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BMC Cancer Dec 2018Prostate biopsy is the most common method for the diagnosis of prostate cancer and the basis for further treatment. Confirmation using radical prostatectomy specimens is...
BACKGROUND
Prostate biopsy is the most common method for the diagnosis of prostate cancer and the basis for further treatment. Confirmation using radical prostatectomy specimens is the most reliable method for verifying the accuracy of template-guided transperineal prostate biopsy. The study aimed to reveal the spatial distribution of prostate cancer in template-guided transperineal saturation biopsy and radical prostatectomy specimens.
METHODS
Between December 2012 to December 2016, 171 patients were diagnosed with prostate cancer via template-guided transperineal prostate biopsy and subsequently underwent laparoscopic radical prostatectomy. The spatial distributions of prostate cancer were analyzed and the consistency of the tumor distribution between biopsy and radical prostatectomy specimens were compared.
RESULTS
The positive rate of biopsy in the apex region was significantly higher than that of the other biopsy regions (43% vs 28%, P < 0.01). In radical prostatectomy specimens, the positive rate was highest at the region 0.9-1.3 cm above the apex, and it had a tendency to decrease towards the base. There was a significant difference in the positive rate between the cephalic and caudal half of the prostate (68% vs 99%, P < 0.01). There were no significant differences between the anterior and posterior zones for either biopsy or radical prostatectomy specimens.
CONCLUSION
The tumor spatial distribution generated by template-guided transperineal prostate biopsy was consistent with that of radical prostatectomy specimens in general. The positive rate was consistent between anterior and posterior zones. The caudal half of the prostate, especially the vicinity of the apex, was the frequently occurred site of the tumor.
Topics: Aged; Biopsy; Humans; Male; Middle Aged; Prostate; Prostatectomy; Prostatic Neoplasms
PubMed: 30514243
DOI: 10.1186/s12885-018-5124-9 -
Urology Mar 2021To assess treatment satisfaction and decision regret post robot-assisted radical prostatectomy (RARP) and correlate these with clinical, demographic and quality of life...
OBJECTIVE
To assess treatment satisfaction and decision regret post robot-assisted radical prostatectomy (RARP) and correlate these with clinical, demographic and quality of life indicators. Our study took place at a high-volume United Kingdom center and patients were assessed at a minimum of 18 months postsurgery.
METHODS
Patients who underwent RARP between June 2011 and May 2016 were invited to participate through mailed questionnaires. A total of 207 patients formed our cohort. The questionnaires included European Organization for Research and Treatment of Cancer Quality of Life of Cancer patients 30 and PR25 modules, sexual health inventory in men and Likert decisional regret scale. A Decisional Regret Scale score of >15 was used to define an outcome of high decision regret.
RESULTS
The mean patient age was 63 years and the mean duration of follow up was 36 months. Of the 106 responders, 51 (48%) were fully satisfied with the decision to undergo RARP and 32 (30%) recorded high regret. The mean Decisional Regret Scale score was 11.3. High decision regret associated with the length of time from RARP to questionnaire administration, higher prostate specific quality of life symptom scores and lower sexual and erectile function scores.
CONCLUSION
Our study represents the first contemporary United Kingdom series assessing decision regret following the management of localised prostate cancer with RARP. Higher regret was seen in one third of patients and was associated with worse disease-specific quality of life, sexual and erectile function measures. To minimize regret, collaborative and detailed discussion should take place pre-operatively when counselling patients about RARP. The potential longevity and impact on quality of life of these side effects should be made clear.
Topics: Aged; Cohort Studies; Decision Making; Emotions; Erectile Dysfunction; Follow-Up Studies; Humans; Male; Middle Aged; Patient Satisfaction; Prostate; Prostatectomy; Prostatic Neoplasms; Quality of Life; Robotic Surgical Procedures; Sexual Health; Surveys and Questionnaires; Treatment Outcome; United Kingdom
PubMed: 33359493
DOI: 10.1016/j.urology.2020.12.015 -
Actas Urologicas Espanolas 2020Historical review of the procedures and maneuvers described in the literature for the performance of vesicourethral anastomosis (VUA) after retropubic prostatectomy.
OBJECTIVE
Historical review of the procedures and maneuvers described in the literature for the performance of vesicourethral anastomosis (VUA) after retropubic prostatectomy.
