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PURPOSE: This study aimed to evaluate the usefulness of the LDN-PSA (LacdiNAc-glycosylated-prostate specific antigen) in detecting clinically significant prostate cancer in patients suspected of having clinically significant prostate cancer on multiparametric magnetic resonance imaging. MATERIALS AND METHODS: Patients with prostate specific antigen levels ranging between 3.0 ng/mL and 20 ng/mL and suspicious lesions with PI-RADS (Prostate Imaging-Reporting and Data System) category ≥3 were included prospectively. The LDN-PSA was measured using an automated 2-step Wisteria floribunda agglutinin lectin-anti-prostate specific antigen antibody sandwich immunoassay. RESULTS: Two hundred four patients were included. Clinically significant prostate cancer was detected in 105 patients. On multivariable logistic regression analysis, prostate specific antigen density (OR 1.61, P = .010), LDN-PSAD (OR 1.04, P = .012), highest PI-RADS category (3 vs 4, 5; OR 14.5, P < .0001), and location of the lesion with highest PI-RADS category (transition zone vs peripheral zone) (OR 0.34, P = .009) were significant risk factors for detecting clinically significant prostate cancer. Among the patients with the highest PI-RADS category 3 (n=113), clinically significant prostate cancer was detected in 28 patients. On multivariable logistic regression analysis to predict the detection of clinically significant prostate cancer in patients with the highest PI-RADS category 3, age (OR 1.10, P = .026) and LDN-PSAD (OR 1.07, P < .0001) were risk factors for detecting clinically significant prostate cancer. CONCLUSIONS: LDN-PSAD would be a biomarker for detecting clinically significant prostate cancer in patients with prostate specific antigen levels ≤20 ng/mL and suspicious lesions with PI-RADS category ≥3. The use of LDN-PSAD as an adjunct to the use of prostate specific antigen levels would avoid unnecessary biopsies in patients with the highest PI-RADS category 3. Multi-institutional studies with large population are recommended.
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Antígeno Prostático Específico , Neoplasias da Próstata , Humanos , Masculino , Imageamento por Ressonância Magnética , Neoplasias da Próstata/diagnóstico por imagemRESUMO
BACKGROUND: Collecting system entry in robot-assisted partial nephrectomy may occur even in cases showing a low N factor in the R.E.N.A.L nephrometry score. Therefore, in this study, we focused on the tumor contact surface area with the adjacent renal parenchyma and attempted to construct a novel predictive model for collecting system entry. METHODS: Among 190 patients who underwent robot-assisted partial nephrectomy at our institution from 2015 to 2021, 94 patients with a low N factor (1-2) were analyzed. Contact surface was measured with three-dimensional imaging software and defined as the C factor, classified as C1, < 10 cm [2]; C2, ≥ 10 and < 15 cm [2]; and C3: ≥ 15 cm [2]. Additionally, a modified R factor (mR) was classified as mR1, < 20 mm; mR2, ≥ 20 and < 40 mm; and mR3, ≥ 40 mm. We discussed the factors influencing collecting system entry, including the C factor, and created a novel collecting system entry predictive model. RESULTS: Collecting system entry was observed in 32 patients with a low N factor (34%). The C factor was the only independent predictive factor for collecting system entry in multivariate regression analysis (odds ratio: 4.195, 95% CI: 2.160-8.146, p < 0.0001). Models including the C factor showed better discriminative power than the models without the C factor. CONCLUSIONS: The new predictive model, including the C factor in N1-2 cases, may be beneficial, considering its indication for preoperative ureteral catheter placement in patients undergoing robot-assisted partial nephrectomy.
