Retrospective study on the toxicity induced by stereotactic body radiotherapy: overview of the reunion experience on prostate cancer in elderly patients.

Introduction: Prostate cancer is the fourth most commonly diagnosed cancer among men worldwide. Various tools are used to manage disease such as conventional radiotherapy. However, it has been demonstrated that large prostate volumes were often associated with higher rates of genitourinary and gastrointestinal toxicities. Currently, the improvements in radiotherapy technology have led to the development of stereotactic body radiotherapy, which delivers higher and much more accurate radiation doses. In order to complete literature data about short-term outcome and short-term toxic effects of stereotactic body radiotherapy, we aimed to share our experience about gastrointestinal and genitourinary toxicities associated with stereotactic body radiotherapy in prostate cancer in patients over 70 years old. Methods: We retrospectively reviewed the medical records of elderly patients with prostate cancer treated between 2021 and 2022. The elderly patients were treated with a non-coplanar robotic stereotactic body radiotherapy platform using real-time tracking of implanted fiducials. The prostate, with or without part of the seminal vesicles, was treated with a total dose of 36.25 Gy delivered in five fractions, each fraction being administered every other day. Results: We analyzed a total of 80 elderly patients, comprising 38 low-, 37 intermediate- and 5 high-risk patients. The median follow-up duration was 12 months. We did not observe biochemical/clinical recurrence, distant metastasis, or death. Grade 2 acute genitourinary toxicity was observed in 9 patients (11.25%) and Grade 2 acute gastrointestinal toxicity in 4 patients (5.0%). We did not observe any grade 3 or more acute or late toxicities. Conclusion: Over the follow-up period, we noted a low frequency of gastrointestinal and genitourinary toxicities induced by stereotactic body radiotherapy in the context of prostate cancer in elderly patients. Therefore, stereotactic body radiotherapy seems to represent a promising treatment option for elderly patients, with acceptable acute toxicity.

Gleason Score within Prostate Abnormal Areas Defined by Multiparametric Magnetic Resonance Imaging Did Not Vary According to the PIRADS Score.

BACKGROUND: We aim to correlate multiparametric magnetic resonance imaging (mpMRI) of the prostate reporting (Prostate Imaging Reporting and Data System [PI-RADS] version 2) with the Gleason score into both radical prostatectomy (RP) specimen and MRI fusion-targeted biopsies (FTB). METHODS: mpMRI of 74 patients who underwent an RP after FTB were retrospectively reviewed. The Gleason score distribution was compared according to the PI-RADS score using the Kruskal-Wallis test. Results were compared to those of the mpMRI-guided biopsy of the same anatomical zone. For comparison, 903 RP specimen and their corresponding classical biopsies were also reviewed. Cohen's kappa concordance test was used to compare biopsies and prostatectomy specimen analyses. RESULTS: An exact match between Gleason grade in RP specimen and FTB was found in 62% of the cases. There was no significant difference in Gleason score ≤7 (3 + 4) vs. ≥7 (4 + 3) distribution according to the PI-RADS scores (p = 0.096). Overall, Kappa coefficients were similar with MRI-targeted biopsies compared to classical biopsies (κ = 0.378, 95% CI [0.194-0.563], and κ = 0.316, 95% CI [0.259-0.374], respectively). CONCLUSIONS: PI-RADS score was not associated with significant differences regarding Gleason score distribution within target. Moreover, concordance of Gleason score in both MRI-targeted and classical biopsies with those within target in RP specimen was weak.

Superficial Implantation of the I-Stop TOMS Transobturator Sling in the Treatment of Postprostatectomy Urinary Incontinence: Description of a Novel Technique and 1-Year Outcomes.

INTRODUCTION: To describe a new technique for superficial implantation of the I-Stop TOMS transobturator sling and present the clinical outcomes on patients treated for mild to moderate urinary incontinence after radical prostatectomy. TECHNICAL CONSIDERATIONS: We evaluated the four-arm sub urethral sling I-Stop TOMS performed in our institution between March 2012 and March 2015 using a superficial implantation technique. After a small incision, the perineal aponeurosis was incised but no muscle dissection was performed. Inclusion criteria for sling procedure used in the study was mild (1-2 pads/day) to moderate (3-5 pads/day) postprostatectomy incontinence and at least 12 months after radical prostatectomy. Improvement was defined as the patient having 50% reduction in the number of pads and success as patient either not wearing pads or using one security pad. The primary objective was to evaluate the proportion of patients achieving continence after the modified sling implantation technique at 12 months after surgery. Fifty-two patients underwent our new technique and 34 had completed 12 months follow-up. The procedure was successful for 28 patients (82.4%). There was an improvement in 25 patients (73.5%). Pad use at 12 months had decreased significantly compared with baseline (mean 0.7 vs 2.2, P < .00001). The complications were rare and the procedure was well tolerated as shown by median visual analogic scale of 1.5 (interquartile range, 2 to 1). CONCLUSION: This novel approach for insertion of the transobturator I-Stop TOMS male sling is a quick, simple, and well-tolerated procedure with low complication rate, allowing a significant improvement in postprostatectomy incontinence.

Urinary Bladder Leiomyosarcoma: Primary Surgical Treatment.

Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumors. We present a case report of a 73-year-old man who underwent a radical cystoprostatectomy for a high-grade bladder leiomyosarcoma with an ileal diversion. The patient recovered uneventfully and no surgical margins were verified in final pathology. Early follow-up at 3 months shows no signs of computed tomography recurrence and adequate adaptation to ileal diversion. Although bladder sarcomas were once thought to have a grim prognosis, recent studies suggest that adequate surgical treatment is able to achieve optimal cancer control outcomes.