MATERIAL AND METHOD
Review of the main original articles on the design of VUA maneuvers.
RESULTS
Various techniques have been described to facilitate VUA, the most common being those with soft or hard catheters, or endoscopes.
CONCLUSION
There is no perfect technique for the performance of VUA after retropubic prostatectomy. Since it does not require specific instrumentation, the Gil-Vernet maneuver may be the technique through which a longer urethral segment is transferred inside the abdomen and the easiest to perform.
Topics: Anastomosis, Surgical; History, 20th Century; Humans; Male; Prostatectomy; Urethra; Urinary Bladder
PubMed: 32473821
DOI: 10.1016/j.acuro.2020.02.004 -
Urologic Oncology Mar 2022Results after radical prostatectomy (RP) are generally judged by complete removal of the cancer, return of urinary control, and the ability to have intercourse. Given... (Review)
Review
Results after radical prostatectomy (RP) are generally judged by complete removal of the cancer, return of urinary control, and the ability to have intercourse. Given the complexity of the anatomy of the prostate and its relationship to the surrounding nerves, muscles, and fascia, RP is considered a challenging and technically demanding surgery. Here we propose multiple intraoperative strategies to optimize oncological and functional outcomes.
Topics: Erectile Dysfunction; Humans; Male; Penile Erection; Prostate; Prostatectomy; Prostatic Neoplasms
PubMed: 35012823
DOI: 10.1016/j.urolonc.2021.12.003 -
European Urology Oncology Aug 2023Improved cancer control with increasing surgical experience-the learning curve-was demonstrated for open and laparoscopic prostatectomy. In a prior single-center study,...
BACKGROUND
Improved cancer control with increasing surgical experience-the learning curve-was demonstrated for open and laparoscopic prostatectomy. In a prior single-center study, we found that this might not be the case for robot-assisted radical prostatectomy (RARP).
OBJECTIVE
To investigate the relationship between prior experience of a surgeon and biochemical recurrence (BCR) after RARP.
DESIGN, SETTING, AND PARTICIPANTS
We retrospectively analyzed the data of 8101 patients with prostate cancer treated with RARP by 46 surgeons at nine institutions between 2003 and 2021. Surgical experience was coded as the total number of robotic prostatectomies performed by the surgeon before the patient operation.
OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS
We evaluated the relationship of prior surgeon experience with the probability of BCR adjusting for preoperative prostate-specific antigen, pathologic stage, grade, lymph-node involvement, and year of surgery.
RESULTS AND LIMITATIONS
Overall, 1047 patients had BCR. The median follow-up for patients without BCR was 33 mo (interquartile range: 14, 61). After adjusting for case mix, the relationship between surgical experience and the risk of BCR after surgery was not statistically significant (p = 0.2). The 5-yr BCR-free survival rates for a patient treated by a surgeon with prior 10, 250, and 1000 procedures performed were, respectively, 82.0%, 82.7%, and 84.8% (absolute difference between 10 and 1000 prior procedures: 1.6% [95% confidence interval: 0.4%, 3.3%). Results were robust to a number of sensitivity analyses.
CONCLUSIONS
These findings suggest that, as opposed to open and laparoscopic radical prostatectomy, surgeons performing RARP achieve adequate cancer control in the early phase of their career. Further research should explore why the learning curve for robotic surgery differs from prior findings for open and laparoscopic radical prostatectomy. We hypothesize that surgical education, including simulation training and the adoption of objective performance metrics, is an important mechanism for flattening the learning curve.
PATIENT SUMMARY
We investigated the relationship between biochemical recurrence after robot-assisted radical prostatectomy and surgeon's experience. Surgeons at an early stage of their career had similar outcomes to those of more experienced surgeons, and we hypothesized that surgical education in robotics might be an important determinant of such a finding.