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Carcinoma de Células Renais , Neoplasias Renais , Nefrectomia , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Estudos Retrospectivos , Carcinoma de Células Renais/cirurgia , Neoplasias Renais/cirurgiaRESUMO
OBJECTIVES: There is no recommended observation time for patients who have undergone radical prostatectomy for prostate cancer. This study was undertaken to determine the postoperative observation time by investigating the hazard rate for prostate-specific antigen failure and other-cause death using Weibull analysis. METHODS: We included 612 patients who underwent laparoscopic radical prostatectomy for localized prostate cancer between June 2002 and December 2017. Risk classification was categorized by the D'Amico risk classification, and the patients were divided into three age groups: <60, 60-69 and ≥70 years. The hazard rates at each point were derived using Weibull analysis. The optimal observation time after laparoscopic radical prostatectomy was determined as the intersection point at which the hazard rate of other-cause death overtakes the hazard rate of prostate-specific antigen failure. RESULTS: In all groups classified by age, the hazard rate of other-cause deaths increased over time. In contrast, the hazard rate of prostate-specific antigen failure decreased gradually. The ≥70 years age group showed the highest hazard rate. The hazard rate of prostate-specific antigen failure was highest in the high-risk group. The patients aged ≥70 and 60-69 years in the low-risk group were recommended 6 years 6 months and 14 years 8 months, respectively, for observation. The remaining patients were recommended >25 years of postsurgical observation. CONCLUSIONS: The observation time after laparoscopic radical prostatectomy could be estimated by comparing the estimated hazard rates of prostate-specific antigen failure and other-cause death based on Weibull analysis. Urologists should pay attention to age and risk classifications for optimal postoperative observation.
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Neoplasias da Próstata , Urologistas , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Próstata , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND: Robot-assisted radical prostatectomy (RARP) has gained prominence since the da Vinci surgical system was introduced in 2000. RARP has now become a standard procedure for treating cases with localized prostate cancer. However, no study has examined its surgical time by accurately measuring the pelvic visceral fat (PVF) volume. This study aimed to investigate the factors associated with prolonged console time and surgical difficulty by RARP surgeons. METHODS: This study included 405 patients who underwent RARP between 2014 and 2019 at our institution. Given that the anatomical characteristics were considered to affect RARP, PVF and working space (WS) were estimated preoperatively by computed tomography using a 3D image analysis system. Univariate and multivariate logistic regression analyses were performed to identify the factors prolonging console time, such as body mass index (BMI), prostate volume, previous abdominal surgery, nerve-sparing procedure, PVF, and WS. We also investigated whether post-operative complications were associated with any of these factors. RESULTS: Larger PVF (p = 0.028, odds ratio (OR) 1.43), smaller WS (p < 0.001, OR 2.48), and the nerve-sparing procedure (p = 0.037, OR 1.61) were statistically significant factors associated with prolonged console time. Furthermore, higher BMI (p = 0.013, OR 1.49) and smaller pelvic width (p < 0.001, OR 2.63) were the alternative and more practical factors associated with prolonged console time. The post-operative anastomotic leakage occurrence rate increased with the number of risk factors, while post-operative complications did not change even in high-risk cases. CONCLUSION: PVF and WS are significant factors associated with prolonged console time in RARP cases. However, BMI can be as useful as PVF, since BMI significantly correlated with PVF. Additionally, pelvic width (PW) can be an alternative to WS, since PW correlated with WS. This study demonstrated that preoperative BMI and PW might predict the surgical risk and identify suitable RARP cases for novice surgeons.
