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2.
Orv Hetil ; 162(13): 483-487, 2021 03 28.
Artículo en Húngaro | MEDLINE | ID: mdl-33774598

RESUMEN

Összefoglaló. Bevezetés: Az utóbbi években az oligometastaticus prosztatadaganatok kezelése során a szisztémás kezelés mellett egyre gyakrabban végzik a primer tumor lokális kezelését is. Célkituzés: A szerzok a tanulmányban a cytoreductiv radikális prostatectomia szerepét vizsgálták az oligometastaticus prosztatadaganatok kezelése során. Módszer: 2012. 01. 01. és 2019. 01. 01. között összesen hét betegben végeztek cytoreductiv radikális prostatectomiát oligometastaticus prosztatadaganat esetében. A betegek átlagos életkora 64 év, az átlagos PSA-koncentráció 43 ng/ml volt. Az áttétek száma minden beteg vonatkozásában maximum három volt, és valamennyi esetben csontáttét volt jelen. A betegek androgéndeprivatiós hormonkezelést kaptak, és közülük négy esetben már a mutét elott elkezdték a hormonterápiát. Négy betegnél a csontmetastasisok miatt az áttétek sugárkezelése is megtörtént. Eredmények: A cytoreductiv prostatectomia szövettana öt esetben igazolt lokálisan elorehaladott (pT3) daganatot, és két alkalommal marginpozitivitás volt jelen. Emiatt öt beteg kapott adjuváns lokális irradiációt a metastasisok besugárzásán kívül. A mutétet követoen biokémiai progresszió egy esetben jelentkezett. Ennek oka lokális recidíva volt, mely miatt a beteg 'salvage' irradiációt kapott. Az átlagosan 38 hónapos utánkövetés során új metastasist nem diagnosztizáltak, és tumor okozta halálozás nem fordult elo. Következtetés: A cytoreductiv prostatectomia oligometastaticus prosztatarákos betegek kezelésében - válogatott beteganyagon - megvalósítható lehetoség. Ugyanakkor a cytoreductiv prostatectomia elonyei a tumorprogresszió szempontjából még nem egyértelmuek, ennek eldöntéséhez további vizsgálatok szükségesek. Orv Hetil. 2021; 162(13): 483-487. INTRODUCTION: In recent years, in addition to systemic therapy, local treatment of primary tumor has become increasingly common in the treatment of oligometastatic prostate cancers. Objectve: The authors measured the role of cytoreductive radical prostatectomy in the treatment of oligometastatic prostate carcinoma. METHODS: From Janury 2012 to January 2019, they performed cytoreductive radical prostatectomy in seven patients with oligometastatic prostate cancer. The mean age of the patients was 64 years, and the mean PSA value was 43 ng/ml. The patients had maximum three distant metastases and all metastases were localized to the bones. The patients received androgene deprivation therapy and this treatment was started before the surgery in four cases. Irradiation of the bone metastasis was performed in four cases. RESULTS: The histology of the cytoreductive radical prostatectomy showed locally advanced tumor (pT3) in five patients and margin-positive status was present in two cases. Hence, adjuvant irradiation was administered locally in five patients in addition to the irradiation of bone metastases. Biochemical progression was detected in one patient during the follow-up period. It was caused by local recurrence of the tumor and the patient was treated with salvage irradiation. During the 38 months follow-up period neither new distant metastasis nor cancer-related mortality was detected. CONCLUSION: The cytoreductive radical prostatectomy is a feasible option in selected cases with oligometastatic prostate cancer. However, the benefits of cytoreductive radical prostatectomy regarding tumor progression are not clear yet and further studies are required. Orv Hetil. 2021; 162(13): 483-487.


