severe preoperative urinary symptoms. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. A comparison of bladder neck preservation and bladder neck reconstruction for urinary incontinence after radical retro pubic prostatectomy

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    Mohammad Hossein Izadpanahi

    2014-01-01

    Full Text Available Background: Prostate cancer is the sixth most common cancer worldwide and will include about 30% of all malignancies in men. Since the initial report of the anatomic radical prostatectomy, refinements in the surgical technique have been made. Several studies show that bladder neck preservation (BNP during radical prostatectomy makes improve early return of urinary continence, erectile function or both. However, some clinical trials have suggested little difference between the return of continence while using modifications. In this study, we compared outcomes of BNP and bladder neck reconstruction (BNR during radical retropubic prostatectomy (RRP. Materials and Methods: This prospective study was performed on 60 patients at a referral university hospital from March 2010 to March 2012. Study population was all patients candidate for RRP (RRP in this period. All patients divided into two groups, A and B (30 patients in each group. Group A (n = 30 who preserved bladder neck (BNP and Group B (n = 30 who had BNR. Prostate specific antigen (PSA before and at 2, 6, 9, 12 and18 months after surgery, anastomotic stricture symptoms, positive bladder neck margin, Gleason score and urine incontinence were compared between two groups. Also, we compared bladder neck contracture, urinary continence and positive surgical margin rates after BNP and BNR while retropubic prostatectomy in 24 months period follow-up. Results: The mean age of the patients was 61.81 ± 7.15 years (range, 50-74 years. After a follow-up period of 24 months, the PSA rising was not different between the two groups. After 2 months, 19 (63.33% of patients in A group and the same number in B group were continent (P = 0.78. Stricture of the bladder neck at the anastomosis site requiring transurethral dilation occurred in 7 (23.33% and 3 (10.0% patients in groups A and B, respectively (P = 0.04. Conclusion: Although there was no difference in prevalence and duration of return of urinary

  14. The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report

    OpenAIRE

    Hasan Hüseyin Tavukçu; Ömer Aytaç; Cem Balcı; Haluk Kulaksızoğıu; Fatih Atuğ

    2015-01-01

    Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI) on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial techniqu...

  15. Zero positive surgical margins after radical prostatectomy: is the end in sight.

    Science.gov (United States)

    Skarecky, Douglas W; Brenner, Mattew; Rajan, Sudhir; Rodriguez, Esequiel; Narula, Navneet; Melgoza, Frank; Ahlering, Thomas E

    2008-11-01

    Positive surgical margins represents incomplete resection by the surgeon, and the elimination of positive margins represents the only clinical feature during radical prostatectomy that can lead directly to improved cancer outcomes. The introduction of new robot-assisted technology and technical refinements has led to declines of positive surgical margins. Although margins induced by incomplete cancer resection by the surgeon have been reduced for organ-confined disease, the 'Holy Grail' of zero margins is not yet attainable in prostatectomy, and is more problematic in cancer that has penetrated beyond the prostate. Intraoperative frozen biopsies are imprecise. The union of real-time optical coherence tomography technology of the da Vinci robotic platform for identification of positive margin sites, and technical advances with wider excisions during surgery may provide promise for further reduction of surgical margins to zero.

  16. VERIFICATION OF A TUMOR LESION OF INTRAPELVIC LYMPH NODES AFTER RADICAL PROSTATECTOMY. THE FIRST EXPERIENCE

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    V. V. Kapustin

    2014-08-01

    Full Text Available Objective: to study the possibilities of transrectal ultrasound scan (TRUS and magnetic resonance imaging (MRI in identifying and verifying a tumor lesion of intrapelvic lymph nodes (LN in patients with biochemical recurrence after radical prostatectomy.Subjects and methods. Metastatic tumor lesion of intrapelvic LNs was verified in 4 patients by transrectal ultrasound (US-guided needle biopsies. All the patients underwent multi-parametric MRI studies and TRUS.Results. The application of current MRI technologies (for qualitative and quantitative analysis of diffusion-weighted images and for postcontrast sequences could detect and judge with confidence the metastatic lesion of intrapelvic LNs. TRUS permits clearly visualizing pathologically altered LNs, by taking into account their MRI pattern and verifying their tumor lesion by US-guided core needle biopsy.Conclusion. The combined use of multi-parametric MRI and TRUS provides a means for diagnosing and verifying the tumor lesion of pelvic LNs in patients after prostatectomy.

  17. VERIFICATION OF A TUMOR LESION OF INTRAPELVIC LYMPH NODES AFTER RADICAL PROSTATECTOMY. THE FIRST EXPERIENCE

    Directory of Open Access Journals (Sweden)

    V. V. Kapustin

    2012-01-01

    Full Text Available Objective: to study the possibilities of transrectal ultrasound scan (TRUS and magnetic resonance imaging (MRI in identifying and verifying a tumor lesion of intrapelvic lymph nodes (LN in patients with biochemical recurrence after radical prostatectomy.Subjects and methods. Metastatic tumor lesion of intrapelvic LNs was verified in 4 patients by transrectal ultrasound (US-guided needle biopsies. All the patients underwent multi-parametric MRI studies and TRUS.Results. The application of current MRI technologies (for qualitative and quantitative analysis of diffusion-weighted images and for postcontrast sequences could detect and judge with confidence the metastatic lesion of intrapelvic LNs. TRUS permits clearly visualizing pathologically altered LNs, by taking into account their MRI pattern and verifying their tumor lesion by US-guided core needle biopsy.Conclusion. The combined use of multi-parametric MRI and TRUS provides a means for diagnosing and verifying the tumor lesion of pelvic LNs in patients after prostatectomy.

  18. Radical prostatectomy in the presence of ongoing refractory ESBL Escherichia coli bacterial prostatitis

    Science.gov (United States)

    McLoughlin, Louise Catherine; McDermott, T E D; Thornhill, John Alan

    2014-01-01

    A 44-year-old Indian national with a prostate-specific antigen of 5.4 ng/mL underwent 12-core transrectal ultrasound-guided prostate biopsies. Following this, he had three hospital admissions with severe urosepsis secondary to extended spectrum β lactamase (ESBL) producing Escherichia coli. He had recurrent sepsis immediately after discontinuation of intravenous meropenem to which the ESBL was sensitive. He proceeded to radical prostatectomy for intermediate-high risk Gleason 7 prostate cancer, while still on intravenous meropenem, 2 months after his biopsy. His prostatectomy involved a difficult dissection due to inflammatory changes and fibrosis after multiple septic episodes. He had complete resolution of infection after surgery with discontinuation of antibiotics on the third postoperative day, without any recurrence of sepsis. PMID:25315803

  19. The use of a bulldog clamp to control the dorsal vein complex during robot-assisted radical prostatectomy.

    Science.gov (United States)

    Tüfek, Ilter; Atuğ, Fatih; Argun, Burak; Keskin, Selçuk; Obek, Can; Coşkuner, Enis; Kural, Ali Riza

    2012-12-01

    Optimal control of the dorsal venous complex (DVC) is a critical step in robot-assisted radical prostatectomy (RARP). If DVC is not controlled properly, bleeding may occur during the apical dissection. On the other hand, if it is controlled well, a bloodless field is attained and, thus, a precise apical dissection and urethral division is possible. Suture ligation is the most common technique used for dorsal vein control, while some authors recommend using an endovascular stapler. Recently, athermal division and selective suture ligation technique has been reported for DVC control. We describe a new technique: Use of a bulldog clamp to control the DVC during RARP. The control of the DVC with a bulldog clamp allows a bloodless field with precise apical dissection and provides preservation of maximum urethral length while avoiding sphincteral injury.

  20. 4-Ports endoscopic extraperitoneal radical prostatectomy: preliminary and learning curve results

    Science.gov (United States)

    Barbosa, Humberto do Nascimento; Siqueira, Tiberio Moreno; Barreto, Françualdo; Menezes, Leonardo Gomes; Luna, Mauro José Catunda; Calado, Adriano Almeida

    2016-01-01

    ABSTRACT Introduction There is a lack of studies in our national scenario regarding the results obtained by laparoscopic radical prostatectomy technique (LRP). Except for a few series, there are no consistent data on oncological, functional, and perioperative results on LRP held in Brazil. As for the LRP technique performed by extraperitoneal access (ELRP), when performed by a single surgeon, the results are even scarcer. Objective To analyze the early perioperative and oncologic results obtained with the ELRP, throughout the technical evolution of a single surgeon. Patients and methods A non-randomized retrospective study was held in a Brazilian hospital of reference. In the 5-year period, 115 patients underwent the ELRP procedure. Patients were divided into two groups, the first 57 cases (Group 1) and the following 58 cases, (Group 2). A comparative analysis between the groups of efficacy results and ELRP safety was carried out. Results The average age of patients was 62.8 year-old and the PSA of 6.9ng/dl. The total surgery time was 135.8 minutes on average, and the urethral-bladder anastomosis was 21.9 min (23.3 min versus 20.7 min). The positive surgical margins (PSM) rate was 17.1%, showing no difference between groups (16.4% versus 17.9%; p=0.835). There was statistical difference between the groups in relation to the anastomosis time, estimated blood loss and the withdrawal time of the urinary catheter. Conclusion The ELRP technique proved to be a safe and effective procedure in the treatment of prostate cancer, with low morbidity. PMID:27286105

  1. Monotherapy of androgen deprivation therapy versus radical prostatectomy among veterans with localized prostate cancer: comparative effectiveness analysis of retrospective cohorts

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    Liu J

    2012-05-01

    Full Text Available Jinan Liu1,2, Lizheng Shi1,2,3, Oliver Sartor31Tulane University, School of Public Health and Tropical Medicine, 2Southeast Louisiana Veterans Health Care System, Tulane University, 3School of Medicine and Tulane Cancer Center, New Orleans, LA, USABackground: This retrospective cohort study aimed to examine the comparative effectiveness of monotherapy of primary androgen deprivation therapy or radical prostatectomy.Methods: Male patients with localized prostate cancer (T1-T2, N0, M0 were identified in the Veterans Affairs Veterans Integrated Service Network 16 data warehouse (January 2003 to June 2006, with one-year baseline and at least three-year follow-up data (until June 2009. Patients were required to be 18–75 years old and without other recorded cancer history. The initiation of primary androgen deprivation therapy or monotherapy of radical prostatectomy within six months after the first diagnosis of prostate cancer was used as the index date. Primary androgen deprivation therapy patients were matched to the radical prostatectomy patients via propensity score, which was predicted from a logistic regression of treatment selection (primary androgen deprivation therapy versus radical prostatectomy on age, race, marital status, insurance type, cancer stage, Charlson comorbidity index, and alcohol and tobacco use. The overall survival from initiation of index treatment was then analyzed using the Kaplan–Meier and Cox proportional hazards model.Results: The two cohorts were well matched at baseline (all P > 0.05. During a median follow-up of 4.3 years, the cumulative incidence of death was 13 (10.57% among 123 primary androgen deprivation therapy patients and four (3.25% among 123 radical prostatectomy patients (P < 0.05. The overall three-year survival rate was 92.68% for primary androgen deprivation therapy and 98.37% for radical prostatectomy (P < 0.05. Patients who received primary androgen deprivation therapy had almost three times as

  2. Is There a Concordance Between the Gleason Scores of Needle Biopsy and Radical Prostatectomy Specimens in Prostatic Carsinoma?

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    Faruk Özgör

    2016-03-01

    Full Text Available Aim: To evaluate the concordance between the Gleason Scores (GS of prostate biopsy and radical prostatectomy specimens. Methods: Prostate biopsy was performed in 1135 patients with the suspicion of prostate cancer in our clinic between 2008 and 2012. A total of 366 patients were diagnosed with prostate cancer. Radical prostatectomy was performed in 73 of these patients and GS of pathology specimens were included in this study for comparison. The patients were divided into three groups (low intermediate- and high-risk patients according to the D’amico risk classification for prostate cancer. Results: The median age of the patients was 64.2±6.1 years (54- 73. The mean prostate specific antigen level was 20.34 ng/mL and the mean biopsy core number was 12±0.58. A statistically significant concordance was detected between the GS of biopsy specimens and radical prostatectomy materials in 65.7% of patients (p<0.01. There were 40 patients in the low-risk group, however, 8 (20% of them were identified to be intermediate-risk patients and one (2.5% was found to be a high-risk patient after radical prostatectomy. Conclusion: Concordance between the GS of prostate biopsy and radical prostatectomy materials are important for selection of the appropriate treatment

  3. Outcome of postoperative radiotherapy following radical prostatectomy: a single institutional experience

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    Lee, Sea Won; Chung, Mi Joo; Jeong, Song Mi; Kim, Sung Hwan; Lee, Jong Hoon [Dept.of Radiation Oncology, St. Vincent' s Hospital, The Catholic University of Korea College of Medicine, Suwon (Korea, Republic of); Hwang, Tae Kon; Hong, Sung Hoo; Lee, Ji Youl; Jang, Hong Seok [Seoul St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Seoul (Korea, Republic of); Yoon, Sei Chul [Dept.of Radiation Oncology, Bucheon St. Mary' s Hospital, The Catholic University of Korea College of Medicine, Bucheon (Korea, Republic of)

    2014-09-15

    This single institutional study is aimed to observe the outcome of patients who received postoperative radiotherapy after radical prostatectomy. A total of 59 men with histologically identified prostate adenocarcinoma who had received postoperative radiation after radical prostatectomy from August 2005 to July 2011 in Seoul St. Mary's Hospital of the Catholic University of Korea, was included. They received 45-50 Gy to the pelvis and boost on the prostate bed was given up to total dose of 63-72 Gy (median, 64.8 Gy) in conventional fractionation. The proportion of patients given hormonal therapy and the pattern in which it was given were analyzed. Primary endpoint was biochemical relapse-free survival (bRFS) after radiotherapy completion. Secondary endpoint was overall survival (OS). Biochemical relapse was defined as a prostate-specific antigen level above 0.2 ng/mL. After median follow-up of 53 months (range, 0 to 104 months), the 5-year bRFS of all patients was estimated 80.4%. The 5-year OS was estimated 96.6%. Patients who were given androgen deprivation therapy had a 5-year bRFS of 95.1% while the ones who were not given any had that of 40.0% (p < 0.01). However, the statistical significance in survival difference did not persist in multivariate analysis. The 3-year actuarial grade 3 chronic toxicity was 1.7% and no grade 3 acute toxicity was observed. The biochemical and toxicity outcome of post-radical prostatectomy radiotherapy in our institution is favorable and comparable to those of other studies.

  4. Does index tumor predominant location influence prognostic factors in radical prostatectomies?

    Science.gov (United States)

    Billis, Athanase; Freitas, Leandro L. L.; Costa, Larissa B. E.; de Angelis, Camila M.; Carvalho, Kelson R.; Magna, Luis A.; Ferreira, Ubirajara

    2017-01-01

    ABSTRACT Purpose To find any influence on prognostic factors of index tumor according to predominant location. Materials and Methods Prostate surgical specimens from 499 patients submitted to radical retropubic prostatectomy were step-sectioned. Each transverse section was subdivided into 2 anterolateral and 2 posterolateral quadrants. Tumor extent was evaluated by a semi-quantitative point-count method. The index tumor (dominant nodule) was recorded as the maximal number of positive points of the most extensive tumor area from the quadrants and the predominant location was considered anterior (anterolateral quadrants), posterior (posterolateral quadrants), basal (quadrants in upper half of the prostate), apical (quadrants in lower half of the prostate), left (left quadrants) or right (right quadrants). Time to biochemical recurrence was analyzed by Kaplan-Meier product-limit analysis and prediction of shorter time to biochemical recurrence using univariate and multivariate Cox proportional hazards model. Results Index tumors with predominant posterior location were significantly associated with higher total tumor extent, needle and radical prostatectomy Gleason score, positive lymph nodes and preoperative prostate-specific antigen. Index tumors with predominant basal location were significantly associated with higher preoperative prostate-specific antigen, pathological stage higher than pT2, extra-prostatic extension, and seminal vesicle invasion. Index tumors with predominant basal location were significantly associated with time to biochemical recurrence in Kaplan-Meier estimates and significantly predicted shorter time to biochemical recurrence on univariate analysis but not on multivariate analysis. Conclusions The study suggests that index tumor predominant location is associated with prognosis in radical prostatectomies, however, in multivariate analysis do not offer advantage over other well-established prognostic factors. PMID:28379672

  5. Effect of Sulforaphane in Men with Biochemical Recurrence after Radical Prostatectomy.

    Science.gov (United States)

    Cipolla, Bernard G; Mandron, Eric; Lefort, Jean Marc; Coadou, Yves; Della Negra, Emmanuel; Corbel, Luc; Le Scodan, Ronan; Azzouzi, Abdel Rahmene; Mottet, Nicolas

    2015-08-01

    Increases in serum levels of prostate-specific antigen (PSA) occur commonly in prostate cancer after radical prostatectomy and are designated "biochemical recurrence." Because the phytochemical sulforaphane has been studied extensively as an anticancer agent, we performed a double-blinded, randomized, placebo-controlled multicenter trial with sulforaphane in 78 patients (mean age, 69 ± 6 years) with increasing PSA levels after radical prostatectomy. Treatment comprised daily oral administration of 60 mg of a stabilized free sulforaphane for 6 months (M0-M6) followed by 2 months without treatment (M6-M8). The study was designed to detect a 0.012 log (ng/mL)/month decrease in the log PSA slope in the sulforaphane group from M0 to M6. The primary endpoint was not reached. For secondary endpoints, median log PSA slopes were consistently lower in sulforaphane-treated men. Mean changes in PSA levels between M6 and M0 were significantly lower in the sulforaphane group (+0.099 ± 0.341 ng/mL) than in placebo (+0.620 ± 1.417 ng/mL; P = 0.0433). PSA doubling time was 86% longer in the sulforaphane than in the placebo group (28.9 and 15.5 months, respectively). PSA increases >20% at M6 were significantly greater in the placebo group (71.8%) than in the sulforaphane group (44.4%); P = 0.0163. Compliance and tolerance were very good. Sulforaphane effects were prominent after 3 months of intervention (M3-M6). After treatment, PSA slopes from M6 to M8 remained the same in the 2 arms. Daily administration of free sulforaphane shows promise in managing biochemical recurrences in prostate cancer after radical prostatectomy. ©2015 American Association for Cancer Research.

  6. Radical prostatectomy in patients aged 75 years or older: review of the literature.

    Science.gov (United States)

    Mandel, Philipp; Chandrasekar, Thenappan; Chun, Felix K; Huland, Hartwig; Tilki, Derya

    2017-09-26

    Given the demographic trends toward a considerably longer life expectancy, the percentage of elderly patients with prostate cancer will increase further in the upcoming decades. Therefore, the question arises, should patients ≥75 years old be offered radical prostatectomy and under which circumstances? For treatment decision-making, life expectancy is more important than biological age. As a result, a patient's health and mental status has to be determined and radical treatment should only be offered to those who are fit. As perioperative morbidity and mortality in these patients is increased relative to younger patients, patient selection according to comorbidities is a key issue that needs to be addressed. It is known from the literature that elderly men show notably worse tumor characteristics, leading to worse oncologic outcomes after treatment. Moreover, elderly patients also demonstrate worse postoperative recovery of continence and erectile function. As the absolute rates of both oncological and functional outcomes are still very reasonable in patients ≥75 years, a radical prostatectomy can be offered to highly selected and healthy elderly patients. Nevertheless, patients clearly need to be informed about the worse outcomes and higher perioperative risks compared to younger patients.

  7. Delaying Renal Transplant after Radical Prostatectomy for Low-Risk Prostate Cancer.

    Science.gov (United States)

    Özçelik, Ümit; Bircan, Hüseyin Yüce; Karakayalı, Feza; Moray, Gökhan; Demirağ, Alp

    2015-11-01

    To minimize the recurrence of a previously treated neoplasm in organ recipients, a period of 2 to 5 years without recurrence is advocated for most malignancies. However, prostate cancer is different because of its biological properties, diagnosis, and treatment. Most prostate cancers are detected at a low stage and demonstrate slow growth after detection. Definitive treatment with radical prostatectomy affords excellent results. Renal transplant candidates with early-stage prostate cancer have a higher risk of dying on dialysis than dying from prostate cancer; therefore, renal transplant candidates with organ-confined prostate cancer should be immediately considered for transplant.

  8. DNA methylation signatures for prediction of biochemical recurrence after radical prostatectomy of clinically localized prostate cancer

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    Haldrup, Christa; Mundbjerg, Kamilla; Vestergaard, Else Marie;

    2013-01-01

    Purpose Diagnostic and prognostic tools for prostate cancer (PC) are suboptimal, causing overtreatment of indolent PC and risk of delayed treatment of aggressive PC. Here, we identify six novel candidate DNA methylation markers for PC with promising diagnostic and prognostic potential. Methods...... Microarray-based screening and bisulfite sequencing of 20 nonmalignant and 29 PC tissue specimens were used to identify new candidate DNA hypermethylation markers for PC. Diagnostic and prognostic potential was evaluated in 35 nonmalignant prostate tissue samples, 293 radical prostatectomy (RP) samples...

  9. Comprehensive preoperative evaluation and repair of inguinal hernias at the time of open radical retropubic prostatectomy decreases risk of developing post-prostatectomy hernia.

    Science.gov (United States)

    Marien, Tracy; Taouli, Bachir; Telegrafi, Shpetim; Babb, James S; Lepor, Herbert

    2012-12-01

    What's known on the subject? and What does the study add? Some studies have evaluated preoperative and intraoperative examination for inguinal hernias and their repair, noting a decrease in the rate of post-prostatectomy hernias. However, this did not eradicate post-prostatectomy hernias, indicating that this method probably missed subclinical hernias. Other studies looked at prophylactic procedures to prevent the formation of inguinal hernias at the time of prostatectomy and showed a decrease in the rate of postoperative hernias. To our knowledge this is the only series evaluating a multi-modal approach with magnetic resonance imaging, ultrasonography and examination to identify all clinical and subclinical hernias and repair them at the time of prostatectomy. This approach only subjects those patients at risk for symptomatic hernias to an additional procedure and decreases the post-prostatectomy hernia rate to hernias and repair of these hernias at the time of open radical retropubic prostatectomy (ORRP) decreases the incidence of clinical inguinal hernias (IHs) after ORRP. • Between 1 July 2007 and 31 July 2010, 281 consecutive men underwent ORRP by a single surgeon. • Of these men, 207 (74%) underwent comprehensive preoperative screening for IH, which included physical examination, upstanding ultrasonography and magnetic resonance imaging. • Between 12 and 24 months after ORRP, 178 (86%) of these men completed a questionnaire designed to capture development of clinical IHs. • Of the 178 evaluable patients, 92 (52%) were diagnosed preoperatively with IH by at least one diagnostic modality. • Forty-one and 51 of the men had bilateral or unilateral IHs, respectively for a total of 133 IHs. • No preoperative factor was significantly associated with the presence of an IH before prostatectomy. • No groin subjected to IH repair (IHR) at the time of ORRP developed a clinical IH compared with four of the 21 patients with postoperative IHs who did not

  10. Correlation of diffusion-weighted MRI with whole mount radical prostatectomy specimens.

    Science.gov (United States)

    Van As, N; Charles-Edwards, E; Jackson, A; Jhavar, S; Reinsberg, S; Desouza, N; Dearnaley, D; Bailey, M; Thompson, A; Christmas, T; Fisher, C; Corbishley, C; Sohaib, S

    2008-06-01

    The purpose of this study was to compare the apparent diffusion coefficient (ADC) of benign central gland (bCG), benign peripheral zone (bPZ) and cancer using diffusion-weighted MRI and whole mount specimens. 11 patients with biopsy-proven prostate cancer underwent diffusion-weighted MRI prior to radical prostatectomy. A single-shot echo planar image technique was used with b-values of 0 s mm(-2), 300 s mm(-2), 500 s mm(-2) and 800 s mm(-2). Whole mount specimens were compared with ADC maps. Areas of cancer, bCG and bPZ were identified, and regions of interest were drawn on ADC maps. Mean ADC values were recorded for all regions of interest, and paired t-tests were performed to compare mean values. Cancer was outlined in nine patients. In two patients, the tumours were too small to correlate with images; bCG was identified in 11 patients and bPZ was identified in 10 patients. Mean ADC values for bCG, bPZ and cancer were, 1.5 x 10(-3) mm(2) s(-1) (standard error (SE) = 0.04), 1.7 x 10(-3) mm(2) s(-1) (SE = 0.1), and 1.3 x 10(-3) mm(2) s(-1) (SE = 0.09), respectively. The most significant difference between benign tissue and cancer existed at b-values of 0-300 s mm(-2) (bCG vs cancer: mean difference = 0. 29, p = 0.001, 95% confidence interval (CI) = 0.17-0.41; bPZ vs cancer: mean difference = 0.34, p = 0.003, 95% CI = 0.18-0.61). In conclusion, we have confirmed, using whole mount verification, a significant difference in the ADC between benign tissue and cancer.

  11. PROGNOSTIC FACTORS OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY FOR LOCALIZED AND LOCALLY-ADVANCED PROSTATE CANCER

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    V. A. Chernyaev

    2014-08-01

    Full Text Available Purpose. To reveal prognostic factors of PSA-failure following radical prostatectomy in patients with localized and locally-advanced prostate cancer.Materials and methods. Medical data of 386 consecutive patients with localized and locally-advanced prostate cancer who underwent radical prostatectomy from 1997 to 2011 were analyzed. Median age was 61.0 years. Median PSA before surgery – 10.3 ng/ml. Plasma levels of VEGF, VEGFR2, VEGFR3, TGF-β1, CD105, IL-6 were measured using Enzyme Linked-Immuno-Sorbent Assay (ELISA before radical prostatectomy in 77 patients. Postoperatively the tumours were categorized as pT2 in 288 (59.1 %, pT3 – in 144 (37.3 %, pT4 – in 14 (3.6; pN+ – in 34 (8.8 % cases. Gleason score < 7 was present in 254 (65.8 %,  7 – in 132 (34.2 % specimens. Perineural invasion was identified in 188 (48.7 %, angiolymphatic invasion – in 126 (32.6 cases.Results. Biochemical recurrence occurred in 64 (16.6 % out of 386 patients at a median follow-up of 30.5 (12−164 months. Independent predictors of biochemical recurrence were PSA (HR 0.161 (95% CI:0.058−0.449; р = 0.001, Gleason sum in surgical specimens (HR 0.496 (95 % CI:0.268−0.917; p = 0.025, pN (HR 0.415 (95 % CI:0.181−0.955; p = 0.039. The patients were divided into 3 prognostic groups: good (0 factor, intermediate (1 factor, poor (2 factors and very poor (3 factors (AUC – 0.720 (95% CI: 0.656−0.784. High preoperative levels VEGF ( 67 pg/ml (р = 0.005, VEGFR2 ( 3149 pg/ml (р = 0.036, VEGFR3 ( 2268 pg/ml (р = 0.001, TGF-β1 ( 14473 pg/ml (р = 0.052 were identified as unfavorable prognostic factors for survival without PSA-failure. Conclusion. Independent prognostic factors of biochemical recurrence after prostatectomy were PSA, Gleason sum and pN. Joint effect of the factors allows to predict PSA-relapse with accuracy 0.720. Preoperative serum levels VEGF, VEGFR2, VEGFR3, TGF-β1 potentially are perspective markers for PSA-failure after

  12. PROGNOSTIC FACTORS OF BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY FOR LOCALIZED AND LOCALLY-ADVANCED PROSTATE CANCER

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    V. A. Chernyaev

    2012-01-01

    Full Text Available Purpose. To reveal prognostic factors of PSA-failure following radical prostatectomy in patients with localized and locally-advanced prostate cancer.Materials and methods. Medical data of 386 consecutive patients with localized and locally-advanced prostate cancer who underwent radical prostatectomy from 1997 to 2011 were analyzed. Median age was 61.0 years. Median PSA before surgery – 10.3 ng/ml. Plasma levels of VEGF, VEGFR2, VEGFR3, TGF-β1, CD105, IL-6 were measured using Enzyme Linked-Immuno-Sorbent Assay (ELISA before radical prostatectomy in 77 patients. Postoperatively the tumours were categorized as pT2 in 288 (59.1 %, pT3 – in 144 (37.3 %, pT4 – in 14 (3.6; pN+ – in 34 (8.8 % cases. Gleason score < 7 was present in 254 (65.8 %,  7 – in 132 (34.2 % specimens. Perineural invasion was identified in 188 (48.7 %, angiolymphatic invasion – in 126 (32.6 cases.Results. Biochemical recurrence occurred in 64 (16.6 % out of 386 patients at a median follow-up of 30.5 (12−164 months. Independent predictors of biochemical recurrence were PSA (HR 0.161 (95% CI:0.058−0.449; р = 0.001, Gleason sum in surgical specimens (HR 0.496 (95 % CI:0.268−0.917; p = 0.025, pN (HR 0.415 (95 % CI:0.181−0.955; p = 0.039. The patients were divided into 3 prognostic groups: good (0 factor, intermediate (1 factor, poor (2 factors and very poor (3 factors (AUC – 0.720 (95% CI: 0.656−0.784. High preoperative levels VEGF ( 67 pg/ml (р = 0.005, VEGFR2 ( 3149 pg/ml (р = 0.036, VEGFR3 ( 2268 pg/ml (р = 0.001, TGF-β1 ( 14473 pg/ml (р = 0.052 were identified as unfavorable prognostic factors for survival without PSA-failure. Conclusion. Independent prognostic factors of biochemical recurrence after prostatectomy were PSA, Gleason sum and pN. Joint effect of the factors allows to predict PSA-relapse with accuracy 0.720. Preoperative serum levels VEGF, VEGFR2, VEGFR3, TGF-β1 potentially are perspective markers for PSA-failure after

  13. [Radical prostatectomy: local recurrence and persistence of disease. Is it possible to hypothesize any responsibility of the surgeon?].

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    Zattoni, Filiberto; Gigli, Francesca

    2010-01-01

    Radical prostatectomy (RP) represents the most frequently chosen therapeutic option for treating newly diagnosed localized prostate cancer. Cancer recurrence after surgery is linked to biologic variables. But are these the only ones that must be considered to give an explanation of a possible local or distal recurrence, or can it also admit the possibility that an incorrectly conducted surgery has a negative role in the unfavorable evolution after PR? Prostate cancer recurrence, as a matter of fact, is related also to surgical technique. The PR, by definition is a surgical, potentially complicated act. Surgery outcomes depend on a whole series of factors: the surgeon's ability, and the way the surgical procedure is conducted, play an essential role. Here we evaluate the role of biological and surgical factors on biochemical recurrence.

  14. Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015

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    Augusto Cesar Soares dos Santos Junior

    Full Text Available ABSTRACT This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5. The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years, was 44% (n=40. The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years. Thirty-seven AUS implants (40.7% resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3% additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1% underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%. Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%. In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

  15. Radiotherapy after radical prostatectomy: treatment recommendations differ between urologists and radiation oncologists.

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    Luke T Lavallée

    Full Text Available PURPOSE: There is no consensus on optimal use of radiotherapy following radical prostatectomy. The purpose of this study was to describe opinions of urologists and radiation oncologists regarding adjuvant and salvage radiotherapy following radical prostatectomy. METHODS: Urologists and genitourinary radiation oncologists were solicited to participate in an online survey. Respondent characteristics included demographics, training, practice setting, patient volume/experience, and access to radiotherapy. Participant practice patterns and attitudes towards use of adjuvant and salvage radiotherapy in standardized clinical scenarios were assessed. RESULTS: One hundred and forty-six staff physicians participated in the survey (104 urologists and 42 genitourinary radiation oncologists. Overall, high Gleason score (Gleason 7 vs. 6, RR 1.37 95% CI 1.19-1.56, p<0.0001 and Gleason 8-10 vs. 6, RR 1.56 95% CI 1.37-1.78, p<0.0001, positive surgical margin (RR 1.43 95% CI 1.26-1.62, p<0.0001, and extraprostatic tumour extension (RR 1.16 95% CI 1.05-1.28, p<0.002 conferred an increased probability of recommending adjuvant radiotherapy. Radiation oncologists were more likely to recommend adjuvant radiotherapy across all clinical scenarios (RR 1.48, 95% CI 1.39, 1.60, p <0.001. Major differences were found for patients with Gleason 6 and isolated positive surgical margin (radiotherapy selected by 21% of urologists vs. 70% of radiation oncologists, and patients with extraprostatic extension and negative surgical margins (radiotherapy selected by 18% of urologist vs. 57% of radiation oncologists. CONCLUSIONS: Urologists and radiation oncologists frequently disagree about recommendation for post-prostatectomy adjuvant radiotherapy. Since clinical equipoise exists between adjuvant versus early salvage post-operative radiotherapy, support of clinical trials comparing these approaches is strongly encouraged.

  16. Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015

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    dos Santos, Augusto Cesar Soares; Rodrigues, Luíza de Oliveira; Azevedo, Daniela Castelo; Carvalho, Lélia Maria de Almeida; Fernandes, Mariana Ribeiro; Avelar, Sandra de Oliveira Sapori; Horta, Maria da Glória Cruvinel; Kelles, Silvana Márcia Bruschi

    2017-01-01

    ABSTRACT This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

  17. Preservation of penile length after radical prostatectomy: early intervention with a vacuum erection device.

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    Dalkin, B L; Christopher, B A

    2007-01-01

    Radical prostatectomy has been shown to have a potential negative impact on penile health. Stretched penile length (SPL), which most closely correlates with erect penile length, was significantly reduced in almost half of men undergoing surgery in several studies. The purpose of this study was to test whether early intervention after surgery with a vacuum erection device could prevent the changes in penile health, as defined by SPL, found in prior studies. Forty-two men with good preoperative sexual function undergoing nerve-sparing radical prostatectomy underwent measurement of SPL preoperative and at 3 months postoperative by a single investigator. Daily use of a vacuum erection device (VED) was begun the day after catheter removal, and continued for 90 days. Men kept a log of their compliance with daily VED use. A decrease in SPL of > or = 1.0 cm was considered significant. Out of 42 men, 39 completed the study. In men who used the VED >50% of possible days, only 1/36 (3%) had a decrease in SPL of > or = 1.0 cm. Of the three men with poor VED compliance, two (67%) had a reduction in SPL of > or = 1.0 cm. When compared to prior studies where 48% of men after surgery had a significant reduction in SPL, early intervention with the daily use of a VED resulted in a significantly lower risk of loss of penile length (PVED should be strongly recommended.

  18. Vacuum erection devices to treat erectile dysfunction and early penile rehabilitation following radical prostatectomy.

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    Zippe, Craig D; Pahlajani, Geetu

    2008-11-01

    Vacuum erection devices (VED) are becoming first-line therapies for erectile dysfunction and preservation (rehabilitation) of erectile function following treatment for prostate cancer. Currently, phosphodiesterase-5 inhibitors have limited efficacy in elderly patients or patients with moderate to severe diabetes, hypertension, and coronary artery disease. Alternative therapies, such as VED, have emerged as a primary option for patients refractory to oral therapy. VED has also been successfully used in combination treatment with oral therapy and penile injections. More recently, there has been interest in the use of VED in early intervention protocols to encourage corporeal rehabilitation and prevention of post-radical prostatectomy venoocclusive dysfunction. This is evident by the preservation of penile length and girth seen with the early use of the VED following radical prostatectomy. There are ongoing studies to help preserve penile length and girth with early use of VED following prostate brachytherapy and external beam radiation for prostate cancer. Recently, there has also been interest in VED to help maintain penile length following surgical correction of Peyronie's disease and to increase penile size before implantation of the penile prosthesis.

  19. Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan.

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    Yoshioka, K; Hatano, T; Nakagami, Y; Ozu, C; Horiguchi, Y; Yonou, H; Tachibana, M; Coughlin, G; Patel, V R

    2008-07-01

    Recently, we have introduced robotic-assisted laparoscopic radical prostatectomy (RALP) in Japan. This article describes the details of a training program to shorten the learning curve in the absence of an urologist with expertise in robotic surgery. Five months after a 2-day training course of robotic surgery, RALP was first performed in Japan, and a total of 15 cases were performed in the subsequent 4 months. Our training program consisted of: (1) image training using surgical operation videos, (2) dry lab training using a sham pelvic cavity model, and (3) intraoperative mentoring. The operative procedure was divided into five consecutive stages, and time required to complete each stage was recorded. Robotic radical prostatectomy was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-h operation had been imposed by the ethics committee. The mean console time and the mean intraoperative blood loss (including urine) reduced from 264.2 min and 459.4 ml, respectively, in the first 11 cases, to 151 min and 133.3 ml, respectively, in the last three cases. With direct intraoperative guidance by the mentor during cases 13 and 14, the operation time was reduced at all five stages of the operative procedure. Our training program proved remarkably effective in reducing the learning curve of RALP in Japan, where there is no person with expertise in robotic surgery.

  20. High Chance of Late Recovery of Urinary and Erectile Function Beyond 12 Months After Radical Prostatectomy.

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    Mandel, Philipp; Preisser, Felix; Graefen, Markus; Steuber, Thomas; Salomon, Georg; Haese, Alexander; Michl, Uwe; Huland, Hartwig; Tilki, Derya

    2017-06-01

    Urinary incontinence (UI) and erectile dysfunction (ED) after radical prostatectomy (RP) can impose a strong burden. While most studies focus on certain time points after RP when analyzing functional outcome, there is paucity of evidence on late functional recovery in patients with UI or ED at 12 mo after RP. Using longitudinal patient data from a large European single-center, we show that the chance of regaining continence among patients (n=974) with UI (≥1 pad/24h) at 12 mo after RP was 38.6% after 24 mo and 49.7% after 36 mo. The corresponding rates for patients (n=1115) with ED (defined as International Index of Erectile Function-5 score <18) at 12 mo after RP were 30.8% at 24 mo and 36.5% at 36 mo after RP. Patients with postoperative UI or ED 12 mo after RP should be counseled about their good chance of achieving continence or potency in the course of time. We analyzed the probability of functional recovery among patients with urinary incontinence (UI) and erectile dysfunction (ED) 12 mo after radical prostatectomy. We found that up to 49.7% (36.5%) of patients with UI (ED) regain function within the next 24 mo and should be informed about these encouraging numbers. Copyright © 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  1. Undergrading and understaging in patients with clinically insignificant prostate cancer who underwent radical prostatectomy

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    Irai S. Oliveira

    2010-06-01

    Full Text Available PURPOSE: The aim of our study is to evaluate the undergrading and understaging rates in patients with clinically localized insignificant prostate cancer who underwent radical prostatectomy. MATERIALS AND METHODS: Between July 2005 and July 2008, 406 patients underwent radical prostatectomy for clinical localized prostate cancer in our hospital. Based on preoperative data, 93 of these patients fulfilled our criteria of non-significance: Gleason score < 7, stage T1c, PSA < 10 ng/mL and percentage of affected fragments less than 25%. The pathologic stage and Gleason score were compared to preoperative data to evaluate the rate of understaging and undergrading. The biochemical recurrence free survival of these operated insignificant cancers were also evaluated. RESULTS: On surgical specimen analysis 74.7% of patients had Gleason score of 6 or less and 25.3% had Gleason 7 or greater. Furthermore 8.3% of cases showed extracapsular extension. After 36 months of follow-up 3.4% had biochemical recurrence, defined by a PSA above 0.4 ng/mL. CONCLUSIONS: Despite the limited number of cases, we have found considerable rates of undergrading and understaging in patients with prostate cancer whose current definitions classified them as candidates for active surveillance. According to our results the current definition seems inadequate as up to a third of patients had higher grade or cancer outside the prostate.

  2. Comparison between needle biopsy and radical prostatectomy samples in assessing Gleason score and modified Gleason score in prostatic adenocarcinomas

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    Banu DOĞAN GÜN

    2007-01-01

    Full Text Available Histologic grading is an important predictor of prostatic disease stage and prognosis. We aimed to assess the degree of concordance between pathologic characteristics of the specimens obtained from biopsy and radical prostatectomy materials.Gleason scores and modified Gleason scores calculated for 25 cases of prostatic adenocarcinoma from both needle biopsy and radical prostatectomy specimens were analyzed.Mean Gleason scores for biopsy and radical specimens were 6.4 (SD:±0.7 and 6.64 (SD:±1.3; and corresponding modified Gleason scores were 7.32 (SD:±1.43 and 7.32 (SD:±0.98, respectively. The Gleason scores of biopsy and radical prostatectomy specimens were identical in 48% (12/25 of the cases, while 32% (8/25 of the biopsy specimens were over-and 20% (5/25 of them were undergraded. While assessing modified Gleason scores, the exact degree of concordance of biopsy specimens with radical prostatectomy materials was 56% (14/25 and of the 11 (44% cases not correlated exactly, 6 (24% were over- and 5 (20% were undergraded. When the exact, over- and underestimated scores of Gleason and modified Gleason grading systems were compared statistically, no difference between two groups was seen (p>0.05. Overgrading errors were found to be more than undergrading errors for both of the scoring systems. Using either the modified Gleason or traditional Gleason scoring

  3. Robotics and telesurgery--an update on their position in laparoscopic radical prostatectomy.

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    Rassweiler, J; Safi, K C; Subotic, S; Teber, D; Frede, T

    2005-01-01

    Laparoscopy is handicapped by the reduction of the range of motion from six to only four degrees of freedom. In complicated cases (i.e. radical prostatectomy), there is often a crossing of the hands of surgeon and assistant. Finally, standard laparoscopes allow only 2D-vision. This has a major impact on technically difficult reconstructive procedures such as laparoscopic radical prostatectomy. Solutions include the understanding of the geometry of laparoscopy, but also newly developed surgical robots. During the last five years, there has been an increasing development and experience with robotics in urology. This article reviews the actual results focussing on the benefits and problems of robotics in laparoscopic radical prostatectomy. Own experiences with robot-assisted surgery include more than 1200 laparoscopic radical prostatectomies using a voice-controlled camera-arm (AESOP) as well as six telesurgical interventions with the da Vinci-system. Substantial experimental studies have been performed focussing on the geometry of laparoscopy and new training concepts such as perfused pelvitrainers and models for simulation of urethrovesical anastomosis. The recent literature on robotics in urology has been reviewed based on a MEDLINE/PUBMED research. The geometry of laparoscopy includes the angles between the instruments which have to be in a range of 25 degrees to 45 degrees ; the angles between the instrument and the working plane that should not exceed 55 degrees ; and the bi-planar angle between the shaft of the needle holder and the needle which has to be adapted according to the anatomical situation in range of 90 degrees to 110 degrees . 3-D-systems have not yet proved to be effective due to handling problems such as shutter glasses, video helmets or reduced brightness. At the moment, there are only two robotic surgical systems (AESOP, da Vinci) in clinical use, of which only the da Vinci provides stereovision and all six degrees of freedom (DOF). To date

  4. The "halo effect" in Korea: change in practice patterns since the introduction of robot-assisted laparoscopic radical prostatectomy.

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    Sung, Ee-Rah; Jeong, Wooju; Park, Sung Yul; Ham, Won Sik; Choi, Young Deuk; Hong, Sung Joon; Rha, Koon Ho

    2009-03-01

    Acquisition of the da Vinci surgical system (Intuitive Surgical, Mountain View, USA) has enabled robot-assisted surgery to become an acceptable alternative to open radical prostatectomy (ORP). Implementation of robotics at a single institution in Korea induced a gradual increase in the number of performances of robot-assisted laparoscopic radical prostatectomy (RALP) to surgically treat localized prostate cancer. We analyzed the impact of robotic instrumentation on practice patterns among urologists and explain the change in value in ORP and RALP-the standard treatment and the new approach or innovation of robotic technology. The overall number of prostatectomies has increased over time because the number of RALPs has grown drastically whereas the number of OPRs did not decrease during the period of evaluation. Our experience emphasizes the potential of RALP to become the gold standard in the treatment of localized prostate cancer in various parts of the world.

  5. Prostate cancer recurrence after radical prostatectomy: the role of 3-T diffusion imaging in multi-parametric magnetic resonance imaging.

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    Panebianco, Valeria; Barchetti, Flavio; Sciarra, Alessandro; Musio, Daniela; Forte, Valerio; Gentile, Vincenzo; Tombolini, Vincenzo; Catalano, Carlo

    2013-06-01

    To validate the role of 3-T diffusion-weighted imaging (DWI) in the detection of local prostate cancer recurrence after radical prostatectomy (RP). T2-weighted imaging, DWI and dynamic contrast-enhanced MRI (DCE-MRI) were performed with a 3-T magnet in 262 patients after RP. Twenty out of 262 patients evaluated were excluded. MRI results were validated by prostate-specific antigen (PSA) reduction after external beam radiotherapy in group A (126 patients, local recurrence size range 4-8 mm) and by transrectal ultrasound biopsy in group B (116 patients, local recurrence size range 9-15 mm). In group A combined T2-weighted and DCE-MRI (T2+DCE) shows 98 % sensitivity, 94 % specificity and 93 % accuracy in identifying local recurrence; combined T2-weighted and DWI with a b value of 3,000 s/mm(2) (T2+DW3) displays 97 % sensitivity, 95 % specificity and 92 % accuracy, while with a b value of 1,000 s/mm(2) (T2+DW1) affords 93 % sensitivity, 89 % specificity and 88 % accuracy. In group B T2+DCE shows 100 % sensitivity, 97 % specificity and 91 % accuracy in detecting local cancer recurrence; T2+DW3 displays 98 % sensitivity, 96 % specificity and 89 % accuracy; T2+DW1 has 94 % sensitivity, 92 % specificity and 86 % accuracy. DCE-MRI is the most reliable technique in detecting local prostate cancer recurrence after RP, though DWI can be proposed as a reliable alternative. • Diffusion-weighted magnetic resonance imaging (DWI-MRI) is being increasingly used in oncology. • PSA analysis does not distinguish prostate cancer recurrence from distant metastasis. • DWI-MR can diagnose local prostate cancer recurrence after radical prostatectomy. • DWI-MR is almost comparable to DCE-MRI in detecting local recurrence.

  6. Radical prostatectomy

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    ... to see inside your belly during the procedure. Robotic surgery : Sometimes, laparoscopic surgery is performed using a robotic ... near the operating table. Not every hospital offers robotic surgery. Perineal : Your surgeon makes a cut in the ...

  7. Impact of age on the biochemical failure and androgen suppression after radical prostatectomy for prostate cancer in chilean men

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    Nigel P Murray

    2016-01-01

    Conclusion: After radical prostatectomy, the older men with pathological features of Gleason score ≥ 8, pT3 tumors, and positive extracapsular extension had higher frequency of biochemical failure and the presence of CPCs. The treatment of androgen blockade was less successful to suppress the disease relapse in the older men than that in the younger man.

  8. Body mass index as a prognostic marker for biochemical recurrence in Dutch men treated with radical prostatectomy

    NARCIS (Netherlands)

    Roermund, van J.G.H.; Kok, D.E.G.; Wildhagen, M.F.; Kiemeney, L.A.; Struik, F.; Sloot, S.; Oort, van I.M.; Hulsbergen- van de Kaa, C.A.; Leenders, van G.J.L.H.; Bangma, C.H.; Witjes, J.A.

    2009-01-01

    OBJECTIVE To investigate whether body mass index (BMI) is a prognostic factor for biochemical recurrence (BCR) in Dutch men after radical prostatectomy (RP), as although epidemiological studies of obesity in relation to prostate cancer have provided conflicting results, recent studies from the USA

  9. Body mass index as a prognostic marker for biochemical recurrence in Dutch men treated with radical prostatectomy.

    NARCIS (Netherlands)

    Roermund, J.G. van; Kok, D.E.; Wildhagen, M.F.; Kiemeney, L.A.L.M.; Struik, F.; Sloot, S.; Oort, I.M. van; Hulsbergen- van de Kaa, C.A.; Leenders, G.J.L.H. van; Bangma, C.H.; Witjes, J.A.

    2009-01-01

    OBJECTIVE: To investigate whether body mass index (BMI) is a prognostic factor for biochemical recurrence (BCR) in Dutch men after radical prostatectomy (RP), as although epidemiological studies of obesity in relation to prostate cancer have provided conflicting results, recent studies from the USA

  10. Body mass index is not a predictor of biochemical recurrence after radical prostatectomy in Dutch men diagnosed with prostate cancer

    NARCIS (Netherlands)

    Kok, D.E.G.; Roermond, van J.G.; Aben, K.K.; Luijtgaarden, van de M.W.; Karthaus, H.F.; Vierssen Trip, van O.B.; Kampman, E.; Witjes, A.J.; Kiemeney, L.A.

    2011-01-01

    Purpose To determine the eVect of body mass index (BMI) on clinical and pathological characteristics at time of diagnosis and on risk of biochemical recurrence after radical prostatectomy among Dutch men diagnosed with prostate cancer. Methods In total, 1,116 prostate cancer patients with known BMI,

  11. Biochemical failure after radical prostatectomy in intermediate-risk group men increases with the number of risk factors

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    Nobuki Furubayashi

    2017-01-01

    Conclusion: The number of intermediate risk factors is significantly associated with the PSA failure-free survival rate after radical prostatectomy in the intermediate-risk group. Patients classified into the intermediate-risk group based on all three intermediate risk factors are less likely to achieve a complete cure through surgery alone.

  12. Radical Prostatectomy is a Valuable Treatment Alternative in Patients with High-Risk Prostate Cancer

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    Naşide Mangır

    2015-09-01

    Full Text Available Objective To review the high-risk prostate cancer (PCa patient database with special emphasis on the role of radical prostatectomy (RP in comparison to external beam radiotherapy (EBRT. Materials and Methods A total of 102 patients with complete and long-term follow-up data were included. High-risk PCa was defined as: a pre-treatment PSA level of ≥20 ng/mL and/or a primary Gleason score of ≥4 and/or clinical stage ≥T3N0M0 disease. A total of 45 (42.5% patients underwent radical RP with extended pelvic lymphadenectomy for-high risk PCa and a total of 57 (53.8% patients received EBRT. Results The mean overall survival (mean survival 95.2 vs. 129.2 months, log rank p=0.73 and cancer-specific survival (mean survival 104 vs. 151.4 months, log rank p=0.35 were not significantly different between RP and EBRT groups. Univariate analysis of variables that may affect overall survival showed no significant effect of pre-treatment PSA, Gleason score, clinical stage or type of therapy. The only factor which reached statistical significance was patient age (p=0.002. Multivariate analysis of variables also showed no significant effect of pre-treatment PSA, Gleason score, clinical stage or type of therapy and, again, the only factor which reached statistical significance was patient age (p=0.012. Conclusion Radical prostatectomy appears to be an effective and a non-inferior treatment option in patients with high-risk localized PCa with acceptable overall and cancer-specific survival compared to RT. Therefore, as the guidelines suggest, it should be provided as an option during patient consultation for a proper informed decision-making.

  13. Cancer/Testis antigens as potential predictors of biochemical recurrence of prostate cancer following radical prostatectomy

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    Trock Bruce

    2011-09-01

    Full Text Available Abstract Background The Cancer/Testis Antigens (CTAs are an important group of proteins that are typically restricted to the testis in the normal adult but are aberrantly expressed in several types of cancers. As a result of their restricted expression patterns, the CTAs could serve as unique biomarkers for cancer diagnosis/prognosis. The aim of this study was to identify promising CTAs that are associated with prostate cancer (PCa recurrence following radical prostatectomy (RP. Methods The expression of 5 CTAs was measured by quantitative multiplex real-time PCR using prostate tissue samples obtained from 72 patients with apparently clinically localized PCa with a median of two years follow-up (range, 1 to 14 years. Results The expression of CTAs namely, CEP55, NUF2, PBK and TTK were significantly higher while PAGE4 was significantly lower in patients with recurrent disease. All CTAs with the exception of TTK were significantly correlated with the prostatectomy Gleason score, but none were correlated with age, stage, or preoperative PSA levels. In univariate proportional hazards models, CEP55 (HR = 3.59, 95% CI: 1.50-8.60, p = 0.004; NUF2 (HR = 2.28, 95% CI: 1.11-4.67, p = 0.024; and PAGE4 (HR = 0.44, 95% CI: 0.21-0.93, p = 0.031 were significantly associated with the risk of PCa recurrence. However, the results were no longer significant after adjustment for prostatectomy Gleason score. Conclusions To our knowledge, this is the first study to identify CTAs as biomarkers that can differentiate patients with recurrent and non-recurrent disease following RP and underscores its potential impact on PCa prognosis and treatment.

  14. Abdominal obesity, hypertension, antihypertensive medication use and biochemical recurrence of prostate cancer after radical prostatectomy.