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Laparoscopia , Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Masculino , Duração da Cirurgia , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/cirurgiaRESUMO
OBJECTIVE: To evaluate the accuracy of real-time elastic fusion image-guided transperineal prostate biopsy with needle tracking involving a mechanical position-encoded stepper in detecting clinically significant prostate cancer for biopsy-naïve men. METHODS: We prospectively recruited patients with serum prostate-specific antigen levels of 4.0-20 ng/mL and suspicious of prostate cancer on multiparametric magnetic resonance imaging. They underwent targeted biopsies for cancer-suspicious lesions and 12-core systematic biopsies. Pathological findings from biopsy cores and whole-mount specimens (for those who underwent radical prostatectomy) were analyzed. RESULTS: A total of 250 patients were included, in whom targeted and systematic biopsies detected significant cancers in 55% and 25%, respectively (P < 0.001). The targeted biopsy cores (n = 527) showed significantly greater biopsy-proven significant cancer detection rates (P < 0.001), cancer core length (P < 0.0001), cancer core percentage (P < 0.001) and Gleason scores (P < 0.001) than did the systematic biopsies. The significant cancer detection rate for targeted lesions (those with Prostate Imaging and Reporting and Data System classification scores of 5) was 80%. Biopsy-proven significant cancer detection rates for targeted lesions ≤10 mm and >10 mm were similar for Prostate Imaging and Reporting and Data System scores of 4 (P = 0.707) and 5 (P = 0.386). In whole-mount specimens (n = 30), locations for 95% of significant cancers were diagnosed preoperatively. Targeted biopsies alone diagnosed 79% of significant cancers. CONCLUSIONS: Although targeted biopsies are superior to systematic biopsies in detecting significant cancers, systematic biopsies maintain an important role in the diagnosis of prostate cancer in biopsy-naïve men.
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Processamento de Imagem Assistida por Computador/métodos , Imageamento por Ressonância Magnética/métodos , Neoplasias da Próstata/diagnóstico , Ultrassonografia de Intervenção/métodos , Idoso , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre/métodos , Humanos , Biópsia Guiada por Imagem/métodos , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Períneo/cirurgia , Estudos Prospectivos , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/patologiaRESUMO
PURPOSE: We evaluated the association between long-term clinical outcomes and morbidity with high intensity focused ultrasound. MATERIALS AND METHODS: We included patients with stage T1c-T3N0M0 prostate cancer who were treated with Sonablate® (SB) devices during 1999 to 2012 and followed for more than 2 years. Risk stratification and complication rates were compared among the treatment groups (ie SB200/500 group, SB500 version 4 group and SB500 tissue change monitor group). Primary study outcomes included overall, cancer specific and biochemical disease-free survival rates determined using Kaplan-Meier analysis (Phoenix definition). Secondary outcomes included predictors of biochemical disease-free survival using Cox models. RESULTS: A total of 918 patients were included in the study. Median followup in the SB200/500, SB500 version 4 and the SB500 tissue change monitor groups was 108, 83 and 47 months, respectively. The 10-year overall and cancer specific survival rates were 89.6% and 97.4%, respectively. The 5-year biochemical disease-free survival rate in the SB200/500, SB500 version 4 and SB500 tissue change monitor group was 48.3%, 62.3% and 82.0%, respectively (p < 0.0001). The overall negative biopsy rate was 87.3%. On multivariate analysis pretreatment prostate specific antigen, Gleason score, stage, neoadjuvant androgen deprivation therapy and high intensity focused ultrasound devices were significant predictors of biochemical disease-free survival. Urethral stricture, epididymitis, urinary incontinence and rectourethral fistula were observed in 19.7%, 6.2%, 2.3% and 0.1% of cases, respectively. CONCLUSIONS: Long-term followup of patients with high intensity focused ultrasound demonstrated improved clinical outcomes due to technical, imaging and technological advancements.