Asunto(s)
Procedimientos Quirúrgicos de Citorreducción , Prostatectomía , Neoplasias de la Próstata , Estudios de Factibilidad , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prostatectomía/métodos , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Resultado del Tratamiento
3.
Medicine (Baltimore) ; 100(8): e23778, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663041

RESUMEN

BACKGROUND: To verify which phosphodiesterase type 5 inhibitors (PDE5is) strategy is better for erectile dysfunction (ED) following nerve-sparing radical prostatectomy (NSRP). METHODS: This systematic literature search was conducted in MEDLINE, Web of Science and Cochrane Central Register of Controlled Trials database to identify eligible studies from the startup of these databases to 1 November, 2019. The ED recovery rate was the main outcome. Traditional pair-wise meta-analysis and multivariate random-effects network meta-analysis (NMA) were performed to explore direct and indirect comparisons, respectively. The surface under the cumulative ranking (SUCRA) probabilities was used to evaluate the efficacy of treatments. RESULTS: A total of 14 randomized controlled trials with four kinds of PDE5is were included. Further pooled evidence suggested that PDE5is followed by NSRP had a benefit for penile rehabilitation compared to placebo using traditional pair-wise meta-analyses. Our NMA showed that Avanafil 200 mg on demand might be most likely to be the best treatment option according to the first rank of SUCRA both in NMA (SUCRA 83.5) and sensitivity analysis (SUCRA 90.2). CONCLUSION: Avanafil 200 mg on demand has the highest probability of being the best intervention among PDE5is in treating ED following NSRP. However, more randomized controlled trials are needed to validate this in consideration of the published data regarding Avanafil is relatively small scale.


Asunto(s)
Disfunción Eréctil/tratamiento farmacológico , Disfunción Eréctil/etiología , Inhibidores de Fosfodiesterasa 5/uso terapéutico , Prostatectomía/efectos adversos , Neoplasias de la Próstata/cirugía , Humanos , Masculino , Metaanálisis en Red , Erección Peniana , Ensayos Clínicos Controlados Aleatorios como Asunto , Recuperación de la Función
4.
Arch Esp Urol ; 74(2): 231-238, 2021 Mar.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33650538

RESUMEN

OBJECTIVES: Recently laparoscopic radical prostatectomy (LRP) is a minimally invasive surgical option for prostate cancer (PCa) treatment in the lack of robot. To eliminate numbers of trocars and to modify surgical technique can make the LRP procedure easier. We aimed to introduce our novel approach on LRP by using just only 3 trocars and to compare conventional extraperitoneal LRP (eLRP) with 3 trocars eLRP. METHODS: Of the 223 PCa patients undergone eLRP were divided into 2 groups as Group 1 (n=69) consisted of conventional eLRP, Group 2 (n=154) consisted of consecutive 3 trocars eLRP. Demographic, operative, postoperative, and short-term follow-up data including functional results were analysed. RESULTS: Mean follow-up was 10.9±5.1 months. Preoperative and demographic parameters were comparable between the groups. Mean operative time, intraoperative used carbon dioxide (CO2) gas, and hospital stay were significantly shorter in Group 2 (for all parameters p<0.001). Haemoglobin decrease was also less in Group 2 without statistical significance. Oncologic and functional results were similar. There was no major complication in Group 2. CONCLUSIONS: According to our results 3 trocars eLRP can be performed safely and effectively in experienced hands. Haemorrhage, operative time, CO2 usage, and hospital stay could be shortened with our novel approach.


Asunto(s)
Laparoscopía , Neoplasias de la Próstata , Humanos , Masculino , Complicaciones Posoperatorias , Prostatectomía , Neoplasias de la Próstata/cirugía , Instrumentos Quirúrgicos , Resultado del Tratamiento
5.
Urologia ; 88(1): 3-8, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33632087