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    Ohwaki, Kazuhiro; Endo, Fumiyasu; Hattori, Kazunori

    2015-03-01

    The aim of this study was to determine whether abdominal obesity, including visceral adipose tissue (VAT) measured by computed tomography and blood pressure (BP) were associated with biochemical recurrence of prostate cancer after prostatectomy. We investigated 283 patients who underwent radical prostatectomy for prostate cancer retrospectively. We obtained information on body mass index (BMI), waist circumference (WC), VAT, BP, antihypertensive drug use, pretreatment prostate-specific antigen levels, pathological Gleason scores and postoperative surgical margin status. Hypertension was defined as systolic BP (SBP)⩾130mmHg or diastolic BP⩾85mmHg. Among 283 patients, 41 (14%) developed biochemical recurrence subsequently. We performed a Cox proportional hazard regression analysis to assess the association of each obesity measurement and SBP with biochemical recurrence using clinical predictors as potential confounders. No association was observed between any obesity measurement assessed and biochemical recurrence. Adjusting for each of BMI, WC and VAT, a higher SBP was associated significantly with biochemical recurrence (hazard ratio [HR], adjusted for VAT=1.04; 95% confidence interval [CI]=1.02-1.07). Adjusting for obesity (BMI⩾25kg/m(2)), hypertension was also associated significantly with biochemical recurrence (HR=2.08; 95% CI=1.09-3.97). Compared with normotensive patients, those with untreated and uncontrolled hypertension had a significantly increased risk of biochemical recurrence (HR=2.45; 95% CI=1.06-5.66). A higher BP and untreated, uncontrolled hypertension were independent risk factors for biochemical recurrence after prostatectomy. Control of hypertension could be an important treatment strategy for preventing biochemical recurrence. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Testosterone replacement therapy in patients with prostate cancer after radical prostatectomy.

    Science.gov (United States)

    Pastuszak, Alexander W; Pearlman, Amy M; Lai, Win Shun; Godoy, Guilherme; Sathyamoorthy, Kumaran; Liu, Joceline S; Miles, Brian J; Lipshultz, Larry I; Khera, Mohit

    2013-08-01

    Testosterone replacement therapy in men with prostate cancer is controversial, with concern that testosterone can stimulate cancer growth. We evaluated the safety and efficacy of testosterone in hypogonadal men with prostate cancer treated with radical prostatectomy. We performed a review of 103 hypogonadal men with prostate cancer treated with testosterone after prostatectomy (treatment group) and 49 nonhypogonadal men with cancer treated with prostatectomy (reference group). There were 77 men with low/intermediate (nonhigh) risk cancer and 26 with high risk cancer included in the analysis. All men were treated with transdermal testosterone, and serum hormone, hemoglobin, hematocrit and prostate specific antigen were evaluated for more than 36 months. Median (IQR) patient age in the treatment group was 61.0 years (55.0-67.0), and initial laboratory results included testosterone 261.0 ng/dl (213.0-302.0), prostate specific antigen 0.004 ng/ml (0.002-0.007), hemoglobin 14.7 gm/dl (13.3-15.5) and hematocrit 45.2% (40.4-46.1). Median followup was 27.5 months, at which time a significant increase in testosterone was observed in the treatment group. A significant increase in prostate specific antigen was observed in the high risk and nonhigh risk treatment groups with no increase in the reference group. Overall 4 and 8 cases of cancer recurrence were observed in treatment and reference groups, respectively. Thus, testosterone therapy is effective and, while followed by an increase in prostate specific antigen, does not appear to increase cancer recurrence rates, even in men with high risk prostate cancer. However, given the retrospective nature of this and prior studies, testosterone therapy in men with history of prostate cancer should be performed with a vigorous surveillance protocol. Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  16. Robotic radical prostatectomy-a minimally invasive therapy for prostate cancer: results of initial 530 cases

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    A Tewari

    2005-01-01

    Full Text Available Context: In 2000, the number of new cases of prostate cancer was estimated at 5 13 000 worldwide [Eur J Cancer 2001; 37 (Suppl 8: S4]. In next 15 years, prostate cancer is predicted to be the most common cancer in men [Eur J Cancer 2001; 37 (Suppl 8: S4]. Radical prostatectomy is one of the most common surgical treatments for clinically localized prostate cancer. In spite of its excellent oncological results, due to the fear of pain, risk for side effects, and inconvenience (Semin Urol Oncol 2002; 20: 55, many patients seek alternative treatments for their prostate cancer. At Vattikuti Urology institute, we have developed a minimally invasive technique for treating prostate cancer, which achieves oncological results of surgical treatment without causing significant pain, large surgical incision, and side effects (BJU Int, 2003; 92: 205. This technique involves a da Vinci™ (Intuitive Surgical ®, Sunnyvale, CA surgical robot with 3-D stereoscopic visualization and ergonomic multijointed instruments. Presented herein are our results after treating 750 patients. Methods: We prospectively collected baseline demographic data such as age, race, body mass index (BMI, serum prostate specific antigen, prostate volume, Gleason score, percentage cancer, TNM clinical staging, and comorbidities. Urinary symptoms were measured with the international prostate symptom score (IPSS, and sexual health with the sexual health inventory of males (SHIM. In addition, the patients were mailed the expanded prostate inventory composite at baseline and at 1, 3, 6, 12 and 18 months after the procedure. Results: Gleason seven or more cancer grade was noted in 33.5% of patients. The average BMI was high (27.7 and 87% patients had pathological stage PT2a-b. The mean operative time was 160 min and the mean blood loss was 153 cm3. No patient required blood transfusion. At 6 months 82% of the men who were younger and 75% of those older than 60 years had return of sexual

  17. Erectile dysfunction after radical prostatectomy: hemodynamic profiles and their correlation with the recovery of erectile function.

    Science.gov (United States)

    Mulhall, John P; Slovick, Ron; Hotaling, James; Aviv, Nadid; Valenzuela, Rolando; Waters, W Bedford; Flanigan, Robert C

    2002-03-01

    Despite the advent of nerve sparing radical prostatectomy some men experience erectile dysfunction. Many of these men have vasculogenic erectile impairment in the form of arterial insufficiency or venous leakage. Recent data imply that early postoperative injection therapy may decrease the rate of erectile dysfunction. We defined hemodynamic patterns in patients who underwent bilateral nerve sparing radical prostatectomy to assess the chronology of venous leakage development and explore the correlation of hemodynamic profiles with the return of functional erection 12 months postoperatively. Patients with excellent preoperative erectile function who underwent bilateral nerve sparing surgery and had no pharmacological support for erectile dysfunction in the initial 12 months after surgery received vascular evaluation at presentation. Vascular evaluation involved cavernosometry or penile ultrasonography. Patients were then interviewed again at least 12 months postoperatively to assess the ability to achieve sexual intercourse. Our study group comprised 96 men with a mean age plus or minus standard deviation of 54 +/- 12 years who met all inclusion criteria. All patients had pathologically proved organ confined disease. Mean time to the initial postoperative presentation was 6 +/- 5 months. Patients were divided into 4 groups according to the time of vascular studies postoperatively, namely less than 4 to 8, 9 to 12 and greater than 12 months. Normal vascular status, arterial insufficiency and venous leakage were diagnosed in 35%, 59% and 26% of the group, respectively. No difference in the incidence of arterial insufficiency was noted in the 4 time groups. Time postoperatively was significantly associated with the incidence of venous leakage (14% at less than 4 months and 35% at between 9 and 12). In regard to the correlation of the vascular diagnosis with the return to functional erection 47% of the normal, 31% of the arteriogenic and 9% of the venous leakage group

  18. Radical prostatectomy outcome when performed with PSA above 20 ng/ml.

    LENUS (Irish Health Repository)

    Connolly, S S

    2012-02-01

    Many centres currently do not offer radical prostatectomy (RP) to men with high-risk localised prostate cancer due to concerns regarding poor outcome, despite evidence to the contrary. We identified 18 men undergoing RP with serum PSA >20 ng\\/ml (high-risk by National Comprehensive Cancer Network definition) and minimum follow-up of 12 years (mean 13.5). Mean preoperative PSA was 37.0 ng\\/ml (Range 21.1-94.0). Prostatectomy pathology reported extracapsular disease in 16 (88.9%), positive surgical margins in 15 (83%) and positive pelvic lymph nodes in 5 (27.8%). Overall and cancer-specific survival at 5 and 10-years was 83.3%, 88.2%, 72% and 76.5% respectively. With complete follow-up 11 (61.1%) are alive, and 5 (27.8%) avoided any adjuvant therapy. Complete continence (defined as no involuntary urine leakage and no use of pads) was achieved in 60%, with partial continence in the remainder. We conclude that surgery for this aggressive variant of localised prostate cancer can result in satisfactory outcome.

  19. Late urinary morbidity and quality of life after radical prostatectomy and salvage radiotherapy for prostate cancer

    DEFF Research Database (Denmark)

    Ervandian, Maria; Høyer, Morten; Petersen, Stine Elleberg

    2017-01-01

    -2007, respectively. RESULTS: Weak stream, straining, frequency and nocturia were significantly more prevalent in patients treated with RP + SRT than in patients treated with RP alone. Patients treated with RP + SRT generally suffered from more severe urinary symptoms. The QoL scores of the two treatment groups were......OBJECTIVE: There is a paucity of knowledge of long-term urinary morbidity in patients treated for prostate cancer (PCa) with radical prostatectomy (RP) and salvage radiotherapy (SRT). Improved long-term survival calls for heightened awareness of late effects from radiotherapy after RP. The purpose...... of this study was to assess late urinary morbidity and its potential impact on quality of life (QoL) in patients treated with RP plus SRT compared with patients treated with RP alone. MATERIALS AND METHODS: Long-term morbidity and QoL were evaluated using a cross-sectional design with validated questionnaires...

  20. Early biochemical recurrence, urinary continence and potency outcomes following robot-assisted radical prostatectomy

    DEFF Research Database (Denmark)

    Berg, Kasper Drimer; Thomsen, Frederik Birkebæk; Hvarness, Helle

    2014-01-01

    OBJECTIVE: The aim of this study was to describe recovery of urinary continence and potency and report oncological and functional outcomes using the survival, continence and potency (SCP) system for patients undergoing robot-assisted radical prostatectomy (RARP). MATERIAL AND METHODS: From 2009...... with preoperative ESI, 77.6% (67.9-86.1) and 34.4% (24.1-47.5) maintained ESI 12 months postoperatively after bilateral and unilateral nerve-sparing surgery (NS), respectively. NS (p .... Using the SCP system and defining potency as ESI, functional and oncological success 12 months after surgery was achieved in 69 out of 135 (51.1%) preoperative continent and potent patients who underwent unilateral or bilateral NS, and did not require adjuvant treatment; when defining potency as IIEF...

  1. Does the size matter?: Prostate weight does not predict PSA recurrence after radical prostatectomy.

    Science.gov (United States)

    Davidson, Darrell D; Koch, Michael O; Lin, Haiqun; Jones, Timothy D; Biermann, Katharina; Cheng, Liang

    2010-04-01

    Previous studies suggest that low prostate weight is a significant negative prognostic factor for prostate cancer. In the current study, the data for 431 men who underwent radical retropubic prostatectomy between 1990 and 1998 were analyzed for association between prostate weight and various clinical and pathologic parameters. These included age, preoperative prostate-specific antigen (PSA) level, PSA recurrence, pathologic stage, Gleason grade, extraprostatic extension, positive surgical margins, tumor volume, associated high-grade prostatic intraepithelial neoplasia, perineural invasion, and lymph node metastasis. Potential associations were probed by using Cox regression model analysis. A significant positive correlation was found between prostate weight and increasing patient age or increasing preoperative PSA level. There was no significant independent association between prostate weight and any of the other variables examined. No association was found between prostate weight and PSA recurrence. Although increasing prostate weight correlates with increased patient age and higher preoperative PSA level, it does not independently predict postoperative cancer recurrence.

  2. In incontinence developing after radical prostatectomy the role of nurses on implementing behavioral therapy

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    Aylin Aydın Sayılan

    2016-11-01

    Full Text Available Developing after radical prostatectomy urinary incontinence (UI is a major health problem affecting the quality of life of men. Urinary incontinence patients in their care and treatment purpose is to provide continence. In the treatment of urinary incontinence surgery, medication and behavioral treatments are used. For the purposes of behavioral therapy; increasing the capacity of the bladder function and is aimed at promoting bladder control. Behavioral treatments for incontinence; diet, exercise bladder training and pelvic floor muscle training (PFMT is located.  Diet is regulated by the bladder diary. PFME is first identified in 1948 by Arnold Kegel, which is aimed pelvic to strengthen the muscles of the base and are expressed in improving the urethral sphincter function. In the literature, in the treatment of incontinence; with drug therapy or surgery, it should be emphasized also behavioral therapy.

  3. Nerve sparing can preserve orgasmic function in most men after robotic-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Tewari, Ashutosh; Grover, Sonal; Sooriakumaran, Prasanna; Srivastava, Abhishek; Rao, Sandhya; Gupta, Amit; Gray, Robert; Leung, Robert; Paduch, Darius A

    2012-02-01

    •  To investigate orgasmic outcomes in patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP) and the effects of age and nerve sparing on these outcomes. •  Between January 2005 and June 2007, 708 patients underwent RALP at our institution. •  We analysed postoperative potency and orgasmic outcomes in the 408 men, of the 708, who were potent, able to achieve orgasm preoperatively and available for follow-up. •  Of men aged ≤60 years, 88.4% (198/224) were able to achieve orgasm postoperatively in comparison to 82.6% (152/184) of older men (P function after RALP. •  Men ≤60 years old and those who undergo BNS are most likely to maintain normal sexual function. © 2011 THE AUTHORS. BJU INTERNATIONAL © 2011 BJU INTERNATIONAL.

  4. The Role of Radical Prostatectomy in the Treatment of Patients with High-Risk Prostate Cancer

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    Barış Kuzgunbay

    2015-09-01

    Full Text Available High-risk prostate cancer (PCa, which is defined as PSA >20 ng/mL or Gleason Score (GS >7 or ≥cT3a, accounts for up to 40% of newly diagnosed cases and carries a significant risk of progression and death. However, the best management approach for patients with high-risk PCa is still under debate. Recently, radical prostatectomy (RP with extended lymphadenectomy (LND has become popular for the treatment of high-risk PCa with good prognosis in selected patients in the context of multimodal approach. However, decision should be made after all treatments have been discussed by a multidisciplinary team and the patient should be informed about the likelihood of a multimodal approach. On the other hand, necessity of sufficient surgical expertise for RP to keep the level of morbidity acceptable in high-risk PCa patients should be kept in mind.

  5. Role of robot-assisted radical prostatectomy in the management of high-risk prostate cancer

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    Akshay Sood

    2014-01-01

    Full Text Available We aimed to evaluate the role of robot-assisted radical prostatectomy (RARP in the management of high-risk prostate cancer (PCa, with a focus on oncological, functional and perioperative outcomes. Further, we also aimed to briefly describe our novel modification to conventional RARP that allows immediate organ retrieval and examination for intra-operative surgical margin assessment. A literature search of PubMed was performed for articles on the management of high-risk PCa. Papers written in English and concerning clinical outcomes following RARP for locally advanced and high-risk PCa were selected. Outcomes data from our own center were also included. A total of 10 contemporary series were evaluated. Biopsy Gleason score ≥ 8 was the most common cause for classification of patients into the high-risk PCa group. Biochemical failure rate, in the few series that looked at long-term follow-up, varied from 9% to 26% at 1 year. The positive surgical margin rate varied from 12% to 53.3%. Urinary continence rates varied from 78% to 92% at 1 year. The overall complication rates varied from 2.4% to 30%, with anastomotic leak and lymphocele being the most common complications. Long-term data on oncological control following RARP in high-risk patients is lacking. Short-term oncological outcomes and functional outcomes are equivalent to open radical prostatectomy (RP. Safety outcomes are better in patients undergoing RARP when compared with open RP. Improved tools for predicting the presence of organ-confined disease (OCD are available. High-risk patients with OCD would be ideal candidates for RARP and would benefit most from surgery alone.

  6. The Timing of Salvage Radiotherapy After Radical Prostatectomy: A Systematic Review

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    King, Christopher R., E-mail: crking@mednet.ucla.edu [Department of Radiation Oncology, UCLA School of Medicine, Los Angeles, California (United States)

    2012-09-01

    Purpose: Salvage radiotherapy (SRT) after radical prostatectomy can potentially eradicate residual microscopic disease. Defining the optimal patient and treatment factors is essential and is particularly relevant within the context of adjuvant vs early vs delayed postoperative radiotherapy (RT). Methods and Materials: A systematic review of all published SRT studies was performed to identify the pathologic, clinical, and treatment factors associated with relapse-free survival (RFS) after SRT. A total of 41 studies encompassing 5597 patients satisfied the study entry criteria. Radiobiologic interpretation of biochemical tumor control was used to provide the framework for the observed relationships. Results: Prostate-specific antigen (PSA) level before SRT (P<.0001) and RT dose (P=.0052) had a significant and independent association with RFS. There was an average 2.6% loss of RFS for each incremental 0.1 ng/mL PSA at the time of SRT (95% CI, {approx}2.2-3.1). With a PSA level of 0.2 ng/mL or less before SRT, the RFS approached 64%. The dose for salvage RT in the range of 60-70 Gy seemed to be on the steep part of the sigmoidal dose-response curve, with a dose of 70 Gy achieving 54% RFS compared with only 34% for 60 Gy. There was a 2% improvement in RFS for each additional Gy (95% CI, {approx}0.9-3.2). The observed dose-response was less robust on sensitivity analysis. Conclusions: This study provides Level 2a evidence for initiating SRT at the lowest possible PSA. Dose escalation is also suggested by the data. Progressively better tumor control rates with SRT after radical prostatectomy are achieved with a lower PSA at initiation and with a higher RT dose. Early salvage RT may be an equivalent strategy to adjuvant RT.

  7. Difference between actual vs. pathology prostate weight in TURP and radical robotic-assisted prostatectomy specimen

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    Szilveszter Lukacs

    2014-12-01

    Full Text Available Introduction To investigate and highlight the effect of formaldehyde induced weight reduction in transurethral resection of prostate (TURP and radical robotically-assisted prostatectomy (RALP specimen as a result of standard chemical fixation. Materials and Methods 51 patients were recruited from January 2013 to June 2013 who either underwent a TURP (n=26 or RALP (n=25. Data was collected prospectively by the operating surgeon who measured the native, unfixed histology specimen directly after operation. The specimens were fixed in 10% Formaldehyde Solution BP and sent to the pathology laboratory where after sufficient fixation period was re-weighed. Results Overall mean age 64.78 years, TURP mean age 68.31 years RALP mean age 61.12years. We found that the overall prostatic specimen (n=51 weight loss after fixation was a mean of 11.20% (3.78 grams (p≤0.0001. Subgroup analysis of the native TURP chips mean weight was 16.15 grams and formalin treated mean weight was 14.00 grams (p≤0.0001. Therefore, TURP chips had a mean of 13.32 % (2.15 grams weight loss during chemical fixation. RALP subgroup unfixed specimen mean weight was 52.08 grams and formalin treated mean weight was 42.60 grams (p≤0.0001, a 19.32 % (9.48grams mean weight reduction. Conclusion It has not been known that prostatic chips and whole human radical prostatectomy specimen undergo a significant weight reduction. The practical significance of the accurate prostate weight in patient management may be limited, however, it is agreed that this should be recorded correctly, as data is potential interest for research purposes and vital for precise documentation.

  8. Influence of pathologist experience on positive surgical margins following radical prostatectomy.

    Science.gov (United States)

    Tallman, Jacob E; Packiam, Vignesh T; Wroblewski, Kristen E; Paner, Gladell P; Eggener, Scott E

    2017-07-01

    A positive surgical margin (PSM) following radical prostatectomy (RP) for prostate cancer is associated with increased risk of biochemical recurrence. We sought to examine whether the pathologist is an independent predictor of PSMs. We performed a retrospective review of 3,557 men who underwent RP for localized prostate cancer at our institution from 2003 to 2015. We evaluated 29 separate pathologists. Univariate and multivariable logistic regression were used to test variables previously shown to influence PSM rates. Overall rate of PSM was 18.9%. Compared with patients without PSM, patients with PSM had higher body mass index (mean: 28.8 vs. 28.3), Gleason score≥7 (84% vs. 66%), extracapsular extension (51% vs. 20%), and median prostate-specific antigen (5.9 vs. 5.1ng/ml) (all Pexperience, pathologist experience, and pathologist genitourinary fellowship training were all predictors of PSMs (all Pexperience, increased pathologist experience, higher pathologic Gleason score, higher pathologic stage, and higher prostate-specific antigen were significant predictors of PSMs. Increasing surgeon experience was associated with decreased odds of PSM (odds ratio = 0.79 per 1 standard deviation increase, 95% CI [0.70-0.89]). In contrast, increasing pathologist experience was associated with increased odds of PSM (odds ratio = 1.11 per 1 standard deviation increase, 95% CI [1.03-1.19]). The relationship between pathologist experience and PSM appeared to be nonlinear (Fig. 2). Greater pathologist experience appears to be associated with greater odds of PSMs following radical prostatectomy, even after controlling for case mix, pathologist fellowship training, and surgeon experience. Based on these findings, pathologists with less experience reviewing RP specimens may consider requesting rereview by a dedicated genitourinary pathologist. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Prostate Cancer Biochemical Recurrence Rates After Robotic-Assisted Laparoscopic Radical Prostatectomy

    Science.gov (United States)

    Ginzburg, Serge; Nevers, Thomas; Staff, Ilene; Tortora, Joseph; Champagne, Alison; Kesler, Stuart S.; Laudone, Vincent P.

    2012-01-01

    Background and Objectives: To determine prostate cancer biochemical recurrence rates with respect to surgical margin (SM) status for patients undergoing robotic-assisted laparoscopic radical prostatectomy (RALP). Methods: IRB-approved radical prostatectomy database was queried. Patients were stratified as low, intermediate, and high risk according to D’Amico's risk classification. Postoperative prostate-specific antigen (PSA) values were obtained every 3 mo for the first year, then biannually and annually thereafter. Biochemical recurrence was defined as ≥0.2ng/mL. Patients receiving adjuvant or salvage treatment were included. Positive surgical margin was defined as presence of cancer cells at inked resection margin in the final specimen. Margin presence (negative/positive), margin multiplicity (single/multiple), and margin length (≤3mm focal and >3mm extensive) were noted. Kaplan-Meier curves of biochemical recurrence-free survival (BRFS) as a function of SM were generated. Forward stepwise multivariate Cox regression was performed, with preoperative PSA, Gleason score, pathologic stage, prostate gland weight, and SM as covariates. Results: At our institution, 1437 patients underwent RALP (2003-2009). Of these, 1159 had sufficient data and were included in our analysis. Mean follow-up was 16 mo. Kaplan-Meier curves demonstrated significant increase in BRFS in low-risk and intermediate-risk groups with negative SM. Overall BRFS at 5 y was 72%. Gleason score, pathologic stage, and SM status were significant prognostic factors in multivariate analysis. Conclusions: Negative surgical margins resulted in lower biochemical recurrence rates for low-risk and intermediate-risk groups. Multifocal and longer positive margins were associated with higher biochemical recurrence rates compared with unifocal and shorter positive margins. Documenting biochemical recurrence rates for RALP is important, because this treatment for localized prostate cancer is validated. PMID

  10. Correlation Between MRS and Serum PSA in the Diagnosis of Local Recurrence After Radical Prostatectomy

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    M Ghafuri

    2012-08-01

    Full Text Available Background: Multifocality, multicentricity and extension beyond the prostate capsule are all characteristics of prostatic adenocarcinoma that may escape diagnosis by conventional CT scanning or MRI. This study was designed to assess the diagnostic value of magnetic resonance spectroscopy (MRS in prostatic carcinoma and its compatibility with prostatic specific antigen (PSA as the conventional method.Methods: In this cross-sectional study, we recruited 139 patients with previous radical prostatectomy referring to Radiology department of Hazrate-e-Rasul Hospital during the first half of 2011 for the evaluation of local recurrence. Traditionally, local recurrence is defined as serum PSA concentration >0.2 ng/dl. We used 1.5-tesla Siemens Avanto MRI unit with endorectal coil and measured creatine, choline and citrate levels before calculating choline-creatine/citrate ratio. Correlation between MRS findings with PSA concentration was evaluated in regards to the multiple levels of the previously mentioned ratio.Results: Local recurrence was found in 107 (77% patients based on PSA levels. The mean values for serum PSA levels and creatine-choline/citrate ratio were significantly different in patients with and without local recurrence. Creatine-choline/citrate ratios greater than 50, 100 and 150 (as different cut-off points of recurrence were respectively seen in 104, 102 and 97 patients and agreement ratio between MRS and PSA in these levels were 94.1%, 94.4% and 85.1%, respectively. Correlation coefficient between these two methods was 0.481.Conclusion: MRS is a valuable tool for evaluating recurrence inpatients with prostate cancer treated by radical prostatectomy and it is in good agreement with serum PSA levels.

  11. Incidence, Risk Factors, Management, and Complications of Rectal Injuries During Radical Prostatectomy.

    Science.gov (United States)

    Mandel, Philipp; Linnemannstöns, Anna; Chun, Felix; Schlomm, Thorsten; Pompe, Raisa; Budäus, Lars; Rosenbaum, Clemens; Ludwig, Tim; Dahlem, Roland; Fisch, Margit; Graefen, Markus; Huland, Hartwig; Tilki, Derya; Steuber, Thomas

    2017-02-07

    Rectal injury (RI) during radical prostatectomy (RP) is a severe complication. So far, only limited data describing the incidence, risk factors, management, and complications of RI are available. In an analysis of data for 24178 patients, we identified 113/24076 patients (0.47%) undergoing open or robotic RP and 7/102 patients (6.86%) after salvage RP who experienced an RI. Besides salvage RP, local tumor stage, Gleason grade, lymph node status, and surgical experience, but not surgical approach (robotic vs open), could be identified as risk factors for RI in univariate and multivariate analysis. Intraoperative management of RI comprised closure with two to three layers. In 13/109 patients (11.9%), a diverting colostomy/ileostomy was carried out. Some 12% of men with closure of an RI developed a recto-anastomosis fistula, and 57% of those who had an additional diverting enterostomy. Thus, the overall incidence of recto-anastomosis fistula after RP was <0.1%. The extent of rectal laceration, prior radiation, and intraoperative signs of rectal infiltration were associated with the development of a subsequent recto-anastomosis fistula. Some 83% of patients with a recto-anastomosis fistula needed further intervention. We analyzed the incidence, risk factors, management, and complications of rectal injury during radical prostatectomy. Overall, the incidence of rectal injury and subsequent development of recto-anastomosis fistulas is low unless the patient has significant risk factors. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  12. Robot-assisted radical prostatectomy in low- and high-risk prostate cancer patients

    Science.gov (United States)

    Boylu, Uğur; Bindayi, Ahmet; Küçük, Eyüp Veli; Önol, Fikret Fatih; Gümüş, Eyüp

    2017-01-01

    Objective To evaluate the benefit of robot-assisted radical prostatectomy (RARP) in the low-risk prostate cancer (PCa) patients suitable for active surveillance and in the high-risk PCa patients who would be considered for alternative treatments such as radiotherapy (RT) and androgen deprivation therapy (ADT) instead of radical prostatectomy. Material and methods Of 548 patients, who underwent RARP, 298 PCa patients (258 low-risk and 40 high-risk) with a mean of 3.6 years follow-up, were included into this study. Oncological outcomes were compared separately in low- and high-risk PCa patients. Results The pathologic Gleason scores were ≥7 in 73 (28%), and 68 (26%) patients had a pathologic stage of T3, 29 (11%) patients had a positive surgical margin (PSM), and 20 (7%) patients had biochemical recurrence (BCR) in the first year follow-up in the low-risk group. Of 258 low-risk PCa patients, a total of 93 (36%) patients had not either BCR, pathologic Gleason score ≥7, or ≥pT3 disease with PSM. In the high-risk group, the pathologic stage was pT2 in 14 (35%) patients and 29 (72%) patients had no biochemical recurrence in the follow-up of these high-risk PCa patients. Of 40 high-risk PCa patients, in a total of 25 (62.5%) patients ≥pT3b disease, BCR, pT3a disease with PSM were not detected. Conclusion Approximately two thirds of high-risk PCa patients benefit from RARP without additional RT or ADT. Besides, more than one third of low-risk PCa patients who fit active surveillance criteria would have unfavorable results. PMID:28270949

  13. Robotic-assisted radical prostatectomy learning curve for experienced laparoscopic surgeons: does it really exist?

    Science.gov (United States)

    Tobias-Machado, Marcos; Mitre, Anuar Ibrahim; Rubinstein, Mauricio; da Costa, Eduardo Fernandes; Hidaka, Alexandre Kyoshi

    2016-01-01

    ABSTRACT Background Robotic-assisted radical prostatectomy (RALP) is a minimally invasive procedure that could have a reduced learning curve for unfamiliar laparoscopic surgeon. However, there are no consensuses regarding the impact of previous laparoscopic experience on the learning curve of RALP. We report on a functional and perioperative outcome comparison between our initial 60 cases of RALP and last 60 cases of laparoscopic radical prostatectomy (LRP), performed by three experienced laparoscopic surgeons with a 200+LRP cases experience. Materials and Methods Between January 2010 and September 2013, a total of 60 consecutive patients who have undergone RALP were prospectively evaluated and compared to the last 60 cases of LRP. Data included demographic data, operative duration, blood loss, transfusion rate, positive surgical margins, hospital stay, complications and potency and continence rates. Results The mean operative time and blood loss were higher in RALP (236 versus 153 minutes, p<0.001 and 245.6 versus 202ml p<0.001). Potency rates at 6 months were higher in RALP (70% versus 50% p=0.02). Positive surgical margins were also higher in RALP (31.6% versus 12.5%, p=0.01). Continence rates at 6 months were similar (93.3% versus 89.3% p=0.43). Patient’s age, complication rates and length of hospital stay were similar for both groups. Conclusions Experienced laparoscopic surgeons (ELS) present a learning curve for RALP only demonstrated by longer operative time and clinically insignificant blood loss. Our initial results demonstrated similar perioperative and functional outcomes for both approaches. ELS were able to achieve satisfactory oncological and functional results during the learning curve period for RALP. PMID:27136471

  14. Future Directions of Robotic Surgery: A Case Study of the Cornell Athermal Robotic Technique of Prostatectomy

    Directory of Open Access Journals (Sweden)

    Robert A. Leung

    2006-01-01

    Full Text Available Robotic radical prostatectomy (RRP has become an effective modality in the treatment of localized prostate cancer. We detail the experience at our institution and provide a perspective for future considerations of RRP with respect to improved preoperative imaging and surgical instrumentation.

  15. The Role of 11C-Choline-PET/CT-Guided Secondary Lymphadenectomy in Patients with PSA Failure after Radical Prostatectomy: Lessons Learned from Eight Cases

    OpenAIRE

    Thomas Martini; Roman Mayr; Emanuela Trenti; Salvatore Palermo; Evi Comploj; Armin Pycha; Maria Zywica; Michele Lodde

    2011-01-01

    Introduction. 11C-choline-PET/CT is a promising technique for detection/restaging of patients with biochemical failure (BF) after curative therapy for prostate cancer (PCA). The aim of this paper was to evaluate the PSA response in patients with BF after radical prostatectomy (RP) who underwent secondary lymphadenectomy (LAD) due to 11C-choline-PET/CT findings. Material and Methods. Eight patients with BF and positive lymph nodes in 11C-choline-PET/CT after RP were retrospectively included in...

  16. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes.

    NARCIS (Netherlands)

    Berney, D.M.; Wheeler, T.M.; Grignon, D.J.; Epstein, J.I.; Griffiths, D.F.; Humphrey, P.A.; Kwast, T. van der; Montironi, R.; Delahunt, B.; Egevad, L.; Srigley, J.R.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coo

  17. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    NARCIS (Netherlands)

    Tan, P.H.; Cheng, L.; Srigley, J.R.; Griffiths, D.; Humphrey, P.A.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Delahunt, B.; Egevad, L.; Epstein, J.I.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed

  18. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 5: surgical margins.

    NARCIS (Netherlands)

    Tan, P.H.; Cheng, L.; Srigley, J.R.; Griffiths, D.; Humphrey, P.A.; Kwast, T.H. van der; Montironi, R.; Wheeler, T.M.; Delahunt, B.; Egevad, L.; Epstein, J.I.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to surgical margin assessment were coordinated by working group 5. Pathologists agreed

  19. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes.

    NARCIS (Netherlands)

    Berney, D.M.; Wheeler, T.M.; Grignon, D.J.; Epstein, J.I.; Griffiths, D.F.; Humphrey, P.A.; Kwast, T. van der; Montironi, R.; Delahunt, B.; Egevad, L.; Srigley, J.R.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coo

  20. Postoperative radiotherapy after radical prostatectomy: a randomized controlled trial (E.O.R.T.C. trial 22911)

    Energy Technology Data Exchange (ETDEWEB)

    Bolla, M. [Centre Hospitalier Universitaire A Michallon, Dept. of Radiation Oncology, 38 - Grenoble (France); Van Poppel, H. [Universitair Ziekenhuis Gasthuisberg, Dept. of Urology, Leuven (Belgium); Collette, L.; Haustermans, K. [Universitair Ziekenhuis Gasthuisberg, Dept. of Radiation Oncology, Leuven (Belgium); Collette, L. [European Organisation for Research and Treatment of Cancer (EORTC) data Center, Brussels (Belgium); Van Cangh, P. [Hopital Saint Luc, Dept. of Urology, Brussels (Belgium); Vekemans, K. [Virga Jesse Ziekenhuis, Dept. of Urology, Hasselt (Belgium); Da Pozzo, L. [Ospedale San Rafaele, Dept. of Urology, Milano (Italy); Reijke, T.M. de [Academisch Medisch Centrum, Dept. of Urology, Amsterdam (Netherlands); Verbaeys, A. [University Hospital, Dept. of Urology, Gent (Belgium); Bosset, J.F. [Hopital Jean Minjoz, Dept. of Radiation Oncology, 25 - Besancon (France); Van Velthoven, R. [Institut Jules Bordet, Dept. Urology, Brussels (Belgium); Marechal, J.M. [Hopital Edouard Herriot, Dept. of Urology, 69 - Lyon (France)

    2008-01-15

    Background - Local failure after prostatectomy can arise in patients with cancer extending beyond the capsule. We did a randomized controlled trial to compare radical prostatectomy followed by immediate external irradiation with prostatectomy alone for patients with positive surgical margin or pT3 prostate cancer. Methods - After undergoing radical retro-pubic prostatectomy, 503 patients were randomly assigned to a wait-and-see policy, and 502 to immediate postoperative radiotherapy (60 Gy conventional irradiation delivered over 6 weeks). Eligible patients had pNOMO tumours and one or more pathological risk factors: capsule perforation, positive surgical margins, invasion of seminal vesicles. Our revised primary endpoint was biochemical progression-free survival. Analysis was by intention to treat. bindings - The median age was 65 years (1QR 61-69). After a median follow-up of 5 years, biochemical progression-free survival was significantly improved in the irradiated group (74.0%, 98% CI 68.7-79.3 vs 52.6%, 46.6-58.5: p0.0001). Clinical progression-free survival was also significantly improved (p=0.0009). The cumulative rate of locoregional failure was significantly lower in the irradiated group (p<0.0001). Grade 2 or 3 late effects were significantly more frequent in the postoperative irradiation group (p=0.0005), but severe toxic toxicity (grade 3 or higher) were rare, with a 5-year rate of 2.6% in the wait-and-see group and 4.2% in the postoperative irradiation group (p=00726). Interpretation: Immediate external irradiation after radical prostatectomy improves biochemical progression-free survival and local control in patients with positive surgical margins or pT3 prostate cancer who are at high risk of progression. Further follow-up is needed to assess the effect on overall survival. (authors)

  1. Perioperative differences in open radical prostatectomy versus laparoscopic radical prostatectomy%开放和经腹腔镜前列腺癌根治术围手术期的临床差异分析

    Institute of Scientific and Technical Information of China (English)

    李雪梅; 季惠翔; 潘进洪; 方强; 周占松; 陈志文

    2013-01-01

    目的 探讨经腹腔镜前列腺癌根治术较开放性前列腺癌根治术围手术期的优点.方法 回顾分析2006年1月至2012年2月我科收治的75例前列腺癌患者的临床资料,对比开放性前列腺癌根治术与经腹腔镜前列腺癌根治术两组患者围术期的临床特征及并发症等.结果 经腹腔镜前列腺癌根治术组的患者术中出血量和总输血量以及住院时间显著低于开放性前列腺癌根治术组(P<0.05).开放性前列腺癌根治术组与经腹腔镜前列腺癌根治术组的总并发症分别为38.7%和18.2% (P <0.05),其中重度并发症分别为6.5%和4.5%(P>0.05).结论 经腹腔镜前列腺癌根治术因创伤小,术中出血量和围手术期输血量显著减少,总并发症率显著减少,最终可能节约了医疗资源.%Objective To determine the perioperative advantages in laparoscopic radical prostatectomy compared with open radical prostatectomy.Methods The perioperative clinical characteristics in both groups of laparoscopic radical prostatectomy and open radical prostatectomy were reviewed and statistically investigated.The complications related to operations were recorded and graded according to the severity grading system of surgical complications.Results The blood loss,transfusion and days of hospital stay were significantly less in the group of laparoscopic radical prostatectomy than in the group of open radical prostatectomy.The incidences of total complications were 38.7% vs 18.2%,and the incidences of severe complications were 6.5% vs 4.5% in the groups of open radical prostatectomy and laparoscopic radical prostatectomy,respectively.Conclusion The blood loss,transfusion,complications and days of hospital stay are decreased significantly in minimally invasive prostate cancer surgery.Thus the medical resource is saved eventually.

  2. Radical prostatectomy versus expectant treatment for early carcinoma of the prostate. Twenty-three year follow-up of a prospective randomized study

    DEFF Research Database (Denmark)

    Iversen, P; Madsen, P O; Corle, D K

    1995-01-01

    In a study by the Veterans Administration Cooperative Urological Research Group (VACURG), 142 patients with localized prostate cancer, VACURG stage I and II, were randomized between radical prostatectomy plus placebo versus placebo alone as initial treatment. 111 patients were evaluable for treat......In a study by the Veterans Administration Cooperative Urological Research Group (VACURG), 142 patients with localized prostate cancer, VACURG stage I and II, were randomized between radical prostatectomy plus placebo versus placebo alone as initial treatment. 111 patients were evaluable...

  3. Concordance between biopsy and radical prostatectomy specimen Gleason score in internal and external pathology facilities.

    Science.gov (United States)

    Grasso, Angelica A C; Cozzi, Gabriele; Palumbo, Carlotta; Albo, Giancarlo; Rocco, Bernardo

    2014-10-01

    Biopsy Gleason score (bGS) is an important tool for staging and decision making in patients with prostate cancer. Therefore, the data from biopsy should be both reproducible across different pathologists and predictive of the true underlying tumour. We evaluated the agreement between bGS with prostatectomy Gleason score (pGS) comparing patients who underwent prostate biopsy at our hospital with those who did it at an outside facility. We retrospectively analyzed patients who underwent robot-assisted radical prostatectomy at our Hospital in 2011 and 2012. Patients were divided depending on the site of prostate biopsy. We calculated a weighted κ statistic to evaluate the concordance from bGS and pGS in the two groups and to evaluate the Gleason score (GS) concordance comparing the proportion of positive cores at biopsy. A total of 124 patients with completed data were identified (70 patients performed biopsy at our institution and 54 at an outside facility). The weighted κ score for GS agreement was 0.40 for our Institution and 0.27 for other facilities. The weighted κ score stratified by biopsy hospital for patients with at least 30% of positive cores was 0.46 for our hospital and 0.42 for other facilities. Internal prostate biopsy predicted better pGS than outside facility biopsy reports. When the percentage of biopsy-positive cores increases, the agreement between bGS and pGS is similar between the two groups. For certain cases in which an outside laboratory biopsy results in equivocal clinical decision, biopsy re-evaluation by internal pathologists can help reveal the true underlying tumor architecture and extension. Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  4. Pathologic outcomes during the learning curve for robotic-assisted laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Amul Shah

    2008-03-01

    Full Text Available OBJECTIVE: We report our initial experience with 62 patients undergoing robotic-assisted laparoscopic prostatectomy (RALP, focusing on the primary parameter of positive surgical margins. The authors demonstrate that excellent oncologic outcomes can be attained with a less steep learning curve than previously hypothesized. MATERIALS AND METHODS: The first 62 patients undergoing RALP by a single physician (DPD at our institution between November 2005 and August 2007 were retrospectively assessed. Surgical pathology records were reviewed for Gleason score, pathologic tumor stage, nodal status, location of prostate cancer within the specimen, extracapsular extension, surgical margin status, presence of perineural invasion, tumor volume, and weight of the surgical specimen. Margin status was determined using surgical specimens only, and not intraoperative frozen sections. All cases in this series were completed using the four-arm da Vinci Robotic System (Intuitive Surgical, Sunnyvale, California. RESULTS: Sixty-one patients had prostate cancer on their final surgical pathology specimens. Pathologic stage T2 and stage T3 patients were 88.7% and 9.7% of all cases, respectively. The pathologic Gleason score was 7 or greater in 62.3%. Our overall positive surgical margin rate was 3.3%. Patients with pathologic T2 and T3 disease had a positive surgical margin rate of 1.8% and 16.7%, respectively. CONCLUSIONS: Our study suggests that RALP can have equal if not better pathologic outcomes compared to open radical prostatectomy even during the initial series of cases. We argue that the learning curve for RALP is shorter than previously thought with respect to oncologic outcomes, and concerns asserting that lack of tactile feedback leads to poor oncologic outcomes are unfounded.

  5. Discovery and validation of a prostate cancer genomic classifier that predicts early metastasis following radical prostatectomy.

    Directory of Open Access Journals (Sweden)

    Nicholas Erho

    Full Text Available PURPOSE: Clinicopathologic features and biochemical recurrence are sensitive, but not specific, predictors of metastatic disease and lethal prostate cancer. We hypothesize that a genomic expression signature detected in the primary tumor represents true biological potential of aggressive disease and provides improved prediction of early prostate cancer metastasis. METHODS: A nested case-control design was used to select 639 patients from the Mayo Clinic tumor registry who underwent radical prostatectomy between 1987 and 2001. A genomic classifier (GC was developed by modeling differential RNA expression using 1.4 million feature high-density expression arrays of men enriched for rising PSA after prostatectomy, including 213 who experienced early clinical metastasis after biochemical recurrence. A training set was used to develop a random forest classifier of 22 markers to predict for cases--men with early clinical metastasis after rising PSA. Performance of GC was compared to prognostic factors such as Gleason score and previous gene expression signatures in a withheld validation set. RESULTS: Expression profiles were generated from 545 unique patient samples, with median follow-up of 16.9 years. GC achieved an area under the receiver operating characteristic curve of 0.75 (0.67-0.83 in validation, outperforming clinical variables and gene signatures. GC was the only significant prognostic factor in multivariable analyses. Within Gleason score groups, cases with high GC scores experienced earlier death from prostate cancer and reduced overall survival. The markers in the classifier were found to be associated with a number of key biological processes in prostate cancer metastatic disease progression. CONCLUSION: A genomic classifier was developed and validated in a large patient cohort enriched with prostate cancer metastasis patients and a rising PSA that went on to experience metastatic disease. This early metastasis prediction model based on

  6. Average Weight of Seminal Vesicles: An Adjustment Factor for Radical Prostatectomy Specimens Weighed With Seminal Vesicles.

    Science.gov (United States)

    Tjionas, George A; Epstein, Jonathan I; Williamson, Sean R; Diaz, Mireya; Menon, Mani; Peabody, James O; Gupta, Nilesh S; Parekh, Dipen J; Cote, Richard J; Jorda, Merce; Kryvenko, Oleksandr N

    2015-12-01

    The International Society of Urological Pathology in 2010 recommended weighing prostates without seminal vesicles (SV) to include only prostate weight in prostate-specific antigen (PSA) density (PSAD) calculation, because SV do not produce PSA. Large retrospective cohorts exist with combined weight recorded that needs to be modified for retrospective analysis. Weights of prostates and SV were separately recorded in 172 consecutive prostatectomies. The average weight of SV and proportion of prostate weight from combined weight were calculated. The adjustment factors were then validated on databases of 2 other institutions. The average weight of bilateral SV was 6.4 g (range = 1-17.3 g). The prostate constituted on average 87% (range = 66% to 98%) of the total specimen weight. There was no correlation between patient age and prostate weight with SV weight. The best performing correction method was to subtract 6.4 g from total radical prostatectomy weight and to use this weight for PSAD calculation. The average weights of retrospective specimens weighed with SV were not significantly different between the 3 institutions. Using our data allowed calibration of the weights and PSAD between the cohorts weighed with and without SV. Thus, prostate weight in specimens including SV weight can be adjusted by subtracting 6.4 g, resulting in significant change of PSAD. Some institution-specific variations may exist, which could further increase the precision of retrospective analysis involving prostate weight and PSAD. However, unless institution-specific adjustment parameters are developed, we recommend that this correction factor be used for retrospective cohorts or in institutions where combined weight is still recorded.

  7. Effect of minimizing tension during robotic-assisted laparoscopic radical prostatectomy on urinary function recovery.

    Science.gov (United States)

    Kowalczyk, Keith J; Huang, Andy C; Hevelone, Nathanael D; Lipsitz, Stuart R; Yu, Hua-yin; Lynch, John H; Hu, Jim C

    2013-06-01

    Although most prostatectomy studies emphasize optimal nerve-sparing dissection planes, subtle technical variation also affects functional outcomes. The impact of minimizing assistant/surgeon tension on urinary function has not been quantified. We assess urinary function after attenuating neurovascular bundle (NVB) and rhabdosphincter tension during robotic-assisted radical prostatectomy (RARP). Retrospective study of prospectively collected data for 268 (RARP-T) versus 342 (RARP-0T) men with versus without tension on the NVB and rhabdosphincter during RARP. Outcomes compared include Expanded Prostate Cancer Index (EPIC) urinary function, estimated blood loss (EBL), operative time, and positive surgical margins (PSM). In unadjusted analysis, men undergoing RARP-T versus RARP-0T were older, had higher biopsy and pathologic Gleason grade, and higher preoperative prostate specific antigen (all p ≤ 0.023). Baseline urinary function was similar. Postoperatively, RARP-0T versus RARP-T was associated with higher 5-month urinary function scores (69.7 versus 64, p = 0.049). In adjusted analyses, RARP-0T versus RARP-T was associated with improved 5-month urinary function [Parameter Estimate (PE) 7.37, Standard Error (SE) 2.67, p = 0.006], while bilateral versus non-/unilateral nerve-sparing was associated with improved 12-month urinary function and continence (both p ≤ 0.035). RARP-0T versus RARP-T was associated with shorter operative times (PE 6.66, SE 1.90, p = 0.001) and higher EBL (PE 20.88, SE 6.49, p = 0.001). There were no significant differences in PSM. While the use of tension aids in dissection of anatomic planes, avoidance of NVB counter-traction and minimizing tension on the rhabdosphincter during apical dissection attenuates neuropraxia and leads to earlier urinary function recovery. Bilateral versus non-/unilateral nerve-sparing also improves urinary function recovery.

  8. International Society of Urological Pathology (ISUP) consensus conference on handling and staging of radical prostatectomy specimens: rationale and organization.

    Science.gov (United States)

    Egevad, Lars; Srigley, John R; Delahunt, Brett

    2011-01-01

    The 2009 International Society of Urological Pathology consensus conference in Boston, made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. The activities of the conference were coordinated through five workgroups. The results are presented in five separate reports covering (1) specimen handling, (2) T2 substaging and prostate cancer volume, (3) extraprostatic extension, lymphovascular invasion and locally advanced disease, (4) seminal vesicles and lymph node metastases and (5) surgical margins. In this introductory article we describe some novel features of the organization of the consensus process. Following the completion of a pre-meeting survey conference, participants discussed and voted on 43 specific issues of contention relating to the pathological reporting of radical prostatectomy specimens. Consensus, defined as agreement by at least 65% of participants present, was achieved for 30 questions.

  9. Preservation of the smooth muscular internal (vesical sphincter and of the proximal urethra during retropubic radical prostatectomy: A technical modification to improve the early recovery of continence

    Directory of Open Access Journals (Sweden)

    Eugenio Brunocilla

    2014-06-01

    Full Text Available Objective: We describe our technique for preservation of the smooth muscular internal (vesical sphincter and proximal urethra during radical retropubic prostatectomy (RRP and present our preliminary clinical results. Materials and methods: The first steps of the prostatectomy reflect the standard RRP, while for the final phases the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally oriented smooth muscle component of the urethral musculature that extends distally to the verumontanum. These two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring shaped vesical sphincter is separated from the prostate and the longitudinally oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Results: After 30 initial set-up procedures, 40 consecutive patients with organ confined prostate cancer were submitted to radical retropubic prostatectomy with the preservation of muscular internal sphincter and the proximal urethra and compared to 40 patients submitted to standard procedure who served as control group. The group of patients submitted to our technical modification had a faster recovery of early continence than control group at 3 and 7 days. Conclusions: The described technique is a feasible and safe method for preservation of the internal urethral sphincter and allows improving the early recovery of urinary continence. The technique does not increase the rate of positive margins and the duration of the procedure.

  10. Increased fatty acid synthase expression in prostate biopsy cores predicts higher Gleason score in radical prostatectomy specimen

    OpenAIRE

    HAMADA, SHINSUKE; Horiguchi, Akio; Kuroda, Kenji; Ito, Keiichi; ASANO, TOMOHIKO; Miyai, Kosuke; Iwaya, Keiichi

    2014-01-01

    Background Fatty acid synthase (FAS) is highly expressed in various types of cancer, and elevated expression of FAS has been suggested to be a predictor of tumor aggressiveness and poor prognosis. We examined whether FAS expression in prostate biopsy cores could predict the pathological characteristics of radical prostatectomy (RP) specimens. Methods Paraffin-embedded prostate biopsy cores, obtained from 102 patients who subsequently underwent RP, were immunostained with polyclonal anti-FAS a...

  11. Stratified analysis of 800 Asian patients after robot-assisted radical prostatectomy with a median 64 months of follow up.

    Science.gov (United States)

    Abdel Raheem, Ali; Kim, Dae Keun; Santok, Glen Denmer; Alabdulaali, Ibrahim; Chung, Byung Ha; Choi, Young Deuk; Rha, Koon Ho

    2016-09-01

    To report the 5-year oncological outcomes of robot-assisted radical prostatectomy from the largest series ever reported from Asia. A retrospective analysis of 800 Asian patients who were treated with robot-assisted radical prostatectomy from July 2005 to May 2010 in the Department of Urology and Urological Science Institute, Yonsei University College of Medicine, Seoul, Korea was carried out. The primary end-point was to evaluate the biochemical recurrence. The secondary end-point was to show the biochemical recurrence-free survival, metastasis-free survival and cancer-specific survival. A total of 197 (24.65%), 218 (27.3%), and 385 (48.1%) patients were classified as low-, intermediate- and high-risk patients according to the D'Amico risk stratification risk criteria, respectively. The median follow-up period was 64 months (interquartile range 28-71 months). The overall incidence of positive surgical margin was 36.6%. There was biochemical recurrence in 183 patients (22.9%), 38 patients (4.8%) developed distant metastasis and 24 patients (3%) died from prostate cancer. Actuarial biochemical recurrence-free survival, metastasis-free survival, and cancer-specific survival rates at 5 years were 76.4%, 94.6% and 96.7%, respectively. Positive lymph node was associated with lower 5-year biochemical recurrence-free survival (9.1%), cancer-specific survival (75.7%) and metastasis-free survival (61.9%) rates (P < 0.001). On multivariable analysis, among all the predictors, positive lymph node was the strongest predictor of biochemical recurrence, cancer-specific survival and metastasis-free survival (P < 0.001). Herein we report the largest robot-assisted radical prostatectomy series from Asia. Robot-assisted radical prostatectomy is confirmed to be an oncologically safe procedure that is able to provide effective 5-year cancer control, even in patients with high-risk disease. © 2016 The Japanese Urological Association.