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Neoplasias da Próstata/cirurgia , Ultrassom Focalizado Transretal de Alta Intensidade/instrumentação , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate longitudinal changes in urinary function and quality of life, and the oncological outcomes of patients treated with urethra-sparing high-intensity focused ultrasound for localized prostate cancer. METHODS: Patients with negative findings in the urethra and the anterior urethral zone using transrectal ultrasound-guided targeted biopsies, and magnetic resonance imaging, received urethra-sparing or whole-gland high-intensity focused ultrasound as the primary therapy for localized prostate cancer without transurethral resection of the prostate. Longitudinal changes in urinary function and quality of life, and the oncological outcomes of the patients were analyzed retrospectively. RESULTS: The median follow-up times for urethra-sparing and whole-gland high-intensity focused ultrasound were 36 and 30 months, respectively. Comparing the patients treated with urethra-sparing high-intensity focused ultrasound (n = 45) with those treated with whole-gland high-intensity focused ultrasound (n = 65), there were significant differences in the International Prostate Symptom Score (P = 0.014) at 3 months, International Prostate Symptom Score quality of life (P = 0.033) at 3 months, maximum urinary flow rate (mL/s; at 3 months, P = 0.010; at 6 months, P = 0.038) and residual urine volume (mL; at 3 months, P < 0.0001; at 6 months, P = 0.016; at 12 months, P = 0.028). For quality of life, there were significant differences in Functional Assessment of Cancer Therapy - General (at 3 months, P = 0.022) and Functional Assessment of Cancer Therapy - Prostate (at 3 months, P = 0.028; at 6 months, P = 0.034). There were no significant differences in oncological outcomes regarding negative biopsy rates on follow up (91% vs 92%; P = 0.8) or biochemical disease-free survival rates (86.7% vs 89.2%; P = 0.7). CONCLUSIONS: Urethra-sparing high-intensity focused ultrasound might prevent prolonged bladder outlet obstruction, and could be a treatment option for localized prostate cancer.
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Complicações Pós-Operatórias , Próstata/patologia , Neoplasias da Próstata/cirurgia , Ultrassom Focalizado Transretal de Alta Intensidade , Uretra/patologia , Obstrução do Colo da Bexiga Urinária/cirurgia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Intervalo Livre de Doença , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Antígeno Prostático Específico , Neoplasias da Próstata/patologia , Qualidade de Vida , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate the effects of transrectal compression of the prostate for intra-operative prostatic swelling and intraprostatic point shift during high-intensity focused ultrasound treatment of localized prostate cancer. METHODS: Patients treated with whole-gland high-intensity focused ultrasound as primary monotherapy for localized prostate cancer were enrolled in the study. Using the standard and compression method, the volumes of degassed water in the balloon covering the high-intensity focused ultrasound probe were 50 mL and 80-160 mL, respectively. To identify prostatic swelling and shift during high-intensity focused ultrasound and the volume occupied by the non-enhanced area, three-dimensional prostate models were reconstructed using ultrasound and contrast-enhanced magnetic resonance imaging. RESULTS: In comparison with the standard (n = 40) and compression (n = 48) methods, intraoperative increase in the prostate volume (21% vs 5.3%; P = 0.044), intraprostatic point shift (4 mm vs 2 mm, P = 0.040 in the transition zone; 3 mm vs 0 mm; P = 0.001 in the peripheral zone) and the volume occupied by the non-enhanced area (89% vs 96%; P = 0.001) were significantly suppressed. The biochemical disease-free survival rate in patients treated using the compression method was significantly improved relative to the standard method (92.6% vs 76.5%; P = 0.038). Regarding complications, there was no significant difference in the rate of urethral stricture (P = 0.9), urinary tract infection (P = 0.9), incontinence (P = 0.3), erectile dysfunction (P = 0.9) or recto-urethral fistula between the patients treated using the standard and compression methods. CONCLUSIONS: Intraoperative transrectal compression suppresses intraoperative increase in the prostate volume and intraprostatic point shift during high-intensity focused ultrasound, having the potential to achieve precise whole-gland and lesion-targeted focal therapy.
