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Research and Reports in Urology 2023This study aimed to evaluate what objectives are most important to men undergoing radical prostatectomy to allow treating physicians to personalize perioperative... (Review)
Review
PURPOSE
This study aimed to evaluate what objectives are most important to men undergoing radical prostatectomy to allow treating physicians to personalize perioperative counselling and improve patient quality of life outcomes.
MATERIALS AND METHODS
A predefined search protocol of the Medline and Embase databases was performed from database inception to May 2023. The search was limited to English language and full text. All articles with a specific consideration of patient objectives, preferences or reasons for decision to undergo radical prostatectomy were included for review.
RESULTS
Ten articles out of 375 screened met inclusion criteria for review. All 10 articles utilized a qualitative design and originated across 5 countries across the developed world. A common theme of men placing importance on having their tumor physically removed was found. Methodologies allowing free response beyond predefined categories identified a breadth of considerations including personal circumstance, personal belief and current function in the decision-making process. An investigation on radical prostatectomy performed robotically found some men placed preference on the quicker treatment time with surgery compared to radiation therapy, reflective of shorter recovery times with the robotic approach.
CONCLUSION
Variability in results across studies highlights the heterogeneity in patient preferences. Directed investigation of patient objectives with an open-ended questioning approach would personalize the perioperative experience and may improve patient satisfaction and quality of life outcomes.
PubMed: 38145157
DOI: 10.2147/RRU.S444033 -
Cancers Dec 2023Nerve sparing (NS) is a surgical technique to optimize functional outcomes of radical prostatectomy (RP). However, it is not recommended in high risk (HR) cases because...
Nerve sparing (NS) is a surgical technique to optimize functional outcomes of radical prostatectomy (RP). However, it is not recommended in high risk (HR) cases because of the risk of a positive surgical margin that may increase the risk of cancer recurrence. In the last two decades there has been a change of perspective to the effect that in well-selected cases NS could be an oncologically safe option with better functional outcomes. Therefore, we aim to compare the functional outcomes and oncological safety of NS during RP in men with HR disease. A total of 1340 patients were included in this analysis, of which 12% ( = 158) underwent non-NSRP and 39% ( = 516) and 50% ( = 666) uni- and bilateral NSRP, respectively. We calculated a propensity score and used inverse probability of treatment weighting (IPTW) to balance the baseline characteristics of Pca patients undergoing non-NSRP and those having uni- and bilateral NSRP, respectively. NS improved functional outcomes; after IPTW, only 3% of patients having non-NSRP reached complete erectile function recovery (without erectile aid) at 24 months, whereas 22% reached erectile function recovery (with erectile aid), while 87% were continent. Unilateral NS increased the probability of functional recovery in all outcomes (OR 1.1 or 1.2, respectively), bilateral NS slightly more so (OR 1.1 to 1.4). NSRP did not impact the risk of any recurrence (HR 0.99, 95%CI 0.73-1.34, = 0.09), and there was no difference in survival for men who underwent NSRP (HR 0.65, 95%CI 0.39-1.08). There was no difference in cancer-specific survival (0.56, 95%CI 0.29-1.11). Our study found that NSRP significantly improved functional outcomes and can be safely performed in carefully selected patients with HR-PCa without compromising long term oncological outcomes.
PubMed: 38136384
DOI: 10.3390/cancers15245839 -
JAMA Network Open Dec 2023Recent data suggest that local treatment with radical prostatectomy or radiation may improve survival outcomes in men with advanced prostate cancer. However, evidence is...
IMPORTANCE
Recent data suggest that local treatment with radical prostatectomy or radiation may improve survival outcomes in men with advanced prostate cancer. However, evidence is lacking on treatment-related adverse effects among men with advanced prostate cancer.
OBJECTIVE
To assess the association of local treatment on treatment-related adverse effects among men diagnosed with advanced prostate cancer.