  12. Pharmacological Prevention and Reversion of Erectile Dysfunction after Radical Prostatectomy, By Modulation of Nitric Oxide/Cgmp Pathways

    Science.gov (United States)

    2008-03-01

    sparing quality with potency following laparoscopic radical prostatectomy. J Urol. 2008 Apr;179(4):1510-4. 2: Madeb R, Golijanin D, Knopf J, Vicente I...222–227. 23 Perez -Sala D, Cernuda-Morollon E, Diaz-Cazorla M, Rodriguez- Pascual F, Lamas S. Posttranscriptional regulation of human iNOS by the NO...De Nicola AF (1990) Estrogens down-regulate type I but not type II adrenal corticoids receptors in rat anterior pituitary. J Steroid Biochem Mol

  13. Clinical results of radical prostatectomy for patients with prostate cancer in Macau

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    Background Incidence of prostate cancer has been increasing in recent decades.In the year 2005,prostate cancer became the second most common cancer in males in Macau.The purpose of this report was to review and summarize the clinical features and prognosis of the 54 patients undergoing radical prostatectomy in Macau Special Administrative Region(SAR),China.Methods From November 2000 to November 2006,retropubic radical prostatectomy were performed in 54 cases for the treatment of prostate cancer.The mean age of patients was 69.8 years(range from 54 to 79).The preoperative prostate specific antigen(PSA)level,postoperative pathologic stage and Gleason's score,operation duration,intraoperative bleeding and intraoperative and postoperative complications were reported.The follow-up duration was 3months to 6.25 years with a mean of 2.1 years.Postoperative parameters including PSA alteration,biochemical recurrence,local recurrence,distant metastasis and mortality were observed.Results Most of the patients in our study were diagnosed as localized prostate cancer.The patients'preoperative serum PSA was 0-4.0 ng/ml(16.7%),4.0-10.0 ng/ml(51.8%),10.1-20.0ng/ml(24.1%) and above 20.0 ng/ml(7.4%).The TNM stage T1a+T1b comprised 7.6%of patients,stage T2a+T2b comprised 20.3%,stage T2c 38.9%,stage T3a20.3%and over T3a only 12.9%.There were 9.5% cases with Gleason scores of 2-4,41.5% with scores of 5-6,30.2% with scores of 7 and 18.8%with scores of 8-10.The average operative duration was 216 minutes and the average intraoperative bleeding was 760 ml.Intraoperative complications included one massive hemorrhage(1.9%),one rectal injury(1.9%)and one obturator nerve injury(1.9%).Early postoperative complications consisted of urinary incontinence (14 cases,25.9%),bladder neck stricture(5 cases,9.3%),acute urinary retention(4 cases,7.4%),pelvic effusion(2cases,3.8%),lymphocele(1 case,1.9%)and vesicorectal fistula(only 1 case,1.9%).For late postoperative complications,total incontinence or

  14. Risk factors of positive surgical margin and biochemical recurrence of patients treated with radical prostatectomy:a single-center 10-year report

    Institute of Scientific and Technical Information of China (English)

    LI Kin; LI Hong; YANG Yong; Ian Lap-hong; Pun Wai-hong; Ho Son-fat

    2011-01-01

    Background Many studies have shown that positive surgical margin and biochemical recurrence could impact the life of patients with prostate cancer treated with radical prostatectomy. With more and more patients with prostate cancer appeared in recent 20 years in China,it is necessary to investigate the risk of positive surgical margin and biochemical recurrence,and their possible impact on the prognosis of patients treated with radical prostatectomy. In this study,we analyzed the characteristics of patients with prostate cancer who had undergone radical prostatectomy in Macau area and tried to find any risk factor of positive surgical margin and biochemical recurrence and their relationship with the prognosis of these patients.Methods From 2000 to 2009,149 patients with prostate cancer received radical prostatectomy and were followed up.Among these patients,111 received retropubic radical prostatectomies,38 received laparoscopic radical prostatectomies.All patients were followed-up on in the 3rd month,6th month and from that point on every 6 months after operation. At each follow-up a detailed record of any complaint,serum prostate-specific antigen (PSA),full biochemical test and uroflowmetry was acquired.Results The average age was (69.0±6.1) years,preoperative average serum PSA was (10.1 ±12.1) ng/ml and average Gleason score was 6.4±1.3. The incidence of total complications was about 47.7%,the incidence of the most common complication,bladder outlet obstruction,was about 26.8%,and that of the second most common complication,urinary stress incontinence,was about 16.1% (mild 9.4% and severe 6.7%). The incidence of positive surgical margin was about 38.3%. The preoperative serum PSA ((13.4±17.6) ng/ml),average Gleason score (7.1±1.3) and pathological T stage score (7.0±1.4) were higher in patients with positive surgical margins than those with negative margins ((8.0±5.8) ng/ml,6.0±1.2 and 5.4±1.4,respectively) (P=0.004,P=0.001 and P=0.001,respectively). A

  15. The normal post-surgical anatomy of the male pelvis following radical prostatectomy as assessed by magnetic resonance imaging

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    Allen, Steven D.; Sohaib, S.A. [Royal Marsden Hospital, Department of Imaging, Sutton, Surrey (United Kingdom); Thompson, Alan [Royal Marsden Hospital, Department of Surgery, Sutton, Surrey (United Kingdom)

    2008-06-15

    The magnetic resonance imaging (MRI) appearances of recurrent prostate cancer following radical prostatectomy have been documented in the radiology literature; however little has been written on the range of normal post-operative appearances. Common routes of surgical access for radical prostatectomy include retropubic and transperineal, although newer minimally invasive methods are gaining increasing acceptance. Specifically the range of appearances of the anastomotic site, the prostatic bed, the position of the bladder base, periurethral tissue, levator sling, rectum and residual seminal vesicles (if present) are demonstrated. A non-enhancing low signal nodule is frequently seen at the vesicourethral anastomosis or within the seminal vesicle remnant and usually represents fibrosis. Appearances following different surgical accesses do not differ tremendously, although the retropubic fat pad is reduced or absent following a retropubic approach. Anterior rectal-wall scarring may be present following a transperineal approach. Other post-surgical findings that may mimic disease include a lymphocoele and injected bladder-neck bulking agent. Many patients referred for MRI following radical prostatectomy will have a pathological study showing disease recurrence, although in non-pathological studies the radiological features can differ significantly. It is important for the radiologist to be aware of the spectrum of normal post-surgical appearances so not to confuse these with locally recurrent disease. (orig.)

  16. Penile vascular evaluation and sexual function before and after radical retropubic prostatectomy: 5-year follow-up.

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    Dubbelman, Yvette D; Wildhagen, Mark F; Dohle, Gert R

    2008-09-01

    Sexual dysfunction is common after surgery for prostate cancer. The aetiology of changes in sexual potency after radical prostatectomy is probably multifactorial, including neurogenic, vascular and psychosexual factors. A prospective study was designed to investigate haemodynamic and psychosexual changes before and after radical retropubic prostatectomy (RRP) for organ-confined prostate cancer. Penile haemodynamic evaluation and an assessment of sexual excitement were performed preoperatively and 3 months after RRP by colour Doppler ultrasonography (CDU) with visual erotic stimulation combined with a single intracavernous injection of a mixture of papaverine/phentolamine. Questionnaires on sexual function [International Index of Erectile Function (IIEF)], general health and quality of life were sent to the patients preoperative, 3 months and 5 years after operation. Forty-eight men participated in the study. Mean age was 62.6 years (range 55-69). CDU did not show any significant reduction in mean peak systolic flow velocity and mean resistance index. From the men who preoperatively had normal arterial inflow 18% developed arteriogenic insufficiency. Some form of veno-occlusive insufficiency and low resistance indices were already present in the majority of normal potent men preoperatively. Surgical technique did not influence penile arterial blood flow after the operation. Three months and 5 years postoperatively, there was a highly significant reduction in erectile function, intercourse satisfaction, overall satisfaction, orgasmic function and sexual desire. However, with respect to the outcome at 3 months there was a significant improvement of orgasmic function 5 years after operation, especially after a bilateral nerve sparing procedure. Erections sufficient for vaginal penetration (questions 3 and 4 of the IIEF, score >or=8) improved from 2% to 11% 3 months and 5 years after RRP respectively. Total IIEF score was significantly better after a bilateral nerve

  17. Ocular parameters before and after steep Trendelenburg positioning for robotic-assisted laparoscopic radical prostatectomy

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    Mizumoto K

    2017-09-01

    Full Text Available Kyoichi Mizumoto,1 Masahiko Gosho,2 Masayoshi Iwaki,1 Masahiro Zako3 1Department of Ophthalmology, Aichi Medical University, Nagakute, Aichi, Japan; 2Department of Clinical Trial and Clinical Epidemiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan; 3Department of Ophthalmology, Asai Hospital, Seto, Aichi, Japan Purpose: Intraocular pressure (IOP increases in patients in a steep Trendelenburg position during robotic-assisted laparoscopic radical prostatectomy (RALP. We hypothesized that a steep Trendelenburg position during RALP, an unusual systemic condition involving a transiently increased IOP, may induce ocular pathology that can be detected by detailed evaluations long after the surgery. This study aims to explore ocular structural and functional parameters in patients before and in the long term after the surgery. Patients and methods: A comparative observational study was performed. A total of 44 eyes of 22 male patients scheduled for RALP at Aichi Medical University from August 2012 to July 2013 were included. Clinical parameters before and after RALP were compared. Peri­operative IOP was measured immediately post-induction of anesthesia in the flat supine position (T1, immediately post-steep Trendelenburg position (T2, and prior to returning to a flat supine position while in a steep Trendelenburg position (T3. The thicknesses of the peripapillary retinal nerve fiber layer, ganglion cell complex (GCC, and central fovea were measured with spectral domain optical coherence tomography. Humphrey perimetry was performed before and at 3 and 6 months after surgery. Results: The average IOPs (mmHg at each stage were T1=10.4, T2=21.7, and T3=29.6, and differed significantly. The mean visual acuity (logarithm of the minimal angle of resolution, IOP, mean deviation, and pattern standard deviation measured by the Humphrey field analyzer showed no statistically significant difference before and after surgery. The ganglion

  18. Upgrading and upstaging in prostate cancer: From prostate biopsy to radical prostatectomy.

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    D'Elia, Carolina; Cerruto, Maria Angela; Cioffi, Antonio; Novella, Giovanni; Cavalleri, Stefano; Artibani, Walter

    2014-11-01

    Prostate cancer (CaP) is the most common malignancy in men and the second cause of cancer-related mortality after lung cancer. Several studies have evaluated the correlation between bioptic and pathological Gleason score (GS), documenting a correlation ranging between 30 and 60%. The aim of this study was the evaluation of the association between bioptic and pathological GS in a series of patients undergoing prostate needle biopsy and subsequent radical prostatectomy. We also aimed to evaluate the possible prognostic factors of upgrading and upstaging. We prospectively collected and retrospectively reviewed data from 300 consecutive patients who underwent radical retropubic or robot-assisted prostatectomy at our Institution. Patients who underwent prostate needle biopsy, transrectal or transperineal, with a minimum of 5 samples, were included in this study. Upgrading and downgrading were defined as increase or decrease, respectively, from one prognostic grade group to another, similar to up- or downstaging. The mean age of the patients was 62.97 years and the mean prostate-spesific antigen (PSA) level was 7.83 ng/ml. A total of 51.3% of the population underwent a transperineal prostate biopsy. The most frequently represented bioptic GS was 3+3 (64.0%) followed by 3+4=7 (15.6%); the most frequent pathological Gleason score was 3+4 (44.3%), followed by 3+3 (31.0%). With reagard to the bioptic GS 4-5-6 group, approximately half of the specimens (46.7%) were subsequently upgraded to GS 3+4, and 5.3% to 4+3. With regards to the bioptic GS 3+4 group, 57.4% was confirmed in the surgical specimen. In the 4+3 group, 23.5% of the cases was downgraded to 3+4 and 35.3% was confirmed. With regards to stage, ~39.7% of the patients received an upstaging on the pathological specimen. We evaluated the correlations between preoperative serum PSA level, prostate volume, digital rectal examination and biopsy type and none of the variables considered exhibited a correlation with any

  19. Influential factors in the response to salvage radiotherapy after radical prostatectomy.

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    Algarra, R; Tienza, A; Hevia, M; Zudaire, J; Rosell, D; Robles, J E; Pascual, I

    2014-12-01

    To analyze the influential factors in the response in prostatectomized patients with subsequent biochemical relapse (BCR) and treated with salvage radiotherapy (RTP). We analyzed 313 patients with pT2/pT3 prostate cancer who were receiving salvage therapy due to biochemical relapse (from a series of 1,310 radical prostatectomies between 1989-2012). Of the 313 patients; 159 (50.8%) only received androgen deprivation (AD), 63 (20.1%) Radiotherapy (RTP) plus concomitant AD and 91 (29.1%) only RTP. Of these, 57 (62.6%) have maintained complete response and 34 (37.4%) had failure response with post-RTP BCR. Study of the group treated exclusively with salvage RTP. Ninety-one patients were treated with salvage RTP. Median follow-up was 6.4 years and median to recurrence 11 months. Post-RTP biochemical relapse-free survival (PRBRFS) was 68 ± 7% and 30 ± 10% in 5 to 10 years. Median PRBRFS was 7.3 years (6.3-8.3). Initial PSA (HR: 1.08; 95% CI: 1.01-1.1 P=.02) with best PSA cut-off point PSA>20 ng/ml (HR: 13.6; 95% CI: 2.1-86 P=.005) and PSA pre-RTP (HR: 1.9; 95% CI: 1.2-3.3; P=.009), best PSA cut-off point PSA preRTP 0.92 ng/ml (HR: 4.5; 95% CI: 1.3-15.6; P=.01) showed independent influence in the response in the multivariate study. PRBRFS at 5 years, 81 ± 9% versus 58 ± 9% with initial PSA 20 ng/ml (P=.03). PRBRFS at 5 years, 93 ± 5% versus 53 ± 10% according to PSA pre-RTP 0.9 ng/ml (P=.02). In patients treated with salvage RTP after radical prostatectomy, the preoperative PSA>20 ng/ml and PSA preRTP>0.92 ng/ml shows an independent influence on the response. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  20. ROBOT-ASSISTED RADICAL PROSTATECTOMY: ANALYSIS OF THE FIRST 80 CASES

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    D. Yu. Pushkar

    2010-01-01

    Full Text Available Background. As a common disease, prostate cancer (PC has taken now first place among all malignancies in many countries of the world.The authors have analyzed the results of their series of robot-assisted radical laparoscopic prostatectomy (RALP in patients with PC. They also present a number of surgical techniques that may be useful for novice surgeons. Materials and methods. In November 2008 to November 2009, the Department of Urology, Moscow State University of Medicine and Dentistry, performed 80 RALPs using the da Vinci S surgical robotic system. The patients’ mean age was 63.7 (49–71 years; the mean blood level of total prostate-specific antigen was 6.1 (2.1–20.84 ng/ml; the mean prostate volume was 44 (18–94 cm3, as evidenced by transrectal ultrasound study. The authors analyzed the following indicators: operating time, degree of blood loss, conversion of surgical intervention,degrees of intra- and postoperative complications, and oncological and functional results. Results. In our series, RALP was performed without preserving neurovascular bundles or by using a nerve-sparing procedure in 66 (82.5% and 14 (17.5%, respectively; 22 (27.5% patients underwent lymphadenectomy. The average length of hospital stay was 7 (4–21 days; the mean time of urethral catheter removal was 10 (6–21 days postoperatively. The mean time of surgical intervention was 174 (121–276 min. Mean blood loss was 248 (35–1950 ml. Postmortem study revealed a positive surgical margin in 19 (24% cases and tumor invasion into the seminal vesicles in 5 (6% patients. Stages pT2 and pT3 were found in 56 (70% and 24 (30%, respectively; total Gleason scores were 6 (3+3, 7 (3+4, 7 (4+3, 8 (4+4 in 38 (47.5%, 35 (43.75%, 5 (6.25%, and 2 (2.5% patients, respectively. Among 34 patients examined 3 months after RALP, 28 (82.4% patients completely retained urine; 5 (14.7% applied not more than a pad a day. In patients with preserved erectile function, the

  1. ROBOT-ASSISTED RADICAL PROSTATECTOMY: ANALYSIS OF THE FIRST 80 CASES

    Directory of Open Access Journals (Sweden)

    D. Yu. Pushkar

    2014-07-01

    Full Text Available Background. As a common disease, prostate cancer (PC has taken now first place among all malignancies in many countries of the world.The authors have analyzed the results of their series of robot-assisted radical laparoscopic prostatectomy (RALP in patients with PC. They also present a number of surgical techniques that may be useful for novice surgeons. Materials and methods. In November 2008 to November 2009, the Department of Urology, Moscow State University of Medicine and Dentistry, performed 80 RALPs using the da Vinci S surgical robotic system. The patients’ mean age was 63.7 (49–71 years; the mean blood level of total prostate-specific antigen was 6.1 (2.1–20.84 ng/ml; the mean prostate volume was 44 (18–94 cm3, as evidenced by transrectal ultrasound study. The authors analyzed the following indicators: operating time, degree of blood loss, conversion of surgical intervention,degrees of intra- and postoperative complications, and oncological and functional results. Results. In our series, RALP was performed without preserving neurovascular bundles or by using a nerve-sparing procedure in 66 (82.5% and 14 (17.5%, respectively; 22 (27.5% patients underwent lymphadenectomy. The average length of hospital stay was 7 (4–21 days; the mean time of urethral catheter removal was 10 (6–21 days postoperatively. The mean time of surgical intervention was 174 (121–276 min. Mean blood loss was 248 (35–1950 ml. Postmortem study revealed a positive surgical margin in 19 (24% cases and tumor invasion into the seminal vesicles in 5 (6% patients. Stages pT2 and pT3 were found in 56 (70% and 24 (30%, respectively; total Gleason scores were 6 (3+3, 7 (3+4, 7 (4+3, 8 (4+4 in 38 (47.5%, 35 (43.75%, 5 (6.25%, and 2 (2.5% patients, respectively. Among 34 patients examined 3 months after RALP, 28 (82.4% patients completely retained urine; 5 (14.7% applied not more than a pad a day. In patients with preserved erectile function, the

  2. [Individual learning curve for radical robot-assisted prostatectomy based on the example of three professionals working in one clinic].

    Science.gov (United States)

    Rasner, P I; Pushkar', D Iu; Kolontarev, K B; Kotenkov, D V

    2014-01-01

    The appearance of new surgical technique always requires evaluation of its effectiveness and ease of acquisition. A comparative study of the results of the first three series of successive robot-assisted radical prostatectomy (RARP) performed on at time by three surgeons, was conducted. The series consisted of 40 procedures, and were divided into 4 groups of 10 operations for the analysis. When comparing data, statistically significant improvement of intra- and postoperative performance in each series was revealed, with increase in the number of operations performed, and in each subsequent series compared with the preceding one. We recommend to perform the planned conversion at the first operation. In our study, previous laparoscopic experience did not provide any significant advantages in the acquisition of robot-assisted technology. To characterize the individual learning curve, we recommend the use of the number of operations that the surgeon looked in the life-surgery regimen and/or in which he participated as an assistant before his own surgical activity, as well as the indicator "technical defect". In addition to the term "individual learning curve", we propose to introduce the terms "surgeon's individual training phase", and "clinic's learning curve".

  3. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence

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    Sheng-Qiang Qian

    2016-01-01

    Full Text Available Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function. [1] Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy (NPWT. However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO 2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO 2 measurements in different parts of the penis, should be performed.

  4. Vacuum therapy in penile rehabilitation after radical prostatectomy: review of hemodynamic and antihypoxic evidence.

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    Qian, Sheng-Qiang; Gao, Liang; Wei, Qiang; Yuan, Jiuhong

    2016-01-01

    Generally, hypoxia is a normal physiological condition in the flaccid penis, which is interrupted by regular nocturnal erections in men with normal erectile function. [1] Lack of spontaneous and nocturnal erections after radical prostatectomy due to neuropraxia results in persistent hypoxia of cavernosal tissue, which leads to apoptosis and degeneration of cavernosal smooth muscle fibers. Therefore, overcoming hypoxia is believed to play a crucial role during neuropraxia. The use of a vacuum erectile device (VED) in penile rehabilitation is reportedly effective and may prevent loss of penile length. The corporal blood after VED use is increased and consists of both arterial and venous blood, as revealed by color Doppler sonography and blood gas analysis. A similar phenomenon was observed in negative pressure wound therapy (NPWT). However, NPWT employs a lower negative pressure than VED, and a hypoperfused zone, which increases in response to negative pressure adjacent to the wound edge, was observed. Nonetheless, questions regarding ideal subatmospheric pressure levels, modes of action, and therapeutic duration of VED remain unanswered. Moreover, it remains unclear whether a hypoperfused zone or PO 2 gradient appears in the penis during VED therapy. To optimize a clinical VED protocol in penile rehabilitation, further research on the mechanism of VED, especially real-time PO 2 measurements in different parts of the penis, should be performed.

  5. Pelvic Radiotherapy versus Radical Prostatectomy with Limited Lymph Node Sampling for High-Grade Prostate Adenocarcinoma

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    Christopher B. Baker

    2016-01-01

    Full Text Available Purpose. To compare oncologic outcomes for patients with Gleason score (GS ≥ 8 prostate adenocarcinoma treated with radical prostatectomy (RP versus external beam radiotherapy combined with androgen deprivation (RT + ADT. Methods. Between 2001 and 2014, 121 patients with GS ≥ 8 were treated at our institution via RT + ADT (n=71 or RP (n=50 with ≥ 1 year of biochemical follow-up. Endpoints included biochemical failure (BF, distant metastasis, and initiation of salvage ADT. Results. The RT + ADT group was older, had higher biopsy GS, and had greater risk of lymph node involvement. All other pretreatment characteristics were similar between groups. Mean number of lymph nodes (LNs sampled for patients undergoing RP was 8.2 (±6.18. Mean biochemical follow-up for all patients was 61 months. Five-year estimates of BF for the RT + ADT and RP groups were 7.2% versus 42.3%, (p<0.001. The RT + ADT group also had lower rates of distant metastasis (2% versus 7.8% and salvage ADT (8% versus 33.8%. Conclusion. In this analysis, RT + ADT was associated with improved biochemical and metastatic control when compared to RP with limited LN sampling. How RT + ADT compares with more aggressive lymphadenectomy, as is currently our institutional standard, remains an important unanswered question.

  6. Management of pelvic lymphoceles after radical prostatectomy: A multicentre community based study

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    Khoder WY

    2011-06-01

    Full Text Available Abstract Introduction Pelvic lymphoceles (LC following radical prostatectomy (LC-RP have an incidence up to 27%. LC-managements constitute 50% of surgical interventions performed in post-RP patients. Objectives To describe a therapeutic algorithm for LC-managements based on a community based representative retrospective study. Patients and methods: Multicentre data from 304 patients with LC-RP were retrospectively examined for LC-managements. RPs were performed by various surgeons from 67 urological departments. All patients had undergone 3 weeks rehabilitation in a specialized hospital where the data base was generated. Indications and results of therapeutic manoeuvres were used to develop a general concept for planning therapy decisions. Results Median age was 64 years. Complications occurred in 9% (28/304 of patients. Median LC-volume was 36 ml (range 20-1800 ml. There were more complications for LCs with ≥100 ml volume than those Conclusions This study based treatment algorithm provides a rationale approach with an accurate LC-classification as regard the indications and decision making for the available LC-RP-therapies. This could facilitate management decisions. Evaluation of this concept prospectively in large patient cohort is mandatory.

  7. Radical prostatectomy neutralizes obesity-driven risk of prostate cancer progression.

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    Schiffmann, Jonas; Salomon, Georg; Tilki, Derya; Budäus, Lars; Karakiewicz, Pierre I; Leyh-Bannurah, Sami-Ramzi; Pompe, Raisa S; Haese, Alexander; Heinzer, Hans; Huland, Hartwig; Graefen, Markus; Tennstedt, Pierre

    2017-05-01

    Obesity negatively affects several prostate cancer (PCa) outcomes, including mortality to PCa. However, the validity of several such associations is still under debate, including its effect on pathological stage at radical prostatectomy (RP) and subsequent biochemical recurrence (BCR), which represents the focus of this study. We relied on patients with PCa treated with RP at the Martini-Klinik Prostate Cancer Center between 2004 and 2015. First, multivariable logistic regression analyses tested for association between obesity and non-organ-confined disease (≥pT3 or pN1). Second, multivariable Cox regression analyses examined obesity effect on BCR. Last, in a propensity score-matched cohort, Kaplan-Meier analyses assessed BCR-free survival according to body mass index (kg/m(2)) (BMI) strata (≥30 vs.obese (BMI≥30). Median follow-up was 36.4 months (interquartile range: 13.3-60.8). Obese patients were more likely to harbor non-organ-confined disease at final pathology (odds ratio = 1.27; 95% CI: 1.13-1.43; Pobese and nonobese men, after propensity score matching (log rank P = 0.9). Obesity (BMI ≥30) might predispose to higher rates of non-organ-confined disease at RP. However, obesity was not an independent predictor of BCR after surgery. Consequently, the unfavorable effect of obesity on PCa might be limited to local spread of the disease and might be neutralized after RP. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Multiparametric MRI for recurrent prostate cancer post radical prostatectomy and postradiation therapy.

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    Barchetti, Flavio; Panebianco, Valeria

    2014-01-01

    The clinical suspicion of local recurrence of prostate cancer (PCa) after radical prostatectomy (RP) and after radiation therapy (RT) is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI) in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam). Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.

  9. Multiparametric MRI for Recurrent Prostate Cancer Post Radical Prostatectomy and Postradiation Therapy

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    Flavio Barchetti

    2014-01-01

    Full Text Available The clinical suspicion of local recurrence of prostate cancer (PCa after radical prostatectomy (RP and after radiation therapy (RT is based on the onset of biochemical failure. The aim of this paper was to review the current role of multiparametric-MRI (mp-MRI in the detection of locoregional recurrence. A systematic literature search using the Medline and Cochrane Library databases was performed from January 1995 up to November 2013. Bibliographies of retrieved and review articles were also examined. Only those articles reporting complete data with clinical relevance for the present review were selected. This review article is divided into two major parts: the first one considers the role of mp-MRI in the detection of PCa local recurrence after RP; the second part provides an insight about the impact of mp-MRI in the depiction of locoregional recurrence after RT (interstitial or external beam. Published data indicate an emerging role for mp-MRI in the detection and localization of locally recurrent PCa both after RP and RT which represents an information of paramount importance to perform focal salvage treatments.

  10. Erectile dysfunction post-radical prostatectomy – a challenge for both patient and physician

    Science.gov (United States)

    Bratu, O; Oprea, I; Marcu, D; Spinu, D; Niculae, A; Geavlete, B; Mischianu, D

    2017-01-01

    Post-radical prostatectomy erectile dysfunction (post RP ED) is a major postoperative complication with a great impact on the quality of life of the patients. Until present, no proper algorithm or guideline based on the clinical trials has been established for the management of post RP ED. According to literature, it is better to initiate a penile rehabilitation program as soon as possible after surgery than doing nothing, in order to prevent and limit the postoperative local hypoxygenation and fibrosis. The results of numerous clinical trials regarding the effectiveness of the phosphodiesterase 5 inhibitors therapy on post RP ED have made them the gold standard treatment. Encouraging results have been achieved in studies with vacuum erectile devices, intraurethral suppositories with alprostadil and intracavernosal injections, but due to their side effects, especially in the cases of intracavernosal injections and intraurethral suppositories, their clinical use was limited therefore making them a second line option for the post RP ED treatment. What should not be forgotten is that penile implant prosthesis has proven very effective, numerous studies confirming high rates of satisfaction for both patients and partners. PMID:28255370

  11. Preoperative predictors of blood loss at the time of radical prostatectomy: results from the SEARCH database.

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    Lloyd, J C; Bañez, L L; Aronson, W J; Terris, M K; Presti, J C; Amling, C L; Kane, C J; Freedland, S J

    2009-01-01

    The literature contains conflicting data on preoperative predictors of estimated blood loss (EBL) at radical retropubic prostatectomy (RRP). We sought to examine preoperative predictors of EBL at the time of RRP among patients from the SEARCH database to lend clarity to this issue. A total of 1154 patients were identified in the SEARCH database who underwent RRP between 1988 and 2008 and had EBL data available. We examined multiple preoperative factors for their ability to predict EBL using multivariate linear regression analysis. Median EBL was 900 ml (s.d. 1032). The 25th and 75th percentile for EBL were 600 and 1500 ml, respectively. EBL increased significantly with increasing body mass index (BMI) and increasing prostate size and decreased with more recent year of RRP (all PEBL in normal-weight men (BMIor=35 kg/m(2)). Predicted EBL for men with the smallest prostates (or=100 g. Finally, statistically significant differences between centers were observed, with mean-adjusted EBL ranging from 844 to 1094 ml. Both BMI and prostate size are predictors of increased EBL. Prostate size is of particular note, as a nearly twofold increased EBL was seen from the smallest (or=100 g). Over time, average EBL significantly decreased. Finally, significant differences in EBL were observed between centers. Patients with multiple risk factors should be forewarned they are at increased risk for higher EBL, which may translate into a greater need for blood transfusion.

  12. Frozen section evaluation of margins in radical prostatectomy specimens: a contemporary study and literature review.

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    Nunez, Amberly L; Giannico, Giovanna A; Mukhtar, Faisal; Dailey, Virginia; El-Galley, Rizk; Hameed, Omar

    2016-10-01

    The utility of routine frozen section (FS) analysis for margin evaluation during radical prostatectomy (RP) remains controversial. A retrospective search was conducted to identify RPs evaluated by FS over a 5-year period. The potential of FS to discriminate between benign and malignant tissue and to predict final margins was evaluated. During the study period, 71 (12.3%) of 575 cases underwent FS evaluation of margins, generating 192 individual FSs. There were 8 FSs diagnosed as atypical/indeterminate because of significant freezing, crushing, and/or thermal artifacts; 11 as positive for carcinoma; and 173 as benign. Two FSs classified as benign were diagnosed as positive for carcinoma on subsequent permanent section. Frozen sections' sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of prostatic adenocarcinoma were 85%, 100%, 100%, 99%, and 99%, respectively. Overall RP final margin predictive accuracy was 81%. Positive FS was significantly associated with perineural invasion on biopsy and extraprostatic extension and higher stage disease on RP, but not with the overall final margin status. The high FS accuracy supports its use to guide the extent of surgery. However, FS cannot be used to predict the overall final margin status. Recognition of the histological artifacts inherent to the FS procedure is important to ensure appropriate utilization.

  13. Total cysto-prostatectomy: Technique description and results in 2 dogs.

    Science.gov (United States)

    Bacon, Nicholas; Souza, Carlos H de M; Franz, Sarah

    2016-02-01

    We describe a novel technique for total cysto-prostatectomy, followed by uretero-urethral anastomosis in 2 dogs. The technique was successful and was performed without pubic osteotomy. Post-operative urinary tract infections may be a potentially serious event.

  14. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 4: seminal vesicles and lymph nodes.

    Science.gov (United States)

    Berney, Daniel M; Wheeler, Thomas M; Grignon, David J; Epstein, Jonathan I; Griffiths, David F; Humphrey, Peter A; van der Kwast, Theo; Montironi, Rodolfo; Delahunt, Brett; Egevad, Lars; Srigley, John R

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the infiltration of tumor into the seminal vesicles and regional lymph nodes were coordinated by working group 4. There was a consensus that complete blocking of the seminal vesicles was not necessary, although sampling of the junction of the seminal vesicles and prostate was mandatory. There was consensus that sampling of the vas deferens margins was not obligatory. There was also consensus that muscular wall invasion of the extraprostatic seminal vesicle only should be regarded as seminal vesicle invasion. Categorization into types of seminal vesicle spread was agreed by consensus to be not necessary. For examination of lymph nodes, there was consensus that special techniques such as frozen sectioning were of use only in high-risk cases. There was no consensus on the optimal sampling method for pelvic lymph node dissection specimens, although there was consensus that all lymph nodes should be completely blocked as a minimum. There was also a consensus that a count of the number of lymph nodes harvested should be attempted. In view of recent evidence, there was consensus that the diameter of the largest lymph node metastasis should be measured. These consensus decisions will hopefully clarify the difficult areas of pathological assessment in radical prostatectomy evaluation and improve the concordance of research series to allow more accurate assessment of patient prognosis.

  15. PROGNOSTIC FACTORS OF BIOCHEMICAL RELAPSE FREE SURVIVAL FOLLOWING SALVAGE RADIOTHERAPY IN MEN WITH BIOCHEMICAL RECURRENCE AFTER RADICAL PROSTATECTOMY

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    P. D. Demeshko

    2014-07-01

    Full Text Available Purpose. To evaluate influence of clinical, biochemical and histological factors to biochemical relapse free survival (BRFS following salvage radiotherapy (RT in men with biochemical recurrence after radical prostatectomy.Material and methods. 77 patients with newly diagnosed biochemical recurrence (BR after RPE were included into retrospective study. All of them underwent local salvage RT. Сlinical variables (age, serum prostate-specific antigen [PSA] level and PSA kinetics, time RPE-BR, Gleason grade, stage after RPE and clinical findings were evaluated using Cox proportional hazards regression analysis.Results. The median, 1- and 3-year BRFS were 19,9 months, 63,8 ± 6,5 % and 24,7 ± 8,5 % respectively. Significant variables in the multivariable model were age, PSA level before RT, prostatectomy T3b stage, PSA doubling time and positive digital rectal examination findings (p < 0,05. Several clinical parameters help predict the outcomes of men with PSA elevation after radical prostatectomy. These data may be useful in counseling men regarding the timing of administration of adjuvant therapies.

  16. Erectile Function and Oncologic Outcomes Following Open Retropubic and Robot-assisted Radical Prostatectomy: Results from the LAParoscopic Prostatectomy Robot Open Trial.

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    Sooriakumaran, Prasanna; Pini, Giovannalberto; Nyberg, Tommy; Derogar, Maryam; Carlsson, Stefan; Stranne, Johan; Bjartell, Anders; Hugosson, Jonas; Steineck, Gunnar; Wiklund, Peter N

    2017-09-04

    Whether surgeons perform better utilising a robot-assisted laparoscopic technique compared with an open approach during prostate cancer surgery is debatable. To report erectile function and early oncologic outcomes for both surgical modalities, stratified by prostate cancer risk grouping. In a prospective nonrandomised trial, we recruited 2545 men with prostate cancer from seven open (n=753) and seven robot-assisted (n=1792) Swedish centres (2008-2011). Clinometrically-validated questionnaire-based patient-reported erectile function was collected before, 3 mo, 12 mo, and 24 mo after surgery. Surgeon-reported degree of neurovascular-bundle preservation, pathologist-reported positive surgical margin (PSM) rates, and 2-yr prostate-specific antigen-relapse rates were measured. Among 1702 preoperatively potent men, we found enhanced erectile function recovery for low/intermediate-risk patients in the robot-assisted group at 3 mo. For patients with high-risk tumours, point estimates for erectile function recovery at 24 mo favoured the open surgery group. The degree of neurovascular bundle preservation and erectile function recovery were greater correlated for robot-assisted surgery. In pT2 tumours, 10% versus 17% PSM rates were observed for open and robot-assisted surgery, respectively; corresponding rates for pT3 tumours were 48% and 33%. These differences were associated with biochemical recurrence in pT3 but not pT2 disease. The study is limited by its nonrandomised design and relatively short follow-up. Earlier recovery of erectile function in the robot-assisted surgery group in lower-risk patients is counterbalanced by lower PSM rates for open surgeons in organ-confined disease; thus, both open and robotic surgeons need to consider this trade-off when determining the plane of surgical dissection. Robot-assisted surgery also facilitates easier identification of nerve preservation planes during radical prostatectomy as well as wider dissection for pT3 cases. For

  17. Evaluation of a genomic classifier in radical prostatectomy patients with lymph node metastasis

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    Lee HJ

    2016-06-01

    Full Text Available Hak J Lee,1 Kasra Yousefi,2 Zaid Haddad,2 Firas Abdollah,3 Lucia LC Lam,2 Heesun Shin,2 Mohammed Alshalalfa,2 Elana Godebu,1 Song Wang,4 Ahmed Shabaik,5 Elai Davicioni,2 Christopher J Kane1 1Department of Urology, University of California, San Diego, San Diego, CA, USA; 2GenomeDx Biosciences Inc., Vancouver, BC, Canada; 3Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, 4UC San Diego Health System, San Diego, CA, 5Department of Pathology, University of California, San Diego, San Diego, CA, USA Objective: To evaluate the performance of the Decipher test in predicting lymph node invasion (LNI on radical prostatectomy (RP specimens. Methods: We identified 1,987 consecutive patients with RP who received the Decipher test between February and August 2015 (contemporary cohort. In the contemporary cohort, only the Decipher score from RP specimens was available for analysis. In addition, we identified a consecutive cohort of patients treated with RP between 2006 and 2012 at the University of California, San Diego, with LNI upon pathologic examination (retrospective cohort. The retrospective cohort yielded seven, 22, and 18 tissue specimens from prostate biopsy, RP, and lymph nodes (LNs for individual patients, respectively. Univariable and multivariable logistic regression analyses were used to evaluate the performance of Decipher in the contemporary cohort with LNI as the endpoint. In the retrospective cohort, concordance of risk groups was assessed using validated cut-points for low (<0.45, intermediate (0.45–0.60, and high (>0.60 Decipher scores. Results: In the contemporary cohort, 51 (2.6% patients had LNI. Decipher had an odds ratio of 1.73 (95% confidence interval, 1.46–2.05 and 1.42 (95% confidence interval, 1.19–1.7 per 10% increase in score on univariable and multivariable (adjusting for pathologic Gleason score, extraprostatic extension, and seminal vesicle invasion, respectively. No significant difference in the clinical

  18. Clinical and biochemical outcomes of men undergoing radical prostatectomy or radiation therapy for localized prostate cancer

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    Schreiber, David; Weiss, Jeffrey P.; Safdieh, Joseph; Weiner, Joseph; Rotman, Marvin; Schwartz, David [Veterans Affairs, New York Harbor Healthcare System, Brooklyn (United States); Rineer, Justin [University of Florida Health Cancer Center at Orlando Health, Orlando (United States)

    2015-03-15

    We analyzed outcomes of patients with prostate cancer undergoing either radical retropubic prostatectomy (RRP) +/- salvage radiation or definitive radiation therapy (RT) +/- androgen deprivation. From 2003-2010 there were 251 patients who underwent RRP and 469 patients who received RT (> or =7,560 cGy) for prostate cancer. Kaplan-Meier analysis was performed with the log-rank test to compare biochemical control (bCR), distant metastatic-free survival (DMPFS), and prostate cancer-specific survival (PCSS) between the two groups. The median follow-up was 70 months and 61.3% of the men were African American. For low risk disease the 6-year bCR were 90.3% for RT and 85.6% for RRP (p = 0.23) and the 6-year post-salvage bCR were 90.3% vs. 90.9%, respectively (p = 0.84). For intermediate risk disease the 6-year bCR were 82.6% for RT and 59.7% for RRP (p < 0.001) and 82.6% vs. 74.0%, respectively, after including those salvaged with RT (p = 0.06). For high risk disease, the 6-year bCR were 67.4% for RT and 41.3% for RRP (p < 0.001) and after including those salvaged with RT was 67.4% vs. 43.1%, respectively (p < 0.001). However, there were no significant differences between the two groups in regards to DMPFS or PCSS. Treatment approaches utilizing RRP +/- salvage radiation or RT +/- androgen deprivation yielded equivalent DMPFS and PCSS outcomes. Biochemical control rates, using their respective definitions, appeared equivalent or better in those who received treatment with RT.

  19. Robot assisted laparoscopic radical prostatectomy: assistant's seniority has no influence on perioperative course.

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    Abu-Ghanem, Yasmin; Erlich, Tomer; Ramon, Jacob; Dotan, Zohar; Zilberman, Dorit E

    2016-11-09

    An experienced surgical team, in general, and the surgeon assistant in particular are believed to play a critical role in the operation's safety and success. We sought to explore whether the assistant's seniority influences perioperative course following robot assisted laparoscopic radical prostatectomy (RALP). We reviewed our prospective registry database of RALP cases performed by a single surgeon who during the study period was beyond his learning curve. The following parameters were documented and analyzed: patient's age, body mass index (BMI), associated comorbidities, previous abdominal surgeries, assistant's identity, total and skin-to-skin operative time (tOT, ssOT, respectively), estimated blood loss (EBL), immediate post-operative complications, length of stay (LOS), and prostate weight per final pathology report. Univariate analysis and Spearman's correlation test were used to evaluate whether the assistant's seniority influenced perioperative course. Between the years 2011-2015, 106 consecutive cases were retrieved and analyzed. Prostate weight was found to be associated with longer tOT (Spearman's ρ = 0.34, p < 0.001), ssOT (0.3, p < 0.01) and increased EBL (0.28, p < 0.01). Patient's age, BMI, associated comorbidities, and previous abdominal surgeries were found to have no influence on neither tOT, ssOT nor EBL. Three assistants' subgroups were identified (seniors, PGY 1-3, PGY 4-6). The assistant's seniority was found to have no influence on tOT, ssOT, EBL, immediate post-operative complications and LOS. Same results were obtained following prostate size adjustments. The assistant's seniority has no influence on perioperative course following RALP. Consequently, given a highly experienced primary surgeon, a less experienced assistant can be safely incorporated into this procedure.

  20. Oncological outcomes following radical prostatectomy for patients with pT4 prostate cancer

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    Dharam Kaushik

    Full Text Available ABSTRACT Objectives: Radical prostatectomy (RP for locally advanced prostate cancer may reduce the risk of metastasis and cancer-specific death. Herein, we evaluated the outcomes for patients with pT4 disease treated with RP. Materials and methods: Among 19,800 men treated with RP at Mayo Clinic from 1987 to 2010, 87 were found to have pT4 tumors. Biochemical recurrence (BCR-free survival, systemic progression (SP free survival and overall survival (OS were estimated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were used to assess the association of clinic-pathological features with outcome. Results: Median follow-up was 9.8 years (IQR 3.6, 13.4. Of the 87 patients, 50 (57.5% were diagnosed with BCR, 30 (34.5% developed SP, and 38 (43.7% died, with 11 (12.6% dying of prostate cancer. Adjuvant androgen deprivation therapy was administered to 77 men, while 32 received adjuvant external beam radiation therapy. Ten-year BCR-free survival, SP-free survival, and OS was 37%, 64%, and 70% respectively. On multivariate analysis, the presence of positive lymph nodes was marginally significantly associated with patients' risk of BCR (HR: 1.94; p=0.05, while both positive lymph nodes (HR 2.96; p=0.02 and high pathologic Gleason score (HR 1.95; p=0.03 were associated with SP. Conclusions: Patients with pT4 disease may experience long-term survival following RP, and as such, when technically feasible, surgical resection should be considered in the multimodal treatment approach to these men.

  1. Low serum testosterone predicts upgrading and upstaging of prostate cancer after radical prostatectomy

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    Yuan Gao

    2016-01-01

    Full Text Available Often, pathological Gleason Score (GS and stage of prostate cancer (PCa were inconsistent with biopsy GS and clinical stage. However, there were no widely accepted methods predicting upgrading and upstaging PCa. In our study, we investigated the association between serum testosterone and upgrading or upstaging of PCa after radical prostatectomy (RP. We enrolled 167 patients with PCa with biopsy GS ≤6, clinical stage ≤T2c, and prostate-specific antigen (PSA <10 ng ml−1 from April 2009 to April 2015. Data including age, body mass index, preoperative PSA level, comorbidity, clinical presentation, and preoperative serum total testosterone level were collected. Upgrading occurred in 62 (37.1% patients, and upstaging occurred in 73 (43.7% patients. Preoperative testosterone was lower in the upgrading than nonupgrading group (3.72 vs 4.56, P< 0.01. Patients in the upstaging group had lower preoperative testosterone than those in the nonupstaging group (3.84 vs 4.57, P= 0.01. In multivariate logistic regression analysis, as both continuous and categorical variables, low serum testosterone was confirmed to be an independent predictor of pathological upgrading (P = 0.01 and P= 0.01 and upstaging (P = 0.01 and P = 0.02 after RP. We suggest that low serum testosterone (<3 ng ml−1 is associated with a high rate of upgrading and upstaging after RP. It is better for surgeons to ensure close monitoring of PSA levels and imaging examination when selecting non-RP treatment, to be cautious in proceeding with nerve-sparing surgery, and to be enthusiastic in performing extended lymph node dissection when selecting RP treatment for patients with low serum testosterone.

  2. RADICAL RETROPUBIC PROSTATECTOMY: THE FIRST RUSSIAN EXPERIENCE OF 15-YEAR FOLLOW-UP AFTER SURGERY

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    E. I. Veliev

    2014-07-01

    Full Text Available The results of the maximum of more than 15 years of follow-up of Russia’s first large series of patients after radical retropubic prostatectomy (RPE were traced. The data of 1367 patients who had undergone RPE at the Clinic of Urology, S.P. Kirov Military Medical Academy, in 1997 to 2003 and at the Clinic of Urology, Russian Medical Academy of Postgraduate Education, in 2001 to 2010 were retrospectively studied. After excluding 626 patients who had an incomplete set of preoperative/postoperative characteristics, a postoperative follow-up of < 6 months, neoadjuvant hormonal or radiation therapy, the trial included 741 patients. Their median age at surgery was 64 years (interquartile range (IQR: 59-68; median prostatespecific antigen (PSA, 8.7 ng/ml (IQR: 6.2-14; median follow-up, 65 months (IQR: 50-87; the maximum follow-up period, 189 months. Out of the 741 patients, 30.2, 28.3, and 41.5% were referred to as D’Amico classification low-, moderate-, and high-risk groups, respectively. Five-, 10-, and 15-year relapse-free survival rates were 80.3, 74.7, and 66.7%; 5-, 10-, and 15-year cancer-specific survival rates were 98.3, 95.9, and 85.7%; and 5-, 10-, and 15-year overall survival rates were 92.5, 81.4, and 64.3%, respectively. The significant predictors of biochemical recurrence were a preoperative PSA level of 10.1–20 ng/ml (p = 0.041, > 20 ng/ml (p = 0.003; pathological stage pT3b–4N0 (p = 0.006 and any stage pT N1 (p = 0.003. Further investigations are needed to identify groups of patients who will have the most benefit from surgery.

  3. RADICAL RETROPUBIC PROSTATECTOMY: THE FIRST RUSSIAN EXPERIENCE OF 15-YEAR FOLLOW-UP AFTER SURGERY

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    E. I. Veliev

    2013-01-01

    Full Text Available The results of the maximum of more than 15 years of follow-up of Russia’s first large series of patients after radical retropubic prostatectomy (RPE were traced. The data of 1367 patients who had undergone RPE at the Clinic of Urology, S.P. Kirov Military Medical Academy, in 1997 to 2003 and at the Clinic of Urology, Russian Medical Academy of Postgraduate Education, in 2001 to 2010 were retrospectively studied. After excluding 626 patients who had an incomplete set of preoperative/postoperative characteristics, a postoperative follow-up of < 6 months, neoadjuvant hormonal or radiation therapy, the trial included 741 patients. Their median age at surgery was 64 years (interquartile range (IQR: 59-68; median prostatespecific antigen (PSA, 8.7 ng/ml (IQR: 6.2-14; median follow-up, 65 months (IQR: 50-87; the maximum follow-up period, 189 months. Out of the 741 patients, 30.2, 28.3, and 41.5% were referred to as D’Amico classification low-, moderate-, and high-risk groups, respectively. Five-, 10-, and 15-year relapse-free survival rates were 80.3, 74.7, and 66.7%; 5-, 10-, and 15-year cancer-specific survival rates were 98.3, 95.9, and 85.7%; and 5-, 10-, and 15-year overall survival rates were 92.5, 81.4, and 64.3%, respectively. The significant predictors of biochemical recurrence were a preoperative PSA level of 10.1–20 ng/ml (p = 0.041, > 20 ng/ml (p = 0.003; pathological stage pT3b–4N0 (p = 0.006 and any stage pT N1 (p = 0.003. Further investigations are needed to identify groups of patients who will have the most benefit from surgery.

  4. Critical analysis of salvage radical prostatectomy in the management of radioresistant prostate cancer

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    Seabra, Daniel; Faria, Eliney; Dauster, Breno; Rodrigues, Gunther; Fava, Gilberto [Pio XII Foundation, Barretos, SP (Brazil). Section of Urology], e-mail: daniel.seabra@terra.com.br

    2009-01-15

    Purpose: To critically evaluate salvage radical prostatectomy (SRP) in the treatment of patients with recurrent prostate cancer (PCa). Materials and Methods: From January 2005 to June 2007, we assessed patients with recurrent localized PCa. Recurrence was suspected when there were three or more successive increases in prostate specific antigen (PSA) after nadir. After the routine imagery examinations, and once localized PCa was confirmed, patients were offered SRP. Following surgery, we evaluated bleeding, rectal injury, urinary incontinence or obstruction and impotence. PSA values were measured at 1, 3, 6, months and thereafter twice a year. Results: Forty-two patients underwent SRP. The average age was 61 years. Following radiotherapy , the mean PSA nadir was 1.5 ng/mL (0.57-5.5). The mean prostate specific antigen doubling time (PSA-DT) was 14 months (6-20). Prior to SRP, the mean PSA was 5.7 ng/mL (2.9-18). The pathologic staging was pT2a: 13%; pT2b: 34%; pT2c: 27%; pT3a: 13%; and pT3b: 13%. Bleeding > 600 mL occurred in 14% of the cases; urethral stenosis in 50%; and urinary incontinence (two or more pads/day) in 72%. The mean follow-up post-SRP ranged from 6 to 30 months. The PSA level rose in 9, of which 6 had PSA-DT < 10 months. Conclusions: SRP is a feasible method in the management of localized radioresistant PCa. PSA-DT has shown to be important for the selection and SRP should not be performed if PSA-DT > 10 months. Due to its increased morbidity, SRP should be only offered to the patients who are more concerned about survival rather than quality of life. (author)

  5. The natural history of voiding function after robot-assisted laparoscopic radical prostatectomy.

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    Wang, Lushun; Chung, Stephanie Fook-Chong Man; Yip, Sidney Kam Hung; Lau, Weber Kam On; Cheng, Christopher Wai Sam; Sim, Hong Gee

    2011-01-01

    We report the natural history of voiding function in men with clinically localized prostate cancer after robot-assisted laparoscopic radical prostatectomy (RLRP), describing the trend of functional recovery, which is currently not well described using the robot-assisted laparoscopic approach. We determined the impact on voiding function by prospectively evaluating 100 consecutive men who underwent RLRP between May 2005 and December 2006 and compared their reported International Prostate Symptom Score (IPSS) and Quality of Life (QOL) scores at 3, 6, and 12 months with preoperative scores after surgery. Patients with preoperative IPSS of 0-7 and 8-35 were defined as having mild lower urinary tract symptoms (LUTS) and moderate to severe LUTS, respectively. Continence was achieved in 82%, 87%, and 91% of men at 3, 6, and 12 months after RLRP, respectively. There were statistically and clinically significant improvements in both IPSS and QOL preoperative scores at all studied time points for patients with moderate to severe preexisting LUTS. The mean IPSS scores for these patients preoperatively and at 3, 6, and 12 months after surgery were 14.1, 5.2, 3.0, and 2.9, respectively and the corresponding mean QOL scores were 3.4, 2.1, 1.6, and 1.6, respectively. Patients with mild preexisting LUTS showed no statistically significant improvement in IPSS at 3 and 6 months after surgery but significant improvement was found at 1 year (P = 0.04). Good continence recovery is expected in most patients undergoing RLRP. Patients with moderate to severe preexisting LUTS can expect early and clinically significant symptom and QOL improvements after RLRP. Patients with mild preexisting LUTS show significant symptom improvement at 1 year. Copyright © 2011 Elsevier Inc. All rights reserved.

  6. Gleason sum upgrading between biopsy and radical prostatectomy in Chinese population: Updated nomograms.

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    Xu, H; Bai, P D; Hu, M B; Mao, S H; Zhu, W H; Hu, J M; Liu, S H; Yang, T; Hou, J Y; Hu, Y; Ding, Q; Jiang, H W

    2017-04-01

    To assess the risk factors of Gleason sum upgrading between biopsy and radical prostatectomy (RP) and update the nomogram for the prediction of Gleason sum upgrading. The study cohort consisted of 237 Chinese prostate adenocarcinoma patients who underwent 10-core prostate biopsy and subsequently received RP in Huashan Hospital from February 2011 to May 2015. The main outcome of our study was Gleason sum upgrading between biopsy and RP pathology. Univariate and multivariate logistic regression models were conducted to explore the potential predictors, and ultimately to build the nomograms. The prediction model was further evaluated for its ability to predict significant upgrading in patients with biopsy Gleason sum<8. In the main cohort of all the patients, Gleason sum upgrading was observed in 62 (26.16%) patients. The pre-operative prostate-specific antigen (PSA) level, biopsy Gleason sum, and digital rectal examination were used in building the nomogram, which was validated internally with a bootstrap-corrected concordance index of 0.787. In the sub-cohort of 115 patients with standardized biopsy details, Gleason sum upgrading was observed in 31 (26.96%) patients. The pre-operative PSA level, biopsy Gleason sum, and number of positive cores were used in the nomogram, which was also validated internally with a bootstrap-corrected concordance index of 0.833. These two nomograms both demonstrated satisfactory statistical performance for predicting significant upgrading. Updated nomograms to predict Gleason sum upgrading in Chinese population between biopsy and RP were developed, demonstrating good statistical performance upon internal validation. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. Pentafecta rates of three-dimensional laparoscopic radical prostatectomy: our experience after 150 cases.