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Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Neoplasias da Próstata/cirurgia , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Intervalo Livre de Doença , Ablação por Ultrassom Focalizado de Alta Intensidade/efeitos adversos , Humanos , Imageamento Tridimensional , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pressão , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia , UltrassonografiaRESUMO
OBJECTIVES: To report our early experience with manually controlled targeted biopsy with real-time multiparametric magnetic resonance imaging and transrectal ultrasound fusion images for the diagnosis of prostate cancer. METHODS: A total of 20 consecutive patients suspicious of prostate cancer at the multiparametric magnetic resonance imaging scan were recruited prospectively. Targeted biopsies were carried out for each cancer-suspicious lesion, and 12 systematic biopsies using the BioJet system. Pathological findings of targeted and systematic biopsies were analyzed. RESULTS: The median age of the patients was 70 years (range 52-83 years). The median preoperative prostate-specific antigen value was 7.4 ng/mL (range 3.54-19.9 ng/mL). Median preoperative prostate volume was 38 mL (range 24-68 mL). The number of cancer-detected cases was 14 (70%). The median Gleason score was 6.5 (range 6-8). Cancer-detected rates of the systematic and targeted biopsy cores were 6.7 and 31.8%, respectively (P < 0.0001). In six patients who underwent radical prostatectomy, the geographic locations and pathological grades of clinically significant cancers and index lesions corresponded to the pathological results of the targeted biopsies. CONCLUSION: Prostate cancers detected by targeted biopsies with manually controlled targeted biopsy using real-time multiparametric magnetic resonance imaging and transrectal ultrasound fusion imaging have significantly higher grades and longer length compared with those detected by systematic biopsies. Further studies and comparison with the pathological findings of whole-gland specimens have the potential to determine the role of this biopsy methodology in patients selected for focal therapy and those under active surveillance.
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Endossonografia/métodos , Biópsia Guiada por Imagem/métodos , Imageamento por Ressonância Magnética/métodos , Cuidados Pré-Operatórios/métodos , Próstata/diagnóstico por imagem , Próstata/patologia , Neoplasias da Próstata/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Prostatectomia , Neoplasias da Próstata/cirurgia , Reto , Reprodutibilidade dos Testes , Fatores de TempoRESUMO
Avascular areas on contrast-enhanced magnetic resonance imaging have been considered to be areas of localized prostate cancer successfully treated by high-intensity focused ultrasound. However, the optimal timing of magnetic resonance imaging has not been discussed. The thermal effect of high-intensity focused ultrasound is degraded by regional prostatic blood flow. Conversely, the mechanical effect of high-intensity focused ultrasound (cavitation) is not affected by blood flow, and can induce vessel damage. In this series, the longitudinal change of blood flow on contrast-enhanced magnetic resonance imaging was observed from postoperative day 1 to postoperative day 14 in 10 patients treated with high-intensity focused ultrasound. The median rates of increase in the non-enhanced volume of the whole gland, transition zone and peripheral zone from postoperative day 1 to postoperative day 14 were 36%, 39%, and 34%, respectively. In another pathological analysis of the prostate tissue of 17 patients immediately after high-intensity focused ultrasound without neoadjuvant hormonal therapy, we observed diffuse coagulative degeneration and partial non-coagulative prostate tissue around arteries with vascular endothelial cell detachment. These observations on contrast-enhanced magnetic resonance imaging support a time-dependent change of the blood flow in the prostate treated with high-intensity focused ultrasound. Additionally, our pathological findings support the longitudinal changes of these magnetic resonance imaging findings. Further large-scale studies will investigate the most appropriate timing of contrast-enhanced magnetic resonance imaging for evaluation of the effectiveness of high-intensity focused ultrasound for localized prostate cancer.
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Neoplasias da Próstata/irrigação sanguínea , Neoplasias da Próstata/diagnóstico por imagem , Fluxo Sanguíneo Regional , Ablação por Ultrassom Focalizado de Alta Intensidade , Humanos , Imageamento por Ressonância Magnética , Masculino , Estudos Retrospectivos , Fatores de Tempo , UltrassonografiaRESUMO
Recent advances in high-intensity focused ultrasound, which was developed in the 1940s as a viable thermal tissue ablation approach, have increased its popularity. High-intensity focused ultrasound is currently utilized the most in Europe and Japan, but has not yet been approved by the Food and Drug Administration, USA, for this indication. The purpose of the present report is to review the scientific foundation of high-intensity focused ultrasound technology and the clinical outcomes achieved with commercially available devices. Recently published articles were reviewed to evaluate the current status of high-intensity focused ultrasound as a primary or salvage treatment option for localized prostate cancer. Improvements in the clinical outcome as a result of technical, imaging and technological advancements are described herein. A wide range of treatment options for organ-confined prostate cancer is available. However, high-intensity focused ultrasound is an attractive choice for men willing to choose less invasive options, although establishing the efficacy of high-intensity focused ultrasound requires longer follow-up periods. Technological advances, together with cultural and economic factors, have caused a dramatic shift from traditional open, radical prostatectomy to minimally invasive techniques. High-intensity focused ultrasound is likely to play a significant role in the future of oncology practice.
