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PloS One 2024We aimed to compare the prognostic values of 'localized treatment to the primary lesion (LT) plus hormone therapy (HT)' versus 'HT alone' in metastatic hormone-sensitive... (Meta-Analysis)
Meta-Analysis
The prognostic significance of additional localized treatment to primary lesion in patients undergoing hormone therapy for metastatic hormone-sensitive prostate cancer: A systematic review and meta-analysis.
BACKGROUND
We aimed to compare the prognostic values of 'localized treatment to the primary lesion (LT) plus hormone therapy (HT)' versus 'HT alone' in metastatic hormone-sensitive prostate cancer (mHSPC).
METHODS
We conducted a systematic search through the databases of PubMed®, Web of Science®, and Cochrane library® in April 2023 based on the PRISMA (Preferred Reporting Items for Systemic Reviews and Meta-Analyses) statement. A pooled meta-analysis was performed to assess the prognostic differences between LT + HT and HT alone according to randomized and non-randomized controlled studies (RCTs and NRCTs, respectively).
RESULTS
The search identified three RCTs and eight NRCTs. In RCTs, LT did not show prognostic benefits regarding biochemical-failure free rate nor overall survival (OS), although in patients with low tumor burdens, the LT + HT group showed better OS (HR: 0.68, 95% CI: 0.54-0.86). In the NRCTs, the LT+HT group showed superior progression-free survival (hazard ratio (HR): 0.42, 95% confidence interval (CI): 0.21-0.87), cancer-specific survival (HR: 0.39, 95% CI: 0.20-0.76), and OS (HR: 0.63, 95% CI: 0.57-0.69) to the HT alone group. In addition, better OS was observed in the LT +HT group regardless of the type of treatment modality for LT; radical prostatectomy (HR: 0.52, 95% CI: 0.39-0.69), radiotherapy (HR: 0.63, 95% CI: 0.56-0.71) in NRCTs.
CONCLUSIONS
LT to the primary lesion in metastatic hormone-sensitive prostate cancer may provide prognostic benefits and especially in patients with low tumor burden.
Topics: Humans; Male; Prostatic Neoplasms; Prognosis; Neoplasm Metastasis; Antineoplastic Agents, Hormonal
PubMed: 38857208
DOI: 10.1371/journal.pone.0304963 -
Translational Andrology and Urology May 2024
PubMed: 38855605
DOI: 10.21037/tau-23-665 -
Frontiers in Oncology 2024Distinguishing between prostatic cancer (PCa) and chronic prostatitis (CP) is sometimes challenging, and Gleason grading is strongly associated with prognosis in PCa....
BACKGROUND
Distinguishing between prostatic cancer (PCa) and chronic prostatitis (CP) is sometimes challenging, and Gleason grading is strongly associated with prognosis in PCa. The continuous-time random-walk diffusion (CTRW) model has shown potential in distinguishing between PCa and CP as well as predicting Gleason grading.
PURPOSE
This study aimed to quantify the CTRW parameters (α, β & Dm) and apparent diffusion coefficient (ADC) of PCa and CP tissues; and then assess the diagnostic value of CTRW and ADC parameters in differentiating CP from PCa and low-grade PCa from high-grade PCa lesions.
STUDY TYPE
Retrospective (retrospective analysis using prospective designed data).
POPULATION
Thirty-one PCa patients undergoing prostatectomy (mean age 74 years, range 64-91 years), and thirty CP patients undergoing prostate needle biopsies (mean age 68 years, range 46-79 years).
FIELD STRENGTH/SEQUENCE
MRI scans on a 3.0T scanner (uMR790, United Imaging Healthcare, Shanghai, China). DWI were acquired with 12 b-values (0, 50, 100, 150, 200, 500, 800, 1200, 1500, 2000, 2500, 3000 s/mm).
ASSESSMENT
CTRW parameters and ADC were quantified in PCa and CP lesions.