    Science.gov (United States)

    Benelli, Andrea; Varca, Virginia; Simonato, Alchiede; Terrone, Carlo; Gregori, Andrea

    2017-04-28

    Three-dimensional (3D) laparoscopy with a flexible camera was developed to overcome the main limitation of traditional laparoscopic surgery, which is two-dimensional (2D) vision.The aim of our article is to present the largest casistic of 3D laparoscopic radical prostatectomy (LRP) available in literature and evaluate our results in terms of pentafecta and compare it with the literature. We retrospectively evaluated consecutive patients who underwent LRP with 3D technology between March 2014 and December 2015. Total operative time (TOT), anasthomosis time (AT), blood loss and complications were registered. All patients presented at least 3 months of follow-up. Surgical outcome was evaluated in terms of Pentafecta. One hundred fifty consecutive patients underwent 3D LRP. Mean follow-up was 16.9 months. Mean age was 67.7 ± 8.3 years (range 50-76). Mean preoperative PSA value was 8.3 ± 5.8 ng/ml and mean bioptic Gleason Score (GS) was 6.6. We had a mean TOT of 158 ± 23 minutes and a mean AT of 25 ± 12.6. Mean blood loss was 240 ± 40 ml. Eighteen (12%) postoperative complications occurred. Pathologic results: pT2 in 91 patients (58%) and pT3 in 59 (39.3%). Pentafecta was reached by 31.3% of patients at 3 months and 51.6% at 12 months. Our oncological and functional results are comparable to those present in literature for laparoscopic and robotic surgery. We believe that our findings can encourage the use of 3D laparoscopy especially considering the increasing attention to healthcare costs.

  8. Hormonal changes after localized prostate cancer treatment. Comparison between external beam radiation therapy and radical prostatectomy.

    Science.gov (United States)

    Planas, J; Celma, A; Placer, J; Maldonado, X; Trilla, E; Salvador, C; Lorente, D; Regis, L; Cuadras, M; Carles, J; Morote, J

    2016-11-01

    To determine the influence of radical prostatectomy (RP) and external beam radiation therapy (EBRT) on the hypothalamic pituitary axis of 120 men with clinically localized prostate cancer treated with RP or EBRT exclusively. 120 patients with localized prostate cancer were enrolled. Ninety two patients underwent RP and 28 patients EBRT exclusively. We measured serum levels of luteinizing hormone, follicle stimulating hormone (FSH), total testosterone (T), free testosterone, and estradiol at baseline and at 3 and 12 months after treatment completion. Patients undergoing RP were younger and presented a higher prostate volume (64.3 vs. 71.1 years, p<0.0001 and 55.1 vs. 36.5 g, p<0.0001; respectively). No differences regarding serum hormonal levels were found at baseline. Luteinizing hormone and FSH levels were significantly higher in those patients treated with EBRT at three months (luteinizing hormone 8,54 vs. 4,76 U/l, FSH 22,96 vs. 8,18 U/l, p<0,0001) while T and free testosterone levels were significantly lower (T 360,3 vs. 414,83ng/dl, p 0,039; free testosterone 5,94 vs. 7,5pg/ml, p 0,018). At 12 months FSH levels remained significantly higher in patients treated with EBRT compared to patients treated with RP (21,01 vs. 8,51 U/l, p<0,001) while T levels remained significantly lower (339,89 vs. 402,39ng/dl, p 0,03). Prostate cancer treatment influences the hypothalamic pituitary axis. This influence seems to be more important when patients with prostate cancer are treated with EBRT rather than RP. More studies are needed to elucidate the role that prostate may play as an endocrine organ. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?

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    Gulsah Karaoren

    2017-01-01

    Full Text Available Background: In patients undergoing robot-assisted radical prostatectomy (RARP, pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI, comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. Subjects and Methods: The study included 52 American Society of Anesthesiologists I–II patients aged 50–80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h and 6% hydroxyethyl starch 200/05 (1 ml/kg/h was given during the surgery. Charlson comorbidity index (CCI, operation time (OT and Trendelenburg time (TT were recorded. Blood samples for creatine phosphokinase (CPK, blood urea nitrogen, creatinine (Cr, aspartate aminotransferase (AST, alanine transferase (ALT, lactate dehydrogenase (LDH, creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. Results: Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05. CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P< 0.01. No renal impairment was detected among patients with RM at the post-operative period. Conclusions: It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients.

  10. Effects of Bowel Preparation and Fluid Restriction in Robot-Assisted Radical Prostatectomy Patients.

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    Karaören, Gülşah Yılmaz; Bakan, Nurten; Yürük, Cafer Tayyar; Çetinkaya, Ali Osman

    2015-04-01

    In Robot-assisted radical prostatectomy (RARP) patients, preoperative bowel preparation and intraoperative fluid restriction may cause dehydration and electrolyte imbalance. In these patients, laboratory results that are considered "normal" in the pre-anaesthesia clinic may be misleading, and cardiac arrhythmia due to hypokalaemia and hypocalcaemia, as well as problems, such as prolonged non-depolarising blockade and delayed recovery from anaesthesia, may be observed during anaesthesia practice. In this study, we aimed to determine these disturbances by comparing the preoperative (T1) laboratory values with those at the beginning of the operation (T2) and at the 6(th) hour of the operation (T3) and values at discharge. This prospective study comprised 49 American Society of Anesthesiologists (ASA) I-II patients. Bowel preparation was made with a rectal enema (NaP) twice in 12 hours and with one single dose of oral laxative soda (NaP). During surgery, 1 mL kg(-1) h(-1) 0.09% NaCl and 1 mL kg(-1) h(-1) 6% HES 200/05 infusions were applied. The potassium level at T2 was significantly lower than at T1 and T3. The calcium levels at T2 and T3 were significantly lower than at T1, and the level at T3 was significantly lower than at T2. The creatinine level at T3 was significantly higher than at T1 and T2. Although there were no severe increases or decreases in laboratory test values due to bowel preparation and fluid restriction in RARP operations, which reflected on the clinical outcome in this ASA I-II patient group, these changes may be important in critically ill or ASA III-IV patients.

  11. Is rhabdomyolysis an anaesthetic complication in patients undergoing robot-assisted radical prostatectomy?

    Science.gov (United States)

    Karaoren, Gulsah; Bakan, Nurten; Kucuk, Eyüp Veli; Gumus, Eyup

    2017-01-01

    In patients undergoing robot-assisted radical prostatectomy (RARP), pneumoperitoneum, intraoperative fluid restriction and prolonged Trendelenburg position may cause rhabdomyolysis (RM) due to hypoperfusion in gluteal muscles and lower extremities. In this study, it was aimed to assess effects of body mass index (BMI), comorbidities, intra-operative positioning, fluid restriction and length of surgery on the development of RM in RARP patients during the perioperative period. The study included 52 American Society of Anesthesiologists I-II patients aged 50-80 years with BMI >25 kg/m2, who underwent RARP. Fluid therapy with normal saline (1 ml/kg/h) and 6% hydroxyethyl starch 200/05 (1 ml/kg/h) was given during the surgery. Charlson comorbidity index (CCI), operation time (OT) and Trendelenburg time (TT) were recorded. Blood samples for creatine phosphokinase (CPK), blood urea nitrogen, creatinine (Cr), aspartate aminotransferase (AST), alanine transferase (ALT), lactate dehydrogenase (LDH), creatinine kinase-MB, cardiac troponin I and arterial blood gases were drawn at baseline and on 6, 12, 24 and 48 h. RM was defined by serum CPK level exceeding 5000 IU/L. Seven patients met predefined criteria for RM. There were positive correlations among serum CPK and Cr, AST, ALT and LDH levels. However, there was no significant difference in BMI, OT and TT between patients with or without RM (P > 0.05). CCI scores were higher in patients with RM than those without (3.00 ± 0.58 vs. 2.07 ± 0.62; P< 0.01). No renal impairment was detected among patients with RM at the post-operative period. It was found that comorbid conditions are more important in the development of RM during RARP rather than BMI, OT or TT. Patients with higher comorbidity are at risk for RM development and that this should be kept in mind at follow-up and when informing patients.

  12. Influence of bladder neck suspension stitches on early continence after radical prostatectomy: a prospective randomized study of 180 patients

    Institute of Scientific and Technical Information of China (English)

    Jens-Uwe Stolzenburg; Evangelos Liatsikos; Martin Nicolaus; Panagiotis Kallidonis; Minh Do; Anja Dietel; Tim H(a)fner; George Sakellaropoulos; James Hicks; David Nikoleishvili

    2011-01-01

    Several techniques have been introduced to improve early postoperative continence.In this study,we evaluated the impact of bladder neck (vesicourethral anastomosis) suspension on the outcome of extraperitoneal endoscopic radical prostatectomy (EERPE).In this research,a total of 180 patients underwent EERPE.Group 1 included patients who underwent nerve-sparing EERPE (nsEERPE) (n=45),and Group 2 included patients who underwent nsEERPE with bladder neck suspension (BNS,n=45).Groups 3 (n=45) and 4 (n=45) included patients who received EERPE and EERPE with BNS,respectively.Patients were randomly assigned to receive BNS with their nsEERPE or EERPE procedure.Perioperative parameters were recorded,and continence was evaluated by determining the number and weight of absorbent pads (pad weighing test) on the second day after catheter removal and by a questionnaire 3 months postoperatively.Two days after catheter removal,11.1% of Group 1,11.1% of Group 2,4.4% of Group 3 and 8.9% of Group 4 were continent.The average urine loss was 80.4,70.1,325.0 and 291.3 g for the each of these groups,respectively.At 3 months,76.5% of Group 1 and 81.3% of Group 2 were continent.The continence figures for Group 3 and 4 were 48.5% and 43.8%,respectively.Similar overall rates were observed in all groups.In conclusion,although there are controversial reports in the literature,early continence was never observed to be significantly higher in the BNS groups when compared with the non-BNS groups,regardless of the EERPE technique performed.

  13. Comparison of Transperineal Mapping Biopsy Results with Whole-Mount Radical Prostatectomy Pathology in Patients with Localized Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Darren J. Katz

    2014-01-01

    Full Text Available Objective. We sought to evaluate the accuracy of transperineal mapping biopsy (TMB by comparing it to the pathology specimen of patients who underwent radical prostatectomy (RP for localized prostate cancer. Methods. From March 2007 to September 2009, 78 men at a single center underwent TMB; 17 of 78 subsequently underwent RP. TMB cores were grouped into four quadrants and matched to data from RP whole-mount slides. Gleason score, tumor location and volume, cross-sectional area, and maximal diameter were measured; sensitivity and specificity were assessed. Results. For the 17 patients who underwent RP, TMB revealed 12 (71% had biopsy Gleason grades ≥ 3 + 4 and 13 (76% had bilateral disease. RP specimens showed 14 (82% had Gleason scores ≥ 3 + 4 and 13 (76% had bilateral disease. Sensitivity and specificity of TMB for prostate cancer detection were 86% (95% confidence interval [CI] 72%–94% and 83% (95% CI 62%–95%, respectively. Four quadrants negative for cancer on TMB were positive on prostatectomy, and six positive on TMB were negative on prostatectomy. Conclusion. TMB is a highly invasive procedure that can accurately detect and localize prostate cancer. These findings help establish baseline performance characteristics for TMB and its utility for organ-sparing strategies.

  14. First case of 18F-FACBC PET/CT-guided salvage retroperitoneal lymph node dissection for disease relapse after radical prostatectomy for prostate cancer and negative 11C-choline PET/CT: new imaging techniques may expand pioneering approaches.

    Science.gov (United States)

    Schiavina, Riccardo; Concetti, Sergio; Brunocilla, Eugenio; Nanni, Cristina; Borghesi, Marco; Gentile, Giorgio; Cevenini, Matteo; Bianchi, Lorenzo; Molinaroli, Enrico; Fanti, Stefano; Martorana, Giuseppe

    2014-01-01

    We present the first case of salvage retroperitoneal lymph node dissection based on the results of (18)F-FACBC PET/CT performed for a prostate-specific antigen relapse after radical prostatectomy. The patients underwent (11)C-choline PET/CT, which turned out negative, while (18)F-FACBC PET/CT visualized two lymph node metastases confirmed at pathological examination. Preliminary clinical reports showed an improvement in the detection rate of 20-40% for (18)F-FACBC in comparison with (11)C-choline, rendering the (18)F-FACBC the potential radiotracer of the future. Salvage surgery for prostate cancer is a fascinating but controversial approach. New diagnostic tools may improve its potential by increasing the assessment and the selection of the patients.

  15. A Retrospective Study of Erectile Function and Use of Erectile Aids in Prostate Cancer Patients After Radical Prostatectomy in Denmark

    DEFF Research Database (Denmark)

    Haahr, Martha Kirstine; Azawi, Nessn H; Andersen, Line Grønbaek

    2017-01-01

    INTRODUCTION: Radical prostatectomy (RP) offers a good long-term cancer control for clinically localized prostate cancer. However, complications such as erectile dysfunction and substantial decreases quality of life of the afflicted men and their sexual partners. Identification of pre-, per......-, and postoperative factors that correlate with poor postoperative erectile status must be considered an important step to improving penile rehabilitation. AIM: To describe postoperative erectile function after RP in a Danish cohort. METHODS: The medical records of 1,127 patients undergoing RP from March 2003 through...

  16. Health-related quality of life outcomes in Scandinavian patients after radical prostatectomy or watchful waiting:a critical appraisal

    Institute of Scientific and Technical Information of China (English)

    Andrea A Chan; Steven E Canfield; Run Wang

    2012-01-01

    The Scandinavian Prostate Cancer Group4 recently reported the long-term survival benefit in men who were randomized to radical prostatectomy versus men watchful waiting for localized prostate cancer.The authors have now presented the companion article that updates the long-term quality of life evaluation in these men.2 Given the excellent prognosis of patients with early stage prostate cancer,the impact of therapy on patient's quality of life is a significant factor in the optimal management of this disease.

  17. Is It Worth Continuing Sexual Rehabilitation after Radical Prostatectomy with Intracavernous Injection of Alprostadil for More than 1 Year?

    Directory of Open Access Journals (Sweden)

    René Yiou, MD, PhD, PUPH

    2015-03-01

    Conclusion: The response to IAI remained stable after 2 years of treatment, and no significant improvement of spontaneous erections during intercourse attempts was found between M12 and M24. Patients should be informed of the limited effect of IAI on natural erections after 1 year. Yiou R, Bütow Z, Parisot J, Binhas M, Lingombet O, Augustin D, de la Taille A, and Audureau E. Is it worth continuing sexual rehabilitation after radical prostatectomy with intracavernous injection of alprostadil for more than 1 year? Sex Med 2015;3:42–48.

  18. [Incontinence after radical prostatectomy and cystectomy: are combined training with mechanical devices and whole body vibration effective?].

    Science.gov (United States)

    Zellner, M

    2011-04-01

    In spite of improvements in nerve-sparing operation techniques in radical prostatectomies, a disturbance of (early) continence is subjectively perceived by a number of patients as burdensome, which can last for several months. Skilled physiotherapy is appreciated as causal therapy in the hands of the qualified therapist. In an open randomised controlled trial the efficacy of a standardised rehabilitation therapy with pelvic floor re-education instructed by a physiotherapist (n=25) as the control group in comparison to a group with additional combined electrostimulation and biofeedback device (Myo 420™; n=25) or whole body vibration therapy (FitVibe medical™; n=25). Pre- and post-therapeutic evaluation of the International Prostate Symptom Score (IPSS), the enclosed question about quality of life (IPSS-QL), pad test, pelvic floor strength, maximum uroflow, micturition volume, serum testosterone and blood glucose was done. Within the treatment duration of 3-4 weeks in all treatment groups a statistically significant improvement of IPSS and IPSS-QL was seen. Due to whole body vibration the reduction of urine loss (pad test), increase of voided volume and maximum uroflow were statistically significant. Whereas for isolated physiotherapy during the short therapy duration merely a trend for the improvement of pelvic floor muscle strength was seen, the difference was significant in the Myo 420 and the whole body vibration groups, respectively. It was shown that a continuous improvement in continence depends on the consistent continuation of the training also under domestic conditions. The controlled trial conditions also confirm the efficacy, acceptance and tolerance of a standardised pelvic floor re-education under the conditions of urological inpatient rehabilitation treatment. By additional use of a combined electro- and multichannel biofeedback device or a whole body vibration device, the treatment results could be further improved. Due to the different causal

  19. Estimated blood loss as a predictor of PSA recurrence after radical prostatectomy: results from the SEARCH database.

    Science.gov (United States)

    Lloyd, Jessica C; Bañez, Lionel L; Aronson, William J; Terris, Martha K; Presti, Joseph C; Amling, Christopher L; Kane, Christopher J; Freedland, Stephen J

    2010-02-01

    Diagnosis (exploratory cohort). 2b. To clarify the relationship between estimated blood loss (EBL) and biochemical recurrence, assessed by prostate-specific antigen (PSA) level, as blood loss is a long-standing concern associated with radical prostatectomy (RP), and no studies to date have examined the association between blood loss and cancer control. In all, 1077 patients were identified in the Shared Equal-Access Regional Cancer Hospital database who underwent retropubic RP (between 1998 and 2008) and had EBL and follow-up data available. We examined the relationship between EBL and recurrence using multivariate Cox regression analyses. Increased EBL was correlated with PSA recurrence in a multivariate-adjusted model (P = 0.01). When analysed by 500-mL EBL categories, those with an EBL of EBL of 1500-3499 mL, before decreasing again for patients with an EBL of > or =3500 mL. Men with an EBL of 2500-3499 mL had more than twice the risk of recurrence than men with an EBL of EBL was not associated with adverse tumour stage, grade or margin status. There was a significant correlation between EBL at the time of RP and biochemical recurrence. We hypothesized that this association might be due to transfusion-related immunosuppression, excessive blood obscuring the operative field, EBL being a marker of aggressive disease, or EBL being a marker of poor surgical technique. However, our data did not completely fit any one of these hypotheses, and thus the ultimate cause for the increased risk of recurrence remains unclear and requires further study.

  20. Predictive factors of [{sup 11}C]choline PET/CT in patients with biochemical failure after radical prostatectomy

    Energy Technology Data Exchange (ETDEWEB)

    Giovacchini, Giampiero; Coradeschi, Elisa [University of Milano-Bicocca, Center for Molecular Bioimaging, Milano (Italy); Picchio, Maria; Bettinardi, Valentino; Gianolli, Luigi [Scientific Institute San Raffaele, Department of Nuclear Medicine, Milano (Italy); Scattoni, Vincenzo; Rigatti, Patrizio [Scientific Institute San Raffaele, Department of Urology, Milano (Italy); Cozzarini, Cesare; Di Muzio, Nadia [Scientific Institute San Raffaele, Department of Radiation Oncology, Milano (Italy); Fazio, Ferruccio [University of Milano-Bicocca, Center for Molecular Bioimaging, Milano (Italy); Scientific Institute San Raffaele, Department of Nuclear Medicine, Milano (Italy); Scientific Institute San Raffaele, Department of Radiation Oncology, Milano (Italy); Messa, Cristina [University of Milano-Bicocca, Center for Molecular Bioimaging, Milano (Italy); National Research Council, Institute for Bioimaging and Molecular Physiology, Milano (Italy); Hospital San Gerardo, Department of Nuclear Medicine, Monza (Italy)

    2010-02-15

    Detection of recurrence in prostate cancer patients with biochemical failure after radical prostatectomy by [{sup 11}C]choline PET/CT depends on the prostate-specific antigen (PSA) level. The role of other clinical and pathological variables has not been explored. A total of 2,124 prostate cancer patients referred to our Institution for [{sup 11}C]choline PET/CT from December 2004 to January 2007 for restaging of disease were retrospectively considered for this study. Inclusion criteria were: previous treatment by radical prostatectomy, and biochemical failure, defined as at least two consecutive PSA measurements of >0.2 ng/ml. These criteria were met for 358 patients. Binary logistic analysis was used to investigate the predictive factors of [{sup 11}C]choline PET/CT. PET/CT findings were validated using criteria based on histological analysis, and follow-up clinical and imaging data. Receiver operating characteristic (ROC) analysis was used to assess the performance of [{sup 11}C]choline PET/CT in relation to PSA levels. The mean PSA level was 3.77 {+-} 6.94 ng/ml (range 0.23-45 ng/ml; median 1.27 ng/ml). PET/CT was positive for recurrence in 161 of 358 patients (45%). On an anatomical region basis, [{sup 11}C]choline pathological uptake was observed in lymph nodes (107/161 patients, 66%), prostatectomy bed (55/161 patients, 34%), and in the skeleton (46/161 patients, 29%). PET/CT findings were validated using histological criteria (46/358, 13%), and follow-up clinical and imaging criteria (312/358, 87%). Sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy were, respectively, 85%, 93%, 91%, 87%, and 89%. In multivariate analysis, high PSA levels, advanced pathological stage, previous biochemical failure and older age were significantly (P < 0.05) associated with an increased risk of positive PET/CT findings. The percentage of positive scans was 19% in those with a PSA level between 0.2 and 1 ng/ml, 46% in those

  1. Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience

    Directory of Open Access Journals (Sweden)

    P N Dogra

    2012-01-01

    Full Text Available Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI, prostate specific antigen (PSA level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%. The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

  2. The effect of steep Trendelenburg positioning on intraocular pressure and visual function during robotic-assisted radical prostatectomy.

    Science.gov (United States)

    Hoshikawa, Yuko; Tsutsumi, Noriko; Ohkoshi, Kisiko; Serizawa, Satoshi; Hamada, Masafumi; Inagaki, Keiji; Tsuzuki, Kentaro; Koshimizu, Junko; Echizen, Nariaki; Fujitani, Syuko; Takahashi, Osamu; Deshpande, Gautam A

    2014-03-01

    To evaluate intraocular pressure (IOP) changes in patients undergoing robotic-assisted radical prostatectomy and to evaluate complications from increased IOP. Thirty-one eyes scheduled for robotic prostatectomy were included. Perioperative IOP measurements were performed as follows: prior to induction of anaesthesia while supine and awake (T1); immediately post-induction while supine (T2); every hour from 0 to 5 h while anaesthetised in a steep Trendelenburg position (T3-T8); prior to awakening while supine (T9); and 30 min after awakening while supine (T10). A complete ophthalmic examination including visual acuity and retinal nerve fibre layer thickness (RNFL) was performed at enrolment and 1 month postoperatively. Average IOP (mm Hg) for each time point was as follows: T1=18.0, T2=9.8, T3=18.9, T4=21.6, T5=22.5, T6=22.3, T7=24.2, T8=24.0, T9=15.7 and T10=17.9. The proportion of eyes with intraoperative IOP ≧30 mm Hg were as follows: T3=0%, T4=3.23%, T5=9.68%, T6=6.45%, T7=22.22%, and T8=25%. Maximum IOP was 36 mm Hg. Mean visual acuity (logarithm of the minimal angle of resolution) and RNFL showed no statistically significant difference before and after operation and no other ocular complications were found at final examination. While IOP increased in a time-dependent fashion in anesthaetised patients undergoing robotic-assisted radical prostatectomy in a steep Trendelenburg position, visual function showed no significant change postoperatively and no complications were seen. Steep Trendelenburg positioning during time-limited procedures appears to pose little or no risk from IOP increases in patients without pre-existing ocular disease.

  3. Prognostic Factors for Anastomotic Urinary Leakage Following Retropubic Radical Prostatectomy and Correlation With Voiding Outcomes

    Science.gov (United States)

    Cormio, Luigi; Di Fino, Giuseppe; Scavone, Carmen; Maroscia, Domenico; Mancini, Vito; Ruocco, Nicola; Bellanti, Francesco; Selvaggio, Oscar; Sanguedolce, Francesca; Lucarelli, Giuseppe; Carrieri, Giuseppe

    2016-01-01

    Abstract This study aimed to determine the occurrence and grade of cystographically detected urinary leakage (UL) in a contemporary series of open retropubic radical prostatectomy (RP), whether patients’ clinical variables predict occurrence of UL, and whether occurrence of UL correlates with patients’ voiding outcomes in terms of urinary continence and anastomotic stricture (AS). Enrolled patients underwent cystography 7 days after retropubic RP; in case of UL, the catheter was left in situ and cystography repeated at 7 days intervals until demonstrating absence of UL. Leakage was classified as grade I = extraperitoneal leak 6 cm, grade III = leak freely extending in the small pelvis. Voiding was evaluated at 3, 6, and 12 months after RP using the 24-hour pad test and uroflowmetry; in cases of maximum flow rate cystogram showed UL in 52.6% of patients (grade I in 48.1%, grade II in 21.5%, and grade III in 30.4% of the cases). Multivariate analysis demonstrated that patients with UL had significantly greater prostate volume (64.5 vs 34.8 cc, P < 0.001), loss of serum hemoglobin (4.77 vs 4.19 g/dL, P < 0.001), lower postoperative serum total proteins (4.85 vs 5.4 g/dL, P < 0.001), and higher rate of AS (20.6% vs. 2.8%, p < 0.001) than those without UL. Continence rate at 3, 6, and 12 months postoperatively was 34.2%, 76%, and 90%, respectively, in patients with UL compared with 77.5%, 80.3%, and 93% in patients without UL; such difference was statistically significant (P < 0.001) only at 3 months follow-up. ROC curve analysis showed that prostate volume and postoperative serum total proteins had the best AUC (0.821 and 0.822, respectively) and when combined, their positive and negative predictive values for UL were 90% and 93%, respectively. In conclusion, half of the patients undergoing open retropubic RP may present, 7 days postoperatively, some degree of cystographically detected UL; prostate volume, loss of serum hemoglobin, and

  4. Evaluating the oncologic outcomes in 152 patients undergoing extraperitoneal laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    LI Xun-gang; QU Fa-jun; WANG Jun-kai; CHEN Ming; CHEN Jie; CHEN Lu; WANG Kai; ZHANG Dong-xu; CUI Xin-gang; XU Dan-feng; HONG Yi; LI Yao; GAO Yi; LIU Yu-shan; YIN Lei

    2012-01-01

    Background Although many midterm oncologic data have been reported for extraperitoneal laparoscopic radical prostatectomy (ELRP) in westem countries,few oncologic data of the extraperitoneal procedure was published in China.The aim of the study was to evaluate the oncologic outcomes of patients treated with ELRP in China.Methods From January 2005 to March 2010,a total of 152 consecutive patients diagnosed with clinically localized prostate cancer were included in this study and treated with ELRP.The patients were staged according to the TNM (tumor,nodes,metastases) system.Median and mean postoperative follow-up were 28.1 months and 27.0 months,respectively.The patients were retrospectively analyzed for progression-free survival.Results One hundred and twelve cases (73.7%) were postoperatively diagnosed as pT2 in,and 40 cases (26.3%) as pT3.Positive lymph nodes were shown in 5 patients (3.3%).Gleason score was <7 in 49 men (32.2%),7 in 69 men (45.4%),and >7 in 34 men (22.4%).Positive surgical margins (PSM) were observed in 15 patients (9.9%),which included 32.0% of all pT3a cases and 46.7% of all pT3b cases,respectively.The overall prostate-specific antigen recurrence-free survival rate was 86% in all patients.The recurrence-free survival rates were 91.8% and 62.2% in pT2N0 patients and pT3N0 patients,respectively.Preoperative prostate-specific antigen,surgical margins,tumor stage,and lymph nodal status were identified as independent predictors of biochemical recurrence-free survival using multivariate Cox proportional hazard model.Conclusions ELRP is a precise,safe and effective procedure at this particular Chinese institution.The prognostic power of prostate-specific antigen relapse after ELRP is not identical to that described previously with transperitoneal or open retropubic approaches.

  5. High-Dose Adjuvant Radiotherapy After Radical Prostatectomy With or Without Androgen Deprivation Therapy

    Energy Technology Data Exchange (ETDEWEB)

    Ost, Piet, E-mail: piet.ost@ugent.be [Department of Radiotherapy, Ghent University Hospital (Belgium); Cozzarini, Cesare [Department of Radiotherapy, Hospital San Raffaele, Milan (Italy); De Meerleer, Gert [Department of Radiotherapy, Ghent University Hospital (Belgium); Fiorino, Claudio [Department of Radiotherapy, Hospital San Raffaele, Milan (Italy); De Potter, Bruno [Department of Radiotherapy, Ghent University Hospital (Belgium); Briganti, Alberto [Department of Urology, San Raffaele Hospital, Vita-Salute University, Milan (Italy); Nagler, Evi V.T. [Department of Nephrology, Ghent University Hospital (Belgium); Montorsi, Francesco [Department of Urology, San Raffaele Hospital, Vita-Salute University, Milan (Italy); Fonteyne, Valerie [Department of Radiotherapy, Ghent University Hospital (Belgium); Di Muzio, Nadia [Department of Radiotherapy, Hospital San Raffaele, Milan (Italy)

    2012-07-01

    Purpose: To retrospectively evaluate the outcome and toxicity in patients receiving high-dose (>69 Gy) adjuvant radiotherapy (HD-ART) and the impact of androgen deprivation therapy (ADT). Methods and Materials: Between 1999 and 2008, 225 node-negative patients were referred for HD-ART with or without ADT to two large academic institutions. Indications for HD-ART were extracapsular extension, seminal vesicle invasion (SVI), and/or positive surgical margins at radical prostatectomy (RP). A dose of at least 69.1 Gy was prescribed to the prostate bed and seminal vesicle bed. The ADT consisted of a luteinizing hormone-releasing hormone analog. The duration and indication of ADT was left at the discretion of the treating physician. The effect of HD-ART and ADT on biochemical (bRFS) and clinical (cRFS) relapse-free survival was examined through univariate and multivariate analysis, with correction for known patient- and treatment-related variables. Interaction terms were introduced to evaluate effect modification. Results: After a median follow-up time of 5 years, the 7-year bRFS and cRFS were 84% and 88%, respectively. On multivariate analysis, the addition of ADT was independently associated with an improved bRFS (hazard ratio [HR] 0.4, p = 0.02) and cRFS (HR 0.2, p = 0.008). Higher Gleason scores and SVI were associated with decreased bRFS and cRFS. A lymphadenectomy at the time of RP independently improved cRFS (HR 0.09, p = 0.009). The 7-year probability of late Grade 2-3 toxicity was 29% and 5% for genitourinary (GU) and gastrointestinal (GI) symptoms, respectively. The absolute incidence of Grade 3 toxicity was <1% and 10% for GI and GU symptoms, respectively. The study is limited by its retrospective design and the lack of a standardized use of ADT. Conclusions: This retrospective study shows significantly improved bRFS and cRFS rates with the addition of ADT to HD-ART, with low Grade 3 gastrointestinal toxicity and 10% Grade 3 genitourinary toxicity.

  6. Radical prostatectomy and positive surgical margins: tumor volume and Gleason score predicts cancer outcome

    Energy Technology Data Exchange (ETDEWEB)

    La Roca, Ricardo L.R. Felts de, E-mail: Ricardo@delarocaurologia.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil); Fonseca, Francisco Paula da, E-mail: fpf@uol.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Divisao de Urologia. Dept. de Cirurgia Pelvica; Cunha, Isabela Werneck da; Bezerra, Stephania Martins, E-mail: iwerneck@gmail.com, E-mail: stephaniab@gmail.com [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Patologia

    2013-07-01

    Introduction: positive surgical margins (PSMs) are common adverse factors to predict the outcome of a patient submitted to radical prostatectomy (PR). However, not all of these men will follow with biochemical (BCR) or clinical (CR) recurrence. Relationship between PSMs with these recurrent events has to be correlated with other clinicopathological findings in order to recognize more aggressive tumors in order to recommend complementary treatment to these selected patients. Materials and methods: we retrospectively reviewed the outcome of 228 patients submitted to open retropubic RP between March 1991 and June 2008, where 161 had and 67 did not have PSMs. Minimum follow-up time was considered 2 years after surgery. BCR was considered when PSA {>=} 0.2 ng/ml. CR was determined when clinical evidence of tumor appeared. Chi-square test was used to correlate clinical and pathologic variables with PSMs. The estimated 5-year risk of BCR and CR in presence of PSMs was determined using the Kaplan-Meier method and compared to log-rank tests. Results: from the total of 228 patients, 161 (71%) had PSMs, while 67 (29%) had negative surgical margins (NSMs). Prostatic circumferential margin was the most common (43.4%) site. Univariate analysis showed statistically significant (p < 0.001) associations between the presence of PSMs and BCR, but not with CR (p = 0.06). Among 161 patients with PSMs, 61 (37.8%) presented BCR, while 100 (62.8%) did not. Predicting progression-free survival for 5 years, BCR was correlated with pathological stage; Gleason score; pre-treatment PSA; tumor volume in specimen; capsular and perineural invasion; presence and number of PSMs. RC correlated only with angiolymphatic invasion and Gleason score. Considering univariate analyses the clinicopathological factors predicting BCR for 5 years, results statistically significant links with prostate weight; pre-treatment PSA; Gleason score; pathological stage; tumor volume; PSMs; capsular and perineural

  7. Prognostic significance of fibroblast growth factor receptor 4 polymorphisms on biochemical recurrence after radical prostatectomy in a Chinese population

    Science.gov (United States)

    Chen, Luyao; Lei, Zhengwei; Ma, Xin; Huang, Qingbo; Zhang, Xu; Zhang, Yong; Hao, Peng; Yang, Minggang; Zhao, Xuetao; Chen, Jun; Liu, Gongxue; Zheng, Tao

    2016-01-01

    Fibroblast growth factor receptor 4 (FGFR4) is a transmembrane receptor with ligand-induced tyrosine kinase activity and is involved in various biological and pathological processes. Several polymorphisms of FGFR4 are associated with the incidence and mortality of numerous cancers, including prostate cancer. In this study, we investigated whether the polymorphisms of FGFR4 influence the biochemical recurrence of prostate cancer in Chinese men after radical prostatectomy. Three common polymorphisms (rs1966265, rs2011077, and rs351855) of FGFR4 were genotyped from 346 patients with prostate cancer by using the Sequenom MassARRAY system. Kaplan–Meier curves and Cox proportional hazard models were used for survival analysis. Results showed biochemical recurrence (BCR) free survival was significantly affected by the genotypes of rs351855 but not influenced by rs1966265 and rs2011077. After adjusting for other variables in multivariable analysis, patients with rs351855 AA/AG genotypes showed significantly worse BCR-free survival than those with the GG genotype (HR = 1.873; 95% CI, 1.209–2.901; P = 0.005). Hence, FGFR4 rs351855 could be a novel independent prognostic factor of BCR after radical prostatectomy in the Chinese population. This functional polymorphism may also provide a basis for surveillance programs. Additional large-scale studies must be performed to validate the significance of this polymorphism in prostate cancer. PMID:27640814

  8. Effect of serum testosterone and percent tumor volume on extra-prostatic extension and biochemical recurrence after laparoscopic radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Eu Chang Hwang

    2016-01-01

    Full Text Available Several studies have revealed that the preoperative serum testosterone and percent tumor volume (PTV predict extra-prostatic extension (EPE and biochemical recurrence (BCR after radical prostatectomy. This study investigated the prognostic significance of serum testosterone and PTV in relation to EPE and BCR after laparoscopic radical prostatectomy (LRP. We reviewed 520 patients who underwent LRP between 2004 and 2012. PTV was determined as the sum of all visually estimated tumor foci in every section. BCR was defined as two consecutive increases in the postoperative prostate-specific antigen (PSA >0.2 ng ml−1 . The threshold for serum total testosterone was 3.0 ng ml−1 . Multivariate logistic regression was used to define the effect of variables on the risk of EPE and BCR. A low serum testosterone (<3.0 ng ml−1 was associated with a high serum PSA, Gleason score, positive core percentage of the prostate biopsy, PTV, and all pathological variables. On multivariate analysis, similar to previous studies, the serum PSA, biopsy positive core percentage, Gleason score, and pathological variables predicted EPE and BCR. In addition, low serum testosterone (<3.0 ng ml−1 , adjusted OR, 8.52; 95% CI, 5.04-14.4, P= 0.001 predicted EPE and PTV (adjusted OR, 1.02; 95% CI, 1.01-1.05, P= 0.046 predicted BCR. In addition to previous predictors of EPE and BCR, low serum testosterone and PTV are valuable predictors of EPE and BCR after LRP.

  9. Evaluation of pelvic floor muscle strength before and after robotic-assisted radical prostatectomy and early outcomes on urinary continence.

    Science.gov (United States)

    Manley, Lauren; Gibson, Luke; Papa, Nathan; Beharry, Bhawanie Koonj; Johnson, Liana; Lawrentschuk, Nathan; Bolton, Damien M

    2016-12-01

    The aim of the study was to evaluate the effect of pelvic floor muscle (PFM) assessment and training before and after robot-assisted laparoscopic radical prostatectomy (RARP) in improving PFM strength and urinary continence. We performed an analysis of a database of patients who underwent robot-assisted laparoscopic radical prostatectomy (RARP) performed by two urologists from 2011 to 2013. Pelvic floor muscle (PFM) activation and strength were graded by a trained pelvic floor physiotherapist. Patients were given an exercise program, grouped according to the strength of their pelvic floor as graded by assessment, to complete before and after surgery. PFM strength was recorded preoperatively, 4 days post-catheter removal and 4 weeks post-catheter removal. Continence was recorded at 4 weeks postop and was defined as the requirement of no continence aids. A total of 98 patients had RARP and a preoperative physiotherapy assessment plus postoperative appointments at around 1 and 4 weeks post-RARP. The majority of men improved their PFM strength regardless of preoperative strength with no significant predictors of postoperative strength found. Age was the only significant predictor of postoperative incontinence. In this pilot study, a majority of patients increased their pelvic floor strength with time. Pelvic floor physiotherapy is an important modifiable patient factor, which does have an impact in improving patients' urinary continence by strengthening the pelvic floor muscles. Patient age influences response to pelvic floor physiotherapy.

  10. The new era of minimally invasive interventions for prostate cancer: robot-assisted laparoscopic radical prostatectomy and focal therapy

    Directory of Open Access Journals (Sweden)

    Schatloff O

    2011-10-01

    Full Text Available Oscar Schatloff1, Alyssa S Louis2, Uri Lindner21Global Robotics Institute, Florida Hospital Celebration Health, Celebration, FL, USA; 2Division of Urology, Department of Surgical Oncology, University Health Network, Toronto, ON, CanadaAbstract: Prostate cancer remains a common but highly treatable disease. Innovations in prostate cancer treatment have allowed a transition toward minimally invasive approaches in an attempt to avoid treatment-related morbidities. In the middle of the treatment spectrum between radical open surgeries and active surveillance lies robot-assisted laparoscopic radical prostatectomy (RALP and focal therapy (FT. This review sets out the most current information on RALP and FT (including laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, and irreversible electroporation.Keywords: PCa, RALP, FT, laser ablation, cryotherapy, high-intensity focused ultrasound, photodynamic therapy, irreversible electroporation

  11. SURGICAL TREATMENT FOR VERY HIGH-RISK LOCALLY RECURRENT PROSTATE CANCER AFTER RADICAL RETROPUBIC PROSTATECTOMY: A CLINICAL CASE

    Directory of Open Access Journals (Sweden)

    E. I. Veliyev

    2014-01-01

    Full Text Available Locally recurrent prostate cancer (PC in the bladder neck can substantially worsen quality of life in patients and hinder further treatment when castration-resistant PC develops. The paper describes a clinical case of very high-risk PC in a 55-year-old patient in whom radical cystectomy (RCE with removal of metastases in the bladder neck and the Bricker ileal conduit were performed for a local recurrence after radical retropubic prostatectomy (RPE. It gives the data of preoperative examination, the technical features of the primary operation RPE, the data of postoperative observation, the technical aspects and outcomes of еру surgery for a local recurrence, as well as the results of a 1.5-year follow-up after RCE. 

  12. Localised adenocarcinoma of prostate: the role of pelvis radiotherapy following radical prostatectomy; Adenocarcinome prostatique localise: place de la radiotherapie pelvienne apres prostatectomie radicale

    Energy Technology Data Exchange (ETDEWEB)

    Mazeron, J.J. [Centre Hospitalier Universitaire Pitie-Salpetriere, 75 - Paris (France); Bolla, M. [Centre Hospitalier Universitaire, 38 - Grenoble (France)

    1997-12-31

    Radical prostatectomy after pelvic lymphadenectomy is an effective treatment or patients with T1-2 pN0 adenocarcinoma of the prostate. However, pathologic analysis of resected tissue reveals that in 20 to 40 % of clinical stage B lesions, the tumour has extended locally beyond the prostate. This infra-clinical disease may be the origin of local relapse. Radiation oncologists are often asked to deliver post-operative irradiation. There is sufficient evidence in the literature that postoperative radiation therapy can improve local control rate for patients with pT3 pN0 adenocarcinoma of the prostate; however, the effect of this radiotherapy on survival in this category of patients remains unclear. It is the reason why randomized clinical trials have been implemented for investigating the role of pelvic external irradiation with respect to the effects on local control, acute and late morbidity, overall survival and cancer-related survival, and for better defining the selective indications of radiotherapy, regarding pathological data. (author)

  13. The prognostic influence of neuroendocrine cells in prostate cancer: Results of a long-term follow-up study with patients treated by radical prostatectomy

    NARCIS (Netherlands)

    M.A. Noordzij (Marinus); Th.H. van der Kwast (Theo); G.J. van Steenbrugge (Gert Jan); W.C.J. Hop (Wim); F.H. Schröder (Fritz)

    1995-01-01

    textabstractThe distribution of immunohistochemically defined neuroen-docrine (NE) cells in benign, pre-cancerous and neoplastic prostatic tissues and the prognostic value of these cells in prostate cancer were studied in the radical prostatectomy specimens of 90 patients from whom complete long-ter

  14. Does the tertiary Gleason pattern influence the PSA progression-free interval after retropubic radical prostatectomy for organ-confined prostate cancer?

    NARCIS (Netherlands)

    Oort, I.M. van; Schout, B.M.; Kiemeney, L.A.L.M.; Hulsbergen- van de Kaa, C.A.; Witjes, J.A.

    2005-01-01

    INTRODUCTION: The Gleason sum is an important prognostic parameter for patients treated with radical prostatectomy for localized prostate cancer. However, frequently more than two predominant Gleason patterns are present in one specimen. In this study we investigated the prognostic significance of t

  15. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume.

    NARCIS (Netherlands)

    Kwast, T.H. van der; Amin, M.B.; Billis, A.; Epstein, J.I.; Griffiths, D.; Humphrey, P.A.; Montironi, R.; Wheeler, T.M.; Srigley, J.R.; Egevad, L.; Delahunt, B.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology consensus conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the substaging of pT2 prostate cancers according to the TNM 2002/2010 system, reporti

  16. Inguinal hernia in stage M0 prostate cancer: a comparison of incidence in men treated with and without radical retropubic prostatectomy--an analysis of 1105 patients

    DEFF Research Database (Denmark)

    Stranne, Johan; Hugosson, Jonas; Iversen, Peter;

    2005-01-01

    To analyze the incidence of inguinal hernia (IH) in a large group of patients with nonmetastatic prostate cancer who were treated nonoperatively, and to compare it with the incidence in a subset of patients who had undergone radical retropubic prostatectomy (RRP). IH has been reported in 12% to 21...

  17. Inguinal hernia in stage M0 prostate cancer: a comparison of incidence in men treated with and without radical retropubic prostatectomy--an analysis of 1105 patients

    DEFF Research Database (Denmark)

    Stranne, Johan; Hugosson, Jonas; Iversen, Peter;

    2005-01-01

    To analyze the incidence of inguinal hernia (IH) in a large group of patients with nonmetastatic prostate cancer who were treated nonoperatively, and to compare it with the incidence in a subset of patients who had undergone radical retropubic prostatectomy (RRP). IH has been reported in 12% to 2...

  18. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume.

    NARCIS (Netherlands)

    Kwast, T.H. van der; Amin, M.B.; Billis, A.; Epstein, J.I.; Griffiths, D.; Humphrey, P.A.; Montironi, R.; Wheeler, T.M.; Srigley, J.R.; Egevad, L.; Delahunt, B.; Hulsbergen- van de Kaa, C.A.

    2011-01-01

    The 2009 International Society of Urological Pathology consensus conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the substaging of pT2 prostate cancers according to the TNM 2002/2010 system, reporti

  19. A prospective evaluation of conventional cystography for detection of urine leakage at the vesicourethral anastomosis site after radical prostatectomy based on computed tomography

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    Han, K.S. [Urologic Oncology Clinic, Center for Prostate Cancer, National Cancer Center, 809 Madu-dong, Ilsan-dong-gu, Goyang-si, Gyeonggi-do 411-769, Goyang (Korea, Republic of); Choi, H.J. [Department of Radiology, Asan Medical Center, University of Ulsan, Seoul (Korea, Republic of); Jung, D.C. [Department of Radiology, Center for Specific Organs Cancer, National Cancer Center, Goyang (Korea, Republic of); Park, S. [Cancer Registration and Biostatistics Branch, National Cancer Center, Goyang (Korea, Republic of); Cho, K.S.; Joung, J.Y.; Seo, H.K.; Chung, J. [Urologic Oncology Clinic, Center for Prostate Cancer, National Cancer Center, 809 Madu-dong, Ilsan-dong-gu, Goyang-si, Gyeonggi-do 411-769, Goyang (Korea, Republic of); Lee, K.H., E-mail: uroonco@ncc.re.k [Urologic Oncology Clinic, Center for Prostate Cancer, National Cancer Center, 809 Madu-dong, Ilsan-dong-gu, Goyang-si, Gyeonggi-do 411-769, Goyang (Korea, Republic of)

    2011-03-15

    Aim: To evaluate the diagnostic accuracy of conventional cystography for the detection of urine leakage at the vesicourethral anastomosis (VUA) site after radical prostatectomy based on computed tomography (CT) cystography. Materials and methods: Patients who underwent radical prostatectomies at a single tertiary cancer centre were prospectively enrolled. Conventional cystography was routinely performed on postoperative day 7. Non-enhanced pelvic CT images were obtained after retrograde instillation of the same contrast material for a reference standard of urine leakage at the VUA site. Urine leakage was classified as follows: none; a plication abnormality; mild; moderate; and excessive. Results: One hundred and twenty consecutive patients were enrolled. Conventional cystography detected 14 urine leakages, but CT cystography detected 40 urine leakages, which consisted of 28 mild and 12 moderate urine leakages. When using CT cystography as the standard measurement, conventional cystography showed a diagnostic accuracy of 17.8% (5/28) for mild urine leakage and 75% (9/12) for moderate leakage. Of nine patients diagnosed with mild leakage on conventional cystography, four (44.4%) had complicated moderate urine leakages based on CT cystography, requiring prolonged catheterization. The sensitivity, specificity, positive and negative predictive values, and accuracy of conventional cystography were 35, 100, 100, 75.4, and 78.3%, respectively. Conclusions: Conventional cystography is less accurate than CT cystography for diagnosing urine leakage at the VUA site after a radical prostatectomy. The present results suggest that CT cystography is a good choice for diagnostic imaging of urine leakage after radical prostatectomy.

  20. [First 24 Japanese cases of robotic-assisted laparoscopic radical prostatectomy using the daVinci Surgical System].

    Science.gov (United States)

    Yoshioka, Kunihiko; Hatano, Tadashi; Nakagami, Yoshihiro; Ozu, Choichiro; Horiguchi, Yutaka; Sakamoto, Noboru; Yonov, Hiroyuki; Ohno, Yoshio; Ohori, Makoto; Tachibana, Masaaki; Patel, Vipul R

    2008-05-01

    In Japan, as of September 2007, prostatectomy is conducted with open surgical procedures in more than 90% of the cases. Following the first reported robotic prostatectomy by Binder, et al. in 2000, a robotic-assisted laparoscopic radical prostatectomy (RALP) using the daVinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, California, USA) has been extensively used as a standard procedure with gratifying results in the United States. In the Asian region, in contrast, RALP is still in an introductory phase. Recently, we introduced RALP in Japan. A total of 24 patients received robotic surgery within a year since August 2006. RALP was completed in all patients without conversion to open surgery, except for the first patient in whom a restriction to a 2-hour operation had been imposed by the Ethical Committee. The mean operative time using the daVinci device and the mean estimated blood loss were 232.0 (range; 136-405) minutes and 313.0 (range; 10-1,000) ml, respectively. The training program we recently developed proved remarkably effective in reducing the learning curve of robotic surgery in Japan, where there is no person with expertise in this operating procedure. In particular, the intraoperative guidance given by the expert was useful after relevant problematic points were delineated by operators who received comprehensive video-based image training and actually performed robot surgery in several cases. With direct intraoperative guidance by the mentor during cases 13 and 14, both the operation time and estimated blood loss was markedly reduced.

