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Nature Reviews. Urology Mar 2020The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a... (Review)
Review
The practice of radical prostatectomy for treating prostate cancer has evolved remarkably since its general introduction around 1900. Initially described using a perineal approach, the procedure was later popularized using a retropubic one, after it was first described as such in 1948. The open surgical method has now largely been abandoned in favour of the minimally invasive robot-assisted method, which was first described in 2000. Until 1980, the procedure was hazardous, often accompanied by massive blood loss and poor outcomes. For patients in whom surgery is indicated, prostatectomy is increasingly being used as the first step in a multitherapeutic approach in advanced local, and even early metastatic, disease. However, contemporary molecular insights have enabled many men to safely avoid surgical intervention when the disease is phenotypically indolent and use of active surveillance programmes continues to expand worldwide. In 2020, surgery is not recommended in those men with low-grade, low-volume Gleason 6 prostate cancer; previously these men - a large cohort of ~40% of men with newly diagnosed prostate cancer - were offered surgery in large numbers, with little clinical benefit and considerable adverse effects. Radical prostatectomy is appropriate for men with intermediate-risk and high-risk disease (Gleason score 7-9 or Grade Groups 2-5) in whom radical prostatectomy prevents further metastatic seeding of potentially lethal clones of prostate cancer cells. Small series have suggested that it might be appropriate to offer radical prostatectomy to men presenting with small metastatic burden (nodal and or bone) as part of a multimodal therapeutic approach. Furthermore, surgical treatment of prostate cancer has been reported in cohorts of octogenarian men in good health with minimal comorbidities, when 20 years ago such men were rarely treated surgically even when diagnosed with localized high-risk disease. As medical therapies for prostate cancer continue to increase, the use of surgery might seem to be less relevant; however, the changing demographics of prostate cancer means that radical prostatectomy remains an important and useful option in many men, with a changing indication.
Topics: History, 20th Century; History, 21st Century; Humans; Lymph Node Excision; Male; Prostate; Prostatectomy; Prostatic Neoplasms; Robotic Surgical Procedures
PubMed: 32086498
DOI: 10.1038/s41585-020-0287-y -
Panminerva Medica Sep 2022Metabolic syndrome (MetS) has been linked with several human cancers. Prostate cancer is the most common neoplasm in male adults and is often treated with radical... (Review)
Review
Metabolic syndrome (MetS) has been linked with several human cancers. Prostate cancer is the most common neoplasm in male adults and is often treated with radical prostatectomy (RP). Given the complex hormonal and metabolic alteration present in MetS, a possible role in the development and progression of prostate cancer (PCa) has been hypothesized. Several studies have investigated the connections between MetS and the risk of developing prostate cancer, as well as the oncological outcomes of patients who already suffer from PCa and receive a radical treatment. This comprehensive review explores the available evidence dealing with MetS and the oncological and functional results of RP for PCa.
Topics: Adult; Humans; Male; Metabolic Syndrome; Prostate; Prostate-Specific Antigen; Prostatectomy; Prostatic Neoplasms
PubMed: 34486368
DOI: 10.23736/S0031-0808.21.04511-0 -
World Journal of Urology Apr 2015Lower urinary tract symptoms (LUTS) are a common complaint and although can be adequately managed with medication, surgery remains the mainstay of treatment.... (Review)
Review
INTRODUCTION
Lower urinary tract symptoms (LUTS) are a common complaint and although can be adequately managed with medication, surgery remains the mainstay of treatment. Transurethral resection has been the reference 'gold standard', but due to its complications and issues with larger volume prostates, many alternatives have been developed and assessed. Holmium laser enucleation of the prostate (HoLEP) has shown excellent efficacy, durability and safety and has become an important alternative that has gained guideline approval.
RESULTS
HoLEP has been shown to have outcomes that are equivalent or better than TURP in both urodynamic measurements and symptom scores. Its outcomes have been proven to be durable and cost-effective. HoLEP has fewer and less serious complications when compared to the current reference standard, its use also allows earlier removal of catheter and hospital discharge. Appropriate mentoring reduces many of the issues associated with the steep learning curve, thus removing the main hurdle to its widespread adoption as the surgical treatment of choice for LUTS due to benign prostatic hyperplasia (BPH).