DESIGN, SETTING, AND PARTICIPANTS
This cohort study assessed men diagnosed with advanced prostate cancer (defined as T4, N1, and/or M1 prostate cancer) between January 1, 1999, and December 31, 2013, with follow-up through December 31, 2021, who were treated at Veterans Health Administration medical centers.
EXPOSURE
Local treatment with radical prostatectomy or radiation.
MAIN OUTCOMES AND MEASURES
Main outcomes were treatment-related adverse effects, including constitutional, gastrointestinal, pain, sexual function, and urinary function conditions, at 3 intervals after initial treatment (≤1 year, >1 to ≤2 years, and >2 to ≤5 years) after initial treatment.
RESULTS
This cohort study consisted of 5502 men (mean [SD] age, 68.7 [10.3] years) diagnosed with advanced prostate cancer. Of the cohort, 1705 men (31.0%) received local treatment. There was a high prevalence of adverse conditions in men receiving both local and nonlocal treatment, and these adverse conditions persisted for more than 2 years to 5 years or less after initial treatment. A total of 916 men (75.2%) with initial local treatment and 897 men (67.1%) with initial nonlocal treatment reported the presence of at least 1 adverse condition for more than 2 years to 5 years or less after initial treatment. In the first year, local treatment (vs nonlocal) was associated with adverse gastrointestinal (multivariable-adjusted odds ratio [AOR], 4.08; 95% CI, 3.06-5.45), pain (AOR, 1.57; 95% CI, 1.35-1.83), sexual (AOR, 2.96; 95% CI, 2.42-3.62), and urinary (AOR, 2.25; 95% CI, 1.90-2.66) conditions. Local treatment (without secondary treatment) remained significantly associated with adverse gastrointestinal (AOR, 2.39; 95% CI, 1.52-3.77), sexual (AOR, 3.36; 95% CI, 2.56-4.41), and urinary (AOR, 1.39; 95% CI, 1.09-1.78) conditions at more than 2 years to 5 years or less after treatment.
CONCLUSIONS AND RELEVANCE
In this cohort study of men with advanced prostate cancer, local treatment was associated with persistent treatment-related adverse effects across multiple domains. These results suggest that patients and clinicians should consider the adverse effects of local treatment when making treatment decisions in the setting of advanced prostate cancer.
Topics: Male; Humans; Aged; Cohort Studies; Drug-Related Side Effects and Adverse Reactions; Prostatic Neoplasms; Patients; Pain
PubMed: 38109113
DOI: 10.1001/jamanetworkopen.2023.48057 -
Open Veterinary Journal Nov 2023Juvenile urinary bladder rhabdomyosarcoma (ubRMS) is a known entity; however, literature regarding its clinical behavior and endoscopic features is scarce. The aim of...
BACKGROUND
Juvenile urinary bladder rhabdomyosarcoma (ubRMS) is a known entity; however, literature regarding its clinical behavior and endoscopic features is scarce. The aim of this study was to describe clinical and endoscopic features, and outcomes of ubRMS in dogs.
CASE DESCRIPTION
Dogs undergoing transurethral endoscopy and with a histological diagnosis of ubRMS were retrospectively collected. Seven dogs with a median age of 18 months (range 6-32 months) were included in this retrospective, multicenter, and descriptive study. Median tumor size was 58 mm (range 30-65 mm), and tumor location was bladder neck in three cases, trigone in two cases, and bladder body in two cases. Two dogs had monolateral ureteral obstruction. Two dogs presented with regional lymphadenopathy and one dog had lung lesions suggestive of metastatic disease. A grape-like mass was reported in four cases and solid in two, with variable consistency (two friables, two firms, and two not reported). Tumor treatments included surgery in three cases, surgery, and adjuvant doxorubicin in one case, and palliative therapy in three cases. The overall median survival time (ST) was 45 days. STs were shorter (range 20-45 days) for dogs treated with palliative care than for dogs treated with curative-intent treatment (range 70-120 days).