  1. Influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression following radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Athanase Billis

    2012-04-01

    Full Text Available PURPOSE: The amount of extraprostatic extension and positive surgical margin correlates in most studies with biochemical recurrence following radical prostatectomy. We studied the influence of focal and diffuse extraprostatic extension and positive surgical margins on biochemical progression using a simple method for quantification. MATERIALS AND METHODS: A total of 360 prostates were step-sectioned and totally processed from 175 patients with stage T1c and 185 patients with clinical stage T2 submitted to radical retropubic prostatectomy. Extraprostatic extension was stratified into 2 groups: present up to 1 quadrant and/or section from the bladder neck or apex (Group 1, focal and in more than 1 quadrant or section (Group 2, diffuse; and, positive surgical margin present up to 2 quadrants and/or sections (Group 1, focal and in more than 2 quadrants or sections (Group 2, diffuse. The Kaplan-Meier product-limit analysis was used for the time to biochemical recurrence, and an univariate and multivariate Cox stepwise logistic regression model to identify significant predictors. RESULTS: Extraprostatic extension was found in 129/360 (35.8% patients, 39/129 (30.2% in Group 1 and 90/129 (69.8% in Group 2. In univariate analysis but not in multivariate analysis, patients showing diffuse extraprostatic extension (Group 2 had a significant higher risk to develop biochemical recurrence in a shorter time. Positive surgical margin was present in 160/360 (44.4% patients, 81/160 (50.6% patients in Group 1 and 79/160 (49.4% patients in Group 2. Patients with diffuse positive surgical margins (Group 2 had a significant higher risk in both univariate and multivariate analyses. Diffuse positive surgical margin was the strongest predictor on both analyses and an independent predictor on multivariate analysis. CONCLUSION: Diffuse extraprostatic extension in univariate analysis and positive surgical margins on both univariate and multivariate analyses are significant

  2. Neoadjuvant hormone therapy following treatment with robotic-assisted radical prostatectomy achieved favorable in high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Hou CP

    2014-12-01

    Full Text Available Cheng-Pang Hou,1,2,* Wei-Chang Lee,1,2,* Yu-Hsiang Lin,1,2 Shao-Ming Chen,3 Chien-Lun Chen,1,2 Phei-Lang Chang,1,2,4 Horng-Heng Juang,4,5 Ke-Hung Tsui1,2,4 1Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China; 2School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China; 3Hou-Pin Taipei Hospital, 4Bioinformation Center, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China; 5Department of Anatomy, School of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, Republic of China *These authors contributed equally to this work Purpose: Patients with a high risk of prostate carcinoma typically have higher rates of positive surgical margins and biochemical failure following radical prostatectomy and adjuvant hormone therapy. In this study, we assessed the effects of neoadjuvant hormone therapy (NHT on prostate carcinoma in high-risk patients following robotic-assisted radical prostatectomy (RARP. Methods: This retrospective study investigated the medical records of 28 patients who underwent RARP between January 2009 and October 2013. Twenty-two patients underwent NHT prior to RARP. Furthermore, six patients did not undergo NHT prior to RARP. Parameters including age, operating time, blood loss, blood transfusion status, and cancer stage were checked against anatomical correlations. Potential predictors of prolonged operating time and prolonged surgical procedures were assessed using multiple logistic regressions. Results: NHT was shown to be an independent predictor of prolonged total operating time. Tumor stage alterations did not appear to be associated with NHT followed by RARP. The patients who underwent NHT were not more likely to have positive surgical margins, and an increase in patients requiring blood transfusion was not seen. Conclusion: NHT appears to increase

  3. Perioperative and continence outcomes of robotic radical prostatectomy in elderly Indian men (≥70 years: A sub-group analysis

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    Rajiv Yadav

    2015-01-01

    Full Text Available Introduction: Many healthy elderly Indian men seek surgical treatment for localized prostate cancer. Quite often, radical surgery is not offered to the patients over 70 years of age due to the perception of increased side-effects and complications. We have previously reported our results of robotic radical prostatectomy in a study comprising 150 Indian patients, where almost a quarter of patients were elderly. This subgroup analysis was therefore focused on evaluating perioperative and continence outcomes in elderly men (≥70 years with localized prostate cancer. Materials and Methods: Between April 2010 and August 2013, 153 men had robot-assisted radical prostatectomy performed by two surgeons. Of the 150 men analyzed, 39 (26% were aged ≥70 years. All patients underwent robotic prostatectomy using a 4 arm da Vinci surgical system. Pre-operative, intraoperative and post-operative parameters were studied. Check cystogram was performed in all patients prior to catheter removal. Complications were categorized using the Clavien-Dindo classification system. Continence was defined as use of "no pad" or security liner only. All data were recorded prospectively and analyzed using SPSS version 20. Results: There were no significant intraoperative or perioperative complications in this group. Median blood loss during surgery was 150 mL. None of the patient required blood transfusion. There were two minor complications (5.1% within the first 30 days of surgery: Minimal anastomotic site leak (one patient requiring replacement and prolongation of Foley′s drainage by 1 week and ileus (one patient. No patient had any cardiopulmonary or vascular complications in the post-operative period. The median duration of hospital stay was 3 days. The median duration of catheterization was 7 days. No patient had problem of bladder neck stenosis in the follow-up period. At 1 month, 3 months, 6 months and 1 year of follow-up, 66.7% (n = 26, 74.3% (n = 29, 87.9% (n = 34

  4. Incidence of Second Malignancies in Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy and Radical Prostatectomy

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    Hamilton, Sarah Nicole; Tyldesley, Scott [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Hamm, Jeremy [Department of Population Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Jiang, Wei Ning [Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Keyes, Mira; Pickles, Tom [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Lapointe, Vince [Department of Medical Physics, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Kahnamelli, Adam [Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); McKenzie, Michael [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Miller, Stacy [Department of Radiation Oncology, British Columbia Cancer Agency–Centre for the North, Prince George, British Columbia (Canada); Morris, W. James, E-mail: jmorris@bccancer.bc.ca [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada)

    2014-11-15

    Purpose: To compare the second malignancy incidence in prostate cancer patients treated with brachytherapy (BT) relative to radical prostatectomy (RP) and to compare both groups with the cancer incidence in the general population. Methods and Materials: From 1998 to 2010, 2418 patients were treated with Iodine 125 prostate BT monotherapy at the British Columbia Cancer Agency, and 4015 referred patients were treated with RP. Cancer incidence was compared with the age-matched general population using standardized incidence ratios (SIRs). Pelvic malignancies included invasive and noninvasive bladder cancer and rectal cancer. Cox multivariable analysis was performed with adjustment for covariates to determine whether treatment (RP vs BT) was associated with second malignancy risk. Results: The median age at BT was 66 years and at RP 62 years. The SIR comparing BT patients with the general population was 1.06 (95% confidence interval [CI] 0.91-1.22) for second malignancy and was 1.53 (95% CI 1.12-2.04) for pelvic malignancy. The SIR comparing RP patients with the general population was 1.11 (95% CI 0.98-1.25) for second malignancy and was 1.11 (95% CI 0.82-1.48) for pelvic malignancy. On multivariable analysis, older age (hazard ratio [HR] 1.05) and smoking (HR 1.65) were associated with increased second malignancy risk (P<.0001). Radical prostatectomy was not associated with a decreased second malignancy risk relative to BT (HR 0.90, P=.43), even when excluding patients who received postprostatectomy external beam radiation therapy (HR 1.13, P=.25). Older age (HR 1.09, P<.0001) and smoking (HR 2.17, P=.0009) were associated with increased pelvic malignancy risk. Radical prostatectomy was not associated with a decreased pelvic malignancy risk compared with BT (HR 0.57, P=.082), even when excluding postprostatectomy external beam radiation therapy patients (HR 0.87, P=.56). Conclusions: After adjustment for covariates, BT patients did not have an increased second

  5. Radical prostatectomy versus external beam radiotherapy for localized prostate cancer. Comparison of treatment outcomes

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    Kim, Yeon-Joo; Cho, Kwan Ho; Lee, Kang Hyun; Moon, Sung Ho; Kim, Tae Hyun; Shin, Kyung Hwan; Kim, Joo-Young; Kim, Young-kyung; Lee, Se Byeong [National Cancer Center, Research Institute and Hospital, Goyang (Korea, Republic of); Pyo, Hong Ryull [Sungkyunkwan University, Department of Radiation Oncology, Samsung Medical Center, School of Medicine, Seoul (Korea, Republic of)

    2015-04-01

    We retrospectively compared the treatment outcomes of localized prostate cancer between radical prostatectomy (RP) and external beam radiotherapy (EBRT). We retrospectively analyzed 738 patients with localized prostate cancer who underwent either RP (n = 549) or EBRT (n = 189) with curative intent at our institution between March 2001 and December 2011. Biochemical failure was defined as a prostate-specific antigen (PSA) level of ≥ 0.2 ng/ml in the RP group and the nadir of + ≥ 2 ng/ml in the EBRT group. The median (range) follow-up duration was 48.8 months (0.7-133.2 months) and 48.7 months (1.0-134.8 months) and the median age was 66 years (45-89 years) and 71 years (51-84 years; p < 0.001) in the RP and EBRT groups, respectively. Overall, 21, 42, and 36 % of patients in the RP group, and 15, 27, and 58 % of patients in the EBRT group were classified as low, intermediate, and high risk, respectively (p < 0.001). Androgen-deprivation therapy was more common in the EBRT group (59 vs. 27 %, respectively; p < 0.001). The 8-year biochemical failure-free survival rates were 44 and 72 % (p < 0.001) and the disease-specific survival rates were 98 % and 97 % (p = 0.543) in the RP and EBRT groups, respectively. Although the EBRT group included more high-risk patients than did the RP group, the outcomes of EBRT were not inferior to those of RP. Our data suggest that EBRT is a viable alternative to RP for treating localized prostate cancer. (orig.) [German] Wir vergleichen retrospektiv die Verfahrensergebnisse des lokal begrenzten Prostatakarzinoms zwischen radikaler Prostatektomie (RP) und externer Strahlentherapie (EBRT). Wir analysieren zurueckblickend 738 Patienten mit lokal begrenztem Prostatakarzinom, die zwischen Maerz 2001 und Dezember 2011 in unserem Institut entweder eine RP (n = 549) oder eine EBRT (n = 189) mit kurativer Intention durchliefen. Biochemischer Fehler wurde als prostataspezifisches Antigen (PSA) ≥ 0,2 ng/ml in der RP-Gruppe und ein Nadir +

  6. Erectile function following brachytherapy, external beam radiotherapy, or radical prostatectomy in prostate cancer patients

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    Putora, P.M.; Buchauer, K.; Plasswilm, L. [Kantonsspital St. Gallen, Department of Radiation Oncology, St. Gallen (Switzerland); Engeler, D.; Schmid, H.P. [Kantonsspital St. Gallen, Department of Urology, St. Gallen (Switzerland); Haile, S.R.; Graf, N. [Kantonsspital St. Gallen, Clinical Trials Unit, St. Gallen (Switzerland)

    2016-03-15

    For localized prostate cancer, treatment options include external beam radiotherapy (EBRT), radical prostatectomy (RP), and brachytherapy (BT). Erectile dysfunction (ED) is a common side-effect. Our aim was to evaluate penile erectile function (EF) before and after BT, EBRT, or RP using a validated self-administered quality-of-life survey from a prospective registry. Analysis included 478 patients undergoing RP (n = 252), EBRT (n = 91), and BT (n = 135) with at least 1 year of follow-up and EF documented using IIEF-5 scores at baseline, 6 weeks, 6 months, 1 year, and annually thereafter. Differences among treatments were most pronounced among patients with no or mild initial ED (IIEF-5 ≥ 17). Overall, corrected for baseline EF and age, BT was associated with higher IIEF-5 scores than RP (+ 7.8 IIEF-5 score) or EBRT (+ 3.1 IIEF-5 score). EBRT was associated with better IIEF-5 scores than RP (+ 4.7 IIEF-5 score). In patients undergoing EBRT or RP with bilateral nerve sparing (NS), recovery of EF was observed and during follow-up, the differences to BT were not statistically significant. Overall age had a negative impact on EF preservation (corrected for baseline IIEF). In our series, EF was adversely affected by each treatment modality. Considered overall, BT provided the best EF preservation in comparison to EBRT or RP. (orig.) [German] Die externe Radiotherapie (EBRT), die radikale Prostatektomie (RP) sowie die Brachytherapie (BT) stellen Behandlungsoptionen fuer das lokalisierte Prostatakarzinom dar. Die erektile Dysfunktion (ED) ist eine haeufige Nebenwirkung dieser Therapien. Unser Ziel war es, die penile erektile Funktion (EF) vor und nach BT, EBRT und RP mit Hilfe eines validierten, vom Patienten ausgefuellten Lebensqualitaetsfragebogens aus einer prospektiven Datenbank zu beurteilen. Mit einer minimalen Nachbeobachtungszeit von einem Jahr wurden 478 Patienten analysiert, die eine RP (n = 252), EBRT (n = 91) oder BT (n = 135) erhalten hatten und deren EF mit

  7. Regaining Candidacy for Heart Transplantation after Robotic Assisted Laparoscopic Radical Prostatectomy in Left Ventricular Assist Device Patient

    Directory of Open Access Journals (Sweden)

    Tariq A. Khemees

    2012-01-01

    Full Text Available Several factors may highlight the relevance of prostate cancer to the pre-heart-transplant population. First, the expansion in candidate selection criteria led to increased number of men over the age of fifty to be considered for heart transplantation. With the introduction of left ventricular assist device (LVAD therapy, waiting-list mortality has dramatically declined over the past decade. Additionally, transplant candidates are diligently screened for preexisting neoplasm while on the waiting list. Taken together, screening-detected prostate cancer may increasingly be diagnosed in patients on the waiting list. If discovered, it will pose unique challenge to clinicians as to date there has been no universally accepted management guideline. We report a case of LVAD-treated heart transplant candidate diagnosed with prostate cancer while on the waiting list. Patient screening demonstrated PSA elevation which prompted prostate biopsy. Low-risk clinically localized prostate cancer was confirmed and led to removal of patient from transplant list. When counseled regarding management of his cancer, the patient elected to undergo radical prostatectomy in a hope to regain candidacy for heart transplantation. Despite being of high surgical risk, multidisciplinary team approach led to successful management of prostate cancer and the patient eventually received heart transplant one year following prostatectomy.

  8. Changes in reciprocal support provision and need-based support from partners of patients undergoing radical prostatectomy.

    Science.gov (United States)

    Knoll, Nina; Burkert, Silke; Roigas, Jan; Gralla, Oliver

    2011-07-01

    We examined need-related and reciprocal provision of support in couples facing radical prostatectomy and its sequelae, including patients' urinary incontinence. Partners' reciprocal support provision to patients was assumed to drop from prior to until after patients' surgeries and increase again in the following months, while need-related indicators were assumed to remain unique correlates throughout. In this study of German prostatectomy patients and their partners, N = 141 couples provided data on 4 measurement occasions from presurgery to 1-year postsurgery. Need-based predictors of partners' support provision were patients' mobilized support, such as efforts to obtain advice or comfort, and degree of postsurgery incontinence. Strength of association between partner-received and provided supports served as an indicator of reciprocal support provision. Data suggested that partners' reciprocal support provision dropped significantly postsurgery and then increased again in the following months. This was true for emotional as well as instrumental reciprocal support provision. Findings also indicated that one need-based predictor of partners' support provision, patients' mobilization of support from their partners, remained a unique correlate of partners' support provision to patients. Reciprocal support provision in couples may vary during the adaptation to illness-related functional impairment and coexist with need-oriented support provision.

  9. Unidirectional barbed suture versus standard monofilament for urethrovesical anastomosis during robotic assisted laparoscopic radical prostatectomy

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    Marc Manganiello

    2012-02-01

    Full Text Available PURPOSE: V-LocTM180 (Covidien Healthcare, Mansfield, MA is a new unidirectional barbed suture that may reduce loss of tension during a running closure. We evaluated the use of the barbed suture for urethrovesical anastomosis (UVA during robotic assisted laparoscopic prostatectomy (RALP. Time to completion of UVA, post-operative anastomotic leak rate, and urinary incontinence were compared in patients undergoing UVA with 3-0 unidirectional-barbed suture vs. 3-0 MonocrylTM (Ethicon, Somerville, NJ. MATERIALS AND METHODS: Data were prospectively collected for 70 consecutive patients undergoing RALP for prostate cancer between November 2009 and October 2010. In the first 35 patients, the UVA was performed using a modified running van Velthoven anastomosis technique using two separate 3-0 monofilament sutures. In the subsequent 35 patients, the UVA was performed using two running novel unidirectional barbed sutures. At 7-12 days postoperatively, all patients were evaluated with a cystogram to determine anastomotic integrity. Urinary incontinence was assessed at two months and five months by total daily pad usage. Clinical symptoms suggestive of bladder neck contracture were elicited. RESULTS: Age, PSA, Gleason score, prostate size, estimated blood loss, body mass index, and clinical and pathologic stage between the 2 groups were similar. Comparing the monofilament group and V-LocTM180 cohorts, average time to complete the anastomosis was similar (27.4 vs. 26.4 minutes, p = 0.73 as was the rate of urinary extravasation on cystogram (5.7 % vs. 8.6%, p = 0.65. There were no symptomatic bladder neck contractures noted at 5 months of follow-up. At 2 months, the percentage of patients using 2 or more pads per day was lower in the V-LocTM180 cohort (24% vs. 44%, p < 0.02. At 5 months, this difference was no longer evident. CONCLUSIONS: Time to complete the UVA was similar in the intervention and control groups. Rates of urine leak were also comparable

  10. Perforación duodenal espontánea en paciente intervenido de prostatectomía radical Spontaneous duodenal perforation in a radical prostatectomy patient

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    A. Tienza

    2012-12-01

    Full Text Available La prostatectomía radical es una cirugía para el cáncer localizado de próstata, muy conocida y con escaso número de complicaciones precoces postoperatorias. Presentamos el caso de un paciente de 54 años con PSA de 8 ng/ml y biopsia informada como adenocarcinoma de próstata Gleason 3+3=6 intervenido quirúrgicamente mediante prostatectomía radical retropúbica, que presentó una perforación espontánea de duodeno. Se manejó de forma conservadora ante el buen estado del paciente, resolviéndose a los 30 días. Ante un paciente intervenido es importante pensar en todas posibles complicaciones realizando las mínimas pruebas necesarias que permitan un diagnostico certero. El tratamiento habitualmente es quirúrgico, pudiéndose optar por el conservador en casos concretos.Radical prostatectomy is a well known treatment for prostate cancer, with a low incidence of early postoperative complications. Our case is a 54 year old patient diagnosed with prostate adenocarcinoma, Gleason score 3+3=6 with 8 ng/ml of PSA, treated by retropubic prostatectomy, who suffered spontaneous perforation of the duodenum. We chose a conservative management, resolved in 30 days. When dealing with a surgical patient all kinds of complications must be taken into account by performing the minimum tests that will enable a sure diagnosis to be achieved. The usual treatment is surgery or conservative management, depending on the case and the patient.

  11. Bilateral nerve sparing robotic-assisted radical prostatectomy is associated with faster continence recovery but not with erectile function recovery compared with retropubic open prostatectomy: the need for accurate selection of patients.

    Science.gov (United States)

    Ludovico, Giuseppe Mario; Dachille, Giuseppe; Pagliarulo, Giovanni; D'Elia, Carolina; Mondaini, Nicola; Gacci, Mauro; Detti, Beatrice; Malossini, Gianni; Bartoletti, Riccardo; Cai, Tommaso

    2013-06-01

    Robotic-assisted radical prostatectomy (RARP) shows measurable advantages, compared to conventional open surgery, even if some aspects are, still, under debate. The aim of this study was to compare the potency recovery rate of patients with clinically localised prostate cancer treated by bilateral nerve-sparing (BNS) RARP or retropubic radical prostatectomy (RRP), and secondarily, the urinary continence recovery evaluation and the oncological efficacy. All patients treated with BNS-RARP or BNS-RRP for clinically localised prostate cancer, performed by a single dedicated surgeon, between January 2004 and December 2008, were enrolled in this non-randomised prospective comparative study. The International Index of Erectile Function (IIEF) and erection hardness score (EHS), in the form of a questionnaire, were self-administered to each patient pre-operatively and after 12 months. The presence of surgical margins was considered as oncological outcome measure. Eighty-two patients underwent BNS-RARP while 48 underwent BNS-RRP. For BNS-RARP and BNS-RRP the median operative time was 221 and 103 min, respectively (Pfunction recovery compared to open radical prostatectomy; however, it significantly improves urinary continence and decreases the presence of positive surgical margins.

  12. Primary Gleason pattern in biopsy Gleason score 7 is predictive of adverse histopathological features and biochemical failure following radical prostatectomy

    DEFF Research Database (Denmark)

    Berg, Kasper Drimer; Røder, Martin Andreas; Brasso, Klaus;

    2014-01-01

    OBJECTIVE: The aim of this study was to analyse whether primary Gleason pattern in biopsy Gleason score (GS) 7 predicted adverse histopathological features and had an impact on the risk of biochemical failure in a consecutive series of patients undergoing radical prostatectomy (RP). MATERIAL...... (p Gleason score 3+4 had a significantly lower biochemical failure rate compared with Gleason score 4+3 (p = 0.0035). PSA (p Gleason pattern 4 (p = 0.001) and percentage of biopsies......+3. No difference in age, PSA, percentage of biopsies with cancer, clinical tumour stage or volume on transrectal ultrasonography was found. Primary Gleason pattern 4 was associated with worse pathological stage (p = 0.049). On multivariate analysis, primary Gleason pattern 4 (p

  13. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results.

    Science.gov (United States)

    Chopra, Sameer; Satkunasivam, Raj; Aron, Monish

    2016-01-01

    Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), met criteria for National Institute of Health (NIH) Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP). Median operative time (range): 157 (127-259) min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI) score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range) were: International Prostate Symptom Score - 14 (1-19); Sexual Health Inventory for Men - 6 (-14-22); and NIH-CPSI total - 23.5 (13-33). Median length of follow-up (range) was 34 (24-43) months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.

  14. Feasibility of robotic radical prostatectomy for medication refractory chronic prostatitis/chronic pelvic pain syndrome: Initial results

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    Sameer Chopra

    2016-01-01

    Full Text Available Four patients diagnosed with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS, met criteria for National Institute of Health (NIH Category III prostatitis, failed multiple medicinal treatments and underwent robotic radical prostatectomy (RRP. Median operative time (range: 157 (127–259 min. Validated functional questionnaires responses and NIH CP symptom index (NIH-CPSI score were collected for each patient's status at different time points pre- and post-operatively. Median decreases (range were: International Prostate Symptom Score - 14 (1–19; Sexual Health Inventory for Men - 6 (−14–22; and NIH-CPSI total - 23.5 (13–33. Median length of follow-up (range was 34 (24–43 months. RRP appears to be an option for carefully selected patients with medication-refractory CP/CPPS who understand that baseline sexual function may not be restored postoperatively.

  15. FORMATION OF VESICOURETHRAL ANASTOMOSIS DURING ENDOVIDEOSURGICAL EXTRAPERITONEAL RADICAL PROSTATECTOMY: СOMPARATIVE STUDY OF THREE DIFFERENT PROCEDURES

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    S. V. Popov

    2014-01-01

    Full Text Available Extraperitoneoscopic (endovideosurgical extraperitoneal radical prostatectomy (ERPE is one of the current surgical treatment procedures in patients with localized prostate cancer. Failure of vesicourethral anastomosis (VUA and the development of its stricture are common surgi-cal complications. This investigation compares the efficiency and safety of different procedures to form VUA during ERPE: an interrupted suture (n = 24, a MVAC suture (n = 23, and a MVAC suture using self-locking suture material (n = 24. The performed comparative analysis of different procedures for forming VUA during ERPE may conclude that there are a number of advantages of the MVAC suture ap-plying the self-locking suture material. These advantages include less time taken to form VUA with the low frequency of complications, such as leakages occurring during control cystography or the development of delayed VUA strictures. 

  16. High serum folate is associated with reduced biochemical recurrence after radical prostatectomy: Results from the SEARCH Database

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    Daniel M. Moreira

    2013-06-01

    Full Text Available Introduction To analyze the association between serum levels of folate and risk of biochemical recurrence after radical prostatectomy among men from the Shared Equal Access Regional Cancer Hospital (SEARCH database. Materials and Methods Retrospective analysis of 135 subjects from the SEARCH database treated between 1991-2009 with available preoperative serum folate levels. Patients' characteristics at the time of the surgery were analyzed with ranksum and linear regression. Uni- and multivariable analyses of folate levels (log-transformed and time to biochemical recurrence were performed with Cox proportional hazards. Results The median preoperative folate level was 11.6ng/mL (reference = 1.5-20.0ng/mL. Folate levels were significantly lower among African-American men than Caucasians (P = 0.003. In univariable analysis, higher folate levels were associated with more recent year of surgery (P < 0.001 and lower preoperative PSA (P = 0.003. In univariable analysis, there was a trend towards lower risk of biochemical recurrence among men with high folate levels (HR = 0.61, 95%CI = 0.37-1.03, P = 0.064. After adjustments for patients characteristics' and pre- and post-operative clinical and pathological findings, higher serum levels of folate were independently associated with lower risk for biochemical recurrence (HR = 0.42, 95%CI = 0.20-0.89, P = 0.023. Conclusion In a cohort of men undergoing radical prostatectomy at several VAs across the country, higher serum folate levels were associated with lower PSA and lower risk for biochemical failure. While the source of the folate in the serum in this study is unknown (i.e. diet vs. supplement, these findings, if confirmed, suggest a potential role of folic acid supplementation or increased consumption of folate rich foods to reduce the risk of recurrence.

  17. Predictive factors for lymph node positivity in patients undergoing extended pelvic lymphadenectomy during robot assisted radical prostatectomy

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    Vikram Batra

    2015-01-01

    Full Text Available Introduction: Pelvic lymphadenectomy during radical prostatectomy (RP improves staging and may provide a therapeutic benefit. However, there is no clear consensus on the selection criteria for subjecting patients to this additional procedure. With a growing adoption of robot assisted radical prostatectomy (RARP in India, it has become imperative to study the incidence and predictive factors for lymph node involvement in our patients. Materials and Methods: From February 2010 to February 2014, 452 RARP procedures were performed at our institution. A total of 100 consecutive patients from July 2011 to August 2012 were additionally subjected to a robotic extended pelvic lymphadenectomy (EPLND. Lymph node positivity rates and lymph node density were analyzed on the basis of preoperative prostate specific antigen (PSA, Gleason score, clinical stage, D′Amico risk category and magnetic resonance imaging (MRI findings. Multivariate analysis was performed to ascertain factors associated with lymph node positivity in our cohort. Results: The mean age of the patients was 65.5 (47-77 years and the body mass index was 26.3 (16.3-38.7 kg/m 2 . The mean console time for EPLND was 45 (32-68 min. A median of 17 (two to 40 lymph nodes were retrieved. Seventeen patients (17% had positive lymph nodes (median of 1, range 1-6. Median lymph node density in these patients was 10%. When stratified by PSA, Gleason score, clinical stage, D′Amico risk category and features of locally advanced disease on MRI, a trend towards increasing incidence of lymph node positivity was observed, with an increase in adverse factors. However, on multivariate analysis, clinical stage > T2a was the only significant factor impacting lymph node positivity in our cohort. Conclusions: A significant proportion of men undergoing RARP in India have positive lymph nodes on EPLND. While other variables may also have a potential impact, a higher clinical stage predisposes to an increased

  18. Secondary Circulating Prostate Cells Predict Biochemical Failure in Prostate Cancer Patients after Radical Prostatectomy and without Evidence of Disease

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    Nigel P. Murray

    2013-01-01

    Full Text Available Introduction. Although 90% of prostate cancer is considered to be localized, 20%–30% of patients will experience biochemical failure (BF, defined as serum PSA >0.2 ng/mL, after radical prostatectomy (RP. The presence of circulating prostate cells (CPCs in men without evidence of BF may be useful to predict patients at risk for BF. We describe the frequency of CPCs detected after RP, relation with clinicopathological parameters, and association with biochemical failure. Methods and Patients. Serial blood samples were taken during followup after RP, mononuclear cells were obtained by differential gel centrifugation, and CPCs identified using standard immunocytochemistry using anti-PSA monoclonal antibodies. Age, pathological stage (organ confined, nonorgan confined, pathological grade, margin status (positive, negative, extracapsular extension, perineural, vascular, and lymphatic infiltration (positive, negative were compared with the presence/absence of CPCs and with and without biochemical failure. Kaplan Meier methods were used to compare the unadjusted biochemical failure free survival of patients with and without CPCs. Results. 114 men participated, and secondary CPCs were detected more frequently in patients with positive margins, extracapsular extension, and vascular and lymphatic infiltration and were associated with biochemical failure independent of these clinicopathological variables, and with a shorter time to BF. Conclusions. Secondary CPCs are an independent risk factor associated with increased BF in men with a PSA <0.2 ng/mL after radical prostatectomy, but do not determine if the recurrence is due to local or systemic disease. These results warrant larger studies to confirm the findings.

  19. A comparative analysis of primary and secondary Gleason pattern predictive ability for positive surgical margins after radical prostatectomy.

    Science.gov (United States)

    Sfoungaristos, S; Kavouras, A; Kanatas, P; Polimeros, N; Perimenis, P

    2011-01-01

    To compare the predictive ability of primary and secondary Gleason pattern for positive surgical margins in patients with clinically localized prostate cancer and a preoperative Gleason score ≤ 6. A retrospective analysis of the medical records of patients undergone a radical prostatectomy between January 2005 and October 2010 was conducted. Patients' age, prostate volume, preoperative PSA, biopsy Gleason score, the 1st and 2nd Gleason pattern were entered a univariate and multivariate analysis. The 1st and 2nd pattern were tested for their ability to predict positive surgical margins using receiver operating characteristic curves. Positive surgical margins were noticed in 56 cases (38.1%) out of 147 studied patients. The 2nd pattern was significantly greater in those with positive surgical margins while the 1st pattern was not significantly different between the 2 groups of patients. ROC analysis revealed that area under the curve was 0.53 (p=0.538) for the 1st pattern and 0.60 (p=0.048) for the 2nd pattern. Concerning the cases with PSA <10 ng/ml, it was also found that only the 2nd pattern had a predictive ability (p=0.050). When multiple logistic regression analysis was conducted it was found that the 2nd pattern was the only independent predictor. The second Gleason pattern was found to be of higher value than the 1st one for the prediction of positive surgical margins in patients with preoperative Gleason score ≤ 6 and this should be considered especially when a neurovascular bundle sparing radical prostatectomy is planned, in order not to harm the oncological outcome.

  20. Technical refinement and learning curve for attenuating neurapraxia during robotic-assisted radical prostatectomy to improve sexual function.

    Science.gov (United States)

    Alemozaffar, Mehrdad; Duclos, Antoine; Hevelone, Nathanael D; Lipsitz, Stuart R; Borza, Tudor; Yu, Hua-Yin; Kowalczyk, Keith J; Hu, Jim C

    2012-06-01

    While radical prostatectomy surgeon learning curves have characterized less blood loss, shorter operative times, and fewer positive margins, there is a dearth of studies characterizing learning curves for improving sexual function. Additionally, while learning curve studies often define volume thresholds for improvement, few of these studies demonstrate specific technical modifications that allow reproducibility of improved outcomes. Demonstrate and quantify the learning curve for improving sexual function outcomes based on technical refinements that reduce neurovascular bundle displacement during nerve-sparing robot-assisted radical prostatectomy (RARP). We performed a retrospective study of 400 consecutive RARPs, categorized into groups of 50, performed after elimination of continuous surgeon/assistant neurovascular bundle countertraction. Our approach to RARP has been described previously. A single-console robotic system was used for all cases. Expanded Prostate Cancer Index Composite sexual function was measured within 1 yr of RARP. Linear regression was performed to determine factors influencing the recovery of sexual function. Greater surgeon experience was associated with better 5-mo sexual function (p = 0.007) and a trend for better 12-mo sexual function (p = 0.061), with improvement plateauing after 250-300 cases. Additionally, younger patient age (both pfunction (function. Moreover, trainee robotic console time during nerve sparing was associated with worse 12-mo sexual function (p=0.021), while unilateral nerve sparing/non-nerve sparing was associated with worse 5-mo sexual function (p = 0.009). Limitations include the retrospective single-surgeon design. With greater surgeon experience, attenuating lateral displacement of the neurovascular bundle and resultant neurapraxia improve postoperative sexual function. However, to maximize outcomes, appropriate patient selection must be exercised when allowing trainee nerve-sparing involvement. Copyright © 2012

  1. Robot-assisted versus other types of radical prostatectomy: population-based safety and cost comparison in Japan, 2012-2013.

    Science.gov (United States)

    Sugihara, Toru; Yasunaga, Hideo; Horiguchi, Hiromasa; Matsui, Hiroki; Fujimura, Tetsuya; Nishimatsu, Hiroaki; Fukuhara, Hiroshi; Kume, Haruki; Changhong, Yu; Kattan, Michael W; Fushimi, Kiyohide; Homma, Yukio

    2014-11-01

    In 2012, Japanese national insurance started covering robot-assisted surgery. We carried out a population-based comparison between robot-assisted and three other types of radical prostatectomy to evaluate the safety of robot-assisted prostatectomy during its initial year. We abstracted data for 7202 open, 2483 laparoscopic, 1181 minimal incision endoscopic, and 2126 robot-assisted radical prostatectomies for oncological stage T3 or less from the Diagnosis Procedure Combination database (April 2012-March 2013). Complication rate, transfusion rate, anesthesia time, postoperative length of stay, and cost were evaluated by pairwise one-to-one propensity-score matching and multivariable analyses with covariants of age, comorbidity, oncological stage, hospital volume, and hospital academic status. The proportion of robot-assisted radical prostatectomies dramatically increased from 8.6% to 24.1% during the first year. Compared with open, laparoscopic, and minimal incision endoscopic surgery, robot-assisted surgery was generally associated with a significantly lower complication rate (odds ratios, 0.25, 0.20, 0.33, respectively), autologous transfusion rate (0.04, 0.31, 0.10), homologous transfusion rate (0.16, 0.48, 0.14), lower cost excluding operation (differences, -5.1%, -1.8% [not significant], -10.8%) and shorter postoperative length of stay (-9.1%, +0.9% [not significant], -18.5%, respectively). However, robot-assisted surgery also resulted in a + 42.6% increase in anesthesia time and +52.4% increase in total cost compared with open surgery (all P robotic surgery led to a dynamic change in prostate cancer surgery. Even in its initial year, robot-assisted radical prostatectomy was carried out with several favorable safety aspects compared to the conventional surgeries despite its having the longest anesthesia time and the highest cost.

  2. Preservation of the smooth muscular internal (vesical) sphincter and of the proximal urethra for the early recovery of urinary continence after retropubic radical prostatectomy: a prospective case-control study.

    Science.gov (United States)

    Brunocilla, Eugenio; Schiavina, Riccardo; Pultrone, Cristian Vincenzo; Borghesi, Marco; Rossi, Martina; Cevenini, Matteo; Martorana, Giuseppe

    2014-02-01

    To evaluate the influence of preservation of the muscular internal sphincter and proximal urethra on continence recovery after radical prostatectomy. This was a prospective single-center, case-control study. A total of 40 consecutive patients with organ-confined prostate cancer were submitted to radical prostatectomy with the preservation of the muscular internal sphincter and the proximal urethra (group 1), and their outcomes were compared with those of 40 patients submitted to a standard procedure (group 2). Continence rates were assessed using a self-administrated questionnaire at 3, 7 and 30 days, and 3 and 12 months after removal of the catheter. Group 1 had a faster recovery of early continence than group 2 at day 3 (45% vs 22%; P = 0.029) and at day 7 (75% vs 50%; P = 0.018). Considering the number of pads, group 1 had a faster recovery of continence at 3, 7 and 30 days, and also had less incidence of severe incontinence. There was no statistically significant difference in terms of continence at 3 and 12 months among the two groups. Multivariate logistic regression analysis showed that surgical technique and young age were significantly associated with earlier time to continence at 3 and 7 days. The two groups had no significant differences in terms of surgical margins. Our modified technique of radical retropubic prostatectomy with preservation of the smooth muscular internal sphincter, as well as of the proximal urethra during bladder neck dissection, results in a significantly increased urinary continence at 3, 7 and 30 days after catheter removal, with a minor incidence of severe incontinence. The technique is also oncologically safe, and it does not increase the operative duration of the procedure. © 2013 The Japanese Urological Association.

  3. The Efficacy and Utilisation of Preoperative Magnetic Resonance Imaging in Robot-assisted Radical Prostatectomy: Does it Change the Surgical Dissection Plan? A Preliminary Report

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    Hasan Hüseyin Tavukçu

    2015-06-01

    Full Text Available Purpose: We investigated the effect of prostate magnetic resonance imaging (MRI on the dissection plan of the neurovascular bundle and the oncological results of our patients who underwent robotic radical prostatectomy operation. Materials and Methods: We prospectively evaluated 30 consecutive patients, 15 of whom had prostate MRI before the operation, and 15 of whom did not. With the findings of MRI, the dissection plan was changed as intrafascial, interfascial, and extrafascial technique in the MRI group. Two groups were compared in terms of age, prostate-specific antigen (PSA, and Gleason scores (GSs. Surgical margin status was also checked with the final pathology. Results: There was no significant difference between the two groups in terms of age, PSA, biopsy GS, and final pathological GS. MRI changed the initial surgical plan to a nerve-sparing technique in 7 of the 15 patients. Only one patient in the MRI group had a positive surgical margin on bladder neck. MRI was confirmed as the primary tumour localisation in the final pathology in 93.3% of patients. Conclusion: Preoperative prostate MRI influenced the decision to carry out a nerve-sparing technique in 46% of the patients in our study; however, the change to a nerve-sparing technique did not seem to compromise the surgical margin positivity.

  4. Changes in pathologic outcomes and operative trends with robot-assisted laparoscopic radical prostatectomy

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    Aaron Bernie

    2014-01-01

    Full Text Available Introduction: We hypothesized that there is a reverse stage migration, or a shift toward operating on higher-risk prostate cancer, in patients undergoing robot-assisted laparoscopic prostatectomy (RALP. We therefore evaluated the stage of disease at the time of surgery for patients with prostate cancer at a large tertiary academic medical center. Materials and Methods: After institutional review board approval, we reviewed all patients that had undergone robotic prostatectomy. These patients were separated into three categories: An early era of 2005-2008, intermediate era of 2009-2010, and a current era of 2011-2012. Results: A total of 3451 patients underwent robotic prostatectomy from 2005 to 2012. The proportion men with clinical T1 tumors declined from 88.3% in the early era to 72.2% in the current era (P < 0.0001. Men with preoperative biopsy Gleason 6 disease decreased from the early to the current era (P < 0.0001, while men with preoperative biopsy Gleason ≥ 8 showed the opposite trend, increasing from the early to the current era (P = 0.0002. From the early to the current era, the proportion of patients with National Comprehensive Cancer Network (NCCN low risk prostate cancer decreased, while those with NCCN intermediate and high-risk disease increased. The proportion of pathologic T3 disease increased from 15.5% in the early to 30.6% in the current era (P < 0.0001. On the other hand, the proportion of pathologic T2/+ SMS (surgical margin status decreased from 6.6% in the early era to 3.1% in the current era (P = 0.0002. Conclusions: We have demonstrated a reverse stage migration in men undergoing robotic prostatectomy. Despite the increasing proportion of men with extra-capsular disease undergoing RALP, the surgical margin status has remained similar. This could reflect both the changing dynamics of the population opting for surgery as well as the learning curve of the surgeons.

  5. Patients undergoing radical prostatectomy have a better survival than the background population

    DEFF Research Database (Denmark)

    Andreas Røder, Martin; Brasso, Klaus; Drimer Berg, Kasper

    2013-01-01

    -matched Danish population using the methods and macros described by Dickmann. The country-specific population mortality rates used for calculation of the expected survival were based on data from The Human Mortality Database. RESULTS: The median follow-up was 3.4 years (range: 0-14.3 years). A total of 59 (4...... better than expected in the age-matched background population. This finding is likely explained by selection bias. Although the results indicate an excellent outcome in terms of cancer control, the efficacy of prostatectomy for localized prostate cancer remains at debate....

  6. Prediction of biochemical recurrence after radical prostatectomy. New tool for selecting candidates for adjuvant radiation therapy.

    Science.gov (United States)

    Herranz-Amo, F; Molina-Escudero, R; Ogaya-Pinies, G; Ramírez-Martín, D; Verdú-Tartajo, F; Hernández-Fernández, C

    2016-03-01

    To design a risk summation to select patients for adjuvant radiation therapy after prostatectomy. A retrospective study was conducted on 629 patients with localised prostate cancer (pN0-pNx) who were treated with prostatectomy and with a prostate-specific antigen (PSA) value 0.4ng/mL. A multivariate Cox regression analysis was performed. A score (0-2) was assigned according to the hazard ratio of the significant variables. The score summation defined the risk summation. A total of 19.7% of the patients were pT3, 24.2% had a Gleason score ≥ 8, and 26.3% had positive surgical margins. The median follow-up was 82 months. Some 26.6% of the patients experienced biochemical recurrence. The identified prognostic variables independent of biochemical recurrence were a Gleason score =7 (4+3) (HR, 2.01; P=.008), a Gleason score ≥ 8 (HR, 3.07; P 50% survival free of biochemical recurrence at 5 and 8 years. In contrast, the patients with a risk summation ≥ 3 had <44% survival free of biochemical recurrence. The patients with a risk summation ≤ 2 did not benefit from adjuvant radiation therapy, while the patients with a risk summation ≥ 3 might benefit from adjuvant radiation therapy. Copyright © 2015 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  7. A comparison of radical perineal, radical retropubic, and robot-assisted laparoscopic prostatectomies in a single surgeon series.

    Science.gov (United States)

    Mirza, Moben; Art, Kevin; Wineland, Logan; Tawfik, Ossama; Thrasher, J Brantley

    2011-01-01

    Objective. We sought to compare positive surgical margin rates (PSM), estimated blood loss (EBL), and quality of life outcomes (QOL) among perineal (RPP), retropubic (RRP), and robot-assisted laparoscopic (RALP) prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92), RRP (180), or RALP (191) for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC) were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml) group compared to both RPP (475 ml) and RRP (999 ml) groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  8. Urinary and sexual outcomes in long-term (5+ years prostate cancer disease free survivors after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Ambruosi Carlo

    2009-11-01

    Full Text Available Abstract Background After long term disease free follow up (FUp patients reconsider quality of life (QOL outcomes. Aim of this study is assess QoL in prostate cancer patients who are disease-free at least 5 years after radical prostatectomy (RP. Methods 367 patients treated with RP for clinically localized pCa, without biochemical failure (PSA ≤ 0.2 ng/mL at the follow up ≥ 5 years were recruited. Urinary (UF and Sexual Function (SF, Urinary (UB and Sexual Bother (SB were assessed by using UCLA-PCI questionnaire. UF, UB, SF and SB were analyzed according to: treatment timing (age at time of RP, FUp duration, age at time of FUp, tumor characteristics (preoperative PSA, TNM stage, pathological Gleason score, nerve sparing (NS procedure, and hormonal treatment (HT. We calculated the differences between 93 NS-RP without HT (group A and 274 non-NS-RP or NS-RP with HT (group B. We evaluated the correlation between function and bother in group A according to follow-up duration. Results Time since prostatectomy had a negative effect on SF and a positive effect SB (both p Higher stage PCa negatively affected UB, SF, and SB (all: p ≤ 0.05. NS was associated with better UB, SF and SB (all: p ≤ 0.05; conversely, HT was associated with worse UF, SF and SB (all: p ≤ 0.05. More than 8 years after prostatectomy SF of group A and B were similar. Group A subjects (NS-RP without HT demonstrated worsening SF, but improved SB, suggesting dissociation of the correlation between SF and SB over time. Conclusion Older age at follow up and higher pathological stage were associated with worse QoL outcomes after RP. The direct correlation between UF and age at follow up, with no correlation between UF and age at time of RP suggests that other issues (i.e: vascular or neurogenic disorders, subsequent to RP, are determinant on urinary incontinence. After NS-RP without HT the correlation between SF and SB is maintained for 7 years, after which function and bother

  9. Does a history of previous surgery or radiation to the prostate affect outcomes of robot-assisted radical prostatectomy?

    Science.gov (United States)

    Martin, Aaron D; Desai, Premal J; Nunez, Rafael N; Martin, George L; Andrews, Paul E; Ferrigni, Robert G; Swanson, Scott K; Pacelli, Anna; Castle, Erik P

    2009-06-01

    To evaluate retrospectively whether or not previous treatment to the prostate alters the perioperative outcomes from robot-assisted radical prostatectomy (RARP) after the initial 'learning curve', as there are conflicting data on outcomes of RP in patients with previous treatment to the prostate. We retrospectively reviewed the charts of patients who had RARP between March 2005 and August 2007, and analysed demographic, perioperative variables and pathological data. In all, 510 patient charts were reviewed, identifying 24 patients with a history of previous treatment to the prostate including transurethral resection or incision of the prostate, transurethral microwave therapy, transurethral needle ablation, photoselective vaporization, simple prostatectomy, external beam radiotherapy, brachytherapy, and open bladder neck reconstruction (group 1) and 486 with no previous treatment (group 2). There was no significant difference between the groups in body mass index, clinical stage, grade or prostate volume, but the patients in group 1 were older (70 vs 65 years, P = 0.001). Outcome analysis comparing groups 1 and 2 showed an estimated blood loss of 155 vs 137 mL, length of hospital stay of 2.2 vs 1.5 days, operative duration of 200 vs 186 min and catheter time of 12 vs 8 days, respectively; only the last was statistically significant (P = 0.03). There was an 8.3% and 6.8% complication rate in groups 1 and 2, respectively, and the respective overall positive margin rate was 20.8% and 22.6%. A history of previous treatment of the prostate does not appear to compromise the perioperative outcomes of RARP.

  10. Genetic variants of the CYP1B1 gene as predictors of biochemical recurrence after radical prostatectomy in localized prostate cancer patients

    OpenAIRE

    Gu, Cheng-Yuan; Qin, Xiao-Jian; Qu, Yuan-Yuan; Zhu, Yu; Wan, Fang-Ning; Zhang, Gui-Ming; Sun, Li-Jiang; Zhu, Yao; Ye, Ding-Wei

    2016-01-01

    Abstract Clinically localized prostate cancer is curative. Nevertheless many patients suffered from biochemical recurrence (BCR) after radical prostatectomy (RP). Mounting evidence suggest that estrogen and xenobiotic carcinogens play an essential role in progression of prostate cancervia oxidative estrogen metabolism. CYP1B1 is an enzyme involved in the hydroxylation of estrogens, a reaction of key relevance in estrogen metabolism. Given the role of CYP1B1 in the oxidative metabolism of endo...

  11. A Double Blind, Randomized, Neoadjuvant Study of the Tissue effects of POMx Pills in Men with Prostate Cancer Prior to Radical Prostatectomy

    OpenAIRE

    Freedland, Stephen J.; Carducci, Michael; Kroeger, Nils; Partin, Alan; Rao, Jian-yu; Jin, Yusheng; Kerkoutian, Susan; Wu, Hong; Li, Yunfeng; Creel, Patricia; Mundy, Kelly; Gurganus, Robin; Fedor, Helen; King, Serina A.; Zhang, Yanjun

    2013-01-01

    Pomegranates slow prostate cancer xenograft growth and prolong PSA doubling times in single-arm human studies. Pomegranates’ effects on human prostate tissue are understudied. We hypothesized orally administered pomegranate extract (POMx; PomWonderful, Los Angeles, CA) would lower tissue 8-hydroxy-2-deoxyguanosine (8-OHdG), an oxidative stress biomarker. 70 men were randomized to 2 tablets POMx or placebo daily up to 4 weeks prior to radical prostatectomy. Tissue was analyzed for intra-prosta...

  12. RADICAL PROSTATECTOMY FOR PATIENTS WITH CLINICALLY LOCALIZED AND LOCALLY ADVANCED PROSTATE CANCER: THE REMOTE RESULTS OF TREATEMENT

    Directory of Open Access Journals (Sweden)

    V. N. Grygorenko

    2014-07-01

    Full Text Available The purpose of the work was to improve the treatment results among patients with clinically local and locally advanced prostate cancer while using neo-and/or adjuvant hormone- and radiotherapy.Materials and methods. Radical prostatectomy results estimation was conducted among 170 patients. An average survey period continued 35,99 ± 1,88 (1–102 months. An average age was 61,66 ± 0,45 (40–75 years. Moreover, after operation 125 (73,5 % patients proved to have clinically local forms of prostate cancer (рТ1а,b,c,2aN0М0 – 99, рТ2b,cN0М0 – 26, 25 (14,7 % patients – locally advanced forms (рТ3a,bN0М0 and 19 (11,2 % – generalized forms of prostate cancer (рТ4N0М0, рТ2а,bN1М0,. Metastases in pelvic lymph nodes developed among 10 (5,9 % patients. 43 (25,3 % patients with ІІ–III stages received neoadjuvant hormone therapy treatment due to maximum androgen blockade scheme. An average neoadjuvant hormone therapy duration: 10,14 ± 1,98 (1–60 months. The typical characteristic of modified radical prostatectomy is accurate ejection of urinary bladder neck and proximal area of prostatic urethra part from prostate gland. Already formed urethra-urethral anastomosis is additionally fixed to lateral part of endopelvic fascia.Results. An average 3-year survival made up 95,5 ± 3,5 %, 5-year – 84,1 ± 4,7 %, 7-year – 71,7 ± 6,8 % respectively. 3- and 5-year relapse-free survival comprised 87,05 ± 3,20 %, 79.64 ± 3,03 % 67,11 ± 3,93 % respectively. 5-year survival among patients with localized prostate cancer made up 97,18 ± 3,27 %. 48 (28,2 % patients proved to have biochemical relapse so that they were prescribed adjuvant hormone- and/or radiotherapy treatment. Gleason index ≥ and initial PSA level ≥ 20 ng/ml, and their combination are considered as significant factors that foresee Т > Т2 category and biochemical relapse. For рN+ category initial PSA ≥ 20 ng/ml level is principle. Frequency of disease relapse

  13. RADICAL PROSTATECTOMY FOR PATIENTS WITH CLINICALLY LOCALIZED AND LOCALLY ADVANCED PROSTATE CANCER: THE REMOTE RESULTS OF TREATEMENT

    Directory of Open Access Journals (Sweden)

    V. N. Grygorenko

    2013-01-01

    Full Text Available The purpose of the work was to improve the treatment results among patients with clinically local and locally advanced prostate cancer while using neo-and/or adjuvant hormone- and radiotherapy.Materials and methods. Radical prostatectomy results estimation was conducted among 170 patients. An average survey period continued 35,99 ± 1,88 (1–102 months. An average age was 61,66 ± 0,45 (40–75 years. Moreover, after operation 125 (73,5 % patients proved to have clinically local forms of prostate cancer (рТ1а,b,c,2aN0М0 – 99, рТ2b,cN0М0 – 26, 25 (14,7 % patients – locally advanced forms (рТ3a,bN0М0 and 19 (11,2 % – generalized forms of prostate cancer (рТ4N0М0, рТ2а,bN1М0,. Metastases in pelvic lymph nodes developed among 10 (5,9 % patients. 43 (25,3 % patients with ІІ–III stages received neoadjuvant hormone therapy treatment due to maximum androgen blockade scheme. An average neoadjuvant hormone therapy duration: 10,14 ± 1,98 (1–60 months. The typical characteristic of modified radical prostatectomy is accurate ejection of urinary bladder neck and proximal area of prostatic urethra part from prostate gland. Already formed urethra-urethral anastomosis is additionally fixed to lateral part of endopelvic fascia.Results. An average 3-year survival made up 95,5 ± 3,5 %, 5-year – 84,1 ± 4,7 %, 7-year – 71,7 ± 6,8 % respectively. 3- and 5-year relapse-free survival comprised 87,05 ± 3,20 %, 79.64 ± 3,03 % 67,11 ± 3,93 % respectively. 5-year survival among patients with localized prostate cancer made up 97,18 ± 3,27 %. 48 (28,2 % patients proved to have biochemical relapse so that they were prescribed adjuvant hormone- and/or radiotherapy treatment. Gleason index ≥ and initial PSA level ≥ 20 ng/ml, and their combination are considered as significant factors that foresee Т > Т2 category and biochemical relapse. For рN+ category initial PSA ≥ 20 ng/ml level is principle. Frequency of disease relapse

  14. A Comparison of Radical Perineal, Radical Retropubic, and Robot-Assisted Laparoscopic Prostatectomies in a Single Surgeon Series

    Directory of Open Access Journals (Sweden)

    Moben Mirza

    2011-01-01

    Full Text Available Objective. We sought to compare positive surgical margin rates (PSM, estimated blood loss (EBL, and quality of life outcomes (QOL among perineal (RPP, retropubic (RRP, and robot-assisted laparoscopic (RALP prostatectomies. Methods. Records from 463 consecutive men undergoing RPP (92, RRP (180, or RALP (191 for clinically localized prostate cancer were retrospectively reviewed. Age, percent tumor volume, Gleason score, stage, EBL, PSM, and QOL using the expanded prostate cancer index composite (EPIC were compared. Results. PSM were similar when adjusted for stage, grade, and volume. EBL was significantly less in the RALP (189 ml group compared to both RPP (475 ml and RRP (999 ml groups. When corrected for nerve sparing, there were no differences in erectile function and sexual function amongst the three groups. Urinary summary and pad usage scores showed no significant differences. Conclusion. RPP, RRP, and RALP offer similar surgical and QOL outcomes. RALP and RPP demonstrate less EBL compared to RRP.

  15. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 1: specimen handling.

    Science.gov (United States)

    Samaratunga, Hemamali; Montironi, Rodolfo; True, Lawrence; Epstein, Jonathan I; Griffiths, David F; Humphrey, Peter A; van der Kwast, Theo; Wheeler, Thomas M; Srigley, John R; Delahunt, Brett; Egevad, Lars

    2011-01-01

    The 2009 International Society of Urological Pathology Consensus Conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the handling and processing of radical prostatectomy specimens were coordinated by working group 1. Most uropathologists followed similar procedures for fixation of radical prostatectomy specimens, with 51% of respondents transporting tissue in formalin. There was also consensus that the prostate weight without the seminal vesicles should be recorded. There was consensus that the surface of the prostate should be painted. It was agreed that both the prostate apex and base should be examined by the cone method with sagittal sectioning of the tissue sample. There was consensus that the gland should be fully fixed before sectioning. Both partial and complete embedding of prostates was considered to be acceptable as long as the method of partial embedding is stated. No consensus was determined regarding the necessity of weighing and measuring the length of the seminal vesicles, the preparation of whole mounts rather than standardized blocks and the methodology for sampling of fresh tissue for research purposes, and it was agreed that these should be left to the discretion of the working pathologist.

  16. Number of metastatic lymph nodes as determinant of outcome after salvage radical prostatectomy for radiation-recurrent prostate cancer.