STATISTICAL TESTS
The Mann-Whitney U test was used to evaluate the differences in CTRW parameters and ADC between PCa and CP, high-grade PCa, and low-grade PCa. Spearman's correlation of the pathologic grading group (GG) with CTRW parameters and ADC was evaluated. The usefulness of CTRW parameters, ADC, and their combinations (Dm, α and β; Dm, α, β, and ADC) to differentiate PCa from CP and high-grade PCa from low-grade PCa was determined by logistic regression and receiver operating characteristic curve (ROC) analysis. Delong test was used to compare the differences among AUCs.
RESULTS
Significant differences were found for the CTRW parameters (α, Dm) between CP and PCa (all P<0.001), high-grade PCa, and low-grade PCa (α:P=0.024, Dm:P=0.021). GG is correlated with certain CTRW parameters and ADC(α:P<0.001,r=-0.795; Dm:P<0.001,r=-0.762;ADC:P<0.001,r=-0.790). Moreover, CTRW parameters (α, β, Dm) combined with ADC showed the best diagnostic efficacy for distinguishing between PCa and CP as well as predicting Gleason grading. The differences among AUCs of ADC, CTRW parameters and their combinations were not statistically significant (P=0.051-0.526).
CONCLUSION
CTRW parameters α and Dm, as well as their combination were beneficial to distinguish between CA and PCa, low-grade PCa and high-grade PCa lesions, and CTRW parameters and ADC had comparable diagnostic performance.
PubMed: 38854720
DOI: 10.3389/fonc.2024.1389250 -
Journal of Robotic Surgery Jun 2024Previously, our group established a surgical gesture classification system that deconstructs robotic tissue dissection into basic surgical maneuvers. Here, we evaluate...
Previously, our group established a surgical gesture classification system that deconstructs robotic tissue dissection into basic surgical maneuvers. Here, we evaluate gestures by correlating the metric with surgeon experience and technical skill assessment scores in the apical dissection (AD) of robotic-assisted radical prostatectomy (RARP). Additionally, we explore the association between AD performance and early continence recovery following RARP. 78 AD surgical videos from 2016 to 2018 across two international institutions were included. Surgeons were grouped by median robotic caseload (range 80-5,800 cases): less experienced group (< 475 cases) and more experienced (≥ 475 cases). Videos were decoded with gestures and assessed using Dissection Assessment for Robotic Technique (DART). Statistical findings revealed more experienced surgeons (n = 10) used greater proportions of cold cut (p = 0.008) and smaller proportions of peel/push, spread, and two-hand spread (p < 0.05) than less experienced surgeons (n = 10). Correlations between gestures and technical skills assessments ranged from - 0.397 to 0.316 (p < 0.05). Surgeons utilizing more retraction gestures had lower total DART scores (p < 0.01), suggesting less dissection proficiency. Those who used more gestures and spent more time per gesture had lower efficiency scores (p < 0.01). More coagulation and hook gestures were found in cases of patients with continence recovery compared to those with ongoing incontinence (p < 0.04). Gestures performed during AD vary based on surgeon experience level and patient continence recovery duration. Significant correlations were demonstrated between gestures and dissection technical skills. Gestures can serve as a novel method to objectively evaluate dissection performance and anticipate outcomes.
Topics: Prostatectomy; Humans; Robotic Surgical Procedures; Male; Clinical Competence; Dissection; Gestures; Prostatic Neoplasms; Surgeons
PubMed: 38847926
DOI: 10.1007/s11701-024-01902-0 -
European Journal of Case Reports in... 2024A case of bilateral multifocal serous retinal detachments and dry eye complicated with unilateral peripheral ulcerative keratitis (PUK) during erdafitinib therapy is...
Erdafitinib-Induced Bilateral Multifocal Serous Retinal Detachments and Severe Dry Eye Related Unilateral Peripheral Ulcerative Keratitis in a Patient with Metastatic Urothelial Carcinoma.
BACKGROUND
A case of bilateral multifocal serous retinal detachments and dry eye complicated with unilateral peripheral ulcerative keratitis (PUK) during erdafitinib therapy is described.
