Use of PCA3 in detecting prostate cancer in initial and repeat prostate biopsy patients.

BACKGROUND: The PCA3 urinary assay has shown promise in predicting the presence of prostate cancer. We evaluated the value of this test in patients undergoing initial and repeat prostate biopsy. METHODS: PCA3 and PSA levels were obtained from 456 men with no known personal history of prostate cancer prior to prostate biopsy. Two hundred eighty-nine men underwent an initial prostate biopsy and 167 underwent a repeat prostate biopsy. PCA3 and PSA levels were compared to the prostate biopsy results. RESULTS: PCA3 score was shown to be independent of prostate volume (P = 0.162) and PSA level (P = 0.959). PCA3 scores were significantly higher in patients with cancer on prostate biopsy compared to patients with negative biopsy results (P < 0.0001). In logistic regression, PCA3 showed a significantly higher AUC than PSA (0.726 vs. 0.512, P = 0.0001). This difference persisted when examining the initial biopsy subgroup, with PCA3 out-performing PSA (AUC 0.772 vs. AUC = 0.552, P < 0.0001), but not in the repeat biopsy subgroup (AUC = 0.605 vs. AUC = 0.500, P = 0.2488). CONCLUSIONS: PCA3 was found to be a better predictor of prostate cancer than PSA in the total population as well as the initial biopsy population, but was not superior to PSA in the repeat biopsy population. Prostate 73: 48-53, 2013. © 2012 Wiley Periodicals, Inc.

Impact of surgeon and volume on extended lymphadenectomy at the time of robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium (IRCC).

UNLABELLED: WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Lymph node dissection and it's extend during robot-assisted radical cystectomy varies based on surgeon related factors. This study reports outcomes of robot-assisted extended lymphadenectomy based on surgeon experience in both academic and private practice settings. OBJECTIVE: To evaluate the incidence of, and predictors for, extended lymph node dissection (LND) in patients undergoing robot-assisted radical cystectomy (RARC) for bladder cancer, as extended LND is critical for the treatment of bladder cancer but the role of minimally invasive surgery for extended LND has not been well-defined in a multi-institutional setting. PATIENTS AND METHODS: Used the International Robotic Cystectomy Consortium (IRCC) database. In all, 765 patients who underwent RARC at 17 institutions from 2003 to 2010 were evaluated for receipt of extended LND. Patients were stratified by age, sex, clinical stage, institutional volume, sequential case number, and surgeon volume. Logistic regression analyses were used to correlate variables to the likelihood of undergoing extended LND. RESULTS: In all, 445 (58%) patients underwent extended LND. Among all patients, a median (range) of 18 (0-74) LNs were examined. High-volume institutions (≥100 cases) had a higher mean LN yield (23 vs 15, P < 0.001). On univariable analysis, surgeon volume, institutional volume, and sequential case number were associated with likelihood of undergoing extended LND. On multivariable analysis, surgeon volume [odds ratio (OR) 3.46, 95% confidence interval (CI) 2.37-5.06, P < 0.001] and institution volume [OR 2.65, 95% CI 1.47-4.78, P = 0.001) were associated with undergoing extended LND. CONCLUSIONS: Robot-assisted LND can achieve similar LN yields to those of open LND after RC. High-volume surgeons are more likely to perform extended LND, reflecting a correlation between their growing experience and increased comfort with advanced vascular dissection.

Status of robot-assisted radical cystectomy.

PURPOSE: Robot-assisted radical cystectomy (RARC) is an alternative approach for treatment of bladder cancer. We provide a critical review of the current status of RARC and pelvic lymph node dissection with a focus on feasibility, safety and oncological efficacy of the procedure. MATERIALS AND METHODS: The PubMed literature database was reviewed for RARC series that have been reported in the English language until the present time. Surgical technique, operative parameters, pathologic outcome, complications and quality of life were examined. RESULTS: RARC is progressing steadily. With nearly 500 published cases worldwide, RARC proves to be technically feasible and oncologically effective. It is associated with less blood loss, shorter hospital stay, and improved postoperative quality of life. Intracorporeal urinary diversion is still in the experimental phase, and effort is needed to make it technically easier and widely accepted. CONCLUSIONS: With the worldwide rapid spread of robot-assisted surgeries, RARC is evolving as a reliable minimally invasive alternative to standard open surgery. Awaiting long term oncological results, adequately powered prospective randomized trials comparing open, laparoscopic and robotic approaches are urgently needed.

Robot-assisted laparoscopic ureterolysis: case report and literature review of the minimally invasive surgical approach.

OBJECTIVES: To evaluate our case of robot-assisted ureterolysis (RU), describe our surgical technique, and review the literature on minimally invasive ureterolysis. METHODS: One patient managed with robot-assisted ureterolysis for idiopathic retroperitoneal fibrosis was identified. The chart was analyzed for demographics, operative parameters, and immediate postoperative outcome. The surgical technique was assessed and modified. Lastly, a review of the published literature on ureterolysis managed with minimally invasive surgery was performed. RESULTS: One patient underwent robot-assisted ureterolysis at our institution in 2 separate settings. Operative time (OR) decreased from 279 minutes to 191 minutes. Estimated blood loss (EBL) was less than 50 mL. The patient has been free of symptoms and both renal units are unobstructed. According to the published literature, 302 renal units underwent successful laparoscopic ureterolysis (LU), and 6 renal units underwent RU. There were 9 open conversions (all in LU). Mean OR in LU was 248 minutes for unilateral and 386 minutes for bilateral cases. In RU, mean OR was 220 minutes for unilateral and 390 minutes for bilateral cases. EBL averaged 200 mL in LU and 30 mL in RU. CONCLUSIONS: Our data reveal that robot-assisted ureterolysis is safe and feasible. Published data demonstrate the advantages of minimally invasive surgery.