    Science.gov (United States)

    Gugliemetti, G; Sukhu, R; Conca Baenas, M A; Meeks, J; Sjoberg, D D; Eastham, J A; Scardino, P T; Touijer, K

    2016-09-01

    Presence of lymph node metástasis (LNM) at salvage radical prostatectomy (sRP) is associated with poor outcome. Predictors of outcome in this context remain undetermined. ThE objective was to assess the role of number of positive lymph node on outcome of patients with LNM after sRP and for radio-recurrent prostate cancer. We analyzed data from a consecutive cohort of 215 men treated with sRP at a single institution. We used univariate Cox proportional hazard regression models for biochemical recurrence (BCR) and metastatic outcomes, with prostate-specific antigen, Gleason score, extraprostatic extension, seminal vesicle invasion, time between radiation therapy and sRP, and number of positive nodes as predictors. Of the 47 patients with LNM, 37 developed BCR, 11 developed distant metastasis and 4 died with a median follow-up of 2.3 years for survivors. The risk of metastases increased with higher pre-operative PSA levels (HR 1.19 per 1ng/ml; 95% CI: 1.06-1.34; P=.003). The remaining predictors did not reach conventional levels of significance. However, removal of 3 or more positive lymph nodes demonstrated a positive association, as expected, with metastatic disease (HR 3.44; 95% CI: 0.91-13.05; P=.069) compared to one or 2 positive nodes. Similarly, the presence of extraprostatic extension, seminal vesicle invasion and Gleason grade greater than 7 also demonstrated a positive association with higher risk of metástasis, with hazard ratios of 3.97 (95% CI: 0.50, 31.4; P=.2), 3.72 (95% CI: 0.80-17.26; P=.1), and 1.45 (95% CI: 0.44-4.76; P=.5), respectively. In patients with LNM after sRP for radio-recurrent prostate cancer, the risk of distant metástasis is likely to be influenced by the number of positive nodes (3 or more), high preoperative PSA, Gleason grade and advanced pathologic stage. These results are consistent with the findings of number of nodes (1 to 2 vs. 3 or more nodes positive) as a prognostic indicator after primary radical prostatectomy and

  17. 腹腔镜根治性前列腺切除术后控尿功能的影响因素%Factors influencing urinary continence after laparoscopic radical prostatectomy

    Institute of Scientific and Technical Information of China (English)

    黄建林; 邱敏; 马潞林

    2013-01-01

    Radical prostatectomy is one of the most effective treatments for men with clinically localized prostate cancer.Though technical innovations,especially laparoscopic techniques,have developed rapidly for the last decade,urinary incontinence remains one of the most troubling side effects of the operation.While the injury of urethral sphincter and its innervations was considered as the most important reason for incontinence,factors influencing postoperative continence that have been considered include clinical features of patients,such as the patient' s age,size of the prostate,prior prostatic surgery and features of the surgical technique itself,such as preservation of full functional-length urethra,preservation of the neurovascular bundles,bladder neck preservation or reconstruction and pelvic floor muscle training during the early phase after the surgery.Nonetheless,many factors above have not been clearly established,and controversy goes on among different studies.This article reviews factors that may influence urinary continence after laparoscopic radical prostatectomy.

  18. Improvement of recurrence-free survival after radical prostatectomy for locally advanced prostate cancer in relation to the time of surgical intervention

    Directory of Open Access Journals (Sweden)

    E. I. Veliev

    2016-01-01

    Full Text Available Objective: to comparatively estimate the frequency of a positive surgical margin and 5-year biochemical recurrent-free survival (BRFS rates in patients with locally advanced prostate cancer in relation to the time of radical retropubic prostatectomy.Subjects and methods. The investigation enrolled 274 patients with prostate cancer (pT3-4N0-1M0 who were divided into 2 groups of 68 and 20 patients operated on in 1997 to 2006 and 2007 to 2012, respectively. Two surgeons made surgical interventions by the standardized procedure. The 5-year BRFS rates were estimated using the Kaplan-Meier method and log-rank test. A biochemical recurrence was defined as a prostatespecific antigen level of t 0.2 ng / ml in 2 consecutive measurements or as the initiation of adjuvant therapy.Results. The detection rate of a positive surgical margin decreased from 55.9 % in 1997–2006 to 37.9 % in 2007–2012 (p = 0.01; the 5-year recurrence-free survival rates were 38.8 % versus 66.2 % (p < 0.001.Conclusion. These changes would probably be a result of surgeons» better experience and improved surgical techniques in the course of time.

  19. The Role of C11-Choline-PET/CT-Guided Secondary Lymphadenectomy in Patients with PSA Failure after Radical Prostatectomy: Lessons Learned from Eight Cases

    Directory of Open Access Journals (Sweden)

    Thomas Martini

    2012-01-01

    Full Text Available Introduction. 11C-choline-PET/CT is a promising technique for detection/restaging of patients with biochemical failure (BF after curative therapy for prostate cancer (PCA. The aim of this paper was to evaluate the PSA response in patients with BF after radical prostatectomy (RP who underwent secondary lymphadenectomy (LAD due to 11C-choline-PET/CT findings. Material and Methods. Eight patients with BF and positive lymph nodes in 11C-choline-PET/CT after RP were retrospectively included in the study. Extended LAD until the common iliac arteries was performed in all patients. Results. Six of 8 patients had histologically proven lymph node metastases. Four patients showed an initial PSA reduction after LAD, and in 4 patients the PSA increased. Two of the latter had no histological lymph node metastases. Conclusions. Because 50% of our patients showed an initial PSA response, our data suggest that positive 11C-choline-PET/CT after RP and BF could help to select patients that could benefit from secondary LAD.

  20. Positron emission tomography with C11-acetate for tumor detection and localization in patients with prostate-specific antigen relapse after radical prostatectomy.

    Science.gov (United States)

    Sandblom, Gabriel; Sörensen, Jens; Lundin, Niclas; Häggman, Michael; Malmström, Per-Uno

    2006-05-01

    To evaluate positron emission tomography with C11-acetate as a method for detecting and localizing prostate cancer recurrence. No technique for localizing and detecting prostate cancer recurrence after biochemical relapse available today is sensitive enough to localize recurrence at a stage at which salvage radiotherapy is still curative. Twenty patients (age 56 to 77 years) who had undergone radical prostatectomy and had an increasing prostate-specific antigen level measured on two consecutive occasions were included. In addition to the investigations usually performed when prostate cancer recurrence is suspected, they underwent positron emission tomography with C11-acetate as the marker. Pathologic uptake of acetate was seen in 15 (75%) of the 20 patients. In 8 of these patients, a solitary lesion was found (seven in the prostatic fossa and one at the regional lymph nodes). Multiple lesions were found in the remaining 7. False-positive uptake was seen in 3 men (15%). Additional investigations in these men revealed pathologic findings other than prostate cancer. Positron emission tomography with C11-acetate as marker is a promising method for early detection and localization of prostate cancer recurrence. False-positive uptake does occur.

  1. Comparison of pathological data between prostate biopsy and radical prostatectomy specimen in patients with low to very low risk prostate cancer.

    Science.gov (United States)

    Lendínez-Cano, G; Alonso-Flores, J; Beltrán-Aguilar, V; Cayuela, A; Salazar-Otero, S; Bachiller-Burgos, J

    2015-10-01

    To analyze the correlation between pathological data found in radical prostatectomy and previously performed biopsy in patients at low risk prostate cancer. A descriptive, cross-sectional study was conducted to assess the characteristics of radical prostatectomies performed in our center from January 2012 to November 2014. The inclusion criteria were patients with low-risk disease (cT1c-T2a, PSA≤10ng/mL and Gleason score≤6). We excluded patients who had fewer than 8 cores in the biopsy, an unspecified number of affected cores, rectal examinations not reported in the medical history or biopsies performed in another center. Of the 184 patients who underwent prostatectomy during this period, 87 met the inclusion criteria, and 26 of these had<3 affected cores and PSA density≤.15 (very low risk). In the entire sample, the percentage of undergrading (Gleason score≥7) and extracapsular invasion (pT3) was 18.4% (95% CI 10.3-27.6) and 10.35% (95% CI 4.6-17.2), respectively. The percentage of positive margins was 21.8% (95% CI 12.6-29.9). In the very low-risk group, we found no cases of extracapsular invasion and only 1 case of undergrading (Gleason 7 [3+4]), representing 3.8% of the total (95% CI 0-12.5). Predictors of no correlation (stage≥pT3a or undergrading) were the initial risk group, volume, PSA density and affected cores. Prostate volume, PSA density, the number of affected cores and the patient's initial risk group influence the poor pathological prognosis in the radical prostatectomy specimen (extracapsular invasion and Gleason score≥7). Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Clinical map document based on XML (cMDX: document architecture with mapping feature for reporting and analysing prostate cancer in radical prostatectomy specimens

    Directory of Open Access Journals (Sweden)

    Bettendorf Olaf

    2010-11-01

    Full Text Available Abstract Background The pathology report of radical prostatectomy specimens plays an important role in clinical decisions and the prognostic evaluation in Prostate Cancer (PCa. The anatomical schema is a helpful tool to document PCa extension for clinical and research purposes. To achieve electronic documentation and analysis, an appropriate documentation model for anatomical schemas is needed. For this purpose we developed cMDX. Methods The document architecture of cMDX was designed according to Open Packaging Conventions by separating the whole data into template data and patient data. Analogue custom XML elements were considered to harmonize the graphical representation (e.g. tumour extension with the textual data (e.g. histological patterns. The graphical documentation was based on the four-layer visualization model that forms the interaction between different custom XML elements. Sensible personal data were encrypted with a 256-bit cryptographic algorithm to avoid misuse. In order to assess the clinical value, we retrospectively analysed the tumour extension in 255 patients after radical prostatectomy. Results The pathology report with cMDX can represent pathological findings of the prostate in schematic styles. Such reports can be integrated into the hospital information system. "cMDX" documents can be converted into different data formats like text, graphics and PDF. Supplementary tools like cMDX Editor and an analyser tool were implemented. The graphical analysis of 255 prostatectomy specimens showed that PCa were mostly localized in the peripheral zone (Mean: 73% ± 25. 54% of PCa showed a multifocal growth pattern. Conclusions cMDX can be used for routine histopathological reporting of radical prostatectomy specimens and provide data for scientific analysis.

  3. Transperitoneal versus extraperitoneal laparoscopic radical prostatectomy during the learning curve: does the surgical approach affect the complication rate?

    Directory of Open Access Journals (Sweden)

    Tiberio M. Siqueira Jr.

    2010-08-01

    Full Text Available Purpose: To compare the perioperative complication rate obtained with the transperitoneal laparoscopic radical prostatectomy (TLRP and with the extraperitoneal LRP (ELRP during the learning curve (LC. Materials and Methods: Data of the initial 40 TLRP (Group 1 were retrospectively compared with the initial 40 ELRP (Group 2. Each Group of patients was operated by two different surgeons. Results: The overall surgical time (175 min x 267.6 min; p < 0.001 and estimated blood loss (177.5 mL x 292.4 mL; p < 0.001 were statistically better in the Group 1. Two intraoperative complications were observed in Group 1 (5% represented by one case of bleeding and one case of rectal injury, whereas four complications (10% were observed in Group 2, represented by two cases of bleeding, one bladder and one rectal injuries (p = 0.675. Open conversion occurred once in each Group (2.5%. Overall postoperative complications were similar (52.5% x 35%; p = 0.365. Major early postoperative complications occurred in three and in one case in Group 1 and 2, respectively. Group 1 had two peritonitis (fecal and urinary, leading to one death in this group. Conclusions: No statistical differences in overall complication rates were observed. The transperitoneal approach presented more serious complications during the early postoperative time and this fact is attributed to the potential chance of intraperitoneal peritonitis not observed with the extraperitoneal route.

  4. Socioeconomic status is an independent predictor of biochemical recurrence among patients with prostate cancer who undergo radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Victor Srougi

    2011-08-01

    Full Text Available PURPOSE: Socioeconomic status (SES may influence cancer characteristics and behavior in several aspects. We analyzed PCa characteristics and behavior among low income uninsured men, and compare them to high income patients with health insurance in a developing country. MATERIALS AND METHODS: A retrospective case-control study was performed on 934 patients with clinically localized PCa who underwent radical prostatectomy between March, 1999 and July, 2009. Patients were divided in two groups, according to their SES. In group 1 (n=380, all had low income, low educational levels and couldn't afford medical insurance. In group 2 (n=554, all had higher income, higher education and had medical insurance. RESULTS: Patients from group 1 were older, had higher Gleason scores, higher rates of seminal vesicle and bladder neck involvement. The Kaplan Meier disease-free survival curve demonstrated that after a follow-up of four years, about 50% of uninsured patients had biochemical recurrence, versus 21% of insured patients (Log rank test: p < 0.001. A multivariate Cox regression analysis for the risk of disease recurrence demonstrated that only PSA levels, Gleason score, seminal vesicle involvement and SES were statistically significant variables. Patients with a low SES presented 1.8 times the risk of recurrence as compared to patients with a high SES. CONCLUSIONS: Patients with low SES were older, presented more aggressive PCa characteristics and a high rate of disease recurrence. A low SES constituted an independent predictor for disease recurrence.

  5. Age impact in clinicopathologic presentation and the clinical evolution of prostate cancer in patients submitted to radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Alberto A. Antunes

    2006-02-01

    Full Text Available OBJECTIVE: To assess the influence of age in pathological findings and clinical evolution of prostate cancer in patients treated with radical prostatectomy. MATERIALS AND METHODS: Five hundred and fifty-six patients operated on between 1991 and 2000 were selected. Patients were divided into age groups of between 10 and 49 years, 50 to 59 years, 60 to 69 years and 70 to 83 years. RESULTS: Patients having less than 60 years of age presented clinical stage (p = 0.001, PSA (p = 0.013 and biopsy Gleason score (p = 0.013 more favorable than older patients. Age groups did not show any relationship between either postoperative Gleason score or pathological stage or risk of non-confined organ disease and involvement of seminal vesicles. After a mean follow-up of 58.3 months, 149 (27% patients presented recurrence. Patients aged between 40 and 59 years presented a disease-free survival rate significantly higher when compared to patients aged between 60 and 83 years (p = 0.022. However, when controlled with clinical stage, PSA, Gleason score and percentage of positive fragments, there was no relationship between age and biochemical recurrence risk (p = 0.426. CONCLUSIONS: Even though younger patients presented more favorable preoperative characteristics, postoperative pathological findings and biochemical recurrence rates did not differ between studied age groups.

  6. Prognostic implications of 2005 Gleason grade modification. Population-based study of biochemical recurrence following radical prostatectomy

    DEFF Research Database (Denmark)

    Thomsen, Frederik B; Folkvaljon, Yasin; Brasso, Klaus;

    2016-01-01

    ,890 men assessed with the modified Gleason classification, diagnosed between 2003 and 2007, underwent primary RP. Histopathology was reported according to the Gleason Grading Groups (GGG): GGG1 = Gleason score (GS) 6, GGG2 = GS 7(3 + 4), GGG3 = GS 7(4 + 3), GGG4 = GS 8 and GGG5 = GS 9-10. Cumulative......OBJECTIVE: To assess the impact of the 2005 modification of the Gleason classification on risk of biochemical recurrence (BCR) after radical prostatectomy (RP). PATIENTS AND METHODS: In the Prostate Cancer data Base Sweden (PCBaSe), 2,574 men assessed with the original Gleason classification and 1...... of BCR was lower for modified versus original classification, GGG2 Hazard ratio (HR) 0.66, (95%CI 0.49-0.88), GGG3 HR 0.57 (95%CI 0.38-0.88) and GGG4 HR 0.53 (95%CI 0.29-0.94). CONCLUSION: Due to grade migration following the 2005 Gleason modification, outcome after RP are more favourable. Consequently...

  7. Gigapixel surface imaging of radical prostatectomy specimens for comprehensive detection of cancer-positive surgical margins using structured illumination microscopy

    Science.gov (United States)

    Wang, Mei; Tulman, David B.; Sholl, Andrew B.; Kimbrell, Hillary Z.; Mandava, Sree H.; Elfer, Katherine N.; Luethy, Samuel; Maddox, Michael M.; Lai, Weil; Lee, Benjamin R.; Brown, J. Quincy

    2016-06-01

    Achieving cancer-free surgical margins in oncologic surgery is critical to reduce the need for additional adjuvant treatments and minimize tumor recurrence; however, there is a delicate balance between completeness of tumor removal and preservation of adjacent tissues critical for normal post-operative function. We sought to establish the feasibility of video-rate structured illumination microscopy (VR-SIM) of the intact removed tumor surface as a practical and non-destructive alternative to intra-operative frozen section pathology, using prostate cancer as an initial target. We present the first images of the intact human prostate surface obtained with pathologically-relevant contrast and subcellular detail, obtained in 24 radical prostatectomy specimens immediately after excision. We demonstrate that it is feasible to routinely image the full prostate circumference, generating gigapixel panorama images of the surface that are readily interpreted by pathologists. VR-SIM confirmed detection of positive surgical margins in 3 out of 4 prostates with pathology-confirmed adenocarcinoma at the circumferential surgical margin, and furthermore detected extensive residual cancer at the circumferential margin in a case post-operatively classified by histopathology as having negative surgical margins. Our results suggest that the increased surface coverage of VR-SIM could also provide added value for detection and characterization of positive surgical margins over traditional histopathology.

  8. Evaluation of Lymphorrhea and Incidence of Lymphoceles: 4DryField® PH in Radical Retropubic Prostatectomy.

    Science.gov (United States)

    Karsch, Johannes-J; Berthold, Martin; Breul, Jürgen

    2016-01-01

    Purpose. To investigate impact of polysaccharide hemostat 4DryField PH (4DF) applied on lymph node dissection area after radical retropubic prostatectomy (RRP) on lymphorrhea and lymphocele (LC) formation. Methods. 104 consecutive patients underwent RRP, 51 without 4DF treatment (CT-group) and 53 with 4DF treatment (4DF-group). Groups were comparable (age, risk profile, and lymph node numbers). Postoperative drain loss (PDL) and development of early and late LC were analyzed (mean follow-up at 7 months: 100%). Results. PDL was 452.5 ± 634.2 mL without and 308.5 ± 214 mL with 4DF treatment. PDL > 1000 mL only occurred in CT-group (5/51). Overall, 45 LC (26 in CT- versus 19 in the 4DF-group) were diagnosed. At day 8, LC were equally distributed between groups. Incidence of late LC, however, was twice in controls (16/51) versus 4DF-patients (8/53). Symptomatic LC (4 in untreated patients, 2 in 4DF-patients) were treated with percutaneous drainage (duration: 45 days in untreated patients versus 12 days in 4DF-patients). Conclusion. Application of 4DF on lymph node dissection areas lessened total drain loss and significantly lowered high volume drain loss. Furthermore, 4DF reduced frequency of late lymphoceles and lymphoceles requiring treatment by half, as well as duration of percutaneous drainage by more than two-thirds.

  9. Robot-assisted nerve-sparing radical prostatectomy using near-infrared fluorescence technology and indocyanine green: initial experience.

    Science.gov (United States)

    Mangano, Mario S; De Gobbi, Alberto; Beniamin, Francesco; Lamon, Claudio; Ciaccia, Matteo; Maccatrozzo, Luigino

    2017-05-23

    Indocyanine green (ICG) is a fluorescent molecule that provokes detectable photon emission. The use of ICG with near-infrared (NIR) imaging system (Akorn, Lake Forest, IL) has been described during robotic partial nephrectomy (RAPN) as an adjunctive means of identifying renal artery and parenchymal perfusion.We propose the use of the ICG with NIR fluorescence during laparoscopic robot-assisted radical prostatectomy (RARP), to identify the benchmark artery improving the preservation of neurovascular bundle and to improve the visualization of the vascularization and then the hemostasis. From April 2015 to February 2016, 62 patients underwent to RARP in our Urology Unit. In 26 consecutive patients, in the attempt to have a better visualization of neurovascular bundles, we used to inject ICG during the procedure. We evaluated the percentage of identification of neurovascular bundles using NIR fluorescence. Then, we evaluated complications related to injection of ICG and operative time differences between RARP with and without ICG injection performed by the same surgeons. We identified prostatic arteries and neurovascular bundles using NIR fluorescence technology in all patients (100%). There was not any increase in the operative time compared with RARP without ICG injection performed by the same surgeons. Complications related to injection of ICG did not occurred. In our experience, even if on a limited number of patients, the application of ICG with NIR fluorescence during RARP is helpful to identify the benchmark artery of neurovascular bundle.

  10. Three-dimensional surgical navigation model with TilePro display during robot-assisted radical prostatectomy.

    Science.gov (United States)

    Ukimura, Osamu; Aron, Monish; Nakamoto, Masahiko; Shoji, Sunao; Abreu, Andre Luis de Castro; Matsugasumi, Toru; Berger, Andre; Desai, Mihir; Gill, Inderbir S

    2014-06-01

    Abstract To facilitate robotic nerve-sparing radical prostatectomy, we developed a novel three-dimensional (3D) surgical navigation model that is displayed on the TilePro function of the da Vinci® surgeon console. Based on 3D transrectal ultrasonography (TRUS)-guided prostate biopsies, we reconstructed a 3D model of the TRUS-visible, histologically confirmed "index" cancer lesion in 10 consecutive patients. Five key anatomic structures (prostate, image-visible biopsy-proven "index" cancer lesion, neurovascular bundles, urethra, and recorded biopsy trajectories) were image-fused and displayed onto the TilePro function of the robotic console. The 3D model facilitated careful surgical dissection in the vicinity of the biopsy-proven index lesion. Geographic location of the index lesion on the final histology report correlated with the software-created 3D model. Negative surgical margins were achieved in 90%, except for one case with extensive extra-prostate extension. At postoperative 3 months, prostate-specific antigen levels were undetectable (navigation model is presented.

  11. Risk of biochemical recurrence and positive surgical margins in patients with pT2 prostate cancer undergoing radical prostatectomy

    DEFF Research Database (Denmark)

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Berg, Kasper Drimer

    2014-01-01

    BACKGROUND AND OBJECTIVE: To investigate risk factors associated with positive surgical margins (PSM) and biochemical recurrence (BR) in organ confined tumors (pT2) after radical prostatectomy (RP) for localized prostate cancer (PCa). METHODS: Between 1995 and 2011, 1,649 patients underwent RP...... at our institution. The study includes the 1,133 consecutive patients with pT2 tumors at final histopathology. Logistic regression analysis was used for risk of PSM. Risk of BR, defined as the first PSA ≥ 0.2 ng/ml, was analyzed with Kaplan-Meier and Cox regression analysis. RESULTS: Median follow......-up was 3.6 years (range: 0.5-15.5 years). In logistic regression, NS surgery was independently associated with an increased risk of pT2 PSM (OR = 1.68, 95% CI: 1.3-2.0, P = 0.01) relative to non-NS surgery. NS surgery was not independently associated with BR but the interaction of PSM and NS surgery...

  12. Role of short-term antibiotic therapy at the moment of catheter removal after laparoscopic radical prostatectomy.

    Science.gov (United States)

    Pinochet, Rodrigo; Nogueira, Lucas; Cronin, Angel M; Katz, Darren; Rabbani, Farhang; Guillonneau, Bertrand; Touijer, Karim

    2010-01-01

    To assess the role of short-term antibiotic therapy (ABT) in preventing urinary tract infection (UTI) after catheter removal following laparoscopic radical prostatectomy (LRP). 729 consecutive patients underwent LRP by one of two surgeons. One surgeon systematically prescribed a 3-day course of ABT (ciprofloxacin) starting the day before catheter removal; the other surgeon did not. The groups were compared for the incidence of symptomatic UTI occurring within 6 weeks after catheter removal. ABT was given to 261 of 713 patients (37%), while the remaining 452 patients (63%) did not receive ABT. After catheter removal, UTI was observed less frequently among patients receiving ABT: 3.1 vs. 7.3% in those not receiving ABT (p = 0.019). A number needed to treat to prevent 1 UTI is 24. Hospital readmission for febrile UTI was observed only in patients who did not receive ABT (n = 5, 1.1 vs. 0%, p = 0.16). One would need to prescribe ABT for 91 LRP patients to prevent 1 case of febrile UTI. ABT at the time of catheter removal reduced the risk of postoperative UTI after LRP. One would need to prescribe ABT to 24 patients to prevent 1 case of UTI. Copyright © 2010 S. Karger AG, Basel.

  13. Sexual function following radical prostatectomy: a prospective longitudinal study of cultural differences between Japanese and American men.

    Science.gov (United States)

    Namiki, S; Kwan, L; Kagawa-Singer, M; Tochigi, T; Ioritani, N; Terai, A; Arai, Y; Litwin, M S

    2008-01-01

    We conducted a cross-cultural comparison of the recovery of sexual function and bother during the first 2 years after radical prostatectomy (RP) between American and Japanese men. A total of 275 Japanese and 283 American men who underwent RP alone were prospectively enrolled into longitudinal cohort studies of health-related quality of life outcomes. Sexual function and bother (distress) were estimated with English and validated Japanese versions of the UCLA Prostate Cancer Index before RP and 1, 2-3, 4-6, 12, 18 and 24 months after RP. Each subject served as his own control. Japanese men reported lower sexual function scores at baseline, even after adjusted for age, prostate-specific antigen (PSA) and comorbidity (38 vs 61, Pfunction (beta=0.8 vs beta=5.3) and bother (beta=0.2 vs beta=2.9) over time than did the American men postoperatively, after adjusting for baseline score, age, baseline PSA and nerve-sparing. American men were more likely than Japanese men to regain their baseline sexual function by 24 months after surgery (hazard ratio (HR)=1.60; 95% confidence interval (CI)=1.06-2.42). In contrast, American men were less likely than Japanese men to return to baseline sexual bother (HR=0.57; 95% CI=0.44-0.75). This study demonstrates that Japanese and American men experience different patterns of recovery of their sexual function and bother after RP. Ethnicity may be a contributing factor.

  14. Accuracy of prostate biopsies for predicting Gleason score in radical prostatectomy specimens: nationwide trends 2000-2012.

    Science.gov (United States)

    Danneman, Daniela; Drevin, Linda; Delahunt, Brett; Samaratunga, Hemamali; Robinson, David; Bratt, Ola; Loeb, Stacy; Stattin, Pär; Egevad, Lars

    2017-01-01

    To investigate how well the Gleason score in diagnostic needle biopsies predicted the Gleason score in a subsequent radical prostatectomy (RP) specimen before and after the 2005 International Society of Urological Pathology (ISUP) revision of Gleason grading, and if the recently proposed ISUP grades 1-5 (corresponding to Gleason scores 6, 3 + 4, 4 + 3, 8 and 9-10) better predict the RP grade. All prostate cancers diagnosed in Sweden are reported to the National Prostate Cancer Register (NPCR). We analysed the Gleason scores and ISUP grades from the diagnostic biopsies and the RP specimens in 15 598 men in the NPCR who: were diagnosed between 2000 and 2012 with clinical stage T1-2 M0/X prostate cancer on needle biopsy; were aged ≤70 years; had serum PSA concentration of ISUP grades would have led to a decreasing agreement between biopsy and RP grades over time, from 68% in 2000 to 57% in 2012, with an OR of 0.95 in multivariable analysis (P ISUP grading revision. Had ISUP grades been used instead of Gleason score, the agreement between biopsy and RP grade would have decreased, probably because of its separation of Gleason score 7 into ISUP grades 2 and 3 (Gleason score 3 + 4 vs 4 + 3). © 2016 The Authors BJU International © 2016 BJU International Published by John Wiley & Sons Ltd.

  15. Rationale for and review of neoadjuvant therapy prior to radical prostatectomy for patients with high-risk prostate cancer.

    Science.gov (United States)

    McKay, Rana R; Choueiri, Toni K; Taplin, Mary-Ellen

    2013-09-01

    Despite state of the art local therapy, a significant portion of men with high-risk prostate cancer develop progressive disease. Neoadjuvant systemic therapy prior to radical prostatectomy (RP) is an approach that can potentially maximize survival outcomes in patients with localized disease. This approach is under investigation with a wide array of agents and provides an opportunity to assess pathologic and biologic activity of novel treatments. The aim of this review is to explore the past and present role of neoadjuvant therapy prior to definitive therapy with RP in patients with high-risk localized or locally advanced disease. The results of neoadjuvant androgen-deprivation therapy (ADT), including use of newer agents such as abiraterone, are promising. Neoadjuvant chemotherapy, primarily with docetaxel, with or without ADT has also demonstrated efficacy in men with high-risk disease. Other novel agents targeting the vascular endothelial growth factor receptor (VEGFR), epidermal growth factor receptor (EGFR), platelet-derived growth factor receptor (PDGFR), clusterin, and the immune system are currently under investigation and have led to variable results in early clinical trials. Despite optimistic data, approval of neoadjuvant therapy prior to RP in patients with high-risk prostate cancer will depend on positive results from well designed phase III trials.

  16. Prostate biopsy and radical prostatectomy Gleason score correlation in heterogenous tumors: proposal for a composite Gleason score.

    Science.gov (United States)

    Arias-Stella, Javier A; Shah, Alpa B; Montoya-Cerrillo, Diego; Williamson, Sean R; Gupta, Nilesh S

    2015-09-01

    When prostate biopsy cores are separately identified in multiple containers, current recommendations are to grade each specimen individually. For treatment algorithms, the highest Gleason score (HGS) is typically used as the overall score, even if a lower score predominates. This practice has the potential to misrepresent the overall cancer in the entire gland for some patients and place them in a higher-grade group. We compare a novel composite Gleason score (CGS), integrating grade patterns from contiguous positive biopsy sites, with HGS to determine correlation with the radical prostatectomy (RP) Gleason score (GS). One hundred needle biopsy cases from 2008 to 2012 with >2 GSs in a biopsy set (eg, 3+3=6, 3+4=7, and 4+3=7) or more than a 1-step difference in GS (eg, 3+4=7 and 4+4=8 without 4+3=7) were analyzed. Grades were assigned using both methods (HGS and CGS) and compared with RPGS. Grade groups I to V were used to define downgrade and upgrade. Comparing HGS with RPGS, 31% remained the same and 69% had a change in GS (87% downgraded and 13% upgraded). Comparing CGS with RPGS, 59% remained the same and 41% had a change in GS (10% downgraded and 90% upgraded). Of the 2 methods, the CGS showed better overall correlation with RP (P2 grades are present in a biopsy set. CGS has a significantly lower rate of downgrade and predicts the RPGS more accurately than HGS.

  17. Effectiveness of epidural versus alternate analgesia for pain relief after radical prostatectomy and correlation with biochemical recurrence in men with prostate cancer

    Directory of Open Access Journals (Sweden)

    Mir MC

    2013-10-01

    Full Text Available Maria C Mir,1 Binoy Joseph,1 Rona Zhao,1 Damien M Bolton,1 Dennis Gyomber,1 Nathan Lawrentschuk1,21University of Melbourne, Department of Surgery, Austin Hospital, Melbourne, VIC, Australia; 2Ludwig Institute for Cancer Research, Austin Hospital, Melbourne, VIC, AustraliaObjectives: Our objectives were to analyze the effectiveness of epidural anesthesia in patients who underwent open retropubic radical prostatectomy (RRP at our institution over the past decade, and to examine subsequent oncologic outcomes, comparing those receiving with those not receiving epidural anesthesia.Methods: A comprehensive database of all patients undergoing RRP from November 1996 to December 2006 was analyzed; 354 patients underwent RRP at our institution and were divided into those receiving or not receiving an epidural. An independent pain management team scoring technical success found epidural technique to be consistent. Oncological outcome was an endpoint of our study, comparing both analysis groups. We classed prostate-specific antigen (PSA recurrence after RRP as a serum PSA ≥ 0.2 ng/mL at any stage of postoperative follow-up. Complications were recorded to 30 days using the modified Clavien system, and full statistical analyses were undertaken.Results: Records were available for 239 men; we observed a decreased trend in the use of epidural for pain management, along with a decrease in average hospital stay and an overall epidural success rate of 64%. When dividing data into RRP with and without epidural, we found a median hospital stay of 7 days for patients receiving an epidural compared with 6 days for those not receiving an epidural. The differences were statistically significant (P < 0.048 and remained so after adjusting for complications (P < 0.0001. Regarding oncological outcome, PSA recurrence was further analyzed in this cohort. Percentage of recurrence was higher (14.8% for patients receiving an epidural than for the non-epidural group (4.8%. The

  18. [Waist-hip ratio and perioperative bleeding in patients who underwent radical prostatectomy].

    Science.gov (United States)

    León-Ramírez, Víctor; Santiago-López, Janaí; Reyes-Rivera, Juan Gabriel; Miguel-Soto, Edgar

    2016-01-01

    Introducción: la prostatectomía radical se asocia con sangrado perioperatorio y múltiples transfusiones. La obesidad abdominal representa un factor de riesgo perioperatorio. Sugerimos un efecto protector del adipocito en pacientes oncológicos sometidos a prostatectomía radical. El objetivo fue evaluar el efecto del índice cintura-cadera (ICC) sobre la magnitud del sangrado y los requerimientos perioperatorios de transfusiones en pacientes oncológicos sometidos a prostatectomía radical. Métodos: estudio de cohorte en 156 pacientes. Se integraron dos grupos: el control (ICC  0.95); se registraron la magnitud del sangrado y las fracciones transfundidas durante la cirugía y en el postoperatorio. Se utilizaron medidas de tendencia central y dispersión, así como chi cuadrada, t de Student, U de Mann-Whitney y ANOVA. Una p < 0.05 fue significativa. Resultados: encontramos diferencias significativas en el peso, índice de masa corporal, cintura, índice cintura-cadera, sangrado perioperatorio, fracciones transfundidas, permanencia de la sonda y días de hospitalización. Conclusión: los pacientes sometidos a prostatectomía radical con ICC ≥ 0.95 tuvieron un sangrado y requerimientos transfusionales perioperatorios menores que aquellos con un ICC < 0.95.

  19. Robotic Assisted Laparoscopic Prostatectomy Performed after Previous Suprapubic Prostatectomy

    Science.gov (United States)

    Tsui, Johnson F.; Feuerstein, Michael; Jazayeri, Seyed Behzad

    2016-01-01

    Operative management of prostate cancer in a patient who has undergone previous open suprapubic simple prostatectomy poses a unique surgical challenge. Herein, we describe a case of intermediate risk prostate cancer in a man who had undergone simple prostatectomy ten years prior to presentation. The patient was found to have Gleason 7 prostate cancer on MRI fusion biopsy of the prostate for elevated PSA and underwent an uncomplicated robot assisted laparoscopic radical prostatectomy. PMID:27882057

  20. Blind Biobanking of the Prostatectomy Specimen: Critical Evaluation of the Existing Techniques and Development of the New 4-Level Tissue Extraction Model With High Sampling Efficacy.

    Science.gov (United States)

    Tolkach, Yuri; Eminaga, Okyaz; Wötzel, Fabian; Huss, Sebastian; Bettendorf, Olaf; Eltze, Elke; Abbas, Mahmoud; Imkamp, Florian; Semjonow, Axel

    2017-03-01

    Fresh tissue is mandatory to perform high-quality translation studies. Several models for tissue extraction from prostatectomy specimens without guidance by frozen sections are already introduced. However, little is known about the sampling efficacy of these models, which should provide representative tissue in adequate volumes, account for multifocality and heterogeneity of tumor, not violate the routine final pathological examination, and perform quickly without frozen section-based histological control. The aim of the study was to evaluate the sampling efficacy of the existing tissue extraction models without guidance by frozen sections ("blind") and to develop an optimized model for tissue extraction. Five hundred thirty-three electronic maps of the tumor distribution in prostates from a single-center cohort of the patients subjected to radical prostatectomy were used for analysis. Six available models were evaluated in silico for their sampling efficacy. Additionally, a novel model achieving the best sampling efficacy was developed. The available models showed high efficacies for sampling "any part" from the tumor (up to 100%), but were uniformly low in efficacy to sample all tumor foci from the specimens (with the best technique sampling only 51.6% of the all tumor foci). The novel 4-level extraction model achieved a sampling efficacy of 93.1% for all tumor foci. The existing "blind" tissue extraction models from prostatectomy specimens without frozen sections control are suitable to target tumor tissues but these tissues do not represent the whole tumor. The novel 4-level model provides the highest sampling efficacy and a promising potential for integration into routine. Prostate 77: 396-405, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  1. Disseminated Tumor Cells in Prostate Cancer Patients after Radical Prostatectomy and without Evidence of Disease Predicts Biochemical Recurrence

    Science.gov (United States)

    Morgan, Todd M.; Lange, Paul H.; Porter, Michael P.; Lin, Daniel W.; Ellis, William J.; Gallaher, Ian S.; Vessella, Robert L.

    2011-01-01

    Purpose Men with apparently localized prostate cancer often relapse years after radical prostatectomy (RP). We sought to determine if epithelial-like cells identified from bone marrow (BM) in patients after RP (commonly called disseminated tumor cells, DTC) were associated with biochemical recurrence (BR). Experimental Design We obtained BM aspirates from 569 men prior to RP and from 34 healthy men with PSA<2.5 ng/ml to establish a comparison group. Additionally, an analytic cohort consisting of 98 patients after RP with no evidence of disease (NED) was established to evaluate the relationship between DTC and BR. Epithelial cells in the BM were detected by magnetic bead enrichment with antibodies to CD45 and CD61 (negative selection) followed by antibodies to human epithelial antigen (positive selection) and confirmation with FITC-labeled anti-BerEP4 antibody. Results DTC were present in 72% (408/569) of patients prior to RP. There was no correlation with pathologic stage, Gleason grade, or pre-operative PSA. Three of 34 controls (8.8%) had DTC present. In patients NED post-RP, DTC were present in 56/98 (57%). DTC were detected in 12/14 (86%) NED patients post-RP who subsequently suffered BR. Presence of DTC in NED patients was an independent predictor of recurrence (HR 6.9, CI 1.03–45.9). Conclusions Approximately 70% of men undergoing RP had DTC detected in their BM prior to surgery, suggesting that these cells escape early in the disease. Though pre-operative DTC status does not correlate with pathologic risk factors, persistence of DTC after RP in NED patients was an independent predictor of recurrence. PMID:19147774

  2. A decade of robot-assisted radical prostatectomy training: Time-based metrics and qualitative grading for fellows and residents.

    Science.gov (United States)

    Altok, Muammer; Achim, Mary F; Matin, Surena F; Pettaway, Curtis A; Chapin, Brian F; Davis, John W

    2017-09-27

    As modern urology residency and fellowship training in robot-assisted surgery evolves toward standardized curricula (didactics, dry/wet-laboratory exercises, and surgical assistance), additional tools are needed to evaluate on-console performance. At the start of our robotics program in 2006, we set-up a time- and quality-based evaluation program and aim to consolidate this data into a simple set of metrics for self-evaluation. Using our index procedure of robot-assisted radical prostatectomy (RARP), we prospectively collected data on 2,215 cases over 10 years from 6 faculty surgeons and 94 trainees (43 urologic oncology fellows and 51 urology residents). The steps of the operation were divided into 11 consistent steps, and the metrics included time to completion and quality using a 6-level grading system. Time metrics were consolidated into quartiles for benchmarking. The median times for trainees to complete each step were 15% to 120% higher than those of the staff (Pstaff results. Steps performed by trainees were carefully chosen for a high success rate, and on our Likert-like scale were graded 4 to 5 in more than 95% of cases. There were no grade 0 (very poor) cases, and grades 1 (multiple technical errors) and 2 (could not be completed but without safety issues) were rare (staff. As a trainee progress through a rotation, these benchmarks can assist in prioritizing the need for more attention to a basic step vs. progression to more advanced steps. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Pathological findings following radical prostatectomy in patients who are candidates for active surveillance: impact of varying PSA levels

    Institute of Scientific and Technical Information of China (English)

    Dong Il Kang; Thomas L.Jang; Jeongyun Jeong; Eun Young Choi; Kelly Johnson; Dong Hyeon Lee; Wun-Jae Kim; Isaac Yi Kim1

    2011-01-01

    Active surveillance is an acceptable treatment option in men with a low-risk prostate cancer.In the present study,we have retrospectively reviewed the outcomes of 509 men who fit the criteria for active surveillance but selected radical prostatectomy.Then,the impact of varying prostate-specific antigen (PSA) levels on the risk of upstaging and upgrading in these patients was assessed.Pathological characteristics of patients who fulfilled the inclusion criteria under three active surveillance criteria-those of the University of California-San Francisco,the National Cancer Institute and the European Association of Urology-were examined.The proportion of men who were deemed candidates for active surveillance but were subsequently upstaged or upgraded was determined.Of 509 patients,186 (36.5%),132 (25.9%) and 88 (17.3%) men fulfilled the active surveillance criteria,respectively.Upgrading (Gleason scores 7-10) ranged from 32.8% to 38.6%,while upstaging ( ≥ pT3) ranged from 10.2% to 12.5%,depending on the three active surveillance criteria.After a median follow-up of 24 months,three patients developed a biochemical recurrence.When the impact of varying PSA levels was examined using a test for trend analysis in the context of PSA for each protocol,rates of upstaging were lower in men with PSA <4 ng ml-1.However,there was no impact of varying PSA levels on upgrading.In conclusion,commonly used active surveillance protocols carry the risks of upgrading and upstaging.More reliable and accurate markers are needed to better stratify the risks of men who are appropriate candidates for active surveillance.

  4. Analysis of risk factors of involvement of seminal vesicles in patients with prostate cancer undergoing radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Marcos F. Dall'Oglio

    2004-12-01

    Full Text Available OBJECTIVE: To determine through preoperative serum PSA level, Gleason score on biopsy and percentage of fragments affected by tumor on biopsy, the probability of involvement of the seminal vesicles. MATERIALS AND METHODS: During the period between March 1991 to December 2002, we selected 899 patients undergoing radical prostatectomy for treatment of localized prostate adenocarcinoma. The analyzed preoperative variables were PSA, percentage of positive fragments and Gleason score on the biopsy. Pre-operative PSA was divided in scales from 0 to 4.0 ng/mL, 4.1 to 10 ng/mL, 10.1 to 20 ng/mL and > 20 ng/mL, Gleason score was categorized in scales from 2 to 6. 7 and 8 to 10, and the percentage of affected fragments was divided in 0 to 25%, 25.1% to 50%, 50.1% to 75%, and 75.1% to 100%. All these variables were correlated with the involvement of seminal vesicles in the surgical specimen. RESULTS: Of the 899 patients under study, approximately 11% (95% CI, [9% - 13%] had involvement of seminal vesicles. On the multivariate analysis, when PSA was < 4, the Gleason score was 2 to 6, and less than 25% of fragments were involved on the biopsy, only 3.6%, 7.6% and 6.2% of patients respectively, had involvement of seminal vesicles. On the multivariate analysis, we observed that PSA, Gleason score and the percentage of involved fragments were independent prognostic factors for invasion of seminal vesicles. CONCLUSION: The preoperative variables used in the present study allow the identification of men with minimal risk (lower than 5% if involvement of seminal vesicles.

  5. Evaluation of Lymphorrhea and Incidence of Lymphoceles: 4DryField® PH in Radical Retropubic Prostatectomy

    Directory of Open Access Journals (Sweden)

    Johannes-J. Karsch

    2016-01-01

    Full Text Available Purpose. To investigate impact of polysaccharide hemostat 4DryField PH (4DF applied on lymph node dissection area after radical retropubic prostatectomy (RRP on lymphorrhea and lymphocele (LC formation. Methods. 104 consecutive patients underwent RRP, 51 without 4DF treatment (CT-group and 53 with 4DF treatment (4DF-group. Groups were comparable (age, risk profile, and lymph node numbers. Postoperative drain loss (PDL and development of early and late LC were analyzed (mean follow-up at 7 months: 100%. Results. PDL was 452.5 ± 634.2 mL without and 308.5 ± 214 mL with 4DF treatment. PDL > 1000 mL only occurred in CT-group (5/51. Overall, 45 LC (26 in CT- versus 19 in the 4DF-group were diagnosed. At day 8, LC were equally distributed between groups. Incidence of late LC, however, was twice in controls (16/51 versus 4DF-patients (8/53. Symptomatic LC (4 in untreated patients, 2 in 4DF-patients were treated with percutaneous drainage (duration: 45 days in untreated patients versus 12 days in 4DF-patients. Conclusion. Application of 4DF on lymph node dissection areas lessened total drain loss and significantly lowered high volume drain loss. Furthermore, 4DF reduced frequency of late lymphoceles and lymphoceles requiring treatment by half, as well as duration of percutaneous drainage by more than two-thirds.

  6. Association between Seminal Vesicle Invasion and Prostate Cancer Detection Location after Transrectal Systemic Biopsy among Men Who Underwent Radical Prostatectomy.

    Directory of Open Access Journals (Sweden)

    Young Ik Lee

    Full Text Available Our hypothesis is that the location of the seminal vesicles near the base of the prostate, the more positive cores are detected in the base, the greater the risk of seminal vesicle invasion. Therefore we investigate the clinical outcomes of base dominant prostate cancer (BDPC in transrectal ultrasound (TRUS -guided biopsies compared with anteromiddle dominant prostate cancer (AMPC.From November 2003 to June 2014, a total of 990 intermediate and high risk prostate cancer (PCa patients who underwent radical prostatectomy (RP were enrolled and stratified into two groups according to proportion of positive cores-BDPC group had ≥ 33.3% ratio of positive cores from the prostate base among all positive cores and AMPC group < 33.3% in systemic biopsy. Between two groups, we compared the rate of pathologic outcomes and biochemical recurrence (BCR. We performed multivariate logistic regression model to confirm the significance of BDPC to seminal vesicle invasion (SVI and Cox proportional hazard analysis to BCR.Among these 990 PCa patients, the 487 patients in BDPC group had more advanced clinical stage (p<0.001, a higher biopsy GS (p = 0.002, and a higher rate of extracapsular extension (ECE, SVI and BCR (all p<0.001 than AMPC group. The patients in BDPC group had poor BCR free survival rate via Kaplan-meier analysis (p<0.001. The ratio of the base positive cores was a significant predictor to SVI in multivariate analysis (p < 0.001 and significant predictor of BCR in multivariate Cox proportional analysis (hazard ratio: 1.466, p = 0.004.BDPC in TRUS-guided prostate biopsies was significantly associated with SVI and BCR after adjusting for other clinical factors. Therefore, BDPC should be considered to be a more aggressive tumor despite an otherwise similar cancer profile.

  7. Can Single Positive Core Prostate Cancer at biopsy be Considered a Low-Risk Disease after Radical Prostatectomy?

    Directory of Open Access Journals (Sweden)

    Ricardo Kupka da Silva

    2013-12-01

    Full Text Available Purpose Single positive core in a prostate biopsy is usually associated with indolent prostate cancer (PCa and is one of the active surveillance (AS inclusion criteria. We investigated whether single positive core PCa at biopsy could define an archetype of low-risk disease. Materials and Methods A total of 1320 consecutive patients were enrolled. Among them, 249 patients with single positive core PCa were followed up, and the clinical and pathological parameters influencing prognosis were analyzed. Results Out of the 249 patients, 172 (69.0% had pathological findings ≥ pT2c and 87 (34.9% had an undergraded Gleason Score (GS based on the biopsy. Positive surgical margins (PSMs, extraprostatic extension (EPE and seminal vesicle invasion (SVI were found in 20.8%, 10.0% and 6.0% of patients, respectively. In a comparative analysis, we found that the PSA level, prostate weight and number of cores at biopsy are essential to correctly predict an indolent PCa. A total of 125 patients (67.3% with nonpalpable tumors became high-risk tumors (pT2c-T3. Analyzing only nonpalpable tumors with a GS of 6 at biopsy (156 patients, we noted that 106 (67.9% of cT1 progressed from cT1c to pT2c-pT3. Conclusions Single core PCa have clinically significant disease in the Radical Prostatectomy specimens, with considerable rates of overgrading for the GS, pT2c-pT3, PSMs, EPE and SVI. The treatment plan must be evaluated individually for patients with single core PCa and must take into account other prognostic factors when determining whether a patient should be managed with AS.

  8. Impact of prior abdominal surgery on the outcomes after robotic - assisted laparoscopic radical prostatectomy: single center experience

    Directory of Open Access Journals (Sweden)

    Nozomu Kishimoto

    Full Text Available ABSTRACT Purpose: To evaluate the influence of prior abdominal surgery on the outcomes after robotic-assisted laparoscopic radical prostatectomy (RALP. Materials and Methods: We retrospectively analyzed patients with prostate cancer who underwent RALP between June 2012 and February 2015 at our institution. Patients with prior abdominal surgery were compared with those without prior surgery while considering the mean total operating, console, and port-insertion times; mean estimated blood loss; positive surgical margin rate; mean duration of catheterization; and rate of complications. Results: A total of 203 patients who underwent RALP during the study period were included in this study. In all, 65 patients (32% had a prior history of abdominal surgery, whereas 138 patients (68% had no prior history. The total operating, console, and port-insertion times were 328 and 308 (P=0.06, 252 and 242 (P=0.28, and 22 and 17 minutes (P=0.01, respectively, for patients with prior and no prior surgery. The estimated blood losses, positive surgical margin rates, mean durations of catheterization, and complication rates were 197 and 170 mL (P=0.29, 26.2% and 20.2% (P=0.32, 7.1 and 6.8 days (P=0.74, and 12.3% and 8.7% (P=0.42, respectively. Furthermore, whether prior abdominal surgery was performed above or below the umbilicus or whether single or multiple surgeries were performed did not further affect the perioperative outcomes. Conclusions: Our results suggest that RALP can be performed safely in patients with prior abdominal surgery, without increasing the risk of complications.

  9. Pain, psychological distress and health-related quality of life at baseline and 3 months after radical prostatectomy

    Directory of Open Access Journals (Sweden)

    Johansson Fannie

    2006-11-01

    Full Text Available Abstract Background Inadequate management of postoperative pain is common, and postoperative pain is a risk factor for prolonged pain. In addition to medical and technical factors, psychological factors may also influence the experience of postoperative pain. Methods Pain was measured postoperatively at 24, 48, and 72 hr in hospital and after 3 months at home in 140 patients undergoing radical prostatectomy (RP. Patients answered questionnaires about anxiety and depression (HAD scale and health-related quality of life (SF-36 at baseline and 3 months after surgery. Results In the first 3 postoperative days, mild pain was reported by 45 patients (32%, moderate pain by 64 (45%, and severe pain by 31 (22% on one or more days. High postoperative pain scores were correlated with length of hospital stay and with high pain scores at home. Forty patients (29% reported moderate (n = 35 or severe (n = 5 pain after discharge from hospital. Patients who experienced anxiety and depression preoperatively had higher postoperative pain scores and remained anxious and depressed 3 months after surgery. The scores for the physical domains in the SF-36 were decreased, while the mental health scores were increased at 3 months. Anxiety and depression were negatively correlated with all domains of the SF-36. Conclusion There is a need for nurses to be aware of the psychological status of RP patients and its impact upon patients' experience of postoperative pain and recovery. The ability to identify patients with psychological distress and to target interventions is an important goal for future research.

  10. Prognostic Significance of Percentage and Architectural Types of Contemporary Gleason Pattern 4 Prostate Cancer in Radical Prostatectomy.

    Science.gov (United States)

    Choy, Bonnie; Pearce, Shane M; Anderson, Blake B; Shalhav, Arieh L; Zagaja, Gregory; Eggener, Scott E; Paner, Gladell P

    2016-10-01

    The International Society of Urological Pathology (ISUP) 2014 consensus meeting recommended a novel grade grouping for prostate cancer that included dividing Gleason score (GS) 7 into grade groups 2 (GS 3+4) and 3 (GS 4+3). This division of GS 7, essentially determined by the percent of Gleason pattern (GP) 4 (50%), raises the question of whether a more exact quantification of the percent GP 4 within GS 7 will yield additional prognostic information. Modifications were also made by ISUP regarding the definition of GP 4, now including 4 main architectural types: cribriform, glomeruloid, poorly formed, and fused glands. This study was conducted to analyze the prognostic significance of the percent GP 4 and main architectural types of GP 4 according to the 2014 ISUP grading criteria in radical prostatectomies (RPs). The cohort included 585 RP cases of GS 6 (40.2%), 3+4 (49.0%), and 4+3 (10.8%) prostate cancers. Significantly different 5-year biochemical recurrence (BCR)-free survival rates were observed among GS 6 (99%, 95% confidence interval [CI]: 97%-100%), 3+4 (81%, 95% CI: 76%-86%), and 4+3 (60%, 95% CI: 45%-71%) cancers (P70% (P70% [HR 6.57], all PISUP recommendation of recording the percent of GP 4 in GS 7 prostate cancers at RP. However, additional larger studies are needed to establish the optimal interval for reporting percent GP 4 in GS 7 cancers. Among the GP 4 architectures, cribriform independently predicts BCR, whereas glomeruloid reduces the risk of BCR. Distinction should be made between cribriform and glomeruloid architectures, despite glomeruloid being considered as an early stage of cribriform, as cribriform confers a higher risk for poorer outcome.

  11. Robotic and Open Radical Prostatectomy: The First Prospective Randomised Controlled Trial Fuels Debate Rather than Closing the Question.

    Science.gov (United States)

    Fossati, Nicola; Wiklund, Peter; Rochat, Charles-Henry; Montorsi, Francesco; Dasgupta, Prokar; Sanchez-Salas, Rafael; Canda, Abdullah E; Piechaud, Thierry; Artibani, Walter; Mottrie, Alexandre

    2017-03-01

    Despite the finally acquired level 1 evidence, the urologic debate on open versus robotic prostatectomy still persists. This trial from Brisbane will encourage future studies that will better inform this debate and define what robotic surgery offers.

