The Prognostic Role of Preoperative PSMA PET/CT in cN0M0 pN+ Prostate Cancer: A Multicenter Study.

CONTEXT: Despite negative preoperative conventional imaging, up to 10% of patients with prostate cancer (PCa) harbor lymph-node involvement (LNI) at radical prostatectomy (RP). The advent of more accurate imaging modalities such as PET/CT improved the detection of LNI. However, their clinical impact and prognostic value are still unclear. We aimed to investigate the prognostic value of preoperative PET/CT in patients node positive (pN+) at RP. EVIDENCE SYNTHESIS: We retrospectively identified cN0M0 patients at conventional imaging (CT and/or MRI, and bone scan) who had pN+ PCa at RP at 17 referral centers. Patients with cN+ at PSMA/Choline PET/CT but cN0M0 at conventional imaging were also included. Systemic progression/recurrence was the primary outcome; Cox proportional hazards models were used for multivariate analysis. EVIDENCE ACQUISITION: We included 1163 pN+ men out of whom 95 and 100 had preoperative PSMA and/or Choline PET/CT, respectively. ISUP grade ≥4 was detected in 66.6%. Overall, 42% of patients had postoperative PSA persistence (≥0.1 ng/mL). Postoperative management included initial observation (34%), ADT (22.7%) and adjuvant RT+/-ADT (42.8%). Median follow-up was 42 months. Patients with cN+ on PSMA PET/CT had an increased risk of systemic progression (52.9% vs. 13.6% cN0 PSMA PET/CT vs. 21.5% cN0 at conventional imaging; P < .01). This held true at multivariable analysis: (HR 6.184, 95% CI: 3.386-11-295; P < .001) whilst no significant results were highlighted for Choline PET/CT. No significant associations for both PET types were found for local progression, BCR, and overall mortality (all P > .05). Observation as an initial management strategy instead of adjuvant treatments was related with an increased risk of metastases (HR 1.808; 95% CI: 1.069-3.058; P < .05). CONCLUSIONS: PSMA PET/CT cN+ patients with negative conventional imaging have an increased risk of systemic progression after RP compared to their counterparts with cN0M0 disease both at conventional and/or molecular imaging.

Ultrasound-guided transversus abdominis plane block (US-TAPb) for robot-assisted radical prostatectomy: a novel '4-point' technique-results of a prospective, randomized study.

Several works stress the importance of ultrasound-guided transversus abdominis plane block (TAPb) for post-operative analgesia and its versatility in all types of abdominal surgery, thanks to laparotomy and laparoscopy. The aim of this study was to evaluate the impact of TAPb on intra- and post-operative analgesia in the first 24 h after robot-assisted radical prostatectomy (RARP). TAPb is a new local anesthetic technique which provides analgesia after abdominal surgery. It involves injection of local anesthetic into the plane between the transversus abdominis and the internal oblique muscles. TAPb can be performed according to a landmark technique, either through the lumbar triangle or with ultrasound guidance. We evaluated the intra- and post-operative analgesic efficacy of TAPb in 100 ASA I-III patients undergoing RARP under general anesthesia without (group A, 50 patients) or with US-TAPb (group B, 50 patients), in the first 24 post-operative hours. After induction of general anesthesia, US-TAPb was performed in 50 selected patients. All patients received post-operative analgesia (Paracetamol 1 g) three times a day. Tramadol and Ketoprofen were used as rescue drugs if the Numerical Rating Scale test was > 3. No complications were recorded during block performance. A significant reduction was seen in the need to administer intraoperative opioids, and in the occurrence of post-operative pain or post-operative drug consumption in patients receiving US-TAPb. Seven patients, all in group A, received 100 mg of Tramadol. In group B, only one patient received 100 mg Tramadol (first and second post-operative days) due to surgical complications. In conclusion, US-TAPb provided highly effective intra- and post-operative analgesia in the first 24 h after RARP. A further prospective study is necessary to assess the best protocol for all patients.

[Treating cervico-urethral obstructions with laser diode: initial clinical experience]. / Il trattamento dell'ostruzione cervico-uretrale con laser a diodi: esperienza clinica iniziale.

BACKGROUND: The first laser employment for the treatment of the cervico-urethral obstructions (CUO) dates back to the early '90s. This study begins with the analysis of laser basics in Medicine and has the purpose to weigh pros and cons (and limits as well) of laser use in CUO due to Benign Prostatic Hyperplasia (BPH). That is an ageing man's typical disease and there is a huge need of minimally invasive treatments, because people affected by this kind of illness suffer very often from comorbidities, and that could make traditional surgery quite risky. AIM OF THE STUDY: The target of this study is the in vivo experimentation of a brand new laser diode, crated to be specifically used in BPH, and to verify its efficacy and safety. MATERIALS AND METHODS: The subject of the study is the whole laser diode supply, with its double-band laser source (980 nm + 1470 nm), which gains a 140 W-power and is equipped with Water-Free optical fibers of different kinds of tip. We have tested a conical tip fiber on a standard 24-26 F-resectoscope instead of a standard diathermic loop. The conic fiber optimizes the energy on the treated tissue. We recruited 14 patients with CUO caused by BPH, 56 to 70 years old, with a prostatic volume between 33 and 53 cc, and we treated them with laser surgery using the power of 100-110 W. We considered the operative time, the intra-surgery complications and the specific side effects such as hematuria, pain, catheter removal time and the presence or not of acute urinary retention, in order to evaluate the efficacy and safety of this new technique. RESULTS: The possibility of using the same resectoscope as the one used in transurethral resection of prostate (TURP) made everything more comfortable and easy because of the immediate feeling with the new instrument and the actual time of Light Vaporization between 30 and 40 minutes, which is more or less the same time of a standard TURP procedure. CONCLUSIONS: The idea of a double-band-emitting laser used with conical tip fibers appears to be a great solution in the BPH treatment: it uses the principle of low power density plasma in order to treat bigger prostatic tissue areas but never going in depth. In our clinical results, the efficacy of the double-band-emitting laser source (1470 nm + 980 nm) appears to be similar, but even potentially greater, to the actual surgical laser options (such as HoLEP with Ho:YAG laser and PVP with KTP laser), and it is also similar to traditional TURP.