Topics: Male; Humans; Robotic Surgical Procedures; Robotics; Retrospective Studies; Learning Curve; Prostatectomy; Prostatic Neoplasms; Laparoscopy
PubMed: 35850976
DOI: 10.1016/j.euo.2022.06.010 -
Urologic Oncology Feb 2017Introducing the topic of comparative effectiveness for prostate cancer treatments with a reminder of the disease's heterogeneity risks tautology. However, the profound... (Review)
Review
Introducing the topic of comparative effectiveness for prostate cancer treatments with a reminder of the disease's heterogeneity risks tautology. However, the profound variation both in this cancer's biology and its clinical course is increasingly widely recognized, while management alternatives for clinically localized prostate cancer have exploded. Available options now include active surveillance, multiple surgical approaches to prostatectomy, various forms of external-beam and interstitial radiation, and a growing list of energy ablative technologies. Each treatment option has its own efficacy rate as well as its own set of complications, side effects and financial costs. Difficulties comparing these options, together with the high prevalence of the disease, led the Institute of Medicine to include localized prostate cancer among the top 25 priority conditions for future comparative effectiveness research. The sheer volume of possible treatment options, with their individual risks and benefits, can be confusing for patients and clinicians to research, understand and explain. To help clinicians navigate these treatment options, we have assembled this Urologic Oncology Seminar on the comparative effectiveness of treatments for clinically localized prostate cancer. The articles focus on high quality evidence-based medicine and most have included useful tables summarizing seminal trials and available resources.
Topics: Comparative Effectiveness Research; Disease Progression; Evidence-Based Medicine; Humans; Male; Prostatectomy; Prostatic Neoplasms; Radiotherapy; Treatment Outcome
PubMed: 27998677
DOI: 10.1016/j.urolonc.2016.11.013 -
Archivio Italiano Di Urologia,... Nov 2023To compare the outcomes of bipolar Transurethral Enucleation Resection of the Prostate (TUERP) and simple retropubic prostatectomy in patients with prostate volumes... (Randomized Controlled Trial)
Randomized Controlled Trial
Evaluation of bipolar Transurethral Enucleation and Resection of the Prostate in terms of efficiency and patient satisfaction compared to retropubic open prostatectomy in prostates larger than 80 cc. A prospective randomized study.
OBJECTIVES
To compare the outcomes of bipolar Transurethral Enucleation Resection of the Prostate (TUERP) and simple retropubic prostatectomy in patients with prostate volumes larger than 80 cc.
PATIENTS AND METHODS
A prospective randomized study included all patients amenable to surgeries for benign prostate hyperplasia (BPH) with prostate size over 80 cc at a tertiary care hospital between January 2020 to February 2022. Bipolar TUERP and Retropubic open prostatectomy techniques were compared regarding patients' demographics, intraoperative parameters, outcomes, and peri-operative complications.
RESULTS
Ninety patients were included in our study and randomly assigned to bipolar TUERP (Group 1 = 45 patients) and retropubic open prostatectomy (Group 2 = 45 patients). The TUERP group demonstrated significantly lower operative time (77 ± 11 minutes vs. 99 ± 14 minutes, p < 0.001), hemoglobin drop (median = 1.1 vs. 2.5, p < 0.001), and resected tissue weight (71 ± 6.6 cc vs. 84.5 ± 10.6 cc, p < 0.001). Postoperatively, the TUERP group demonstrated significantly lower catheter time (median = 2 vs. 7 days, p < 0.001) and less hospital stay. IPSS, Qmax, and patient satisfaction were better in the TUERP group within six months of surgery. We reported 90-day complications after TUERP in 13.3% of patients compared to 17.8% after retropubic prostatectomy, with a statistically insignificant difference. Urethral stricture predominated after TUERP, while blood transfusion dominated in retropubic prostatectomy.
CONCLUSIONS
The present study found that TUERP had equivalent efficacy and safety to open retropubic prostatectomy for patients with BPH and prostate volumes > 80 ml.
Topics: Male; Humans; Prostate; Prostatic Hyperplasia; Prospective Studies; Transurethral Resection of Prostate; Patient Satisfaction; Treatment Outcome; Prostatectomy
PubMed: 37990975
DOI: 10.4081/aiua.2023.11629 -
West African Journal of Medicine Sep 2023Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce... (Review)
Review
BACKGROUND
Haemorrhage is a common complication following open simple prostatectomy and patients may sometimes require a blood transfusion. Tranexamic acid has been shown to reduce blood loss following transurethral resection of the prostate and open radical prostatectomy. This study evaluated the effect of perioperative intravenous administration of tranexamic acid on blood loss and blood transfusion rates in patients who had OSP for benign prostatic enlargement.