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Hipertermia Induzida , Neoplasias da Próstata/terapia , Terapia por Ultrassom , Humanos , Masculino , Terapia por Ultrassom/efeitos adversos , Terapia por Ultrassom/instrumentaçãoRESUMO
A 43-year-old man was referred to our hospital with a bladder tumor, which was incidentally found by abdominal ultrasonography in a health examination. Cystoscopy and magnetic resonance imaging showed a 3 cm submucosal bladder tumor localized at the top of the bladder. We performed transurethral resection of bladder tumor. Histopathological features was inflammatory tumor of urinary bladder. No local recurrence was seen 6 months after surgery.
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Granuloma de Células Plasmáticas/patologia , Doenças da Bexiga Urinária/patologia , Adulto , Cistoscopia , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
PURPOSE: We aimed to evaluate the impact of stone volume on the surgical outcomes of patients who underwent percutaneous nephrolithotripsy, which is the preferred treatment for renal and upper ureteral stones. MATERIALS AND METHODS: This retrospective study included 37 patients who underwent percutaneous lithotripsy between 2013 and 2019. Preoperative and postoperative stone volumes were quantified using computed tomography scan data. RESULTS: The mean preoperative and postoperative stone volumes were 10.7 cm3 (1.1-50.2 cm3 ) and 2.1 cm3 (0-18.2 cm3 ), respectively. The correlation coefficient between the stone volume and maximum stone length was 0.62 (P < .01). A residual stone volume of >5 mm was observed in 17 cases (45.9%). Thirteen cases underwent secondary treatment (35.1%) who had a preoperative stone volume of >15 cm3 or a postoperative stone volume of <2 cm3 . The areas under the curve for the stone volume for treatment success and the requirement for secondary treatment were 0.701 and 0.739, respectively, and were higher than those of stone length (0.638 and 0.558) and shape (0.644 and 0.641). CONCLUSIONS: Measurement of stone volume using three-dimensional imaging is simple and greatly impacted the course of stone treatment. Information on stone volume may predict an increased likelihood of secondary treatment in patients with a preoperative stone volume of >15 cm3 .
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Cálculos Renais , Litotripsia , Cálculos Ureterais , Humanos , Cálculos Renais/diagnóstico por imagem , Cálculos Renais/cirurgia , Litotripsia/efeitos adversos , Estudos Retrospectivos , Resultado do Tratamento , Cálculos Ureterais/diagnóstico por imagem , Cálculos Ureterais/cirurgiaRESUMO
High-intensity focused ultrasound (HIFU) was experimentally used for focal therapy for anti-cancer effects in prostate cancer (PC). Focal therapy is a diagnosis-based investigational treatment option for localized PC that cures clinically significant PC (csPC) while preserving the anatomical structures related to urinary and sexual function based on its spread observed using multi-parametric magnetic resonance imaging (mpMRI). The European Association of Urology indicated that the current status of focal therapy for localized PC was an investigational modality and encouraged prospective recording of outcomes and recruitment of suitable patients in 2018. During the last few years, large-population multi- and single-center prospective studies have investigated focal therapy as a treatment strategy for localized PC. In a multicenter prospective study with 5-year follow-up, failure-free survival, which was defined as avoidance of local salvage therapy (surgery or radiotherapy), systemic therapy, metastases, and prostate cancer-specific death, was 88%. In the previous studies, there was no significant influence on urinary function before and at 3 months after the treatment, although transient impairment was reported 1 month after the treatment. Pad- and leak-free continence was preserved in 80-100% of the patients after treatment. Erectile function was significantly impaired in the initial 3 months after treatment compared to the pretreatment values, but it improved 6 months after the focal therapy in the previous reports. Paired comparison studies and cohort studies with long-term follow-up will contribute to verifying this treatment's clinical outcomes for patients with localized PC.