CONCLUSION
ubRMS should be considered as a differential diagnosis in young dogs presenting with bladder masses. In this study, ubRMS confirmed its aggressive clinical behavior. Surgery and chemotherapy seem to increase STs but the prognosis remains poor.
Topics: Humans; Dogs; Animals; Urinary Bladder; Retrospective Studies; Urinary Bladder Neoplasms; Prognosis; Rhabdomyosarcoma; Dog Diseases
PubMed: 38107227
DOI: 10.5455/OVJ.2023.v13.i11.15 -
Scandinavian Journal of Urology Dec 2023To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical...
OBJECTIVE
To investigate if treatment with transurethral enucleation of the prostate (TUEP) during the learning curve is as efficient and safe in the short term as transvesical open prostate enucleation (OPE), in patients with benign prostatic obstruction (BPO) > 80 ml in a population in Sweden. Methods: 54 patients with ultrasound verified BPO > 80 ml and indication for surgery underwent TUEP or OPE between 2013 and 2019. Peri- and postoperative outcome variables regarding voiding efficiency and morbidity from 20 OPE at Skåne University Hospital (SUS) and from the first 34 TUEP performed at SUS and Ystad Hospital were retrospectively assembled. Follow-up data from the first 6 postoperative months were collected by chart review.
RESULTS
Intraoperative bleeding during TUEP was less than in OPE (225 ml vs. 1,000 ml). TUEP took longer surgery time than OPE (210 vs. 150 min.). Within 30 days postoperatively, bleeding occurred less often after TUEP (23% vs. 40%), requiring one fourth of the blood transfusions given after OPE. After TUEP, patients had shorter hospitalisation (3 days vs. 7 days) and catheterisation time (3 days vs. 12 days). During the 6-month follow-up period, incontinence and UTI defined as symtomatic significant bacteriuria (urinary culture) were observed as main complications after TUEP and OPE. Functional outcome data availability (International Prostate Symptom Score [IPSS] questionnaire, uroflowmetry, residual urine) were limited.
CONCLUSIONS
Treatment with TUEP during the learning curve led to less bleeding, shorter hospitalisation- and catheterisation time than treatment with OPE. However, surgery time was shorter with OPE. There were no major differences between the groups concerning mid-term functional outcomes, with the reservation of an inconsistent follow-up.
Topics: Male; Humans; Prostate; Retrospective Studies; Transurethral Resection of Prostate; Cohort Studies; Prostatic Hyperplasia; Sweden; Treatment Outcome; Laser Therapy; Quality of Life
PubMed: 38078514
DOI: 10.2340/sju.v58.15327 -
Archivos Espanoles de Urologia Nov 2023Solitary fibrous tumors (SFTs) manifest in various anatomical locations but are seldom encountered in the prostate. Despite their rare occurrence in this region, SFTs...
BACKGROUND
Solitary fibrous tumors (SFTs) manifest in various anatomical locations but are seldom encountered in the prostate. Despite their rare occurrence in this region, SFTs demonstrate a marked propensity for recurrence. This study elucidates a case of recurrent prostate SFT, previously misdiagnosed, and delineates the salient features and diagnostic criteria pertaining for SFTs.
METHODS
Through a meticulous analysis of the patient's antecedent medical records and corroborative diagnostic evaluations, we hypothesized that the presenting pathology was indicative of a prostate SFT. In order to substantiate this supposition, we re-examined archival pathological specimens from the patient. The ensuing pathological assessment validated our conjecture. To address the recurrence, we conducted an open surgical procedure to excise the tumor. Subsequent postoperative pathological evaluations further corroborated the diagnosis of prostate SFT.
RESULTS
Upon re-evaluation of the patient's earlier pathological specimens, we discerned that what had been previously classified as a "seminal vesicle tumor" was, in fact, a prostate SFT. During the surgical intervention, it was observed that the prostatic tumor had invaded the bladder, yet there was no seminal vesicle involvement. The tumor dimensions were approximately 7 × 5 × 4 cm, and the margin between the tumor and the surgical resection edge was less than 0.1 cm. The postoperative histological analysis confirmed the diagnosis of recurrent prostate SFT, substantiating our designation of the patient's condition as such. A year-long follow-up revealed no conspicuous signs of tumor recurrence.
