Does the radiation approach affect acute toxicity in prostate cancer patients? A comparison of four radiation techniques.

INTRODUCTION: Prostate cancer is treated with increasingly sophisticated radiation techniques. The aim of the study is to compare acute toxicity in patients managed with different therapeutic modalities. MATERIAL AND METHODS: A total of 60 patients irradiated between 2012 and 2016 were analyzed: A. conformal 3D - 11, B. intensity-modulated radiation therapy (IMRT) 20, C. image-guided radiation therapy (IGRT) - 19 and D. volumetric modulated arc therapy (VMAT) - 10. Patients' age ranged from 46 to 85 years (median 70.5), prostate-specific antigen values at the time of diagnosis were in the range of 3.54-154 ng/ml (median 15.9). Acute toxicity from the genitourinary (GU) and gastrointestinal (GI) tracts according to the European Organization for Research and Treatment of Cancer (EORTC) /Radiation Therapy Oncology Group (RTOG) grading system were assessed. RESULTS: All irradiation techniques were well tolerated and neither 3 nor 4 degrees acute toxicity was observed. Importantly, IGRT and IMRT did not lead to Grade 2 GI acute toxicity. There was no relationship between the severity of GU acute toxicity depending on the irradiation technique used (p = 0.8), but a trend towards a significant relationship was noted for GI acute toxicity (p = 0.05). CONCLUSIONS: All assessed irradiation methods do not lead to severe acute adverse effects. Importantly, patients treated with IGRT and IMRT had only minor GI toxicity.

Active surveillance and focal ablation for small renal masses: a better solution for comorbid patients.

The natural history of small renal masses (SRM) is still not well understood and they are frequently incidentally diagnosed in elderly patients. Therefore, there is a need for less invasive options sparing the patient from the side-effects related to conventional surgical treatment. PubMed and Medline database search was performed to look for new findings on active surveillance and focal therapy for SRM. Sixty-one articles published between 2002 and 2018 were selected for the purpose of the review. There is growing evidence confirming the safety of active surveillance in patients at surgical risk and there appears to be a satisfactory intermediate-term outcome of focal treatment of SRM. In the group of elderly patients with a decreased life expectancy active surveillance appears to be the most appropriate approach. The future of minimally invasive therapy appears bright, especially with the improvement of new imaging modalities.

Preservation of continence in radical prostatectomy patients: a laparoscopic surgeon's perspective.

INTRODUCTION: Preserving continence in patients who underwent radical prostatectomy is of utmost importance. Therefore, modification of surgical technique that would contribute to the regaining of continence with a shortest possible delay after the procedure and adequate evaluation of chances of continence recovery should be considered. MATERIAL AND METHODS: A PubMed database search was performed to review the current literature concerning the physiology and anatomy of sphincter mechanisms, perioperative risk factors, the effects of surgical techniques on post-prostatectomy continence and post-operative management. RESULTS: Modifications of surgical approach with an aim to minimize damage to the sphincter complex, maintenance of maximal urethral length to enable safe anastomosis, and the reconstruction of the urethral support system appears necessary. The patient should also be informed about the chances of regaining continence after surgery. CONCLUSIONS: There is a need to develop a predictive model to stratify patients according to risk of incontinence and implement adequate action to minimize those risks including preoperative pelvic floor muscle training and/or surgical technique modification.