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The present study aimed to analyze the effect of predisposing clinical factors for severe erectile dysfunction (ED) in patients treated with focal therapy using high-intensity focused ultrasound (HIFU) for localized prostate cancer (PC). Patients without severe ED (International Index of Erectile Function-5 [IIEF-5] score ≥ 8) before focal HIFU therapy were included. A total of 92 of the 240 patients met the inclusion criteria and were included. The rate of severe ED (IIEF-5 ≤ 7) was 36% 12 months after treatment. Multivariable logistic regression analysis showed that the pre-procedural lower IIEF-5 score (odds ratio [OR] 0.812, p = 0.005), the pre-procedural lower score of the sexual domain of the Expanded Prostate Cancer Index Composite (OR 0.960, p = 0.038), and the treatment of the edge of the peripheral zone (PZ) in proximity to the neurovascular bundle (NVB) [treated vs. untreated, OR 8.048, p = 0.028] were significant risk factors for severe ED at 12 months after treatment. In conclusion, pre-procedural lower erectile function and treatment of the part in proximity to the NVB were significant risk factors for severe ED after focal therapy.
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OBJECTIVE: To investigate the use of high-intensity focused ultrasound (HIFU) as a salvage therapy in patients with recurrence of localized prostate cancer after external beam radiation (EBRT), brachytherapy, or proton therapy. PATIENTS AND METHODS: We retrospectively reviewed the charts of all patients who had undergone salvage HIFU for biopsy-proven prostate cancer after primary radiation therapy. Patient characteristics and oncological outcomes were assessed. RESULTS: Records of 22 patients with a median (range) follow-up of 24 (5-80) months were reviewed. Patients were men with presumed organ-confined disease who had been treated with salvage HIFU following recurrent disease after EBRT (fourteen patients), brachytherapy (five patients: four with high-dose brachytherapy using In(192) ; and one with low-dose brachytherapy using Au(98) ) or proton therapy (three patients). The median (range) age at salvage HIFU was 65 (52-80) years, with a median (range) prostate-specific antigen (PSA) level before radiation therapy of 14.3 (5.7-118) ng/mL and a median (range) PSA level of 4.0 (1.2-30.1) ng/mL before HIFU. The median (range) period to HIFU after radiation therapy was 36 (4-96) months. The biochemical disease-free survival (bDFS) rate in all patients at 5 years was 52%. Rates of bDFS in low-, intermediate- and high-risk groups were 100%, 86%, and 14%, respectively. One of the twelve patients who received post-HIFU prostate biopsy showed malignancy. Side effects included urethral stricture in four patients, grade I urinary incontinence in four patients, rectourethral fistula and epididymitis in one of each patient. CONCLUSION: Salvage HIFU is a promising treatment option for local recurrence after radiation therapy, with morbidity comparable with other forms of salvage treatment.
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Recidiva Local de Neoplasia/terapia , Neoplasias da Próstata/terapia , Terapia de Salvação/métodos , Ultrassom Focalizado Transretal de Alta Intensidade , Idoso , Idoso de 80 Anos ou mais , Braquiterapia , Métodos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Antígeno Prostático Específico/metabolismo , Neoplasias da Próstata/patologia , Terapia com Prótons , Resultado do TratamentoRESUMO
INTRODUCTION: Ureteropelvic junction obstruction associated with ureteral duplication is rare, with prevalence reported to be around 2-7%. Ureteropelvic junction obstruction of the lower pole with both complete and incomplete duplex systems is a common cause of obstruction. Here, we report a case of ureteropelvic junction obstruction associated with incomplete ureteral duplication of the solitary kidney successfully treated by pyeloureterostomy. CASE PRESENTATION: The patient was a 39-year-old woman who presented with right hydronephrosis, right back pain, and deteriorated renal function. The patient was referred to our department from the rheumatology department. Her medical history included congenital left renal hypoplasia, Sjogren's syndrome, and hyperphospholipid antibody syndrome. CONCLUSION: We encountered a case of hydronephrosis occurring in a solitary kidney with incomplete ureteral duplication. This case was successfully managed after pyeloureterostomy.