RESUMEN

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic has dramatically hit all Europe and Northern Italy in particular. The reallocation of medical resources has caused a sharp reduction in the activity of many medical disciplines, including urology. The restricted availability of resources is expected to cause a delay in the treatment of urological cancers and to negatively influence the clinical history of many cancer patients. In this study, we describe COVID-19 impact on uro-oncological management in Piedmont/Valle d'Aosta, estimating its future impact. METHODS: We performed an online survey in 12 urological centers, belonging to the Oncological Network of Piedmont/Valle d'Aosta, to estimate the impact of COVID-19 emergency on their practice. On this basis, we then estimated the medical working capacity needed to absorb all postponed uro-oncological procedures. RESULTS: Most centers (77%) declared to be "much"/"very much" affected by COVID-19 emergency. If uro-oncological consultations for newly diagnosed cancers were often maintained, follow-up consultations were more than halved or even suspended in around two out of three centers. In-office and day-hospital procedures were generally only mildly reduced, whereas major uro-oncological procedures were more than halved or even suspended in 60% of centers. To clear waiting list backlog, the urological working capacity should dramatically increase in the next months; delays greater than 1 month are expected for more than 50% of uro-oncological procedures. CONCLUSIONS: COVID-19 emergency has dramatically slowed down uro-oncological activity in Piedmont and Valle d'Aosta. Ideally, uro-oncological patients should be referred to COVID-19-free tertiary urological centers to ensure a timely management.


Asunto(s)
/epidemiología , Continuidad de la Atención al Paciente , Accesibilidad a los Servicios de Salud , Oncología Médica/estadística & datos numéricos , Pandemias , Procedimientos Quirúrgicos Urológicos/estadística & datos numéricos , Urología/estadística & datos numéricos , Citas y Horarios , Femenino , Encuestas de Atención de la Salud , Humanos , Italia/epidemiología , Neoplasias Renales/epidemiología , Neoplasias Renales/cirugía , Masculino , Oncología Médica/organización & administración , Utilización de Procedimientos y Técnicas , Neoplasias de la Próstata/epidemiología , Neoplasias de la Próstata/cirugía , Neoplasias de la Vejiga Urinaria/epidemiología , Neoplasias de la Vejiga Urinaria/cirugía , Neoplasias Urológicas/epidemiología , Neoplasias Urológicas/cirugía , Urología/organización & administración
6.
Isr Med Assoc J ; 23(2): 111-115, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33595217

RESUMEN

BACKGROUND: Little is known about oncologic outcomes following robot-assisted-radical-prostatectomy (RALP) for clinical T3 (cT3) prostate cancer. OBJECTIVES: To investigate oncologic outcomes of patients with cT3 prostate cancer treated by RALP. METHODS: Medical records of patients who underwent RALP from 2010 to 2018 were retrieved. cT3 cases were reviewed. Demographic and pre/postoperative pathology data were analyzed. Patients were followed in 3-6 month intervals with repeat PSA analyses. Adjuvant/salvage treatments were monitored. Biochemical recurrence (BCR) meant PSA levels of ≥ 0.2 ng/ml. RESULTS: Seventy-nine patients met inclusion criteria. Median age at surgery was 64 years. Preoperative PSA level was 7.14 ng/dl, median prostate weight was 54 grams, and 23 cases (29.1%) were down-staged to pathological stage T2. Positive surgical margin rate was 42%. Five patients were lost to follow-up. Median follow-up time for the remaining 74 patients was 24 months. Postoperative relapse in PSA levels occurred in 31 patients (42%), and BCR in 28 (38%). Median time to BCR was 9 months. The overall 5-year BCR-free survival rate was 61%. Predicting factors for BCR were age (hazard-ratio [HR] 0.85, 95% confidence interval [95%CI] 0.74-0.97, P = 0.017) and prostate weight (HR 1.04, 95%CI 1.01-1.08, P = 0.021). Twenty-six patients (35%) received adjuvant/salvage treatments. Three patients died from metastatic prostate cancer 31, 52, and 78 months post-surgery. Another patient died 6 months post-surgery of unknown reasons. The 5-year cancer-specific survival rate was 92. CONCLUSIONS: RALP is an oncologic effective procedure for cT3 prostate cancer. Adjuvant/salvage treatment is needed to achieve optimal disease-control.