CASE DESCRIPTION
A 76-year-old male underwent a baseline examination two months after initiating 8 mg erdafitinib therapy (April 2023) due to metastatic urothelial carcinoma. Left subfoveal serous retinal detachment was observed initially but the treatment was resumed as he was asymptomatic. In May 2023, bilateral multifocal subretinal fluid pockets were identified, and the patient was still asymptomatic. However, in June 2023 he complained of bilateral redness and a stinging sensation in his right eye. Bilateral severe dry eye and right PUK were diagnosed. He was prescribed dexamethasone eye drops and sodium hyaluronate artificial tears for both eyes. One week later corneal staining decreased, and progression of PUK ceased. Erdafitinib therapy was discontinued in June 2023 due to the planned transurethral prostatectomy. By July 2023, after discontinuation of the drug and administration of the topical treatment, the dry eye improved and the PUK became inactive. There was also resolution of subretinal fluid pockets in the right eye and a reduction of subretinal fluid pockets in the left eye. After the reinitiation of erdafitinib therapy, serous retinal detachments recurred in both eyes in September 2023, but both corneas remained stable with topical low-dose dexamethasone, cyclosporine-A and artificial tear usage.
CONCLUSION
Erdafitinib therapy may lead to concurrent anterior and posterior segment complications. Multidisciplinary monitoring is crucial for patients undergoing erdafitinib therapy to prevent possible visual disturbances.
LEARNING POINTS
Erdafitinib, a tyrosine kinase inhibitor of fibroblast growth factor receptors 1 to 4, is administered for the treatment of locally advanced, unresectable or metastatic urothelial carcinoma but however is fraught with several systemic and ocular side effects.Concurrent anterior and posterior segment ocular involvement could be encountered in patients undergoing erdafitinib therapy.Maintaining a high level of suspicion and closely monitoring for potential ocular complications through collaborative efforts is essential for all patients undergoing erdafitinib therapy.
PubMed: 38846673
DOI: 10.12890/2024_004556 -
Cancer Medicine Jun 2024This study evaluates the efficacy of a nomogram for predicting the pathology upgrade of apical prostate cancer (PCa).
BACKGROUND
This study evaluates the efficacy of a nomogram for predicting the pathology upgrade of apical prostate cancer (PCa).
METHODS
A total of 754 eligible patients were diagnosed with apical PCa through combined systematic and magnetic resonance imaging (MRI)-targeted prostate biopsy followed by radical prostatectomy (RP) were retrospectively identified from two hospitals (training: 754, internal validation: 182, internal-external validation: 148). A nomogram for the identification of apical tumors in high-risk pathology upgrades through comparing the results of biopsy and RP was established incorporating statistically significant risk factors based on univariable and multivariable logistic regression. The nomogram's performance was assessed via the receiver operating characteristic (ROC) curve, calibration plots, and decision curve analysis (DCA).
RESULTS
Univariable and multivariable analysis identified age, targeted biopsy, number of targeted cores, TNM stage, and the prostate imaging-reporting and data system score as significant predictors of apical tumor pathological progression. Our nomogram, based on these variables, demonstrated ROC curves for pathology upgrade with values of 0.883 (95% CI, 0.847-0.929), 0.865 (95% CI, 0.790-0.945), and 0.840 (95% CI, 0.742-0.904) for the training, internal validation and internal-external validation cohorts respectively. Calibration curves showed good consistency between the predicted and actual outcomes. The validation groups also showed great generalizability with the calibration curves. DCA results also demonstrated excellent performance for our nomogram with positive benefit across a threshold probability range of 0-0.9 for the training and internal validation group, and 0-0.6 for the internal-external validation group.
CONCLUSION
The nomogram, integrating clinical, radiological, and pathological data, effectively predicts the risk of pathology upgrade in apical PCa tumors. It holds significant potential to guide clinicians in optimizing the surgical management of these patients.
Topics: Humans; Male; Prostatic Neoplasms; Nomograms; Image-Guided Biopsy; Middle Aged; Aged; Retrospective Studies; Prostatectomy; ROC Curve; Magnetic Resonance Imaging; Prostate; Neoplasm Grading; Neoplasm Staging
PubMed: 38845479
DOI: 10.1002/cam4.7341 -
Clinical Genitourinary Cancer Aug 2024Food and Drug Administration must make decisions about emerging high intensity focused ultrasound (HIFU) devices that may lack relevant clinical oncologic data but...