CONCLUSIONS
Therapeutic intervention for prostate SFT is predominantly surgical. However, given the tumor's marked predisposition for recurrence, the specific mechanisms underlying its etiology and pathogenesis remain enigmatic. Hence, a comprehensive understanding of its pathogenic and recurrent characteristics, coupled with regular postoperative surveillance, is imperative for efficacious treatment and prevention of prostate SFT.
Topics: Male; Humans; Prostate; Severe Fever with Thrombocytopenia Syndrome; Prostatic Neoplasms; Solitary Fibrous Tumors; Fibroma; Diagnostic Errors
PubMed: 38053427
DOI: 10.56434/j.arch.esp.urol.20237609.87 -
SAGE Open Medicine 2023The prognosis of local prostate cancer has improved drastically during the past 60 years. Similarly, the prognosis in metastatic stage is constantly improving due to a... (Review)
Review
The prognosis of local prostate cancer has improved drastically during the past 60 years. Similarly, the prognosis in metastatic stage is constantly improving due to a number of new pharmaceuticals introduced over the past 10 years. Previously, only palliative treatments were available for prostate cancer, but today, there are multiple options for treatment with curative intent: robotic-assisted radical prostatectomy, stereotactic radiotherapy and brachytherapy. Additionally, life-prolonging chemotherapeutic and androgen-suppressive treatments, as well as diagnostic imaging and staging, have improved considerably. This review summarizes the history of the treatment and diagnostics of prostate cancer, with a focus on the past 60 years. The aim was to provide a concise and easy-to-read introduction on the matter for all people that work with prostate cancer, as well as for patients. The literature was thoroughly examined covering the period from the earliest traceable records to the latest state-of-the-art studies.
PubMed: 38050625
DOI: 10.1177/20503121231216837 -
Central European Journal of Urology 2023We present the case of a patient who underwent an open radical prostatectomy with pelvic lymph node dissection (Gleason 4+3, pT3a pN1 R0) in March 2017. In November...
We present the case of a patient who underwent an open radical prostatectomy with pelvic lymph node dissection (Gleason 4+3, pT3a pN1 R0) in March 2017. In November 2020, prostate-specific membrane antigen (PSMA)-radioguided salvage lymph node dissection was planned due to a single left para-rectal lymph node at a [Ga] Ga-PSMA-I&T PET. In January 2022, the [Ga] Ga-PSMA-I&T PET showed an isolated liver lesion. Biopsy confirmed prostate adenocarcinoma. A liver segmentectomy was performed. A complete biochemical response was reported until the last follow-up (December 2022). Prostate-specific membrane antigen positron emission tomography (PSMA PET)-directed metastasis-directed therapy may be an effective treatment in selected cases, allowing a benefit in the oncological outcome.
PubMed: 38045775
DOI: 10.5173/ceju.2023.69 -
Frontiers in Endocrinology 2023Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation. (Meta-Analysis)
Meta-Analysis
CONTEXT
Surgical treatment is important for male lower urinary tract symptom (LUTS) management, but there are few reviews of the risks of reoperation.
OBJECTIVE
To systematically evaluate the current evidence regarding the reoperation rates of surgical treatment for LUTS in accordance with current recommendations and guidelines.
EVIDENCE ACQUISITION
Eligible studies published up to July 2023, were searched for in the PubMed (National Library of Medicine, Bethesda, MD, USA), Embase (Elsevier, Amsterdam, the Netherlands), and Web of Science™ (Clarivate™, Philadelphia, PA, USA) databases. STATA (StataCorp LP, College Station, TX, USA) software was used to conduct the meta-analysis. Random-effects models were used to calculate the pooled incidences (PIs) of reoperation and the 95% confidence intervals (CIs).