Asunto(s)
Antígeno Prostático Específico/análisis , Prostatectomía/métodos , Neoplasias de la Próstata/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Anciano , Supervivencia sin Enfermedad , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estadificación de Neoplasias , Neoplasias de la Próstata/patología , Estudios Retrospectivos , Terapia Recuperativa , Tasa de Supervivencia , Resultado del Tratamiento
7.
Hinyokika Kiyo ; 67(1): 1-6, 2021 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-33535289

RESUMEN

Robot-assisted laparoscopic radical prostatectomy (RARP) is becoming the standard treatment procedure for localized prostate cancer. The main complications associated with RARP include urinary incontinence and sexual dysfunction. In addition, acute urinary retention (AUR) after urethral catheter removal is sometimes seen. Early catheter removal is a risk factor for AUR, and administration of alphablockers before catheter removal reduces the occurrence of AUR. However, the ideal management of AUR after RARP is not known. Here we report the clinical course and treatment after AUR. We performed 279 RARPs at our institution, and AUR developed in 11 cases. In all cases, urination status was improved after placement of a urinary catheter or intermittent catheterization. Later, urethral stricture was seen in 2 out of 11 cases. Ourstudy suggests that when AUR is observed afterRARP, catheterur ination should be initially performed. If urinary retention recurs, a urinary catheter should be placed with administration of alpha-blockers. The catheter is removed after about 3 days, and administration of analgesics is effective for reducing the pain on urination. If urination status is not improved, evaluation of the urethral stricture should be considered.


Asunto(s)
Laparoscopía , Neoplasias de la Próstata , Robótica , Retención Urinaria , Humanos , Masculino , Recurrencia Local de Neoplasia , Prostatectomía/efectos adversos , Neoplasias de la Próstata/cirugía , Cateterismo Urinario/efectos adversos , Retención Urinaria/etiología , Retención Urinaria/terapia
8.
Hinyokika Kiyo ; 67(1): 43-46, 2021 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-33535297

RESUMEN

A 67-year-old male came to our department with complaints of urinary retention and gross hematuria. The prostate specific antigen (PSA) level in the serum was elevated to 69.5 ng/ml. Thus a transperineal prostate biopsy was performed. The patient was diagnosed with prostate cancer, and lung and bone metastases were also revealed. Treatment for metastatic prostate cancer was performed for approximately 5 years with combined androgen blockade therapy followed by enzalutamide, docetaxel, estramustine, Ra-223 dichloride, estradiol, and then enzalutamide reintroduction. Thereafter, the patient presented with bilateral breast nodules and we referred him to our breast surgery department. Breast needle biopsy findings revealed breast metastasis from prostate cancer, that was not primary breast cancer. The patient underwent a bilateral mastectomy.


Asunto(s)
Adenocarcinoma , Neoplasias de la Mama , Neoplasias de la Próstata , Radio (Elemento) , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Anciano , Humanos , Masculino , Mastectomía , Antígeno Prostático Específico , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/cirugía
9.
Br J Radiol ; 94(1120): 20201423, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33586998

RESUMEN

OBJECTIVE: We determined the sensitivity and specificity of multiparametric magnetic resonance imaging (MP-MRI) in detection of locally recurrent prostate cancer and extra prostatic extension in the post-radical radiotherapy setting. Histopathological reference standard was whole-mount prostatectomy specimens. We also assessed for any added value of the dynamic contrast enhancement (DCE) sequence in detection and staging of local recurrence. METHODS: This was a single centre retrospective study. Participants were selected from a database of males treated with salvage prostatectomy for locally recurrent prostate cancer following radiotherapy. All underwent pre-operative prostate-specific antigen assay, positron emission tomography CT, MP-MRI and transperineal template prostate mapping biopsy prior to salvage prostatectomy. MP-MRI performance was assessed using both Prostate Imaging-Reporting and Data System v. 2 and a modified scoring system for the post-treatment setting. RESULTS: 24 patients were enrolled. Using Prostate Imaging-Reporting and Data System v. 2, sensitivity, specificity, positive predictive value and negative predictive value was 64%, 94%, 98% and 36%. MP-MRI under staged recurrent cancer in 63%. A modified scoring system in which DCE was used as a co-dominant sequence resulted in improved diagnostic sensitivity (61%-76%) following subgroup analysis. CONCLUSION: Our results show MP-MRI has moderate sensitivity (64%) and high specificity (94%) in detecting radio-recurrent intraprostatic disease, though disease tends to be under quantified and under staged. Greater emphasis on dynamic contrast images in overall scoring can improve diagnostic sensitivity. ADVANCES IN KNOWLEDGE: MP-MRI tends to under quantify and under stage radio-recurrent prostate cancer. DCE has a potentially augmented role in detecting recurrent tumour compared with the de novo setting. This has relevance in the event of any future modified MP-MRI scoring system for the irradiated gland.