  12. Thoracic epidural analgesia inhibits the neuro-hormonal but not the acute inflammatory stress response after radical retropubic prostatectomy

    NARCIS (Netherlands)

    Fant, F.; Tina, E.; Sandblom, D.; Andersson, S. -O.; Magnuson, A.; Hultgren-Hornkvist, E.; Axelsson, K.; Gupta, A.

    2013-01-01

    Background. Epidural anaesthesia and analgesia has been shown to suppress the neurohormonal stress response, but its role in the inflammatory response is unclear. The primary aim was to assess whether the choice of analgesic technique influences these processes in patients undergoing radical retropu

  13. Higher number of transrectal ultrasound guided prostate biopsy cores is associated with higher blood loss and perioperative complications in robot assisted radical prostatectomy.

    Science.gov (United States)

    Carneiro, A; Sivaraman, A; Sanchez-Salas, R; Nunes-Silva, I; Baghdadi, M; Srougi, V; di Trapani, E; Uriburu Pizzaro, F; Doizi, S; Barret, E; Rozet, F; Galiano, M; Cathelineau, X

    2017-04-01

    The local inflammatory process after prostate biopsies can have a negative impact on functional outcomes of radical prostatectomy. There is no evidence in literature demonstrating its impact on radical prostatectomy. To evaluate the impact of the number of TRUS core biopsies in the surgical morbidity and rate of positive margin on robot assisted radical prostatectomy (RARP). A prospectively maintained database of 2,054 RARPs in a single institution. Patients were further grouped into 2 groups based on the number of TRUS biopsy cores (G1≤12 cores; G2>12 cores). Multivariable logistic regression model was applied to analyze the impact of number of cores on complications. A total number of 1,042 patients in the group 1 (≤12 cores) and 1,012 patients in the group 2 (>12 cores) were included. The rate of perioperative complications increased with higher number of biopsies (G1 6.4 vs. G2 8.5%; P=.03), but high grade complication (Clavien 3-4) were similar (G1 1.4 vs. G2 2.2%; P=.16). Positive surgical margin rates were similar in both groups (G1 11.8 vs. 9.98%; P=.2). At the multivariable logistic regression analysis shown that G2 had a 39% (OR 0.645) higher rate to experience perioperative complications during RARP. Higher number of TRUS biopsy cores (>12) is associated to higher blood loss and perioperative complications during RARP. Careful preoperative evaluation for those patients underwent multiple biopsies or saturation protocols is mandatory. Application of longer intervals (>6 weeks) between biopsy and surgery may be advisable to minimize potential risks of surgical complications in patients may benefit from RARP. Further studies are still necessary to confirm these results. Copyright © 2016 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  14. Use of multiparametric MR with neurovascular bundle evaluation to optimize the oncological and functional management of patients considered for nerve-sparing radical prostatectomy.

    Science.gov (United States)

    Panebianco, Valeria; Salciccia, Stefano; Cattarino, Susanna; Minisola, Francesco; Gentilucci, Alessandro; Alfarone, Andrea; Ricciuti, Gian Piero; Marcantonio, Andrea; Lisi, Danilo; Gentile, Vincenzo; Passariello, Roberto; Sciarra, Alessandro

    2012-08-01

    To obtain the best results with radical prostatectomy, either from an oncological or a functional point of view, a correct selection of cases and planning of surgery are crucial. Multiparametric magnetic resonance imaging (MRI) promises to make it a successful imaging tool for improving many aspects of prostate cancer management. The aim of this study is to evaluate whether a modern multiparametric MRI can help either to better select prostate cancer cases for a nerve-sparing radical prostatectomy or to improve the functional evaluation related to neurovascular bundles preservation. The effect of preoperative MRI on neurovascular bundle management was examined for the frequency and the appropriateness of changes of the surgical plane on the basis of MRI indications. In a prospective study, 125 consecutive patients with biopsy proven prostate cancer who were scheduled to undergo bilateral nerve-sparing surgery. All patients included into the study were submitted to a preoperative multiparametric MRI. On the basis of MRI evaluation, patients were divided into two groups. Patients in group A were then submitted to a bilateral nerve-sparing (NS) radical prostatectomy (RP), whereas patients in group B were submitted to unilateral NS or non-NS RP. In group A, the confirmation from the MRI study to perform a bilateral NS procedure was appropriate in 70 of 73 cases (95.9%), whereas in group B, the surgical plan was appropriate in 28 of 32 cases (87.5%). On the contrary, MRI findings suggested a change in the initial surgical plan (group B) for 32 of 105 cases (30.5%). Of these 32 cases in group B, MRI suggested to perform a unilateral NS procedure in 21 of 32 cases (65.6%) and a non-NS procedure in 11 of 32 cases (34.4%). Multiparametric MRI analysis can significantly improve the standard selection and management of prostate carcinoma cases considered for an NS RP. © 2012 International Society for Sexual Medicine.

  15. Delivery of human mesenchymal adipose-derived stem cells restores multiple urological dysfunctions in a rat model mimicking radical prostatectomy damages through tissue-specific paracrine mechanisms

    DEFF Research Database (Denmark)

    Yiou, René; Mahrouf-Yorgov, Meriem; Trébeau, Céline;

    2016-01-01

    Urinary incontinence (UI) and erectile dysfunction (ED) are the most common functional urological disorders and the main sequels of radical prostatectomy (RP) for prostate cancer. Mesenchymal stem cell (MSC) therapy holds promise for repairing tissue damage due to RP. Because animal studies...... accurately replicating post-RP clinical UI and ED are lacking, little is known about the mechanisms underlying the urological benefits of MSC in this setting. To determine whether and by which mechanisms MSC can repair damages to both striated urethral sphincter (SUS) and penis in the same animal, we...

  16. Nonabsorbable polymer clip as a cause of chronic perineal pain after radical prostatectomy: Description of a case treated by transperineal approach

    Directory of Open Access Journals (Sweden)

    Massimiliano Creta

    2017-03-01

    Full Text Available The occurrence of persistent perineal pain caused by surgical clips has rarely been described after radical prostatectomy (RP. We describe the case of a patient complaining of chronic perineal pain occurred soon after robotic RP, refractory to conventional medical therapy and exacerbated by the sitting position. Pain was related to a nonabsorbable polymer clip used to secure lateral pedicles. A transpeerineal approach was used to perform an hydrodissection of the rectovesical space at the level of the surgical clip combined with local injection of mepivacaine and betametasone. The patient experienced a clinically significant reduction of pain that remained stable at three months’ follow-up.

  17. Magnetic resonance imaging for prostate cancer: Comparative studies including radical prostatectomy specimens and template transperineal biopsy

    Directory of Open Access Journals (Sweden)

    Liam Toner

    2015-12-01

    Conclusions: mpMRI has an increasing role for PCa diagnosis, staging, and directing management toward improving patient outcomes. Its sensitivity and specificity when compared with RP and TTPB specimens are less than what some expect, possibly reflecting a learning curve for the technique of mpMRI.

  18. Larger Maximum Tumor Diameter at Radical Prostatectomy Is Associated With Increased Biochemical Failure, Metastasis, and Death From Prostate Cancer After Salvage Radiation for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Johnson, Skyler B.; Hamstra, Daniel A.; Jackson, William C.; Zhou, Jessica; Foster, Benjamin; Foster, Corey; Song, Yeohan; Li, Darren [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States); Palapattu, Ganesh S. [Department of Urology, University of Michigan, Ann Arbor, Michigan (United States); Kunju, Lakshmi; Mehra, Rohit [Department of Pathology, University of Michigan, Ann Arbor, Michigan (United States); Sandler, Howard [Cedars-Sinai Medical Center, Los Angeles, California (United States); Feng, Felix Y., E-mail: ffeng@med.umich.edu [Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan (United States)

    2013-10-01

    Purpose: To investigate the maximum tumor diameter (MTD) of the dominant prostate cancer nodule in the radical prostatectomy specimen as a prognostic factor for outcome in patients treated with salvage external beam radiation therapy (SRT) for a rising prostate-specific antigen (PSA) value after radical prostatectomy. Methods and Materials: From an institutional cohort of 575 patients treated with SRT, data on MTD were retrospectively collected. The impact of MTD on biochemical failure (BF), metastasis, and prostate cancer-specific mortality (PCSM) was assessed on univariate and multivariate analysis using Kaplan-Meier and Cox proportional hazards models. Results: In the 173 patients with MTD data available, median follow-up was 77 months (interquartile range, 47-104 months) after SRT, and median MTD was 18 mm (interquartile range, 13-22 mm). Increasing MTD correlated with increasing pT stage, Gleason score, presence of seminal vesicle invasion, and lymph node invasion. Receiver operating characteristic curve analysis identified MTD of >14 mm to be the optimal cut-point. On univariate analysis, MTD >14 mm was associated with an increased risk of BF (P=.02, hazard ratio [HR] 1.8, 95% confidence interval [CI] 1.2-2.8), metastasis (P=.002, HR 4.0, 95% CI 2.1-7.5), and PCSM (P=.02, HR 8.0, 95% CI 2.9-21.8). On multivariate analysis MTD >14 mm remained associated with increased BF (P=.02, HR 1.9, 95% CI 1.1-3.2), metastasis (P=.02, HR 3.4, 95% CI 1.2-9.2), and PCSM (P=.05, HR 9.7, 95% CI 1.0-92.4), independent of extracapsular extension, seminal vesicle invasion, positive surgical margins, pre-RT PSA value, Gleason score, and pre-RT PSA doubling time. Conclusions: For patients treated with SRT for a rising PSA value after prostatectomy, MTD at time of radical prostatectomy is independently associated with BF, metastasis, and PCSM. Maximum tumor diameter should be incorporated into clinical decision making and future clinical risk assessment tools for those patients

  19. AB094. High-throughput sequencing of small RNA component of penile in a post-radical prostatectomy model of erectile dysfunction

    Science.gov (United States)

    Ruan, Yajun; Luan, Yang; Zhang, Yan; Li, Hao; Li, Rui; Cui, Kai; Jiang, Hongyang; Li, Mingchao; Wang, Tao; Liu, Jihong

    2016-01-01

    Objective The introduction of nerve-sparing radical prostatectomy represents a milestone in the treatment of prostate cancer. However, a certain percentage of cancer survivors still suffer from erectile dysfunction. Recent research has stated that using PDE 5-inhibitors after radical prostatectomy may lead to biochemical recurrence. This study was performed to identify the expression profile of small RNA in rats with neurogenic erectile dysfunction, and to investigate possible genes and signaling pathways involving in the disease. Methods Neurogenic erectile dysfunction (ED) was induced in male rats by bilateral cavernous nerve crushing injury (BCNI). After 28 days, erectile function was evaluated by cavernous nerve electrostimulation. Masson’s trichrome staining was performed to assess histologic changes. RNA was isolated from the corpus cavernosum (CC) of both control rats and neurogenic ED rats. Small RNA sequencing was conducted using an Illumina Hiseq 2,500/2,000 platform. Candidate small RNAs were validated by real-time polymerase chain reaction. Results Intracavernous pressure (ICP) was significantly decreased in BCNI group compared with SHAM group. Corporal tissue in the neurogenic ED rats showed a significantly lower smooth muscle/collagen ratio compared with tissue in the SHAM controls. Real time PCR validated that miR-9a-5p, miR-203a-5p, miR-378a-3p and miR-3557-5p were upregulated, and meanwhile miR-3084a-3p was downregulated. Conclusions Small RNA, including microRNA, may play an important role in the regulation of genes in CC and some certain miRs may participate in post-prostatectomy ED. Further studies will be designed to investigate the specific mechanisms of these changes.

  20. Biochemical outcomes after robot-assisted radical prostatectomy in patients with follow-up more than5-years

    Institute of Scientific and Technical Information of China (English)

    Kwang Hyun Kim; Sey Kiat Lim; Tae-Young Shin; Byung Ha Chung; Sung Joon Hong; Koon Ho Rha

    2013-01-01

    In this study,we assessed biochemical outcomes after robot-assisted radical prostatectomy (RARP).Between July 2005 and November 2007,one hundred and seventy-six consecutive patients treated by RARP without neoadjuvant treatment were included in this study.All procedures were performed by a single surgeon and the median follow-up period was 60 months (interquartile range (IQR):59-69).The median prostate specific antigen was 7.50 ng ml-1 (IQR:5.14-11.45) and 39.2% of the patients were classified as intermediate risk and 15.3% were classified as high risk; on final pathological examination,35.2% of the patients had non-organ confined disease and 37.5%and 14.2% had Gleason scores of 7 and 8-10,respectively.The biochemical recurrence (BCR)-free survival rates at 3 and 5 years were 85.6% and 81.2%,respectively.The 5-year BCR-free survival rates stratified by pathologic Gleason scores were 93.1% in Gleason scores of 6 or less,74.5% in a Gleason score of 7,and 58.1% in Gleason scores of 8 or greater,respectively (P<0.001).When stratified by pathologic stage,the BCR-free survival rates were 89.8% in pT2 patients,66.2% in pT3a patients,and 39.3% in pT3b patients at 5 years following RARP,respectively (P<0.001).Preoperative prostate-specific antigen (PSA),pathologic stage,postoperative Gleason score and surgical margin status were independently associated with BCR in multivariate analysis.In this study,we report biochemical outcomes after RARP with the longest follow-up periods to date in Asian men.We found that robotic surgery provided satisfactory biochemical outcomes,and that RARP is a safe and effective procedure in terms of oncologic outcomes.

  1. Prospective evaluation of early postoperative male and female sexual function after radical prostatectomy with erectile nerves preservation.

    Science.gov (United States)

    Tran, S-N; Wirth, G J; Mayor, G; Rollini, C; Bianchi-Demicheli, F; Iselin, C E

    2015-01-01

    Prostate cancer screening has led to the diagnosis of localized prostate cancer in increasingly young and sexually active men. Accordingly, the impact of cancer treatment on sexual function is gaining more attention. To prospectively evaluate the impact of radical prostatectomy (RP) on male, female and conjugal sexual function. Patients were prospectively assessed by an urologist and a sexologist before and 6 months after robot-assisted laparoscopic RP (RALP). RALP was performed with uni- or bilateral neurovascular bundle preservation by a single surgeon. Postoperatively, all patients were prescribed tadalafil 20 mg, 3 times a week during 6 months. Male and female sexual functions were evaluated by using the International Index of Erectile Function (IIEF-5), the Female Sexual Function Index (FSFI) and the Lock-Wallace Marital Adjustment Test (MAT). Continuous variables were analyzed with rank-sum and t-tests, as needed, and categorical variables with chi-squared tests. All tests were two-sided, with a P-value ⩽ 0.05 considered significant. Twenty-one couples were included. Mean patient male and female age was 62.4 and 60.7 years, respectively. Bilateral nerve sparing was performed in 12/21 (57%) patients. Median preoperative IIEF-5 was 20/25, corresponding to mild erectile dysfunction (ED). Median preoperative FSFI and MAT were both within normal range (28/36 and 114/158, respectively). Six months following surgery, both IIEF-5 (11/25) and FSFI (25/36) had significantly dropped (P=0.007 and 0.003, respectively). Postoperative decreases in IIEF-5 and FSFI scores were associated within couples. MAT scores (115/158), however, remained unaffected by RALP, showing an unmodified relationship satisfaction postoperatively. Finally, bilateral nerve sparing surgery preserved not only male but also female sexual function. This study shows that the expected short-term post-RALP ED is associated with a worsening of female sexual function, whereas nerve sparing surgery has a

  2. Elective pelvic versus prostate bed-only salvage radiotherapy following radical prostatectomy. A propensity score-matched analysis

    Energy Technology Data Exchange (ETDEWEB)

    Song, Changhoon; Kim, Jae-Sung; Eom, Keun-Yong; Kim, In Ah; Chung, Jin-Beom [Seoul National University College of Medicine, Seoul National University Bundang Hospital, Department of Radiation Oncology, Seongnam (Korea, Republic of); Kang, Hyun-Cheol [Seoul National University College of Medicine, Seoul National University Bundang Hospital, Department of Radiation Oncology, Seongnam (Korea, Republic of); Dongnam Institute of Radiological and Medical Sciences, Department of Radiation Oncology, Busan (Korea, Republic of); Hong, Sung Kyu; Byun, Seok-Soo; Lee, Sang Eun [Seoul National University College of Medicine, Seoul National University Bundang Hospital, Department of Urology, Seongnam (Korea, Republic of)

    2015-10-15

    To compare the impact of elective whole pelvic radiotherapy (WPRT) versus prostate bed-only radiotherapy (PBRT) on biochemical relapse-free survival (bRFS) in prostate cancer patients treated with salvage radiotherapy following radical prostatectomy (RP). In our database, 163 lymph node-negative prostate cancer patients who had undergone salvage radiotherapy (SRT) for biochemical relapse after RP between September 2004 and April 2012 were identified. PBRT was administered to 134 patients (the PBRT group), while the remaining 29 patients (the WPRT group) received WPRT. Median follow-up was 57 months (range 18-122 months). In the propensity score-matched cohort, the 4-year bRFS of the WPRT group was significantly higher compared to the PBRT group (63.1 vs. 43.4 %, p = 0.034). Subgroup analysis showed that the bRFS of patients who had two or more risk factors (seminal vesicle invasion, Roach score for lymph node invasion ≥ 45 %, and number of harvested lymph nodes ≤ 5) and were treated with WPRT was significantly improved compared to those who received PBRT (hazard ratio, HR 0.33; 95 % confidence interval, CI 0.13-0.83; p = 0.018). Elective WPRT for SRT may improve bRFS in patients with unfavorable risk factors. These results need to be confirmed by a prospective randomized trial. (orig.) [German] Vergleich der Auswirkungen der gezielten Beckenstrahlentherapie (WPRT) gegenueber der Prostatastrahlentherapie (PBRT) hinsichtlich des biochemischen rezidivfreien Ueberlebens (bRFS) bei Prostatakarzinompatienten, die nach radikaler Prostatektomie (RP) mit einer Salvage-Strahlentherapie (SRT) behandelt wurden. Aus unserer Datenbank wurden 163 lymphknotennegative Patienten mit Prostatakrebs identifiziert, die sich nach RP zwischen September 2004 und April 2012 wegen einem biochemischen Rueckfall einer rettenden SRT unterzogen hatten. PBRT wurde 134 Patienten verabreicht (PBRT-Gruppe), waehrend die uebrigen 29 Patienten eine WPRT erhielten (WPRT-Gruppe). Die mediane

  3. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 3: extraprostatic extension, lymphovascular invasion and locally advanced disease.

    Science.gov (United States)

    Magi-Galluzzi, Cristina; Evans, Andrew J; Delahunt, Brett; Epstein, Jonathan I; Griffiths, David F; van der Kwast, Theo H; Montironi, Rodolfo; Wheeler, Thomas M; Srigley, John R; Egevad, Lars L; Humphrey, Peter A

    2011-01-01

    The International Society of Urological Pathology Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to extraprostatic extension (pT3a disease), bladder neck invasion, lymphovascular invasion and the definition of pT4 were coordinated by working group 3. It was agreed that prostate cancer can be categorized as pT3a in the absence of adipose tissue involvement when cancer bulges beyond the contour of the gland or beyond the condensed smooth muscle of the prostate at posterior and posterolateral sites. Extraprostatic extension can also be identified anteriorly. It was agreed that the location of extraprostatic extension should be reported. Although there was consensus that the amount of extraprostatic extension should be quantitated, there was no agreement as to which method of quantitation should be employed. There was overwhelming consensus that microscopic urinary bladder neck invasion by carcinoma should be reported as stage pT3a and that lymphovascular invasion by carcinoma should be reported. It is recommended that these elements are considered in the development of practice guidelines and in the daily practice of urological surgical pathology.

  4. Robot-Assisted Laparoscopic Radical Prostatectomy in the Morbidly Obese Patient

    Directory of Open Access Journals (Sweden)

    Jennifer Yates

    2011-01-01

    Full Text Available Introduction. Obesity and prostate cancer are among the more common health issues affecting men in the United States. Methods. We retrospectively reviewed morbidly obese (BMI ≥ 40 kg/m2 patients undergoing RALP between 2004–2009 at our institution. Parameters including operative time, estimated blood loss, hospital stay, pathology, and complication rate were examined. Results. A total of 15 patients were included, with a mean BMI of 43 kg/m2. Mean preoperative PSA was 5.78 ng/dL, and Gleason score was 6.6. Mean operative time was 163 minutes, and mean estimated blood loss was 210 mL. The mean hospital stay was 1.3 days. Positive margins were noted in 2 (13% patients, each with pT3 disease. There were no blood transfusions, open conversions, or Clavien Grade II or higher complications. Conclusions. In our experience, RALP is feasible in morbidly obese patients. We noted several challenges in this patient population which were overcome with modification of technique and experience.

  5. Pre-emptive analgesia using intravenous fentanyl plus low-dose ketamine for radical prostatectomy under general anesthesia does not produce short-term or long-term reductions in pain or analgesic use.

    NARCIS (Netherlands)

    Katz, J.; Schmid, R.L.; Snijdelaar, D.G.; Coderre, T.J.; McCartney, C.J.; Wowk, A.

    2004-01-01

    The aim of the study was to evaluate post-operative pain and analgesic use after pre-operative or post-incisional i.v. fentanyl plus low dose i.v. ketamine vs. a standard treatment receiving i.v. fentanyl but not ketamine. Men undergoing radical prostatectomy under general anesthesia were randomly a

  6. Effects of Tadalafil Once-Daily or On-Demand vs Placebo on Return to Baseline Erectile Function After Bilateral Nerve-Sparing Radical Prostatectomy - Results from a Randomized Controlled Trial (REACTT)

    DEFF Research Database (Denmark)

    Mulhall, John P; Brock, Gerald; Oelke, Matthias;

    2016-01-01

    INTRODUCTION AND AIM: The multicenter, randomized, double-blind, double-dummy, placebo-controlled REACTT trial suggested that treatment with tadalafil once daily (OaD) started early after bilateral nerve-sparing radical prostatectomy (nsRP) for prostate cancer may contribute to erectile function ...

  7. Comparison of the effects of two intrathecal anaesthetic techniques for transurethral prostatectomy on haemodynamic and pulmonary function.

    LENUS (Irish Health Repository)

    Walsh, K H

    2012-02-03

    BACKGROUND AND OBJECTIVE: Transurethral prostatectomy is routinely performed under spinal anaesthesia. This technique can cause hypotension, which is particularly undesirable in the elderly. The objective was to compare spinal anaesthesia for transurethral prostatectomy using hyperbaric bupivacaine 15 mg (control group) and hyperbaric bupivacaine 10 mg (limiting spread by maintaining the upright position for 15 min) and fentanyl 25 microg (fentanyl group) in terms of haemodynamic and pulmonary function. METHODS: Thirty ASA I-III patients were randomly selected and underwent spinal anaesthesia with either hyperbaric bupivacaine 15 mg (immediately positioned supine) or hyperbaric bupivacaine 10 mg (upright for 15 min) and fentanyl 25 microg. RESULTS: The greatest changes in mean arterial pressure (P = 0.9), ephedrine requirements (P = 0.8) and mean maximum change in forced vital capacity (P = 0.5) were similar in both groups. CONCLUSIONS: The addition of fentanyl 25 microg to bupivacaine 10 mg and limiting the spread of the block does not improve either haemodynamic or pulmonary function compared with bupivacaine 15 mg in patients undergoing transurethral prostatectomy.

  8. Low central venous pressure versus acute normovolemic hemodilution versus conventional fluid management for reducing blood loss in radical retropubic prostatectomy: a randomized controlled trial.

    Science.gov (United States)

    Habib, Ashraf S; Moul, Judd W; Polascik, Thomas J; Robertson, Cary N; Roche, Anthony M; White, William D; Hill, Stephen E; Nosnick, Israel; Gan, Tong J

    2014-05-01

    To compare acute normovolemic hemodilution versus low central venous pressure strategy versus conventional fluid management in reducing intraoperative estimated blood loss, hematocrit drop and need for blood transfusion in patients undergoing radical retropubic prostatectomy under general anesthesia. Patients undergoing radical retropubic prostatectomy under general anesthesia were randomized to conventional fluid management, acute normovolemic hemodilution or low central venous pressure (≤5 mmHg). Treatment effects on estimated blood loss and hematocrit change were tested in multivariable regression models accounting for surgeon, prostate size, and all two-way interactions. Ninety-two patients completed the study. Estimated blood loss (mean ± SD) was significantly lower with low central venous pressure (706 ± 362 ml) compared to acute normovolemic hemodilution (1103 ± 635 ml) and conventional (1051 ± 714 ml) groups (p = 0.0134). There was no difference between the groups in need for blood transfusion, or hematocrit drop from preoperative values. The multivariate model predicting estimated blood loss showed a significant effect of treatment (p = 0.0028) and prostate size (p = 0.0323), accounting for surgeon (p = 0.0013). In the model predicting hematocrit change, accounting for surgeon difference (p = 0.0037), the treatment effect depended on prostate size (p = 0.0007) with the slope of low central venous pressure differing from the other two groups. Hematocrit was predicted to drop more with increased prostate size in acute normovolemic hemodilution and conventional groups but not with low central venous pressure. Limitations include the inability to blind providers to group assignment, possible variability between providers in estimation of blood loss, and the relatively small sample size that was not powered to detect differences between the groups in need for blood transfusion. Maintaining low central venous

  9. Evaluation of Clinical and MRI Staging for Prostate Cancer before Radical Prostatectomy%磁共振成像(MRI)对前列腺癌分期的临床意义

    Institute of Scientific and Technical Information of China (English)

    钟晨阳; ZHONG Chenyang; 邹恩泽; ZOU Enze; 陈敏; CHEN Min; WANG Wenchao; ZHAO Weifeng; WAN Ben; DENG Shuming; WANG Jianye

    2004-01-01

    Objective: To evaluate the clinical significance of clinical staging and magnetic resonance imaging (MRI) staging for prostate cancer before radical prostatectomy. Methods: Thirty-two patients with organ confined prostate cancer were reviewed to assess the accuracy of clinical staging and MRI staging to correlate with pathological staging results after radical prostatectomy. Results: 33.3% (10/30) prostate cancer patients with staging C and 3.3% (1/30) prostate cancer patients with staging D were diagnosed by pathology after radical prostatectomy in 30 patients with prostate cancer with clinical staging B, and 36.7% (11/30) under staging; Only one patient was over staging in clinical staging C. 19.1% (4/21) prostate cancer patients with staging C were diagnosed in 21 patients with prostate cancer and under staging with MRI staging B; 11.1% (1/9) was over staging with MRI staging C. The clinical staging and MRI staging had more correlation with pathological staging results (P=0.002), and PPV of the organ confined prostate cancer by clinical staging and MRI staging were 63.3% and 80.9% respectively, and NPV of nonorgan confined prostate cancer by clinical staging and MRI staging were 50% and 88.9% respectively. MRI staging was more specificity and accuracy than that of clinical staging to predict pathological staging results before radical prostatectomy (P=0.023). Conclusion: The MRI staging was more accuracy than that of clinical staging to predict pathological staging results in organ confined and nonorgan confined prostate cancer before radical prostatectomy.

  10. Lack of an Association between Neutrophil-to-Lymphocyte Ratio and PSA Failure of Prostate Cancer Patients Who Underwent Radical Prostatectomy

    Directory of Open Access Journals (Sweden)

    Yoko Maeda

    2016-01-01

    Full Text Available Introduction. The neutrophil-to-lymphocyte ratio (NLR, which can be easily calculated from routine complete blood counts of the peripheral blood, has been suggested to serve as a prognostic factor for some solid malignancies. In the present study, we aimed to determine the relationship between NLR in prostate cancer patients undergoing radical prostatectomy (RP and their prognosis. Materials and Methods. We assessed NLR in 73 men (patients who received RP for their prostate cancer. We also performed immunohistochemistry for CD8 and CD66b in a separate set of RP specimens. Results. The median NLR in the 73 patients was 1.85. There were no significant correlations of NLR with tumor grade (p=0.834, pathological T stage (p=0.082, lymph node metastasis (p=0.062, or resection margin status (p=0.772. Based on the area under the receiver operator characteristic curve (AUROC to predict biochemical recurrence after RP, potential NLR cut-off point was determined to be 2.88 or 3.88. However, both of these cut-off points did not precisely predict the prognosis. There were no statistically significant differences in the number of CD66b-positive neutrophils or CD8-positive lymphocytes between stromal tissues adjacent to cancer glands and stromal tissues away from cancer glands and between different grades or stages of tumors. Conclusions. There was no association between NLR and biochemical failure after prostatectomy.

  11. Factors effective on survival after radical prostatectomy: To what extent is pre-operative biopsy Gleason scoring is confident in predicting the prognosis?

    Science.gov (United States)

    Açıkgöz, Onur; Gazel, Eymen; Kasap, Yusuf; Yığman, Metin; Güneş, Zeki Ender; Ölçücüoğlu, Erkan

    2015-01-01

    In the present study, the effect of different grades on independent survival from the biochemical relapse was investigated through comparison of the histological grades of the biopsy and prostatectomy materials in patients undergoing radical prostatectomy (RP). A total of 152 patients undergoing RP following biopsy were retrospectively investigated in an attempt to reveal the effect of discordance between needle biopsy Gleason score and RP Gleason score on prostate specific antigen relapse-free survival. Accordingly, while 58.3% (14/24) survival was seen in the patients in Group 1 (high-graded) with Gleason score 7, 93.7% (15/16) survival has been seen in the patients in Group 2 (low-graded) and Group 3 (same Gleason scores) with Gleason score 7. The difference in-between has been statically found significant (P < 0.001). Similarly, while a 10% (1/10) survival is seen in the patients in Group 1 with Gleason score 8 and above, 75% (3/4) survival has been observed in the patients in Group 2 and 3 with Gleason score 8 and above. Also in this comparison, the difference in-between has been statically found significant (P = 0.041). Eventually, different grading, particularly determination of Gleason score higher than the RP specimen biopsy also bring about bad pathologic parameters and shortened survival periods.

  12. Factors effective on survival after radical prostatectomy: To what extent is pre-operative biopsy Gleason scoring is confident in predicting the prognosis?

    Directory of Open Access Journals (Sweden)

    Onur Açikgöz

    2015-01-01

    Full Text Available In the present study, the effect of different grades on independent survival from the biochemical relapse was investigated through comparison of the histological grades of the biopsy and prostatectomy materials in patients undergoing radical prostatectomy (RP. A total of 152 patients undergoing RP following biopsy were retrospectively investigated in an attempt to reveal the effect of discordance between needle biopsy Gleason score and RP Gleason score on prostate specific antigen relapse-free survival. Accordingly, while 58.3% (14/24 survival was seen in the patients in Group 1 (high-graded with Gleason score 7, 93.7% (15/16 survival has been seen in the patients in Group 2 (low-graded and Group 3 (same Gleason scores with Gleason score 7. The difference in-between has been statically found significant (P < 0.001. Similarly, while a 10% (1/10 survival is seen in the patients in Group 1 with Gleason score 8 and above, 75% (3/4 survival has been observed in the patients in Group 2 and 3 with Gleason score 8 and above. Also in this comparison, the difference in-between has been statically found significant (P = 0.041. Eventually, different grading, particularly determination of Gleason score higher than the RP specimen biopsy also bring about bad pathologic parameters and shortened survival periods.

  13. Detection of local recurrent prostate cancer after radical prostatectomy in terms of salvage radiotherapy using dynamic contrast enhanced-MRI without endorectal coil

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    Rischke Hans Christian

    2012-10-01

    Full Text Available Abstract Purpose To evaluate the value of dynamic contrast enhanced Magnetic Resonance Imaging (DCE-MRI without endorectal coil (EC in the detection of local recurrent prostate cancer (PC after radical prostatectomy (RP. Material and methods Thirty-three patients with recurrent PC underwent DCE-MRI without EC before salvage radiotherapy (RT. At median 15 (mean 16±4.9, range 12–27 months after completion of RT all patients showed complete biochemical response. Additional follow up post RT DCE-MRI scans were available. Prostate specific antigen (PSA levels at the time of imaging were correlated to the imaging findings. Results In 22/33 patients (67% early contrast enhancing nodules were detected in the post-prostatectomy fossa on pre-RT DCE-MRI images. The average pre-RT PSA level of the 22 patients with positive pre-RT DCE-MRI findings was significantly higher (mean, 0.74±0.64 ng/mL compared to the pre-RT PSA level of the 11 patients with negative pre-RT DCE-MRI (mean, 0.24±0.13 ng/mL (p Conclusions This is the first study that shows that DCE-MRI without EC can detect local recurrent PC with an estimated accuracy of 83% at low PSA levels. All false negative DCE-MRI scans were detected using a PSA cut-off of ≥0.54 ng/mL.

  14. Tissue-Based MicroRNAs as Predictors of Biochemical Recurrence after Radical Prostatectomy: What Can We Learn from Past Studies?

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    Zhongwei Zhao

    2017-09-01

    Full Text Available With the increasing understanding of the molecular mechanism of the microRNAs (miRNAs in prostate cancer (PCa, the predictive potential of miRNAs has received more attention by clinicians and laboratory scientists. Compared with the traditional prognostic tools based on clinicopathological variables, including the prostate-specific antigen, miRNAs may be helpful novel molecular biomarkers of biochemical recurrence for a more accurate risk stratification of PCa patients after radical prostatectomy and may contribute to personalized treatment. Tissue samples from prostatectomy specimens are easily available for miRNA isolation. Numerous studies from different countries have investigated the role of tissue-miRNAs as independent predictors of disease recurrence, either alone or in combination with other clinicopathological factors. For this purpose, a PubMed search was performed for articles published between 2008 and 2017. We compiled a profile of dysregulated miRNAs as potential predictors of biochemical recurrence and discussed their current clinical relevance. Because of differences in analytics, insufficient power and the heterogeneity of studies, and different statistical evaluation methods, limited consistency in results was obvious. Prospective multi-institutional studies with larger sample sizes, harmonized analytics, well-structured external validations, and reasonable study designs are necessary to assess the real prognostic information of miRNAs, in combination with conventional clinicopathological factors, as predictors of biochemical recurrence.

  15. Epidural analgesia during open radical prostatectomy does not improve long-term cancer-related outcome: a retrospective study in patients with advanced prostate cancer.

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    Patrick Y Wuethrich

    Full Text Available BACKGROUND: A beneficial effect of regional anesthesia on cancer related outcome in various solid tumors has been proposed. The data on prostate cancer is conflicting and reports on long-term cancer specific survival are lacking. METHODS: In a retrospective, single-center study, outcomes of 148 consecutive patients with locally advanced prostate cancer pT3/4 who underwent retropubic radical prostatectomy (RRP with general anesthesia combined with intra- and postoperative epidural analgesia (n=67 or with postoperative ketorolac-morphine analgesia (n=81 were reviewed. The median observation time was 14.00 years (range 10.87-17.75 yrs. Biochemical recurrence (BCR-free, local and distant recurrence-free, cancer-specific, and overall survival were estimated using the Kaplan-Meier technique. Multivariate Cox proportional-hazards regression models were used to analyze clinicopathologic variables associated with disease progression and death. RESULTS: The survival estimates for BCR-free, local and distant recurrence-free, cancer-specific survival and overall survival did not differ between the two groups (P=0.64, P=0.75, P=0.18, P=0.32 and P=0.07. For both groups, higher preoperative PSA (hazard ratio (HR 1.02, 95% confidence interval (CI 1.01-1.02, P<0.0001, increased specimen Gleason score (HR 1.24, 95% CI 1.06-1.46, P=0.007 and positive nodal status (HR 1.66, 95% CI 1.03-2.67, P=0.04 were associated with higher risk of BCR. Increased specimen Gleason score predicted death from prostate cancer (HR 2.46, 95% CI 1.65-3.68, P<0.0001. CONCLUSIONS: General anaesthesia combined with epidural analgesia did not reduce the risk of cancer progression or improve survival after RRP for prostate cancer in this group of patients at high risk for disease progression with a median observation time of 14.00 yrs.

  16. External validation and comparison of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology in two patient populations: a retrospective cohort study.

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    Utsumi, Takanobu; Oka, Ryo; Endo, Takumi; Yano, Masashi; Kamijima, Shuichi; Kamiya, Naoto; Fujimura, Masaaki; Sekita, Nobuyuki; Mikami, Kazuo; Hiruta, Nobuyuki; Suzuki, Hiroyoshi

    2015-11-01

    The aim of this study is to validate and compare the predictive accuracy of two nomograms predicting the probability of Gleason sum upgrading between biopsy and radical prostatectomy pathology among representative patients with prostate cancer. We previously developed a nomogram, as did Chun et al. In this validation study, patients originated from two centers: Toho University Sakura Medical Center (n = 214) and Chibaken Saiseikai Narashino Hospital (n = 216). We assessed predictive accuracy using area under the curve values and constructed calibration plots to grasp the tendency for each institution. Both nomograms showed a high predictive accuracy in each institution, although the constructed calibration plots of the two nomograms underestimated the actual probability in Toho University Sakura Medical Center. Clinicians need to use calibration plots for each institution to correctly understand the tendency of each nomogram for their patients, even if each nomogram has a good predictive accuracy.

  17. The percent of cores positive for cancer in prostate needle biopsy specimens is strongly predictive of tumor stage and volume at radical prostatectomy.

    Science.gov (United States)

    Sebo, T J; Bock, B J; Cheville, J C; Lohse, C; Wollan, P; Zincke, H

    2000-01-01

    Pretreatment clinical staging of prostatic adenocarcinoma is important due to the increasing use of nonsurgical treatment options. Using multivariate analysis we assessed the predictive value of biopsy cores positive for cancer as a percent of all cores obtained as well as the percent surface area of needle cores involved with tumor for determining tumor volume and pathological stage at radical prostatectomy. Candidate variables for the multivariate model included patient age, clinical disease stage, serum prostate specific antigen (PSA) and Gleason score of cancer in the needle biopsy. We reviewed prostate needle biopsy findings in 207 consecutive patients who subsequently underwent radical retropubic prostatectomy. Each biopsy specimen was assessed for tumor involvement by calculating the percent of cores positive for cancer, percent surface area involved in all cores and Gleason score. Initial serum PSA and preoperative clinical disease stage were incorporated with biopsy results into a multivariate model to determine the parameters most predictive of pathological stage and tumor volume at radical retropubic prostatectomy. Of the 207 patients 152 (73.4%) had organ confined cancer and 55 (26.6%) had extraprostatic extension (pathological stages T2 and T3 or greater, respectively). Preoperative clinical staging information was available in 195 cases, in which disease was clinically confined and not confined in 184 (94.4%) and 11 (5.6%), respectively. Needle biopsy revealed a surface area of cancer ranging from less than 5% in 69 patients (33.3%) to 90% (mean 16, median 10). Univariate analysis demonstrated that the risk of extraprostatic extension was predicted by preoperative serum PSA (p = 0.027), the percent of cores and percent of surface area positive for cancer (p <0.0001), and Gleason score (p = 0.0009). Clinical stage approached significance (p = 0.071). Multivariate analysis showed that the percent of positive cores (p = 0.0003), initial serum PSA (p = 0

  18. Acute Radiation-Induced Nocturia in Prostate Cancer Patients Is Associated With Pretreatment Symptoms, Radical Prostatectomy, and Genetic Markers in the TGF{beta}1 Gene

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    De Langhe, Sofie, E-mail: Sofie.DeLanghe@UGent.be [Department of Basic Medical Sciences, Ghent University, Gent (Belgium); De Ruyck, Kim [Department of Basic Medical Sciences, Ghent University, Gent (Belgium); Ost, Piet; Fonteyne, Valerie [Department of Radiation Oncology, Ghent University Hospital, Gent (Belgium); Werbrouck, Joke [Department of Basic Medical Sciences, Ghent University, Gent (Belgium); De Meerleer, Gert; De Neve, Wilfried [Department of Radiation Oncology, Ghent University Hospital, Gent (Belgium); Thierens, Hubert [Department of Basic Medical Sciences, Ghent University, Gent (Belgium)

    2013-02-01

    Purpose: After radiation therapy for prostate cancer, approximately 50% of the patients experience acute genitourinary symptoms, mostly nocturia. This may be highly bothersome with a major impact on the patient's quality of life. In the past, nocturia is seldom reported as a single, physiologically distinct endpoint, and little is known about its etiology. It is assumed that in addition to dose-volume parameters and patient- and therapy-related factors, a genetic component contributes to the development of radiation-induced damage. In this study, we investigated the association among dosimetric, clinical, and TGF{beta}1 polymorphisms and the development of acute radiation-induced nocturia in prostate cancer patients. Methods and Materials: Data were available for 322 prostate cancer patients treated with primary or postoperative intensity modulated radiation therapy (IMRT). Five genetic markers in the TGF{beta}1 gene (-800 G>A, -509 C>T, codon 10 T>C, codon 25 G>C, g.10780 T>G), and a high number of clinical and dosimetric parameters were considered. Toxicity was scored using an symptom scale developed in-house. Results: Radical prostatectomy (P<.001) and the presence of pretreatment nocturia (P<.001) are significantly associated with the occurrence of radiation-induced acute toxicity. The -509 CT/TT (P=.010) and codon 10 TC/CC (P=.005) genotypes are significantly associated with an increased risk for radiation-induced acute nocturia. Conclusions: Radical prostatectomy, the presence of pretreatment nocturia symptoms, and the variant alleles of TGF{beta}1 -509 C>T and codon 10 T>C are identified as factors involved in the development of acute radiation-induced nocturia. These findings may contribute to the research on prediction of late nocturia after IMRT for prostate cancer.

  19. Establishment of a Web-based System for Collection of Patient-reported Outcomes After Radical Prostatectomy in a Statewide Quality Improvement Collaborative.

    Science.gov (United States)

    Lucas, Steven M; Kim, Tae-Kyung; Ghani, Khurshid R; Miller, David C; Linsell, Susan; Starr, Jay; Peabody, James O; Hurley, Patrick; Montie, James; Cher, Michael L

    2017-09-01

    To report on the establishment of a unified, electronic patient-reported outcome (PRO) infrastructure and pilot results from the first 5 practices enrolled in the web-based collection system developed by the Michigan Urological Surgery Improvement Collaborative. Eligible patients were those undergoing radical prostatectomy of 5 academic and community practices. PRO was obtained using a validated 21-item web-based questionnaire, regarding urinary function, erection function, and sexual interest and satisfaction. Data were collected preoperatively, at 3 months, and 6 months postoperatively. Patients were provided a link via email to complete the surveys. Perioperative and PRO data were analyzed as reports for individual patients and summary performance reports for individual surgeons. Among 773 eligible patients, 688 (89%) were enrolled preoperatively. Survey completion rate was 88%, 84%, and 90% preoperatively, at 3 months, and 6 months. Electronic completion rates preoperatively, at 3 months, and 6 months were 70%, 70%, and 68%, respectively. Mean urinary function scores were 18.3, 14.3, and 16.6 (good function ≥ 17), whereas mean erection scores were 18.7, 7.3, and 9.1 (good erection score ≥ 22) before surgery, at 3 months, and 6 months. Variation was noted for erectile function among the practices. Collection of electronic PRO via this unified, web-based format was successful and provided results that reflect expected recovery and identify opportunities for improvement. This will be extended to more practices statewide to improve outcomes after radical prostatectomy. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Hem-o-lok clip: a neglected cause of severe bladder neck contracture and consequent urinary incontinence after robot-assisted laparoscopic radical prostatectomy.

    Science.gov (United States)

    Cormio, Luigi; Massenio, Paolo; Lucarelli, Giuseppe; Di Fino, Giuseppe; Selvaggio, Oscar; Micali, Salvatore; Carrieri, Giuseppe

    2014-02-20

    Hem-o-lok clips are widely used during robot-assisted and laparoscopic radical prostatectomy to control the lateral pedicles. There are a few reports of hem-o-lok clip migration into the bladder or vesico-urethral anastomosis and only four cases of hem-o-lok clip migration resulting into bladder neck contracture. Herein, we describe the first case, to our knowledge, of hem-o-lok clip migration leading to severe bladder neck contracture and subsequent stress urinary incontinence. A 62-year-old Caucasian man underwent robot-assisted laparoscopic radical prostatectomy for a T1c Gleason 8 prostate cancer. One month after surgery the patient was fully continent; however, three months later, he presented with acute urinary retention requiring suprapubic drainage. Urethroscopy showed a hem-o-lok clip strongly attached to the area between the vesico-urethral anastomosis and the urethral sphincter and a severe bladder neck contracture behind it. Following cold-knife urethral incision and clip removal, the bladder neck contracture was widely resected. At 3-month follow-up, the patient voided spontaneously with a peak flow rate of 9.5 ml/sec and absence of post-void residual urine, but leaked 240 ml urine at the 24-hour pad test. To date, at 1-year follow-up, his voiding situation remains unchanged. The present report provides further evidence for the risk of hem-o-lok clip migration causing bladder neck contracture, and is the first to demonstrate the potential of such complication to result into stress urinary incontinence.

  1. Pathologic correlation of transperineal in-bore 3-Tesla magnetic resonance imaging-guided prostate biopsy samples with radical prostatectomy specimen.

    Science.gov (United States)

    Velez, Erik; Fedorov, Andriy; Tuncali, Kemal; Olubiyi, Olutayo; Allard, Christopher B; Kibel, Adam S; Tempany, Clare M

    2017-08-01

    To determine the accuracy of in-bore transperineal 3-Tesla (T) magnetic resonance (MR) imaging-guided prostate biopsies for predicting final Gleason grades in patients who subsequently underwent radical prostatectomy (RP). A retrospective review of men who underwent transperineal MR imaging-guided prostate biopsy (tpMRGB) with subsequent radical prostatectomy within 1 year was conducted from 2010 to 2015. All patients underwent a baseline 3-T multiparametric MRI (mpMRI) with endorectal coil and were selected for biopsy based on MR findings of a suspicious prostate lesion and high degree of clinical suspicion for cancer. Spearman correlation was performed to assess concordance between tpMRGB and final RP pathology among patients with and without previous transrectal ultrasound (TRUS)-guided biopsies. A total of 24 men met all eligibility requirements, with a median age of 65 years (interquartile range [IQR] 11.7). The median time from biopsy to RP was 85 days (IQR 50.5). Final pathology revealed Gleason 3 + 4 = 7 in 12 patients, 4 + 3 = 7 in 10 patients, and 4 + 4 = 8 in 2 patients. A strong correlation (ρ: +0.75, p < 0.001) between tpMRGB and RP results was observed, with Gleason scores concordant in 17 cases (71%). 16 of the 24 patients underwent prior TRUS biopsies. Subsequent tpMRGB revealed Gleason upgrading in 88% of cases, which was concordant with RP Gleason scores in 69% of cases (ρ: +0.75, p < 0.001). Final Gleason scores diagnosed by tpMRGB at 3-T correlate strongly with final RP surgical pathology. This may facilitate prostate cancer diagnosis, particularly in patients with negative or low-grade TRUS biopsy results in whom clinically significant cancer is suspected or detected on mpMRI.

  2. The use of exome genotyping to predict pathological Gleason score upgrade after radical prostatectomy in low-risk prostate cancer patients.

    Directory of Open Access Journals (Sweden)

    Jong Jin Oh

    Full Text Available Active surveillance (AS is a promising option for patients with low-risk prostate cancer (PCa, however current criteria could not select the patients correctly, many patients who fulfilled recent AS criteria experienced pathological Gleason score upgrade (PGU after radical prostatectomy (RP. In this study, we aimed to develop an accurate model for predicting PGU among low-risk PCa patients by using exome genotyping.We genotyped 242,221 single nucleotide polymorphisms (SNPs on a custom HumanExome BeadChip v1.0 (Illuminam Inc. in blood DNA from 257 low risk PCa patients (PSA <10 ng/ml, biopsy Gleason score (GS ≤6 and clinical stage ≤T2a who underwent radical prostatectomy. Genetic data were analyzed using an unconditional logistic regression to calculate an odds ratio as an estimate of relative risk of PGU, which defined pathologic GS above 7. Among them, we selected persistent SNPs after multiple testing using FDR method, and we compared accuracies from the multivariate logistic model incorporating clinical factors between included and excluded selected SNP information.After analysis of exome genotyping, 15 SNPs were significant to predict PGU in low risk PCa patients. Among them, one SNP--rs33999879 remained significant after multiple testing. When a multivariate model incorporating factors in Epstein definition--PSA density, biopsy GS, positive core number, tumor per core ratio and age was devised for the prediction of PGU, the predictive accuracy of the multivariate model was 78.4% (95%CI: 0.726-0.834. By addition the factor of rs33999879 in aforementioned multivariate model, the predictive accuracy was 82.9%, which was significantly increased (p = 0.0196.The rs33999879 SNP is a predictor for PGU. The addition of genetic information from the exome sequencing effectively enhanced the predictive accuracy of the multivariate model to establish suitable active surveillance criteria.

  3. Increased optical magnification from 2.5x to 4.3x with technical modification lowers the positive margin rate in open radical retropubic prostatectomy.

    Science.gov (United States)

    Magera, James S; Inman, Brant A; Slezak, Jeffrey M; Bagniewski, Stephanie M; Sebo, Thomas J; Myers, Robert P

    2008-01-01

    We compared the positive surgical margin rate of 2.5x and 4.3x optical loupe magnification with associated technical improvement during open radical retropubic prostatectomy. From January 2, 2004 to September 16, 2005, 511 consecutive patients underwent open radical retropubic prostatectomy, as performed by 1 surgeon. Because 10 patients refused authorization for a retrospective chart review, 501 were evaluable. For the first 265 patients 2.5x power loupes were used and for the subsequent 236 we used 4.3x power loupes. We used the chi-square test for univariate analysis, followed by multivariate logistic regression analysis adjusted for commonly recognized predictors of positive surgical margins in the 2 successive cohorts. Focusing on the apex, which was the most commonly reported site of positive surgical margins, we include operative video segments mimicking 4.3x magnification to demonstrate the surgical precision possible at 4.3x for managing the periurethral fascial bands of Walsh and urethral transection at the prostato-urethral junction. Positive surgical margins were identified in 39 of 265 patients (14.7%) at 2.5x and in 12 of 236 (5.1%) at 4.3x. Apical positive surgical margins were identified in 25 of 265 patients (9.4%) at 2.5x and in 5 of 236 (2.1%) at 4.3x. On multivariate analysis 4.3x magnification was independently associated with a 75% decrease in the odds of a positive surgical margin overall and in the apex alone (p technical refinements that are not possible or deemed safe at 2.5x resulted in a substantial decrease in the positive surgical margin rate.

  4. A Critical Analysis of the Learning Curve and Postlearning Curve Outcomes of Two Experience- and Volume-Matched Surgeons for Laparoscopic and Robot-Assisted Radical Prostatectomy.

    Science.gov (United States)

    Good, Daniel W; Stewart, Grant D; Laird, Alexander; Stolzenburg, Jens-Uwe; Cahill, Declan; McNeill, S Alan

    2015-08-01

    There remains equipoise with regard to whether laparoscopic radical prostatectomy (LRP) or robot-assisted radical prostatectomy (RARP) has any benefit over the other. Despite this, there is a trend for the increasing adoption of RARP at great cost to health services across the world. The aim was to critically analyze the learning curve and outcomes for LRP and RARP for two experience- and volume-matched surgeons who have completed the learning curve for LRP and RARP. Two experience- and volume-matched LRP and RARP surgeons who have completed the learning curve were compared with respect to their learning curve and outcomes for RARP and LRP. There were 531 RARP and 550 LRPs analyzed from April 2003 until January 2012 at two relatively high-volume United Kingdom centers. Outcome measures included operative time, blood loss, complication rate (Clavien-Dindo grade III), positive surgical margin (PSM) rate, and early continence rate. Learning curves for blood loss, operative times, and complication rate were similar between groups. The overall PSM rate and pT2 PSM rate learning curves were longer for RARP compared with LRP but shorter for early continence. Apical PSM showed no learning curve for RARP; however, a long learning curve for LRP and the rate was lower for RARP than for LRP (P=learning curves. Despite the long learning curve for RARP, significant benefits in lower PSM rates and better early continence in comparison with LRP exist. There are benefits to patients with RARP over LRP, especially those linked to better apical dissection (apical PSM and early continence).

  5. Hydrocarbon radical thermochemistry: Gas-phase ion chemistry techniques

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    Ervin, Kent M. [Univ. of Nevada, Reno, NV (United States)

    2014-03-21

    Final Scientific/Technical Report for the project "Hydrocarbon Radical Thermochemistry: Gas-Phase Ion Chemistry Techniques." The objective of this project is to exploit gas-phase ion chemistry techniques for determination of thermochemical values for neutral hydrocarbon radicals of importance in combustion kinetics.