CONCLUSIONS
HoLEP fulfils all of the requirements as an alternative/replacement for TURP and open prostatectomy, with equivalent outcomes and reduced complications. With improvements in the learning curve, it could now be considered the true gold standard surgical treatment for BPH. HoLEP has come of age.
Topics: Cost-Benefit Analysis; Humans; Lasers, Solid-State; Learning Curve; Lower Urinary Tract Symptoms; Male; Prostatectomy; Prostatic Hyperplasia; Transurethral Resection of Prostate; Treatment Outcome
PubMed: 25416347
DOI: 10.1007/s00345-014-1443-x -
International Journal of Nursing Studies Sep 2017The purpose of this review was to critically analyze, interpret, and synthesize the literature on men's experiences after prostatectomy. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The purpose of this review was to critically analyze, interpret, and synthesize the literature on men's experiences after prostatectomy.
DESIGN
A meta-synthesis was conducted.
DATA SOURCES
Six databases (PubMed, EMBASE, CINAHL, PsycINFO, AgeLine, and Sociological Abstract) were searched from the earliest year to 2016. From initial searches with main keywords (prostatectomy and qualitative study), 642 abstracts were retrieved. Based on inclusion criteria (English-language published qualitative study focusing on the experience of men after prostatectomy), this meta-synthesis included 15 studies.
REVIEW METHODS
Components of meta-study (meta-data-analysis, meta-method, and meta-theory) were employed to analyze, interpret, and synthesize the results of included studies. Three authors independently appraised the methodological quality of the included studies using a combined appraisal tool (The Critical Appraisal Skills Programme Qualitative Research Checklist and Paterson et al.'s Primary Research Appraisal Tool). The Enhancing Transparency in Reporting the Synthesis of Qualitative Research Statement was used to strengthen the completeness of reporting.
RESULTS
Fifteen studies met inclusion criteria and quality appraisal guidelines, however, most did not identify or relate their findings to theory. Through meta-synthesis, five themes emerged: facing a life-changing situation, experiencing changes and their impact, striving to manage and adjust to changes, coping with masculinity, and anticipating the future.
CONCLUSIONS
After prostatectomy, men experienced physical, psychological, and social changes. Many men are physically and psychologically ill-prepared and suffer from lack of information and support. Health care providers need to be sensitive to men's needs including perceptions of masculinity, realize the importance of support as an essential component of men's adaptation post-prostatectomy, and provide comprehensive and individualized patient-centered interventions. Future studies need to use rigorous research methods, clearly identify methodological approaches, and consider employing or developing theory.
Topics: Humans; Male; Prostatectomy; Qualitative Research
PubMed: 28783561
DOI: 10.1016/j.ijnurstu.2017.07.013 -
World Journal of Urology Jul 2021In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign... (Review)
Review
PURPOSE
In this review, we will discuss the state of the literature regarding Aquablation, its limitations, and opportunities for its application in the treatment of benign prostatic enlargement (BPE).
METHODS
A comprehensive review of original research on Aquablation was conducted. Articles related to transurethral resection of the prostate, holmium laser enucleation of the prostate, greenlight photoselective vaporization of the prostate, and simple prostatectomy were reviewed for discussion.
RESULTS
For small-medium prostates (30-80 mL), Aquablation's main advantages include better ejaculatory function and similar functional outcomes compared to TURP. For large prostates (80-150 mL), Aquablation demonstrates shorter operative time and superior ejaculatory function when compared to simple prostatectomy, HoLEP, and Greenlight PVP. In addition, Aquablation displays shorter hospital stays than simple prostatectomy. The integration of software programming and semi-automatic technology increases the reproducibility of the procedure and helps standardize overall outcomes, while also accelerating the learning curve. Its ability to preserve antegrade ejaculation makes Aquablation a very compelling option for sexually active patients. However cost and postoperative bleeding risks remain a concern.