INTRODUCTION
Food and Drug Administration must make decisions about emerging high intensity focused ultrasound (HIFU) devices that may lack relevant clinical oncologic data but present with known side effects. This study aims to capture patients' perspective by quantifying their preferences regarding the available benefit and important side effects associated with HIFU for localized prostate cancer.
MATERIALS AND METHODS
Preferences for HIFU outcomes were examined using a discrete choice experiment survey. Participants were asked to choose a preferred treatment option in 9 choice questions. Each included a pair of hypothetical treatment profiles that have similar attributes/outcomes with varying levels. Outcomes included prostate biopsy outcome and treatment-related risks of erectile dysfunction (ED) and urinary incontinence (UI). We calculated the maximum risk of side effect patients were willing to tolerate in exchange for increased benefit. Preferences were further explored via clinical and demographic data.
RESULTS
About 223 subjects with a mean age of 64.8 years completed the survey. Respondents were willing to accept a 1.51%-point increase in new ED risk for a 1%-point increase in favorable biopsy outcome. They were also willing to accept a 0.93%-point increase in new UI risk for a 1%-point increase in biopsy outcome. Subjects who perceived their cancer to be more aggressive had higher risk tolerance for UI. Younger men were willing to tolerate less ED risk than older men. Respondents with greater than college level of education had a lower risk tolerance for ED or UI.
CONCLUSIONS
Results may inform development and regulatory evaluation for future HIFU ablation devices by providing supplemental information from the patient perspective.
Topics: Humans; Male; Prostatic Neoplasms; Patient Preference; Middle Aged; Aged; Surveys and Questionnaires; Erectile Dysfunction; Urinary Incontinence; Risk Assessment; Ultrasound, High-Intensity Focused, Transrectal; Treatment Outcome; Prostate; High-Intensity Focused Ultrasound Ablation
PubMed: 38845330
DOI: 10.1016/j.clgc.2024.102113 -
World Journal of Surgical Oncology Jun 2024To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological...
PURPOSE
To evaluate the predictors for short and long term urinary continence (UC) recovery after laparoscopic radical prostatectomy (LRP) from clinical and oncological variables.
METHODS
We retrospectively collected data from 142 prostate cancer patients who underwent LRP between September 2014 and June 2021 at a tumor specialist diagnosis and treatment center in China. The rate of post-prostatectomy incontinence (PPI) was evaluated from immediate and at 3, 6 and 12 mo after LRP, and UC was defined as the use of no or one safety pad. Sixteen clinical and oncological variables were analyzed by univariate and multivariate regression analysis to determine whether they were associated with short (3 mo) or long term (12 mo) UC recovery after LRP.
RESULTS
After eliminating patients who were lost to follow-up, 129 patients were eventually included. The mean ± SD age was 68 ± 6.3 years. The UC rates of immediate, 3, 6 and 12 mo after the operation were 27.9%, 54.3%, 75.2% and 88.4%, respectively. Multivariate analyses revealed that membranous urethral length (MUL) was a protective predictor of UC after catheter extraction(P < 0.001), and at 3 mo (P < 0.001), 6 mo (P < 0.001) and 12 mo (P = 0.009) after surgery.
CONCLUSION
MUL is a significant independent factor that can contribute to short and long term UC recovery post-LRP, which may assist clinicians and their patients in counseling of treatment.
Topics: Humans; Male; Prostatectomy; Laparoscopy; Prostatic Neoplasms; Urinary Incontinence; Aged; Retrospective Studies; China; Postoperative Complications; Follow-Up Studies; Prognosis; Middle Aged; Recovery of Function
PubMed: 38844951
DOI: 10.1186/s12957-024-03425-2 -
Nigerian Journal of Clinical Practice May 2024Organ-confined prostate cancer is curable through surgical treatment by radical prostatectomy.
BACKGROUND
Organ-confined prostate cancer is curable through surgical treatment by radical prostatectomy.
AIM
To report initial outcomes of open radical prostatectomy in Nigeria from 2014 to 2019.