Asunto(s)
Imágenes de Resonancia Magnética Multiparamétrica/métodos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Recurrencia Local de Neoplasia/cirugía , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/cirugía , Anciano , Humanos , Masculino , Persona de Mediana Edad , Próstata/diagnóstico por imagen , Próstata/cirugía , Prostatectomía , Neoplasias de la Próstata/radioterapia , Estudios Retrospectivos , Terapia Recuperativa , Sensibilidad y Especificidad
10.
Cancer Imaging ; 21(1): 3, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407861

RESUMEN

BACKGROUND: The utility of multiparametric MRI (mpMRI) in detecting suspected local recurrence post radical prostatectomy (RP) may be associated with PSA and Gleason grade. The purpose of the study was to evaluate the likelihood of detecting locally recurrent prostate cancer utilizing mpMRI in patients with suspected recurrence following radical prostatectomy (RP) parsed by PSA and Gleason grade. METHODS: One hundred ninety five patients with suspected local recurrence were imaged on a 1.5 T MRI with torso array and endorectal coil in this retrospective study. mpMRI interpretations were stratified by PSA and lower (Gleason < 7) vs. higher grade tumors (Gleason 8-10). Recursive partitioning was used to determine whether mpMRI interpretations could be classified as positive or negative. RESULTS: The majority of mpMRI interpretations in patients with lower Gleason grade tumors and PSA < 0.5 ng/mL were negative (68/78, 87.2%, p = 0.004). The majority of mpMRI interpretations in patients with higher Gleason grade tumors and PSA > 1.5 ng/mL were positive (8/9, 88.9%, p = 0.003). Findings were corroborated by recursive partitioning, which identified a PSA = 0.5 ng/ml in patients with lower grade tumors and a PSA = 1.5 ng/mL in patients with higher grade tumors as differentiating negative and positive mpMRIs. CONCLUSION: In the setting of suspected recurrence after RP, mpMRI results are associated with PSA and Gleason grade, both of which can help guide when mpMRI may find utility. mpMRI is likely to be low diagnostic yield and negative for recurrence (87%) in the setting of lower Gleason grade tumors and PSA < 0.5 ng/mL. mpMRI is likely to be of low diagnostic value and positive for recurrence (89%) in the setting of PSA > 1.5 ng/mL and higher grade tumors; in this case, mpMRI findings may be more useful for directing biopsy and local therapy. Between these extremes, PSA > 0.5 ng/mL and lower grade tumors or PSA < 1.5 ng/mL and higher grade tumors, mpMRI results are less predictable, suggesting greater diagnostic value for detecting recurrence post prostatectomy.


Asunto(s)
Calicreínas/sangre , Imágenes de Resonancia Magnética Multiparamétrica/métodos , Recurrencia Local de Neoplasia/diagnóstico por imagen , Antígeno Prostático Específico/sangre , Neoplasias de la Próstata/diagnóstico por imagen , Anciano , Biopsia , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Recurrencia Local de Neoplasia/sangre , Recurrencia Local de Neoplasia/patología , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos
11.
Cancer Causes Control ; 32(2): 189-197, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33392907