CONCLUSION
The current evidence suggests that Aquablation is a safe and effective alternative for BPE for small to large prostates. Further prospective clinical trials, with comparisons to other BPE modalities, and data from longer follow-up periods are still required.
Topics: Ablation Techniques; Equipment Design; Humans; Male; Prostatectomy; Prostatic Hyperplasia; Transurethral Resection of Prostate; Water
PubMed: 32740805
DOI: 10.1007/s00345-020-03390-x -
Current Urology Reports Sep 2017Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative... (Review)
Review
PURPOSE OF REVIEW
Due to the increasing numbers of radical prostatectomies (RP) performed for prostate cancer, a substantial number of patients are now suffering from post-operative erectile dysfunction (ED). The aim of this study is to summarize the current literature on surgical techniques for managing post-prostatectomy erectile dysfunction.
RECENT FINDINGS
The PubMed database was searched for English-language articles published up to Jan 2017 using the following search terms: "prostatectomy AND erectile dysfunction", "prostatectomy AND penile prostheses", and "prostatectomy AND penile implants". All of the studies that evaluated medical treatment were excluded. In the last few decades, the understanding of the anatomy of the male pelvis and prostate has improved. This has led to significant changes in the nerve-sparing radical prostatectomy techniques, with the aim of preserving post-surgical erectile function (EF). In this scenario, the prostate vascular supply and the anatomy of the neurovascular bundles have a central role. Penile prosthesis implantation is considered the third-line treatment option for RP ED patients, and they have been reported to be a very successful treatment with the highest patient satisfaction rate. Considering the failure of penile rehabilitation, and the lack of evidence for accessory pudendal artery (APA) preservation and nerve graft, nerve-sparing surgery and penile prostheses represent, today, the only methods to permanently and definitively preserve or erectile function after RP.
Topics: Erectile Dysfunction; Humans; Male; Penile Implantation; Penis; Prostatectomy; Prostatic Neoplasms
PubMed: 28965315
DOI: 10.1007/s11934-017-0735-2 -
Current Opinion in Urology Nov 2019During the last 15 years several updates in the Gleason grading have been made. With the help of pertinent research results pathologists have gained a better insight... (Review)
Review
PURPOSE OF REVIEW
During the last 15 years several updates in the Gleason grading have been made. With the help of pertinent research results pathologists have gained a better insight into the meanings of several prostate cancer (PCa) patterns and know better how to classify them in the Gleason grade system.
RECENT FINDINGS
During the last years PCa with cribriform architecture has be given much attention. Many data have also been published about the meaning of comedonecrosis and its relationship with Gleason pattern 4 and 5. The correlationship between comedonecrosis and intraductal PCa has also been highlighted in the recent literature. Intraductal PCa is one of the most described topics at the moment with implications to treatment such as radiation therapy. We also highlight several practical issues such as the differences of grading in prostate biopsies and prostatectomies and describe the problematic of reporting a minor high-grade pattern.
SUMMARY
Many new and recent data have allowed to refine diagnosis in PCa and improve the patients's treatment. We show that comedonecrosis can be overgraded and insist on the implication with cribriform and intraducatal carcinomas. Furthermore, we describe the importance of these PCa types especially in the consideration of further treatment.
Topics: Biopsy; Carcinoma, Ductal; Humans; Image-Guided Biopsy; Male; Neoplasm Grading; Prostatectomy; Prostatic Neoplasms; Ultrasonography, Interventional
PubMed: 31453865
DOI: 10.1097/MOU.0000000000000669 -
Anesthesiology Clinics Mar 2022This article focuses on the anesthetic considerations for major cancer urology surgeries such as cystectomies, nephrectomies, and radical prostatectomies. It aims to... (Review)
Review
This article focuses on the anesthetic considerations for major cancer urology surgeries such as cystectomies, nephrectomies, and radical prostatectomies. It aims to explore the anesthetic considerations for both open and minimally invasive techniques.