EVIDENCE SYNTHESIS
A total of 119 studies with 130,106 patients were included. The reoperation rate of transurethral resection of the prostate (TURP) at 1, 2, 3, and 5 years was 4.0%, 5.0%, 6.0%, and 7.7%, respectively. The reoperation rate of plasma kinetic loop resection of the prostate (PKRP) at 1, 2, 3, and 5 years was 3.5%, 3.6%, 5.7%, and 6.6%, respectively. The reoperation rate of holmium laser enucleation of the prostate (HoLEP) at 1, 2, 3, and 5 years was 2.4%, 3.3%, 5.4%, and 6.6%, respectively. The reoperation rate of photoselective vaporization of the prostate (PVP) at 1, 2, 3, and 5 years was 3.3%, 4.1%, 6.7%, and 7.1%, respectively. The reoperation rate of surgery with AquaBeam at 1, 2, 3, and 5 years was 2.6%, 3.1%, 3.0%, and 4.1%, respectively. The reoperation rate of prostatic artery embolization (PAE) at 1, 2, 3, and 5 years was 12.2%, 20.0%, 26.4%, and 23.8%, respectively. The reoperation rate of transurethral microwave thermotherapy (TUMT) at 1, 2, 3, and 5 years was 9.9%, 19.9%, 23.3%, and 31.2%, respectively. The reoperation rate of transurethral incision of the prostate (TUIP) at 5 years was 13.4%. The reoperation rate of open prostatectomy (OP) at 1 and 5 years was 1.3% and 4.4%, respectively. The reoperation rate of thulium laser enucleation of the prostate (ThuLEP) at 1, 2, and 5 years was 3.7%, 7.7%, and 8.4%, respectively.
CONCLUSION
Our results summarized the reoperation rates of 10 surgical procedures over follow-up durations of 1, 2, 3, and 5 years, which could provide reference for urologists and LUTS patients.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/PROSPERO, identifier CRD42023445780.
Topics: United States; Humans; Male; Prostatic Hyperplasia; Transurethral Resection of Prostate; Prostate; Reoperation; Embolization, Therapeutic; Lower Urinary Tract Symptoms
PubMed: 38027158
DOI: 10.3389/fendo.2023.1287212 -
Journal of Cellular and Molecular... Jan 2024Treatments for organ-confined prostate cancer include external beam radiation therapy, radical prostatectomy, radiotherapy/brachytherapy, cryoablation and high-intensity...
Treatments for organ-confined prostate cancer include external beam radiation therapy, radical prostatectomy, radiotherapy/brachytherapy, cryoablation and high-intensity focused ultrasound. None of these are cancer-specific and are commonly accompanied by side effects, including urinary incontinence and erectile dysfunction. Moreover, subsequent surgical treatments following biochemical recurrence after these interventions are either limited or affected by the scarring present in the surrounding tissue. Carnosine (β-alanyl-L-histidine) is a histidine-containing naturally occurring dipeptide which has been shown to have an anti-tumorigenic role without any detrimental effect on healthy cells; however, its effect on prostate cancer cells has never been investigated. In this study, we investigated the effect of carnosine on cell proliferation and metabolism in both a primary cultured androgen-resistant human prostate cancer cell line, PC346Flu1 and murine TRAMP-C1 cells. Our results show that carnosine has a significant dose-dependent inhibitory effect in vitro on the proliferation of both human (PC346Flu1) and murine (TRAMP-C1) prostate cancer cells, which was confirmed in 3D-models of the same cells. Carnosine was also shown to decrease adenosine triphosphate content and reactive species which might have been caused in part by the increase in SIRT3 also shown after carnosine treatment. These encouraging results support the need for further human in vivo work to determine the potential use of carnosine, either alone or, most likely, as an adjunct therapy to surgical or other conventional treatments.
Topics: Male; Humans; Animals; Mice; Carnosine; Prostatic Neoplasms; Dipeptides; Brachytherapy; Erectile Dysfunction
PubMed: 38018900
DOI: 10.1111/jcmm.18061