METHODS
Open radical prostatectomy in private hospital settings. Thirty-five patients underwent open radical prostatectomy in private hospital settings from 2014 to 2019. A retrospective study of the case notes was undertaken.
RESULTS
The age range was 56-77 years (mean: 67.7 ± 5.6 years); presenting total PSA 7.3-32.0 ng/ml (mean: 16.2 ± 6.4); Gleason score range 6-10 and clinical stage T2c. Mean operation duration 192.4 ± 52.0 min. All patients received blood transfusion (average blood transfusion 4.58 ± 1.9 pints). The median length of hospital stay was 7 days and the catheterization duration was 16.6 days. The Gleason score ranges from 6 to 10. Biopsy and specimen histology Gleason scores correlated in all cases. Biochemical relapse within 1 year occurred in 12 (34.3%) patients. Adequate PSA control was achieved in 23 (65.7%) patients. Two cancer-related deaths occurred within 2 years of surgery. All patients voided well following removal of the catheter; persisting mild stress urinary incontinence resolved on conservative measures within 3-6 months. Anastomotic stricture occurred in one patient 1 (2.9%) in this present. Information on preoperative potency rate was unavailable; however, postoperation, 11 (31.4%) patients achieved erections sufficient for intercourse with oral therapy. All surviving 33 (94.3%) patients reported satisfactory performance status.
CONCLUSIONS
Open radical prostatectomy was successfully performed in all the patients. Reasonable, comparative functional, and oncological outcomes were achieved during the study period.
Topics: Humans; Male; Prostatectomy; Middle Aged; Nigeria; Aged; Prostatic Neoplasms; Retrospective Studies; Treatment Outcome; Neoplasm Grading; Length of Stay; Prostate-Specific Antigen
PubMed: 38842705
DOI: 10.4103/njcp.njcp_453_23 -
Archivos Espanoles de Urologia May 2024Radical prostatectomy (RP) is one of the most effective methods used to cure localised prostate cancer, but the risk of postoperative biochemical recurrence persists....
OBJECTIVE
Radical prostatectomy (RP) is one of the most effective methods used to cure localised prostate cancer, but the risk of postoperative biochemical recurrence persists. This study aims to analyse the effect of continuous nursing based on Internet technology on mental health and quality of life in patients undergoing RP.
METHODS
The medical records of patients undergoing RP in our hospital from February 2021 to February 2023 were retrospectively analysed. From February 2021 to January 2022, 89 patients received routine postoperative nursing, and 85 cases were included in the reference group after excluding 4 patients who had missing clinical data. From February 2022 to February 2023, 86 patients received continuous nursing based on Internet technology, and 80 patients were classified as the observation group after 6 patients (5 patients with incomplete clinical data and 1 patient with cognitive impairment) were excluded. The Hospital Anxiety and Depression Scale (HADS) data were collected, and urinary control, incidence of complications, nursing satisfaction and 36-item short-form health survey (SF-36) were compared between the two groups.
RESULTS
After management, patients in the observation group had lower Hospital Anxiety and Depression Scale-Anxiety (HADS-A) score, Hospital Anxiety and Depression Scale-Depression (HADS-D) score and postvoid residual (PVR) and higher maximum flow rate (Q) and detrusor pressure at the maximum flow rate (P-Q) ( < 0.001) than those in the reference group. The observation group also had significantly lower incidence of complications ( < 0.05), higher scores of physiological function, physiological role, physical pain, general health, vitality, social function, emotional function and mental health ( < 0.01) and significantly higher total nursing satisfaction ( < 0.05). Prostate specific antigen (PSA) level was not significantly different between the two groups after management ( > 0.05).
CONCLUSIONS
Continuous nursing based on Internet technology improves the psychological status and quality of life, reduces the occurrence of postoperative complications and obtains high clinical satisfaction for patients receiving RP.
Topics: Humans; Male; Prostatectomy; Retrospective Studies; Quality of Life; Mental Health; Middle Aged; Aged; Prostatic Neoplasms; Internet; Postoperative Care; Postoperative Complications
PubMed: 38840284
DOI: 10.56434/j.arch.esp.urol.20247704.55