METHODOLOGY
This was a comparative study of patients with documented prostate glands 60g and above scheduled for OSP. Initial hematocrit was done a day before surgery. The patients were randomized into a tranexamic acid group, which received perioperative intravenous tranexamic acid and the no-TXA group which received placebo (0.9% saline). All patients had open simple retropubic prostatectomy. Final post-operative hematocrit was assessed 72 hours after surgery, and blood loss was calculated using the modified Gross formula (actual blood loss = estimated blood volume x change in hematocrit / mean hematocrit). The transfusion rate was documented.
RESULTS
Fifty-six patients participated in this study and were randomized into a tranexamic acid group and no-tranexamic acid group. The mean age of patients in the tranexamic acid group was 66.07 ±7.08 years and was comparable to the no- tranexamic acid group which was 66.50 ± 8.80 years (P = 0.842). The median total blood loss was lower in the tranexamic acid group (502mls, IQR 613) compared to the no-tranexamic acid group (801mls, IQR 1069). The difference in the median blood loss between the two groups was 299mls (U 275, P 0.055). The rate of blood transfusion was lower in the tranexamic acid group (6 patients, 21%) compared to the no tranexamic acid group (11 patients, 39%), (P = 0.146). There was no difference in complication rates between the two groups.
CONCLUSION
The use of tranexamic acid in patients undergoing open simple prostatectomy showed a trend towards reduced intraoperative blood loss and less need no tranexamic for blood transfusion. This is of clinical significance, especially in elderly patients with low cardiovascular reserve.
Topics: Aged; Male; Humans; Middle Aged; Tranexamic Acid; Prospective Studies; Transurethral Resection of Prostate; Prostatectomy; Hemorrhage; Randomized Controlled Trials as Topic
PubMed: 37767102
DOI: No ID Found -
The Prostate Sep 2022Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly... (Review)
Review
BACKGROUND
Radical prostatectomy (RP) and radiation treatment are standard options for localized prostate cancer. Even though nerve-sparing techniques have been increasingly utilized in RP, erectile dysfunction (ED) due to neuropraxia remains a frequent complication. Erectile function recovery rates after RP remain unsatisfactory, and many men still suffer despite the availability of various therapies.
OBJECTIVE
This systematic review aims to summarize the current treatments for post-RP-ED, assess the underlying pathological mechanisms, and emphasize promising therapeutic strategies based on the evidence from basic research.
METHOD
Evaluation and review of articles on the relevant topic published between 2010 and 2021, which are indexed and listed in the PubMed database.
RESULTS
Phosphodiesterase type 5 inhibitors, intracavernosal and intraurethral injections, vacuum erection devices, pelvic muscle training, and surgical procedures are utilized for penile rehabilitation. Clinical trials evaluating the efficacy of erectogenic drugs in this setting are conflicting and far from being conclusive. The use of androgen deprivation therapy in certain scenarios after RP further exacerbates the already problematic situation and emphasizes the need for effective treatment strategies.
CONCLUSION
This article is a detailed overview focusing on the pathophysiology and mechanism of the nerve injury developed during RP and a compilation of various strategies to induce cavernous nerve regeneration to improve erectile function (EF). These strategies include stem cell therapy, gene therapy, growth factors, low-intensity extracorporeal shockwave therapy, immunophilins, and various pharmacological approaches that have induced improvements in EF in experimental models of cavernous nerve injury. Many of the mentioned strategies can improve EF following RP if transformed into clinically applicable safe, and effective techniques with reproducible outcomes.
Topics: Androgen Antagonists; Erectile Dysfunction; Humans; Male; Penile Erection; Prostatectomy; Prostatic Neoplasms
PubMed: 35579053
DOI: 10.1002/pros.24366 -
Missouri Medicine 2018For prostate cancer, radical prostatectomy remains the gold standard for surgical management. Given the side effects associated with surgery, patients at low risk of...
For prostate cancer, radical prostatectomy remains the gold standard for surgical management. Given the side effects associated with surgery, patients at low risk of prostate cancer-specific mortality should consider active surveillance under the guidance of a urologist to safely delay intervention. For patients with an intermediate risk of cancer-specific mortality and otherwise healthy life expectancy, radical prostatectomy has been demonstrated to improve survival. Finally, even for select patients with advanced prostate cancer-metastatic disease to the lymph nodes or distant sites-radical prostatectomy may provide a survival benefit.
Topics: Humans; Male; Prognosis; Prostatectomy; Prostatic Neoplasms
PubMed: 30228706
DOI: No ID Found