RESUMEN

PURPOSE: Circulating inflammatory markers may predict prostate cancer (PC) outcomes. For example, a recent study showed that higher peripheral blood monocyte counts were associated with aggressive PC in Asian men undergoing radical prostatectomy (RP). Herein, we investigated whether peripheral monocyte count can predict long-term PC outcomes after RP in black and white men. METHODS: We retrospectively reviewed data on 2345 men undergoing RP from 2000 to 2017 at eight Veterans Affairs hospitals. Data on monocyte count within 6 and 12 months prior to surgery were collected. The study outcomes were biochemical recurrence (BCR), castration-resistant PC (CRPC), metastasis, all-cause mortality (ACM), and PC-specific morality (PCSM). Cox-proportional hazard models were used to assess the associations between pre-operative monocyte count and the above-mentioned outcomes accounting for confounders. RESULTS: Of 2345 RP patients, 972 (41%) were black and 1373 (59%) were white men. In multivariable analyses, we found no associations between monocyte count and BCR among all men (HR: 1.36, 95%CI 0.90-2.07) or when analyses were stratified by race (HR: 1.30, 95%CI 0.69-2.46, in black men; HR:1.33, 95%CI 0.76-02.33, in white men). Likewise, no overall or race-specific associations were found between monocyte count and CRPC, metastases, ACM, and PCSM, all p ≥ 0.15. Results were similar for monocyte count measured at 12 months prior to RP. CONCLUSION: In black and white PC patients undergoing RP, peripheral monocyte count was not associated with long-term PC outcomes. Contrary to what was found in Asian populations, monocyte count was not associated with PC outcomes in this study.


Asunto(s)
Monocitos , Neoplasias de la Próstata/inmunología , Afroamericanos , Anciano , Bases de Datos Factuales , Grupo de Ascendencia Continental Europea , Hospitales de Veteranos , Humanos , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Antígeno Prostático Específico/sangre , Prostatectomía , Neoplasias de la Próstata/etnología , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/cirugía , Veteranos
12.
J Urol ; 205(4): 1047-1054, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33493001

RESUMEN

PURPOSE: Adoption of prognostic molecular assays for prostate cancer requires evidence of robust performance in different racial groups. Retrospective analysis was conducted to assess the performance of the Oncotype DX® Genomic Prostate Score® test in African American and Caucasian American men with surgically treated prostate cancer. MATERIALS AND METHODS: We compared the assay results (scale 0-100) and the 4 gene group scores in biopsy specimens from 201 African American and 1,144 Caucasian American men with clinically localized prostate cancer in 6 cohorts. Adverse pathology was defined as high grade (primary Gleason pattern 4 or any pattern 5) and/or nonorgan-confined disease (≥pT3). Binary logistic regression models were used for adverse pathology. Biochemical recurrence was defined as 2 successive prostate specific antigen levels >0.2 ng/ml or initiation of salvage therapy after radical prostatectomy. Cox proportional hazards models evaluated the association of the assay result or racial group with time to biochemical recurrence. RESULTS: Each cohort had different clinical risk distributions and percentages of African Americans, although median and interquartile ranges of the assay results and gene group scores were similar between both racial groups. In a multivariable model with the assay and pathological/clinical features including race, the assay was significantly associated with adverse pathology (p ≤0.004) and biochemical recurrence (p <0.001). Race was not a significant predictor of either end point. CONCLUSIONS: The assay is similarly predictive of outcomes in African American and Caucasian American patients, and improves risk stratification in men with newly diagnosed prostate cancer from both racial groups.


Asunto(s)
Afroamericanos/genética , Grupo de Ascendencia Continental Europea/genética , Genómica , Neoplasias de la Próstata/genética , Adulto , Anciano , Anciano de 80 o más Años , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Medición de Riesgo , Terapia Recuperativa
13.
Virchows Arch ; 478(3): 383-391, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33404850