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Background: There is lack of evaluation of the effect of the treated area on the urinary function after focal therapy. The objectives of the study is to evaluate the effects of focal therapy on urinary function in the anterior portion of the transition zone (TZ) with transrectal high-intensity focused ultrasound (HIFU) for localized prostate cancer (PCa). Methods: From 2016 to 2018, patients who were diagnosed as having localized PCa and treated with focal therapy with HIFU, were included prospectively. The urinary function and complications were evaluated separately in the treated regions of the anterior TZ (TZ group) and other portions (other group) for 12 months. Before and after the treatment, the International Prostate Symptom Score (IPSS), IPSS Quality Of Life (QOL), Overactive Bladder Symptom Score (OABSS), and uroflowmetry were evaluated to assess the urinary function. Results: Ninety patients were included in the study. There was no significant differences in the patients' characteristics between the two groups. At 1 month after the treatment, IPSS (p = 0.011), IPSS QOL (p = 0.002), OABSS (p = 0.002), maximum flow rates (p = 0.011), and residual urine volume (p = 0.011) in TZ group were significantly deteriorated compared with the other group. Multivariate logistic regression analysis revealed that anterior TZ treatment (odds ratio, 3.386; p = 0.029) was an independent risk factor for the deterioration with ≥32% of preoperative status of maximum flow rates. Concerning complication, the rates of Grade 2 urinary retention and Grade 3 urethral stricture were 15.4% and 11.5% in the TZ group and 0% and 0% in the other group, respectively. Conclusions: There was a greater risk of urinary dysfunction with treatment in the anterior TZ portion than in the other portion at 1 month after focal therapy with HIFU.
Assuntos
Neoplasias da Próstata , Ultrassom Focalizado Transretal de Alta Intensidade , Estreitamento Uretral , Humanos , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Qualidade de Vida , Resultado do TratamentoRESUMO
PURPOSE: To evaluate the surgical feasibility and postoperative cosmesis of a novel transumbilical laparoendoscopic single-site (LESS) surgical approach involving Y-shaped incisions and three-flap umbilicoplasty in urachal remnant patients. METHODS: Patients with symptomatic urachal remnants who underwent either conventional laparoscopic surgery (CL group, n = 21) or LESS surgery with Y-shaped incisions and three-flap umbilicoplasty (LESS group, n = 36) between May 2010 and September 2019 were retrospectively assessed. Perioperative factors and postoperative esthetic outcomes were compared between the groups using univariate and multivariate analyses. Esthetic outcomes were assessed using the body image questionnaire consisting of the body image scale (BIS) and the cosmetic scale (CS); a higher score indicated a better outcome. RESULTS: The median operative time was greater and the insufflation time was shorter in the LESS group than in the CL group. The estimated blood loss and postoperative hospital stay and surgical site infection rate did not differ significantly between the groups. While the BIS score also did not differ significantly between the groups, the CS score was greater in the LESS group than in the CL group. Multivariate analysis revealed that the surgery type (LESS surgery) was an independent predictor of greater postoperative esthetic satisfaction. CONCLUSION: Transumbilical LESS surgery with Y-shaped incisions and subsequent three-flap umbilicoplasty is feasible in patients with symptomatic urachal remnants. Regarding postoperative cosmesis, the higher CS score suggests that this technique is superior to CL surgery. Furthermore, the selection of this procedure was an independent predictor of good postoperative esthetic outcomes.