Management of patients who opt for radical prostatectomy during the coronavirus disease 2019 (COVID-19) pandemic: an international accelerated consensus statement.

OBJECTIVE: Coronavirus disease-19 (COVID-19) pandemic caused delays in definitive treatment of patients with prostate cancer. Beyond the immediate delay a backlog for future patients is expected. The objective of this work is to develop guidance on criteria for prioritisation of surgery and reconfiguring management pathways for patients with non-metastatic prostate cancer who opt for surgical treatment. A second aim was to identify the infection prevention and control (IPC) measures to achieve a low likelihood of coronavirus disease 2019 (COVID-19) hazard if radical prostatectomy (RP) was to be carried out during the outbreak and whilst the disease is endemic. METHODS: We conducted an accelerated consensus process and systematic review of the evidence on COVID-19 and reviewed international guidance on prostate cancer. These were presented to an international prostate cancer expert panel (n = 34) through an online meeting. The consensus process underwent three rounds of survey in total. Additions to the second- and third-round surveys were formulated based on the answers and comments from the previous rounds. The Consensus opinion was defined as ≥80% agreement and this was used to reconfigure the prostate cancer pathways. RESULTS: Evidence on the delayed management of patients with prostate cancer is scarce. There was 100% agreement that prostate cancer pathways should be reconfigured and measures developed to prevent nosocomial COVID-19 for patients treated surgically. Consensus was reached on prioritisation criteria of patients for surgery and management pathways for those who have delayed treatment. IPC measures to achieve a low likelihood of nosocomial COVID-19 were coined as 'COVID-19 cold' sites. CONCLUSION: Reconfiguring management pathways for patients with prostate cancer is recommended if significant delay (>3-6 months) in surgical management is unavoidable. The mapped pathways provide guidance for such patients. The IPC processes proposed provide a framework for providing RP within an environment with low COVID-19 risk during the outbreak or when the disease remains endemic. The broader concepts could be adapted to other indications beyond prostate cancer surgery.

Cavernosal nerve preservation during robot-assisted radical prostatectomy is a graded rather than an all-or-none phenomenon: objective demonstration by assessment of residual nerve tissue on surgical specimens.

OBJECTIVE: To demonstrate the existence of different degrees of nerve sparing (NS) (graded NS) by comparing the surgeon's intent of NS with the residual nerve tissue on prostatectomy specimens. METHODS: We performed a prospective study of 133 consecutive patients who underwent robot-assisted radical prostatectomy in January and February of 2011. The surgeon graded the amount of NS intraoperatively independently for either side as follows: 1, no NS; 2, <50% NS; 3, 50% NS; 4, 75% NS; and 5, ≥ 95% NS. A pathologist who was unaware of the surgeon's score measured the area of residual nerve tissue on the posterolateral surface of the prostate. RESULTS: A greater NS score correlated significantly with a decreasing area of residual nerve tissue on the prostatectomy specimens (P < .001). Overall, the area of residual nerve tissue on the prostatectomy specimens was significantly different among the NS groups (P < .001). On specific intergroup analysis, significant differences were found in the area of residual nerve tissue on the prostatectomy specimens between the greater NS groups: NS score 3 versus 4, median 13 mm(2) (interquartile range [IQR] 7-23) versus 3 mm(2) (IQR 0-8; P = .01); NS score 4 versus 5, median 3 mm(2) (IQR 0-8) versus 0.5 mm(2) (IQR 0-2; P = .001). CONCLUSION: Subjective NS classification using the surgeon's intraoperative perception correlated significantly with the area of residual nerve tissue on the prostatectomy specimens determined by the pathologist. It is possible to intentionally tailor the amount of NS performed at surgery. This finding demonstrates that NS is a graded rather than an all-or-none phenomenon that can even go beyond the traditional concept of complete, partial, or no NS.

Egresos hospitalarios por cáncer urogenital en Chile: segunda parte / Hospital discharges due to urogenital cancer in Chile: second part

El siguiente trabajo comprendió el análisis de los Egresos Hospitalarios por cáncer urogenital (CUG) para los años 1993, 1996 y 2001. Estos antecedentes permitirán establecer una tendencia que refleje más fielmente el verdadero rol del cáncer urogenital dentro de los egresos hospitalarios totales y más específicamente dentro de las patologías que afectan al aparato génitourinario. Se analizó la base de datos correspondiente al Boletín de Egresos Hospitalarios del MINSAL para los años 1993, 1996 y 2001. Se obtuvo para cada año información concerniente a los egresos hospitalarios totales, por patología génitourinaria y específicamente por cáncer de próstata, testículo, vejiga y riñón. Estos fueron caracterizados según sexo, edad y región del país desde donde egresaron. En 1993, 1996 y 2001 hubo respectivamente: 1.870, 2.745 y 3.544 egresos por cáncer prostático, 964, 964 y 1.071 por cáncer testicular, 826, 962 y 1.195 por cáncer vesical y 469, 535 y 905 egresos por cáncer renal. Estas patologías abarcaron, en su conjunto, el 0,29; 0,36 y 0,43 porciento de los Egresos Hospitalarios totales, y el 6,6, 7,5 y 10,4 porciento de los egresos hospitalarios por patología génitourinaria. Casi la mitad de los egresos corresponde a cáncer prostático, el que se ubica, lejos, como la primera causa de egresos hospitalarios por cáncer urogenital en Chile.

Egresos hospitalarios por patología genitourinaria en Chile: segunda parte / Hospital discharges by pathologies of the genitourinary tract in Chile: second part

Utilizando el Boletín de Egresos Hospitalarios del MINSAL para los años 1993, 1996 y 2001 se analizaron aquellos códigos correspondientes a Patologías del Sistema Génitourinario (PGU) según el sistemade Clasificación Internacional de Enfermedades OMS CIE-9 y CIE-10, caracterizándolos según su composición geográfica y demográfica.En 1993, 1996 y 2001 se registraron en Chile: 1.404.478, 1.441.374 y 1.566.187 egresos hospitalarios, respectivamente. Los egresos por PGU en esos años fueron 62.978, 70.207 y 64.648, lo que correspondea 4,48 porciento, 4,87 porciento y 4,13 porciento de los egresos hospitalarios totales para ese año. La ITU, HPB, litiasis y fimosisse mantienen como las patologías más prevalentes que requirieron hospitalización. Durante el año 2001,se observó una disminución entre 6 porciento y 7 porciento de los egresos por infección urinaria. Destaca el comportamientode los egresos por cánceres urológicos, los que fueron 4.129 en 1993, 5.206 en 1996 y 6.715 en 2001. Esto corresponde a 6,6 porciento, 7,5 porciento y 10,4 porciento del total de egresos por PGU para cada año respectivo. La patología génitourinaria continúa siendo una contribución menor al total de egresos hospitalarios en el país. Destaca la disminución en el número de egresos por infección urinaria registrado el año 2001. Además, es posible observar un aumento sostenido de los egresos por cáncer urogenital durante estos 8 años de seguimiento.