  6. Preoperative 3-Tesla Multiparametric Endorectal Magnetic Resonance Imaging Findings and the Odds of Upgrading and Upstaging at Radical Prostatectomy in Men With Clinically Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hegde, John V. [Harvard Medical School, Boston, Massachusetts (United States); Department of Radiology, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, Connecticut (United States); Mulkern, Robert V. [Department of Radiology, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Department of Radiology, Children' s Hospital Boston, Boston, Massachusetts (United States); Fennessy, Fiona M. [Department of Radiology, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Department of Imaging, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); D' Amico, Anthony V. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Tempany, Clare M.C., E-mail: ctempany@bwh.harvard.edu [Division of MRI, Department of Radiology, Brigham and Women' s Hospital, Boston, Massachusetts (United States)

    2013-02-01

    Purpose: To investigate whether 3-T esla (3T) multiparametric endorectal MRI (erMRI) can add information to established predictors regarding occult extraprostatic or high-grade prostate cancer (PC) in men with clinically localized PC. Methods and Materials: At a single academic medical center, this retrospective study's cohort included 118 men with clinically localized PC who underwent 3T multiparametric erMRI followed by radical prostatectomy, from 2008 to 2011. Multivariable logistic regression analyses in all men and in 100 with favorable-risk PC addressed whether erMRI evidence of T3 disease was associated with prostatectomy T3 or Gleason score (GS) 8-10 (in patients with biopsy GS {<=}7) PC, adjusting for age, prostate-specific antigen level, clinical T category, biopsy GS, and percent positive biopsies. Results: The accuracy of erMRI prediction of extracapsular extension and seminal vesicle invasion was 75% and 95%, respectively. For all men, erMRI evidence of a T3 lesion versus T2 was associated with an increased odds of having pT3 disease (adjusted odds ratio [AOR] 4.81, 95% confidence interval [CI] 1.36-16.98, P=.015) and pGS 8-10 (AOR 5.56, 95% CI 1.10-28.18, P=.038). In the favorable-risk population, these results were AOR 4.14 (95% CI 1.03-16.56), P=.045 and AOR 7.71 (95% CI 1.36-43.62), P=.021, respectively. Conclusions: Three-Tesla multiparametric erMRI in men with favorable-risk PC provides information beyond that contained in known preoperative predictors about the presence of occult extraprostatic and/or high-grade PC. If validated in additional studies, this information can be used to counsel men planning to undergo radical prostatectomy or radiation therapy about the possible need for adjuvant radiation therapy or the utility of adding hormone therapy, respectively.

  7. A Pilot Study of Potential Pre-operative Barriers to Couples’ Sexual Recovery after Radical Prostatectomy for Prostate Cancer

    Science.gov (United States)

    Wittmann, Daniela; Northouse, Laurel; Crossley, Heather; Miller, David; Dunn, Rodney; Nidetz, Jennifer; Montie, Jeanne; Moyad, Mia; Lavin, Katie; Montie, James E.

    2015-01-01

    Objective Prostate cancer affects couples’ sexual intimacy, but men rarely use recommended pro-erectile aids. Our mixed methods study aimed to identify couples’ pre-prostatectomy barriers to sexual recovery. Methods Interviews about anticipated sexual recovery were paired with surveys: the Dyadic Assessment Scale, Protective Buffering Scale, Expanded Prostate Index Composite, Sexual Experience Questionnaire (men), Female Sexual Function Index. Barriers were derived using Grounded Theory. Quantitative data triangulated qualitative findings. Results Heterosexual couples (28) participated. Men were 62, partners 58 years old on average. Pre-existing and diagnosis-related barriers included aging-related sexual dysfunction, inadequate sexual problemsolving skills, stressors, worry, avoidance of planning for sexual recovery, dislike of ‘assisted’ sex. Participants endorsed moderate/high marital satisfaction (Mean DAS: men=110.0, SD ±11.4, partners=114.1, SD±12.1) and communication (Mean PBS: men=24.5.2, SD±6.1, partners=25.1, SD±6.2). Men reported mild ED and incontinence (Mean EPIC: 76.6, SD±.21.5; 88.4, SD±18.2, respectively). Men’s couple sexual satisfaction was lowest (Mean SEX-Q: 60.1, SD±26.9). Mean Total FSFI was low (21.6, SD±7.8). Conclusions Heterosexual couples face prostatectomy-related sexual side-effects having experienced developmental sexual losses. Couples use avoidant strategies to defend against worry about cancer and anticipated prostatectomy-related sexual changes. These barriers are modifiable if couples can learn to cope with sexual losses and accept sexual rehabilitation strategies. PMID:24405053

  8. International Society of Urological Pathology (ISUP) Consensus Conference on Handling and Staging of Radical Prostatectomy Specimens. Working group 2: T2 substaging and prostate cancer volume.

    Science.gov (United States)

    van der Kwast, Theo H; Amin, Mahul B; Billis, Athanase; Epstein, Jonathan I; Griffiths, David; Humphrey, Peter A; Montironi, Rodolfo; Wheeler, Thomas M; Srigley, John R; Egevad, Lars; Delahunt, Brett

    2011-01-01

    The 2009 International Society of Urological Pathology consensus conference in Boston made recommendations regarding the standardization of pathology reporting of radical prostatectomy specimens. Issues relating to the substaging of pT2 prostate cancers according to the TNM 2002/2010 system, reporting of tumor size/volume and zonal location of prostate cancers were coordinated by working group 2. A survey circulated before the consensus conference demonstrated that 74% of the 157 participants considered pT2 substaging of prostate cancer to be of clinical and/or academic relevance. The survey also revealed a considerable variation in the frequency of reporting of pT2b substage prostate cancer, which was likely a consequence of the variable methodologies used to distinguish pT2a from pT2b tumors. Overview of the literature indicates that current pT2 substaging criteria lack clinical relevance and the majority (65.5%) of conference attendees wished to discontinue pT2 substaging. Therefore, the consensus was that reporting of pT2 substages should, at present, be optional. Several studies have shown that prostate cancer volume is significantly correlated with other clinicopathological features, including Gleason score and extraprostatic extension of tumor; however, most studies fail to demonstrate this to have prognostic significance on multivariate analysis. Consensus was reached with regard to the reporting of some quantitative measure of the volume of tumor in a prostatectomy specimen, without prescribing a specific methodology. Incorporation of the zonal and/or anterior location of the dominant/index tumor in the pathology report was accepted by most participants, but a formal definition of the identifying features of the dominant/index tumor remained undecided.

  9. Robot-assisted laparoscopic radical prostatectomy%机器人辅助腹腔镜前列腺癌根治术

    Institute of Scientific and Technical Information of China (English)

    沈周俊; 王先进

    2010-01-01

    @@ 前列腺癌是老年男性最常见的泌尿生殖系统恶性肿瘤之一,严重威胁着患者的生命健康和生活质量.前列腺癌的治疗方法包括随访观察、经尿道前列腺切除术(TURP)、根治性前列腺切除术、放射治疗、冷冻治疗、内分泌治疗、综合治疗等.根治性前列腺切除术目前仍然是治疗前列腺癌的最佳方法,主要包括开放性耻骨后前列腺癌根治术(retropubic radical pro-statectomy,RRP)、腹腔镜前列腺癌根治术(laparos-copic radical prostatectomy,LRP)、机器人辅助腹腔镜前列腺癌根治术(Robot-assisted laparoscopic radicalprostatectomy,RLRP)等.

  10. A pilot study of potential pre-operative barriers to couples' sexual recovery after radical prostatectomy for prostate cancer.

    Science.gov (United States)

    Wittmann, Daniela; Northouse, Laurel; Crossley, Heather; Miller, David; Dunn, Rodney; Nidetz, Jennifer; Montie, Jeanne; Moyad, Mia; Lavin, Katie; Montie, James E

    2015-01-01

    Prostate cancer affects couples' sexual intimacy, but men rarely use recommended proerectile aids. This mixed-methods study aimed to identify couples' preprostatectomy barriers to sexual recovery. Interviews about anticipated sexual recovery were paired with surveys: the Dyadic Assessment Scale, the Protective Buffering Scale, the Expanded Prostate Cancer Index Composite, the Sexual Experience Questionnaire (men), and the Female Sexual Function Index. Potential barriers were derived using Grounded Theory. Quantitative data triangulated qualitative findings. Heterosexual couples (N = 28) participated. Men's average age was 62 years and their partners' average age was 58 years. Preexisting and diagnosis-related barriers included aging-related sexual dysfunction, inadequate sexual problem-solving skills, stressors, worry, avoidance of planning for sexual recovery, and dislike of artificially assisted sex. Participants endorsed moderate/high marital satisfaction (DAS: for men, M = 110.0, SD = 11.4; for partners, M = 114.1, SD = 12.1) and communication (PBS: for men, M = 24.5.2, SD = 6.1; for partners, M = 25.1, SD ± 6.2). Men reported mild erectile dysfunction and incontinence (EPIC sexual function M = 76.6, SD = 21.5, urinary incontinence M = 88.4, SD = 18.2). Men's couple sexual satisfaction was lowest (Sexual Experience Questionnaire: M = 60.1, SD = 26.9). Mean total Female Sexual Function Index was low (M = 21.6, SD = 7.8). Heterosexual couples face prostatectomy-related sexual side-effects having experienced developmental sexual losses. Couples use avoidant strategies to defend against worry about cancer and anticipated prostatectomy-related sexual changes. These potential barriers are modifiable if couples can learn to cope with sexual losses and accept sexual rehabilitation strategies.

  11. Superior quality of life and improved surgical margins are achievable with robotic radical prostatectomy after a long learning curve: a prospective single-surgeon study of 1552 consecutive cases.

    Science.gov (United States)

    Thompson, James E; Egger, Sam; Böhm, Maret; Haynes, Anne-Maree; Matthews, Jayne; Rasiah, Krishan; Stricker, Phillip D

    2014-03-01

    Comparative studies suggest functional and perioperative superiority of robot-assisted radical prostatectomy (RARP) over open radical prostatectomy (ORP). To determine whether high-volume experienced open surgeons can improve their functional and oncologic outcomes with RARP and, if so, how many cases are required to surpass ORP outcomes and reach the learning curve plateau. A prospective observational study compared two surgical techniques: 1552 consecutive men underwent RARP (866) or ORP (686) at a single Australian hospital from 2006 to 2012, by one surgeon with 3000 prior ORPs. Demographic and clinicopathologic data were collected prospectively. The Expanded Prostate Cancer Index Composite quality of life (QoL) questionnaire was administered at baseline, 1.5, 3, 6, 12, and 24 mo. Multivariate linear and logistic regression modelled the difference in QoL domains and positive surgical margin (PSM) odds ratio (OR), respectively, against case number. A total of 1511 men were included in the PSM and 609 in the QoL analysis. RARP sexual function scores surpassed ORP scores after 99 RARPs and increased to a mean difference at 861st case of 11.0 points (95% confidence interval [CI], 5.9-16.1), plateauing around 600-700 RARPs. Early urinary incontinence scores for RARP surpassed ORP after 182 RARPs and increased to a mean difference of 8.4 points (95% CI, 2.1-14.7), plateauing around 700-800 RARPs. The odds of a pT2 PSM were initially higher for RARP but became lower after 108 RARPs and were 55% lower (OR: 0.45; 95% CI, 0.22-0.92) by the 866th RARP. The odds of a pT3/4 PSM were initially higher for RARP but decreased, plateauing around 200-300 RARPs with an OR of 1.15 (0.68-1.95) at the 866th RARP. Limitations include single-surgeon data and residual confounding. RARP had a long learning curve with inferior outcomes initially, and then showed progressively superior sexual, early urinary, and pT2 PSM outcomes and similar pT3 PSM and late urinary outcomes. Learning RARP

  12. Importance of prostate-specific antigen (PSA as a predictive factor for concordance between the Gleason scores of prostate biopsies and RADICAL prostatectomy specimens

    Directory of Open Access Journals (Sweden)

    Nelson Gianni de Lima

    2013-06-01

    Full Text Available OBJECTIVE: To evaluate the concordance between the Gleason scores of prostate biopsies and radical prostatectomy specimens, thereby highlighting the importance of the prostate-specific antigen (PSA level as a predictive factor of concordance. METHODS: We retrospectively analyzed 253 radical prostatectomy cases performed between 2006 and 2011. The patients were divided into 4 groups for the data analysis and dichotomized according to the preoperative PSA, <10 ng/mL and ≥10 ng/mL. A p-score <0.05 was considered significant. RESULTS: The average patient age was 63.3±7.8 years. The median PSA level was 9.3±4.9 ng/mL. The overall concordance between the Gleason scores was 52%. Patients presented preoperative PSA levels <10 ng/mL in 153 of 235 cases (65% and ≥10 ng/mL in 82 of 235 cases (35%. The Gleason scores were identical in 86 of 153 cases (56% in the <10 ng/mL group and 36 of 82 (44% cases in the ≥10 ng/mL group (p = 0.017. The biopsy underestimated the Gleason score in 45 (30% patients in the <10 ng/mL group and 38 (46% patients in the ≥10 ng/mL (p = 0.243. Specifically, the patients with Gleason 3 + 3 scores according to the biopsies demonstrated global concordance in 56 of 110 cases (51%. In this group, the patients with preoperative PSA levels <10 ng/dL had higher concordance than those with preoperative PSA levels ≥10 ng/dL (61% x 23%, p = 0.023, which resulted in 77% upgrading after surgery in those patients with PSA levels ≥10 ng/dl. CONCLUSION: The Gleason scores of needle prostate biopsies and those of the surgical specimens were concordant in approximately half of the global sample. The preoperative PSA level was a strong predictor of discrepancy and might improve the identification of those patients who tended to be upgraded after surgery, particularly in patients with Gleason scores of 3 + 3 in the prostate biopsy and preoperative PSA levels ≥10 ng/mL.

  13. Decipher test impacts decision making among patients considering adjuvant and salvage treatment after radical prostatectomy: Interim results from the Multicenter Prospective PRO-IMPACT study.

    Science.gov (United States)

    Gore, John L; du Plessis, Marguerite; Santiago-Jiménez, María; Yousefi, Kasra; Thompson, Darby J S; Karsh, Lawrence; Lane, Brian R; Franks, Michael; Chen, David Y T; Bandyk, Mark; Bianco, Fernando J; Brown, Gordon; Clark, William; Kibel, Adam S; Kim, Hyung L; Lowrance, William; Manoharan, Murugesan; Maroni, Paul; Perrapato, Scott; Sieber, Paul; Trabulsi, Edouard J; Waterhouse, Robert; Davicioni, Elai; Lotan, Yair; Lin, Daniel W

    2017-08-01

    Patients with prostate cancer and their providers face uncertainty as they consider adjuvant radiotherapy (ART) or salvage radiotherapy (SRT) after undergoing radical prostatectomy. The authors prospectively evaluated the impact of the Decipher test, which predicts metastasis risk after radical prostatectomy, on decision making for ART and SRT. A total of 150 patients who were considering ART and 115 who were considering SRT were enrolled. Providers submitted a management recommendation before processing the Decipher test and again at the time of receipt of the test results. Patients completed validated surveys on prostate cancer (PCa)-specific decisional effectiveness and PCa-related anxiety. Before the Decipher test, observation was recommended for 89% of patients considering ART and 58% of patients considering SRT. After Decipher testing, 18% (95% confidence interval [95% CI], 12%-25%) of treatment recommendations changed in the ART arm, including 31% among high-risk patients; and 32% (95% CI, 24%-42%) of management recommendations changed in the salvage arm, including 56% among high-risk patients. Decisional Conflict Scale (DCS) scores were better after viewing Decipher test results (ART arm: median DCS before Decipher, 25 and after Decipher, 19 [P<.001]; SRT arm: median DCS before Decipher, 27 and after Decipher, 23 [P<.001]). PCa-specific anxiety changed after Decipher testing; fear of PCa disease recurrence in the ART arm (P = .02) and PCa-specific anxiety in the SRT arm (P = .05) decreased significantly among low-risk patients. Decipher results reported per 5% increase in 5-year metastasis probability were associated with the decision to pursue ART (odds ratio, 1.48; 95% CI, 1.19-1.85) and SRT (odds ratio, 1.41; 95% CI, 1.09-1.81) in multivariable logistic regression analysis. Knowledge of Decipher test results was associated with treatment decision making and improved decisional effectiveness among men with PCa who were considering ART and SRT. Cancer 2017

  14. The CPC Risk Calculator: A New App to Predict Prostate-specific Antigen Recurrence During Follow-up After Radical Prostatectomy.

    Science.gov (United States)

    Røder, Martin Andreas; Berg, Kasper Drimer; Loft, Mathias Dyrberg; Thomsen, Frederik Birkebæk; Ferrari, Michelle; Kurbegovic, Sorel; Rytgaard, Helene Charlotte; Gruschy, Lisa; Brasso, Klaus; Gerds, Thomas Alexander; Kjær, Andreas; Brooks, James D; Iversen, Peter

    2016-12-09

    It can be challenging to predict the risk of biochemical recurrence (BR) during follow-up after radical prostatectomy (RP) in men who have undetectable prostate-specific antigen (PSA), even years after surgery. To establish and validate a contemporary nomogram that predicts the absolute risk of BR every year after RP in men with undetectable PSA while accounting for competing risks of death. A total of 3746 patients from Rigshospitalet (Copenhagen, Denmark) and Stanford Urology (Stanford, CA, USA) who underwent RP between 1995 and 2013 were included. Time to BR was defined as the first PSA result ≥0.2 ng/ml. BR risk was computed using multiple cause-specific Cox regression including preoperative PSA, pT category, RP Gleason score (GS), and surgical margin (R) status. Death without BR was considered a competing event. The nomogram presents the future risk of BR for a man who is alive and without BR at the time of follow-up. Validation assessed the discrimination and accuracy using time-dependent area under the curve and Brier scores. The nomogram predicts risk of BR up to 12 yr after RP at an individual level. As example, the risk of BR for a man with pT3a, R-, GS 3 + 4, and preoperative PSA ≤10 ng/ml followed for 5 yr with undetectable PSA is 18% for the next 5 yr. External validation demonstrated both high accuracy and discrimination. The CPC Risk Calculator is available as a free Android and iOS App. Declining discrimination and accuracy after 7 yr of follow-up is the main limitation. This nomogram can be used as a tool to inform men with undetectable PSA during follow-up after RP about their future risk of BR, and may aid in decisions on the necessity for further follow-up. The nomogram is the first to be available as a free app. We developed an easily interpretable nomogram to evaluate the risk of prostate-specific antigen elevation (cancer recurrence) following complete removal of the prostate (radical prostatectomy). The tool can aid both physicians and

  15. Intrafascial endoscopic extraperitoneal radical prostatectomy%筋膜内切除法在腹腔镜下前列腺癌根治术中的应用

    Institute of Scientific and Technical Information of China (English)

    徐亚文; 刘春晓; 郑少波; 李虎林; 方平; 徐啊白; 陈玢屾; 郭凯; 申海燕

    2010-01-01

    目的 探讨筋膜内切除法在腹腔镜下根治性前列腺切除术中的应用.方法 前列腺癌患者23例,平均年龄65岁.术前PSA 4.5~8.6(6.25 ±2.1)ng/ml;临床分期T1 16例、T2 7例;活检组织Gleason评分:5分3例、6分11例、7分9例.有性生活者18例.行腹腔镜下根治性前列腺切除术.不打开盆内筋膜,自前列腺基底部沿前部正中线纵形切开前列腺筋膜,贴前列腺包囊分离前列腺前面、两侧、尖部.保留神经血管束.保护前列腺尖尿道相连处括约肌.结果 23例手术顺利.平均手术时间125(110~170)min.出血量320~1500(550±210)ml,输血3例.平均留置尿管12(9~15)d.术后随访12个月,完全尿控20例(87%).有轻微压力性尿失禁3例(13%).18例术前有性生活的患者能充分勃起完成性交13例(72%).随访期间出现生化复发2例(9%).结论 腹腔镜下筋膜内切除法剥离前列腺对前列腺周围筋膜、附着于筋膜的神经血管束以及尿道外括约肌损伤小.手术方法可行.%Objective To discuss the treatment efficacy of intrafascial endoscopic extraperitoneal radical prostatectomy(EERPE)in prostate cancer patients. Methods The operation was performed in 23 prostate cancer patients.The mean age was 65 years old.Preoperative prostate-specific antigen(PSA)level was 4.5-8.6(6.2±2.1)ng/ml,and patients distribution as Gleason Score 5 in 3 cases,Gleason Score 6 in 11 cases and Gleason Score 7 in 9 cases.Eighteen patients had preoperative potency.The technique was to keep the endopelvic fascia intact.The prostatic fascia was incised anterior medially from the base of the prostate.And the dissection plane was directly on the prostatic capsule.The bilateral and apex prostate fascia were stripped though this plane without inure the neurovascular bundle and external sphincter.All the 23 patients were followed up for 1 2 months. Results The mean operative time was 125 min(range:110-170 min).Hemorrhage was 320-1500(550±210)ml

  16. Variation of prostate-specific antigen expression in different tumour growth patterns present in prostatectomy specimens

    NARCIS (Netherlands)

    M.P.W. Gallee; E. Visser-de Jong (E.); J.A.G.M. van der Korput (J. A G M); Th.H. van der Kwast (Theo); F.J.W. ten Kate (Fiebo); F.H. Schröder (Fritz); J. Trapman (Jan)

    1990-01-01

    textabstractA series of 55 randomly chosen radical prostatectomy specimens was analyzed for expression of prostate-specific antigen (PSA) by immunohistochemical techniques. Tissue sections were selected in such a manner that in addition to glandular benign prostatic hyperplasia (BPH), one or more di

  17. Analysis of urinary continence skills in 80 cases of retro-pubic radical prostatectomy%尿控技术用于经耻骨后前列腺癌根治术80例分析

    Institute of Scientific and Technical Information of China (English)

    马合苏提; 靳宏勇; 白强

    2013-01-01

      目的探索保留尿道括约肌手术技巧在前列腺癌根治术中的应用效果.方法本组80例前列腺癌患者,年龄66岁(范围59~75岁);79例前列腺肿瘤限于T2b期以内,1例T3期;78例因PSA升高行术前经直肠超声波(TRUS)引导下的前列腺穿刺活检,Gleason分级3~7分,另2例为TURP后偶发癌;PSA平均8.5ng/ml(范围2.7~44.5 ng/ml).手术前均无尿失禁情况.手术技巧:处理阴茎背深静脉丛采用集束“8”字缝扎;处理前列腺尖部时紧贴前列腺表面分离,并保留前列腺部尿道0.5~1cm;保留膀胱颈部.结果手术后随访12~48个月,18例生化复发,6例尿失禁.结论尿道外括约肌的保留能够减少前列腺癌根治术后尿失禁的发生.%Objective To investigate the effects of sphincter-preserving technique in retro-pubic radical prostatectomy on post-operative urinary continence. Methods Total of 80 patients with prostate cancer were recruited in this study. Their average age was 66 (range from 59 to 75) years and their clinical stage were all within T2b except 1 case in T3. Seventy-eight patients with abnormal PSA values underwent TRUS biopsies, and their Gleason scores ranged from 3 to 7, other 2 patients with normal PSA value were diagnosed as PCa after TURP;Mean PSA value was 8.5ng/ml(range from 2.7 to 44.5 ng/ml).No urinary incontinence was found pre-operatively for all the patients. Operative skills:“Bunching technique”was used in management of dorsal vein complex;Careful dissection was done by sharp dissection closely to the surface of the apex of the prostate and about 0.5 to 1 cm of urethra within the apex was preserved; Preservation of the bladder neck. Results All the patients were followed up 12 to 48 months after prostatectomy. Biochemical recurrence was found in 18 patients and urinary incontinence in 6 patients. Conclusion External urinary sphincter preserving technique in radical retro-pubic prostatectomy can decrease the rate of post

  18. Efeito do treinamento funcional do assoalho pélvico associado ou não à eletroestimulação na incontinência urinária após prostatectomia radical Effect of functional training for the pelvic floor muscles with or without electrical stimulation in cases of urinary incontinence following radical prostatectomy

    Directory of Open Access Journals (Sweden)

    CT Kakihara

    2007-12-01

    radical prostatectomy is scarce, with descriptions of differing techniques for physical therapy treatment. OBJECTIVE: To evaluate the effect of physical therapy treatment for recovering urinary continence among patients who had undergone radical prostatectomy, by using functional training of the pelvic floor muscles with or without electrical stimulation. METHOD: Twenty patients with urinary incontinence following radical prostatectomy were selected. The patients were randomly allocated to a control or to an experimental group. The experimental group was composed of ten patients who received physical therapy treatment consisting of functional training of the pelvic floor muscles and electrical stimulation. The control group was composed of ten patients who received physical therapy treatment consisting only of functional training of the pelvic floor. All of the patients were reevaluated three, six and twelve months after beginning treatment, by using the pad test, visual analog scale (VAS for incontinence, VAS for the problem and counting the number of diapers (nappies used. RESULTS: There was a statistically significant decrease between the initial and 12th month evaluations of the pad test, VAS for incontinence, VAS for the problem and numbers of diapers of the control group and experimental group. However, no statistically significant difference was found when the same variable was compared between the two groups. CONCLUSION: There was no additional improvement from treatment with functional training of the pelvic floor muscles associated with electrical stimulation, in relation to treatment only using functional pelvic floor training. However, there was a significant improvement in urinary incontinence in both groups.

  19. Prostatectomía radical laparoscópica: primeros dos casos realizados por urólogos costarricenses Laparoscopic Radical Prostatectomy: First Two Cases Performed by Costa Rican Urologists

    Directory of Open Access Journals (Sweden)

    Roy López-Arias

    2010-12-01

    Full Text Available Se reportan los primeros dos casos de prostatectomía radical laparoscópica (PRL realizada por urólogos costarricenses. La PRL se realizó con colocación de 4 trócares luego de poner la cámara en cicatriz umbilical. El tiempo operatorio total fue de 240 y 205 minutos, la pérdida de sangre estimada fue de 150 y 100 ml respectivamente. Se extrajeron las próstatas con vesículas seminales por una incisión umbilical de 3 cm. Un dreno cerrado con succión se externalizó por una de las incisiones de los trócares de 5mm. No hubo complicaciones trans ni post operatorias. La estadia hospitalaria post operatoria fue de 3 y 2 días, el dreno se retiró al tercer y segundo día post operado y las sondas Foley se retiraron a los 14 días. Las próstatas pesaron 27 y 23 gramos, los puntajes Gleason fueron de (3+4 y (3+3 ambos tuvieron márgenes negativos, sin infiltración vascular ni nerviosa. La PRL es un procedimiento mínimamente invasivo para hombres con cáncer de próstata órgano confinado realizable, seguro y reproducible. Con mejor resultado cosmético y menor dolor posoperatorio.We herein report the first two cases of laparoscopic radical prostatectomy (LRP performed by Costarican Urologists. Two 50 and 64-year-old patients respectively, with an adenocarcinoma of the prostate with Gleason scores (3+ 3 6, diagnosed trough transrectal ultrasonografic guided biopsies, indicated by an elevation of the prostate specific antigen (PSA or abnormal rectal digital examination (DRE. The LRP was performed transperitonealy with Montsouris technique using standard laparoscopy instruments and high definition laparoscopic video tower. After placing a 10mm camera port through the umbilicus, the procedure was accomplished with 4 trocars. The entire operative time was 240 and 205 minutes, whereas the blood loss was 150 and 100 ml respectively. The extraction of the specimens with seminal vesicles was through a 3 cm. umbilical incision. A closed drainage

  20. Both radical prostatectomy following treatment with neoadjuvant LHRH agonist and estramustine and radiotherapy following treatment with neoadjuvant hormonal therapy achieved favorable oncological outcome in high-risk prostate cancer: a propensity-score matching analysis.

    Science.gov (United States)

    Koie, Takuya; Ohyama, Chikara; Yamamoto, Hayato; Imai, Atsushi; Hatakeyama, Shingo; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Yoneyama, Tohru; Tobisawa, Yuki; Aoki, Masahiko; Takai, Yoshihiro

    2014-04-30

    To date, the different treatment modalities for high-risk prostate cancer (Pca) have not been compared in any sufficiently large-scale, prospective, randomized clinical trial. We used propensity-score matching analysis to compare the oncological outcomes of high-risk prostate cancer between patients treated with radical prostatectomy (RP) and those treated with radiation therapy (RT). We studied 216 patients who received neoadjuvant therapy followed by RP (RP cohort) and 81 patients who received neoadjuvant androgen-deprivation therapy (ADT) followed by RT (RT cohort). The RP cohort received a luteinizing hormone-releasing hormone agonist and estramustine phosphate (280 mg/day) for 6 months prior to RP. The RT cohort received ADT for at least 6 months prior to RT using a 3-dimensional conformal radiotherapy technique. The total radiation dose was 70 to 76 Gy administered at 2 Gy/fraction. Propensity-score matching identified 78 matched pairs of patients. The 3-year overall survival rates were 98.3% and 92.1% in the RP and RT groups, respectively (P=0.156). The 3-year biochemical recurrence-free survival rates were 86.4% and 89.4% in the RP and RT groups, respectively (P=0.878). Our study findings may suggest almost identical cancer control of RP and RT with appropriate neoadjuvant therapy in high-risk Pca. Therefore, issues of health-related quality of life may have an important impact on decision making in treatment of high-risk Pca.

  1. Relationship between metalloprotease expression in tumour and stromal cells and aggressive behaviour in prostate carcinoma: Simultaneous high-throughput study of multiple metalloproteases and their inhibitors using tissue array analysis of radical prostatectomy samples.

    Science.gov (United States)

    Fernandez-Gomez, Jesus; Escaf, Safwan; Gonzalez, Luis-Ovidio; Suarez, Aurelio; Gonzalez-Reyes, Salome; González, Jose; Miranda, Oscar; Vizoso, Francisco

    2011-04-01

    The aim of this study was to detect a potential association between clinicopathological factors of prostate cancer aggressiveness and the expression of matrix metalloproteases and their inhibitors in tumour and stromal cells. A tissue array technique and immunochemistry with specific antibodies against matrix metalloproteinases (MMPs)-1, 2, 7, 9, 11, 13, 14, and their tissue inhibitors (TIMPs)-1, 2 and 3 were used to analyse the surgical specimens of 133 patients treated by radical prostatectomy. For each antibody preparation, the cellular location of immunoreactivity was determined. The expression of MMP-2 was negatively associated with high tumour grade. With regard to stromal fibroblasts, TIMP-3 expression was positively associated with histological grade. MMP-7 expression was negatively associated with pretreatment serum levels of PSA, whereas MMP-13 was positively associated with higher levels of the antigen. TIMP-2 expression by mononuclear inflammatory cells correlated significantly and negatively with tumour grade. The expression of TIMP-3 by fibroblasts was associated with a higher Gleason score. An increased expression of MMP-13 by fibroblasts was associated with a greater preoperative level of PSA. In contrast, MMP-2 expression by tumour as well as TIMP-2 expression by peritumoral inflammatory cells was associated with less aggressive prostate carcinoma characteristics.

  2. The interplay of dyadic and individual planning of pelvic-floor exercise in prostate-cancer patients following radical prostatectomy.

    Science.gov (United States)

    Burkert, Silke; Knoll, Nina; Luszczynska, Aleksandra; Gralla, Oliver

    2012-06-01

    This study broadens the current understanding of the role of planning by focusing on the interplay between individual and dyadic planning (i.e. making plans about the target person's behaviour together with a partner). Self-report data from N=141 prostatectomy-patients and their partners were assessed at three times within 1 year post-surgery. Direct and indirect effects of dyadic and individual planning on patients' pelvic-floor exercise (PFE) were tested. Proposed mediators were social support, social control, and action control. Cross-sectionally, the dyadic planning-PFE relationship was mediated by patients' received support and partners' provided social control. Longitudinally, mediators of dyadic planning were partners' provided social control and support. Effects of individual planning on PFE were mediated by action control at baseline only. Also, at lower levels of individual planning, patients' dyadic planning was more strongly associated with receipt of social control. Results underscore the importance of social factors in the planning process and its mechanisms in health-behaviour change.

  3. Lack of prognostic significance of p16 and p27 after radical prostatectomy in hormone-naïve prostate cancer

    Directory of Open Access Journals (Sweden)

    Vlachostergios Panagiotis J

    2012-01-01

    Full Text Available Abstract Background Loss of normal cell cycle control is an early event in the evolution of cancer. The expression of cyclin-dependent kinase (CDK inhibitors p16 and p27 has been previously associated with progression of prostate cancer (PC. 70 patients diagnosed with early stage PCwere treated with radical prostatectomy (RP at our institution and their tumor specimens were immunohistochemically evaluated for expression of p16 and p27. Available clinical data of time to PSA recurrence were correlated with the examined parameters and combined with pre-operative PSA level, Gleason score and pathological TNM (pT stage assessment. Results Nuclear overexpression of p16 was not associated with time to biochemical failure (BF (p = 0.572. Same was the case for nuclear p27 overexpression (p = 1.000. Also, no significant correlations were found between either p16 or p27, and pre-operative PSA level, pT stage and Gleason grade. pT stage emerged as the only independent prognostic factor for biochemical recurrence (p = 0.01. Conclusions These data question previously reported data supporting the prognostic relevance of both p16 and p27 proteins in early PC.

  4. Health-related quality of life using SF-8 and EPIC questionnaires after treatment with radical retropubic prostatectomy and permanent prostate brachytherapy.

    Science.gov (United States)

    Hashine, Katsuyoshi; Kusuhara, Yoshito; Miura, Noriyoshi; Shirato, Akitomi; Sumiyoshi, Yoshiteru; Kataoka, Masaaki

    2009-08-01

    The health-related quality of life (HRQOL) after treatment of prostate cancer is examined using a new HRQOL tool. HRQOL, based on the expanded prostate cancer index composite (EPIC) and SF-8 questionnaires, was prospectively compared after either a radical retropubic prostatectomy (RRP) or a permanent prostate brachytherapy (PPB) at a single institute. Between October 2005 and June 2007, 96 patients were treated by an RRP and 88 patients were treated by a PPB. A HRQOL survey was completed at baseline, and at 1, 3, 6 and 12 months after treatment, prospectively. The general HRQOL in the RRP and PPB groups was not different after 3 months. However, at baseline and 1 month after treatment, the mental component summary was significantly better in the PPB group than in the RRP group. Moreover, the disease-specific HRQOL was worse regarding urinary and sexual functions in the RRP group. Urinary irritative/obstructive was worse in the PPB group, but urinary incontinence was worse in the RRP group and had not recovered to baseline after 12 months. The bowel function and bother were worse in the PPB group than in the RRP group after 3 months. In the RRP group, the patients with nerve sparing demonstrated the same scores in sexual function as the PPB group. This prospective study revealed the differences in the HRQOL after an RRP and PPB. Disease-specific HRQOL is clarified by using EPIC survey. These results will be helpful for making treatment decisions.

  5. A prospective longitudinal study comparing a radical retropubic prostatectomy and permanent prostate brachytherapy regarding the health-related quality of life for localized prostate cancer.

    Science.gov (United States)

    Hashine, Katsuyoshi; Kusuhara, Yoshito; Miura, Noriyoshi; Shirato, Akitomi; Sumiyoshi, Yoshiteru; Kataoka, Masaaki

    2008-07-01

    The health-related quality of life (HRQOL) after a radical retropubic prostatectomy (RRP) or a permanent prostate brachytherapy (PPB) was prospectively compared at a single institute. Between 2003 and 2005, 122 patients were treated by RRP and 82 patients were treated by PPB. A QOL survey was completed at baseline, and 1, 3, 6 and 12 months after treatment, prospectively. The general HRQOL was not different between the RRP and PPB groups after 3 months. However, at 1 month after treatment, the general HRQOL scores, except for general health, were significantly better in the PPB group than that in the RRP group. Moreover, the disease-specific QOL was worse in urinary and sexual functions in the RRP group. Urinary function in the RRP group had not recovered to baseline after 12 months. Although the urinary function in the PPB group was better than that of the RRP group, urinary bother continued to worsen until 6 months and thereafter it recovered gradually. The bowel function was not worse in the PPB group but bowel bother was worse at 6 months in the PPB group. In the RRP group, the patients with nerve sparing demonstrated better in sexual function than those without nerve sparing, but the recovery did not reach the level of the PPB group. This prospective study revealed the differences in the QOL after RRP and PPB. These results will be helpful for making treatment decisions.

  6. Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome.

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    Tillier, C; van Muilekom, H A M; Bloos-van der Hulst, J; Grivas, N; van der Poel, H G

    2017-01-12

    The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

  7. Delivery of human mesenchymal adipose-derived stem cells restores multiple urological dysfunctions in a rat model mimicking radical prostatectomy damages through tissue-specific paracrine mechanisms.

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    Yiou, René; Mahrouf-Yorgov, Meriem; Trébeau, Céline; Zanaty, Marc; Lecointe, Cécile; Souktani, Richard; Zadigue, Patricia; Figeac, Florence; Rodriguez, Anne-Marie

    2016-02-01

    Urinary incontinence (UI) and erectile dysfunction (ED) are the most common functional urological disorders and the main sequels of radical prostatectomy (RP) for prostate cancer. Mesenchymal stem cell (MSC) therapy holds promise for repairing tissue damage due to RP. Because animal studies accurately replicating post-RP clinical UI and ED are lacking, little is known about the mechanisms underlying the urological benefits of MSC in this setting. To determine whether and by which mechanisms MSC can repair damages to both striated urethral sphincter (SUS) and penis in the same animal, we delivered human multipotent adipose stem cells, used as MSC model, in an immunocompetent rat model replicating post-RP UI and ED. In this model, we demonstrated by using noninvasive methods in the same animal from day 7 to day 90 post-RP injury that MSC administration into both the SUS and the penis significantly improved urinary continence and erectile function. The regenerative effects of MSC therapy were not due to transdifferentiation and robust engraftment at injection sites. Rather, our results suggest that MSC benefits in both target organs may involve a paracrine process with not only soluble factor release by the MSC but also activation of the recipient's secretome. These two effects of MSC varied across target tissues and damaged-cell types. In conclusion, our work provides new insights into the regenerative properties of MSC and supports the ability of MSC from a single source to repair multiple types of damage, such as those seen after RP, in the same individual.

  8. Time to biochemical recurrence after radical prostatectomy is an important predictor of clinical progression, distant metastases and cancer-specific death

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    E. I. Veliev

    2014-01-01

    Full Text Available Prostate-specific antigen is a sensitive marker for recurrent prostate cancer (PC after radical prostatectomy (RPE, which can predict thedevelopment of clinical progression and distant metastases well long before they occur. The objective of the investigation was to analyze the relationship of the time to biochemical recurrence (BCR after RPE to the development of clinical progression, distant metastases, and PC death. The vast majority (80.5 % of BCRs was common within the first 2 years after RPE and the recurrence was attended by the highest rate of clinical progression, metastases, and PC death during the first year. Correlation analysis shows that there is a statistically significant inverse correlation between the time to BCR following RPE with the development of clinical progression (rs = -0.43; p < 0.001, metastases (rs = -0.46; p < 0.001, and PC death (rs = -0.41; p < 0.001. Regardless of the time to recurrence, none of 27 patients with favorable histological characteristics (a total of post-RPE Gleason scores of ≤ 6, organ-confined disease, and a negative surgical margin developed distant metastases; only one case had a local tumor recurrence.

  9. Predictive value of PSA velocity over early clinical and pathological parameters in patients with localized prostate cancer who undergo radical retropubic prostatectomy

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    Martinez Carlos A.L.

    2004-01-01

    Full Text Available OBJECTIVES: To analyze the behavior of the prostate specific antigen velocity (PSAV in localized prostate adenocarcinoma. MATERIALS AND METHODS: We conducted a retrospective study of 500 men who had localized prostate adenocarcinoma, who underwent radical retropubic prostatectomy between January 1986 and December 1999. The PSAV was calculated for each patient and subsequently, the values were correlated with 5 groups: age, initial PSA value, clinical stage, tumor volume and Gleason score. RESULTS: The behavior of PSAV presented statistic significance with an increment between 1.3 ng/mL and 9.6 ng/mL, ranging from 38.6% and 59.8% when compared with the initial PSA value (p < 0.0001, clinical stage (p = 0.0002, tumor volume (p < 0.0001 and Gleason score (p = 0.0009. CONCLUSION: PSAV up to 2.5 ng/mL/year is associated with factors of good prognosis, such as initial PSA below 10 mg/mL, clinical stage T1, tumor volume below 20% and Gleason score lower than 7.

  10. Correlation between the preoperative serum prostate specific antigen, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy: An Indian experience

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    P Singh

    2011-01-01

    Full Text Available Objectives: To correlate the preoperative serum prostate specific antigen (PSA, Gleason score, and clinical staging with pathological outcome following robot-assisted radical prostatectomy (RARP in Indian men with clinically localized cancer prostate. Materials and Methods: A prospective study analysis was done for 166 consecutive patients of prostate cancer who underwent RARP at our center from June 2006 to October 2009. Preoperative workup included serum PSA, biopsy Gleason score, and clinical staging. The preoperative parameters were correlated with final Gleason score, capsular penetration, seminal vesicle involvement, and lymph node status on final histopathology. Results: The mean age was 64 years (range: 50-76 years with mean and median PSA of 17.98 ng/ml (range: 0.3-68.3 ng/ml and 12.1 ng/ml, respectively. With increase in preoperative Gleason score, chance of organ confinement decreases (P=0.002 and capsular penetration increases (P=0.004 linearly. With increasing serum PSA, there is linear decrease in trend of organ-confined disease (P=0.03 and increased chances of seminal vesicle involvement (P=0.02. Patients with higher clinical stage have less probability of localized disease (P=0.007 and more chances of capsular penetration (P=0.04 and seminal vesicle involvement (P=0.004. Conclusion: Our data suggest that patients with higher preoperative serum PSA, Gleason score, and clinical stage have more chances of advanced pathological stage following RARP.

  11. Exploring Prostate Cancer Genome Reveals Simultaneous Losses of PTEN, FAS and PAPSS2 in Patients with PSA Recurrence after Radical Prostatectomy

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    Chinyere Ibeawuchi

    2015-02-01

    Full Text Available The multifocal nature of prostate cancer (PCa creates a challenge to patients’ outcome prediction and their clinical management. An approach that scrutinizes every cancer focus is needed in order to generate a comprehensive evaluation of the disease, and by correlating to patients’ clinico-pathological information, specific prognostic biomarker can be identified. Our study utilized the Affymetrix SNP 6.0 Genome-wide assay to investigate forty-three fresh frozen PCa tissue foci from twenty-three patients. With a long clinical follow-up period that ranged from 2.0–9.7 (mean 5.4 years, copy number variation (CNV data was evaluated for association with patients’ PSA status during follow-up. From our results, the loss of unique genes on 10q23.31 and 10q23.2–10q23.31 were identified to be significantly associated to PSA recurrence (p < 0.05. The implication of PTEN and FAS loss (10q23.31 support previous reports due to their critical roles in prostate carcinogenesis. Furthermore, we hypothesize that the PAPSS2 gene (10q23.2–10q23.31 may be functionally relevant in post-operative PSA recurrence because of its reported role in androgen biosynthesis. It is suggestive that the loss of the susceptible region on chromosome 10q, which implicates PTEN, FAS and PAPSS2 may serve as genetic predictors of PSA recurrence after radical prostatectomy.

  12. Long-term oncological outcomes in patients with limited nodal disease undergoing radical prostatectomy and pelvic lymph node dissection without adjuvant treatment.

    Science.gov (United States)

    Mandel, Philipp; Rosenbaum, Clemens; Pompe, Raisa S; Steuber, Thomas; Salomon, Georg; Chun, Felix K; Graefen, Markus; Huland, Hartwig; Tilki, Derya

    2017-08-21

    This study aimed at analysing long-term oncologic outcomes in prostate cancer patients with limited nodal disease (1-2 positive lymph nodes) without adjuvant therapy after radical prostatectomy (RP). We retrospectively analysed data of 209 pN1 patients who underwent RP between January 1998 and 2010 with one (160) or two (49) histologically proven positive lymph nodes (LNs) without adjuvant treatment. Biochemical recurrence-free survival, metastasis-free survival and cancer-specific survival (CSS) were reported. In multivariable regression analyses further prognosticators of oncologic outcome in these patients were analysed. Median follow-up was 60.2 months. There was no significant difference in oncologic outcome between patients with one and two positive LNs. 73.1% (76.7%) of patients with one (two) positive LNs had biochemical recurrence during the follow-up period, 20.0% (25.6%) developed metastasis and 8.1% (6.1%) died of their disease. The only factors significantly associated with oncologic outcome in multivariable analysis were Gleason score and pT-stage. Patients with limited nodal disease (1-2 positive LNs) without adjuvant therapy showed favourable CSS-rates above 94% after 5 years. A subgroup of these patients (37%) remained metastasis-free without need of salvage treatment.

  13. 2D and 3D T2-weighted MR sequences for the assessment of neurovascular bundle changes after nerve-sparing radical retropubic prostatectomy with erectile function correlation

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    Panebianco, Valeria; Osimani, Marcello; Lisi, Danilo; Passariello, Roberto [University of Rome ' ' Sapienza' ' -Policlinico Umberto I, Department of Radiological Sciences, Rome (Italy); Sciarra, Alessandro; Ciccariello, Mauro; Salciccia, Stefano; Gentile, Vincenzo; Di Silverio, Franco [University of Rome ' ' Sapienza' ' -Policlinico Umberto I, Department of Urology, Rome (Italy)

    2009-01-15

    The aim of this study was to assess the capability of a 3D isotropic MRI T2-weighted sequence (3D T2 ISO) in the depiction of changes of neurovascular bundles (NVBs) after bilateral nerve-sparing radical retropubic prostatectomy (RRP). Furthermore, our aim was also to introduce a new MRI classification score of the NVB alteration patterns using the International Index Erectile Function Five-Item (IIEF-5) score as standard of reference. Fifty-three consecutive patients were postoperatively submitted to two MR examinations, including both 2D TSE T2-weighted (2D T2) and 3D T2 ISO sequences. Image findings were scored using a relative five-point classification and correlated with the postoperative IIEF-5 score. Radiologists attributed 13.2% of patients to class 0, 11.3% to class I, 34% to class II, 24.5% to class III, and 16.9% to class IV. With 3D T2 ISO images, the same radiologists determined 43.3% class 0, 32% class I, 11.4% class II, 7.5% class III, and 5.7% class IV. In all cases, the correlation and regression analysis between the 3D T2 ISO and IIEF-5 score resulted in higher coefficients values. The 3D sequence correlated most closely with patients' grading of erectile function. (orig.)

  14. 2D and 3D T2-weighted MR sequences for the assessment of neurovascular bundle changes after nerve-sparing radical retropubic prostatectomy with erectile function correlation.

    Science.gov (United States)

    Panebianco, Valeria; Sciarra, Alessandro; Osimani, Marcello; Lisi, Danilo; Ciccariello, Mauro; Salciccia, Stefano; Gentile, Vincenzo; Di Silverio, Franco; Passariello, Roberto

    2009-01-01

    The aim of this study was to assess the capability of a 3D isotropic MRI T2-weighted sequence (3D T2 ISO) in the depiction of changes of neurovascular bundles (NVBs) after bilateral nerve-sparing radical retropubic prostatectomy (RRP). Furthermore, our aim was also to introduce a new MRI classification score of the NVB alteration patterns using the International Index Erectile Function Five-Item (IIEF-5) score as standard of reference. Fifty-three consecutive patients were postoperatively submitted to two MR examinations, including both 2D TSE T2-weighted (2D T2) and 3D T2 ISO sequences. Image findings were scored using a relative five-point classification and correlated with the postoperative IIEF-5 score. Radiologists attributed 13.2% of patients to class 0, 11.3% to class I, 34% to class II, 24.5% to class III, and 16.9% to class IV. With 3D T2 ISO images, the same radiologists determined 43.3% class 0, 32% class I, 11.4% class II, 7.5% class III, and 5.7% class IV. In all cases, the correlation and regression analysis between the 3D T2 ISO and IIEF-5 score resulted in higher coefficients values. The 3D sequence correlated most closely with patients' grading of erectile function.

  15. Long-Term (10-Year Gastrointestinal and Genitourinary Toxicity after Treatment with External Beam Radiotherapy, Radical Prostatectomy, or Brachytherapy for Prostate Cancer

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    Grant K. Hunter

    2012-01-01

    Full Text Available Objective.To examine gastrointestinal (GI and genitourinary (GU toxicity profiles of patients treated in 1999 with external beam radiotherapy (RT, prostate interstitial brachytherapy (PI or radical prostatectomy (RP. Methods. TThe records of 525 patients treated in 1999 were reviewed to evaluate toxicity. Late GI and GU morbidities were graded according to the RTOG late morbidity criteria. Other factors examined were patient age, BMI, smoking history, and medical co-morbidities. Due to the low event rate for late GU and GI toxicities, a competing risk regression (CRR analysis was done with death as the competing event. Results. Median follow-up time was 8.5 years. On CRR univariate analysis, only the presence of DM was significantly associated with GU toxicity grade >2 (=0.43, HR 2.35, 95% Cl = 1.03–5.39. On univariate analysis, RT and DM were significantly associated with late GI toxicity. On multivariable analysis, both variables remained significant (RT: =0.038, HR=4.71, CI=1.09–20.3; DM: =0.008, HR=3.81, 95% Cl = 1.42–10.2. Conclusions. Late effects occur with all treatment modalities. The presence of DM at the time of treatment was significantly associated with worse late GI and GU toxicity. RT was significantly associated with worse late GI toxicity compared to PI and RP.

  16. The Role of M1 and M2 Macrophages in Prostate Cancer in relation to Extracapsular Tumor Extension and Biochemical Recurrence after Radical Prostatectomy

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    M. Lanciotti

    2014-01-01

    Full Text Available Introduction. The aim of our work was to investigate the causal connection between M1 and M2 macrophage phenotypes occurrence and prostate cancer, their correlation with tumor extension (ECE, and biochemical recurrence (BR. Patient and Methods. Clinical and pathological data were prospectively gathered from 93 patients treated with radical prostatectomy. Correlations of commonly used variables were evaluated with uni- and multivariate analysis. The relationship between M1 and M2 occurrence and BR was also assessed with Kaplan-Meier survival analysis. Results. Above all in 63.4% there was a M2 prevalence. M1 occurred more frequently in OC disease, while M2 was more represented in ECE. At univariate analysis biopsy and pathologic GS and M2 were statistically correlated with ECE. Only pathologic GS and M2 confirmed to be correlated with ECE. According to macrophage density BCR free survival curves presented a statistically significant difference. When we stratified our population for M1 and M2,we did not find any statistical difference among curves. At univariate analysis GS, pTNM, and positive margins resulted to be significant predictors of BCR, while M1 and M2 did not achieve the statistical significance. At multivariate analysis, only GS and pathologic stage were independent predictors of BR. Conclusion. In our study patients with higher density of M count were associated with poor prognosis; M2 phenotype was significantly associated with ECE.

  17. Is an Extended Prostate Biopsy Scheme Associated with an Improvement in the Accuracy Between the Biopsy Gleason Score and Radical Prostatectomy Pathology? A Multivariate Analysis.

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    Zugor, Vahudin; Poth, Sandor; Kühn, Reinhard; Bernat, Marija Maja; Porres, Daniel; Labanaris, Apostolos P

    2016-08-01

    To examine whether an extended prostate biopsy (PB) scheme is associated with an improvement in the accuracy between the PB Gleason score (GS) and radical prostatectomy (RP) pathology and to identify probable preoperative variables that stratified patients likely to harbor significant upgrading (SU). A retrospective review of 538 patients' records diagnosed with prostate cancer (PCa) who underwent RP and exhibited a SU, at two tertiary medical centers, was conducted. The patients were divided into 3 groups: 194 who underwent a 6-core PB (36%), 156 who underwent a 12-core PB (28.9%) and 188 (34.9%) who underwent an 18-core PB. A multivariate analysis was conducted, including prostate-specific antigen (PSA) level, clinical stage, prostate size and duration from PB to RP. The 6-core group exhibited a 42.7% SU, the 12-core group exhibited a 38.8% SU and the 18-core group exhibited a 14.1% SU. There was a highly significant lower rate of SU in the 18-core than that in the 6-core (pmultivariate analysis, only a prostate size of >35 g significantly elevated the probability of SU in the 6-core (p35 g in patients who undergo a 6- or 12-core PB is the only preoperative variable that stratifies patients likely to harbor SU. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  18. Is active surveillance a safe alternative in the management of localized prostate cancer? Pathological features of radical prostatectomy specimens in potential candidates for active sur