Topics: Anesthesia; Anesthesiology; Anesthetics; Humans; Laparoscopy; Male; Prostatectomy
PubMed: 35236579
DOI: 10.1016/j.anclin.2021.11.009 -
Journal of Robotic Surgery Dec 2023The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted... (Meta-Analysis)
Meta-Analysis Review
The study aims to synthesize all available prospective comparative studies and reports the latest systematic analysis and updated evidence comparing robot-assisted radical prostatectomy (RARP) with open radical prostatectomy (ORP) for perioperative, functional, and oncological outcomes in patients with clinically localized prostate cancer (PCa). PubMed, Embase, Web of Science, and the Cochrane Library were retrieved up to March 2023. Only randomized controlled trials (RCTs) and prospective comparative studies were included, and weighted mean differences (WMD) and odds ratios (OR) were used to evaluate the pooled results. Twenty-one articles were included in the present meta-analysis. The results indicated that compared to ORP, RARP had longer operative time (OT) (WMD: 51.41 min; 95%CI: 28.33, 74.48; p < 0.0001), reduced blood loss (WMD: -516.59 mL; 95%CI: -578.31, -454.88; p < 0.00001), decreased transfusion rate (OR: 0.23; 95%CI: 0.18, 0.30; p < 0.00001), shorter hospital stay (WMD: -1.59 days; 95%CI: -2.69, -0.49; p = 0.005), fewer overall complications (OR: 0.61; 95%CI: 0.45, 0.83; p = 0.001), and higher nerve sparing rate (OR: 1.64; 95%CI: 1.26, 2.13; p = 0.0003), as well as was more beneficial to postoperative erectile function recovery and biochemical recurrence (BCR). However, no significant disparities were noted in major complications, postoperative urinary continence recovery, or positive surgical margin (PSM) rates. RARP was superior to ORP in terms of hospital stay, blood loss, transfusion rate, complications, nerve sparing, postoperative erectile function recovery, and BCR. It is a safe and effective surgical approach to the treatment of clinically localized PCa.
Topics: Male; Humans; Erectile Dysfunction; Prospective Studies; Robotics; Treatment Outcome; Robotic Surgical Procedures; Prostatectomy; Prostatic Neoplasms
PubMed: 37721644
DOI: 10.1007/s11701-023-01714-8 -
Sexual Medicine Reviews Apr 2018The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual... (Review)
Review
INTRODUCTION
The diagnosis and treatment of prostate cancer adversely affects the physical and emotional well-being of patients and partners and has been associated with sexual dysfunction in patients and their intimate partners.
AIM
To identify predictors of sexual satisfaction in prostate cancer survivors and their partners based on a review of the current literature.
METHODS
We performed a comprehensive review of the PubMed database from January 2000 to May 2017 focused on the (i) prevalence of patient and partner sexual dysfunction related to radical prostatectomy, (ii) differences in patient and partner perspectives of sexual function and dysfunction, and (iii) predictors of patient and partner sexual satisfaction after radical prostatectomy.
MAIN OUTCOME MEASURES
Patient- and partner-reported sexual satisfaction.
RESULTS
There is a paucity of published data examining sexual satisfaction in prostate cancer survivors and their partners. Patients and partners can have different expectations of sexual outcomes after radical prostatectomy and different attitudes toward the relative importance of recovery of sexual function after surgery. Available data suggest that patients' and partners' mental and physical health and the quality of communication between them are important contributors to their sexual satisfaction. Patient-perceived partner support also is associated with better patient-reported erectile function and greater relationship satisfaction.
CONCLUSION
Mental health, physical health, quality of interpersonal communication, and patient-perceived partner support appear to be the most important predictors of sexual satisfaction for patients and partners in the post-prostatectomy period. There is a definite need for further research on this topic to develop interventions to improve sexual function and quality of life for prostate cancer survivors and their intimate partners. Guercio C, Mehta A. Predictors of Patient and Partner Satisfaction Following Radical Prostatectomy. Sex Med Rev 2018;6:295-301.
Topics: Female; Humans; Male; Orgasm; Personal Satisfaction; Prostatectomy; Prostatic Neoplasms; Sexual Dysfunction, Physiological; Sexual Partners
PubMed: 29128271
DOI: 10.1016/j.sxmr.2017.08.005