RESUMEN

Discontinuous tumor involvement (DTI) is a not uncommon finding in the tumor in prostate needle core biopsies undertaken for diagnosis of prostate cancer (PCa). The objective of this review is to establish a clear definition of DTI in order to provide a standardized method of measurement which reliably reflects pathologic features and disease progression following radical prostatectomy (RP). A systematic literature search was performed using PubMed up to March 2020 to identify studies of PCa patients which included needle biopsies containing DTI and matched subsequent RP treatment with or without follow-up information. The methodology and quality of reporting of DTI are reviewed, compared, and summarized. DTI is a frequent finding in diagnostic biopsy for PCa (up to 30%). Six studies were compared by methods of measurement used for predicting pathologic features and outcomes which are observed in subsequent RP. In most cases with DTI (> 90%), intervening benign tissue in the tumor core was less than 5 mm. DTI found in the biopsy was likely to be associated with a single, irregular tumor nodule going in and out of the plane of the section, but DTI was not associated with multiple small foci of the tumor. Immunohistochemistry (IHC) also demonstrated that about 75% of cases of DTI shared an IHC profile which supports the concept that DTI most likely comes from a homogeneous tumor nodule. Furthermore, DTI was associated with positive surgical margin (PSM) and bilateral tumor in RP specimens. Compared to additive measurement (with the subtraction of intervening benign tissue), linear measurement (including intervening benign tissue) of DTI was more accurately predictive of aggressive disease in the RP including higher pT stage, PSM, and greater actual extent of the tumor. However, the advantage of linear measurement was lost in cases where there was an upgrade from the biopsy to the RP which may result from undersampling. For cases with either very small tumor foci or very extensive cancer volume, no difference was observed in these two methods of measurement. DTI in core biopsies may represent undersampling of a larger irregular nodule but likely does not result from multifocality and is similarly unlikely to represent multiclonality. Linear measurement of DTI was more accurately predictive of post-RP pathologic findings and oncologic prognosis. This method should be applied for patient selection for AS.


Asunto(s)
Biopsia con Aguja/normas , Neoplasias de la Próstata/patología , Anciano , Toma de Decisiones Clínicas , Humanos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias , Neoplasia Residual , Valor Predictivo de las Pruebas , Prostatectomía , Neoplasias de la Próstata/cirugía , Resultado del Tratamiento
14.
Anticancer Res ; 41(1): 509-516, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33419850

RESUMEN

BACKGROUND/AIM: To investigate whether surgical margin (SM) status would affect the biochemical recurrence (BCR) after robot-associated RP (RARP). PATIENTS AND METHODS: We evaluated BCR after RARP and the association between pre- and postoperative predictive factors and BCR. RESULTS: Positive SM (PSM) was observed in 97 out of 365 enrolled patients. On multivariate analysis, preoperative prostate specific antigen, biopsy Gleason score (GS), clinical stage, GS ≥7 at the PSM and pathological GS ≥7 were predictive factors for BCR. The 5-year BCR-free survival rate was 84.1% in the negative SM (NSM), 87.4% when GS=6 at the PSM, and 47.6% when GS ≥7 at the PSM. There was no statistically significant difference in BCR-free survival between the NSM group and GS=6 at the PSM group (p=0.966). CONCLUSION: It would be desirable to evaluate GS at PSM when PSM is present in a specimen removed by RP.


Asunto(s)
Márgenes de Escisión , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Biomarcadores de Tumor , Humanos , Estimación de Kaplan-Meier , Masculino , Clasificación del Tumor , Recurrencia Local de Neoplasia , Periodo Posoperatorio , Pronóstico , Modelos de Riesgos Proporcionales , Prostatectomía/métodos , Neoplasias de la Próstata/mortalidad , Resultado del Tratamiento
15.
Medicine (Baltimore) ; 100(2): e24038, 2021 Jan 15.
Artículo en Inglés | MEDLINE | ID: mdl-33466151

RESUMEN

RATIONALE: Prostatic sarcoma (PS) is a very rare malignant tumor that accounts for <0.1% of prostate malignancies, and Ewing's sarcoma is an extremely rare form of PS. PATIENT CONCERNS: We reported on a 64-year-old patient with PS and a 36-year-old patient with Ewing's sarcoma, both of whom were examined by contrast-enhanced ultrasonography (CEUS) before surgery. DIAGNOSES: The 2 cases were proven to be prostatic stromal sarcoma, which was confirmed by imaging manifestations and histopathological findings. INTERVENTIONS: The 64-year-old patient underwent radical prostatectomy, and the 36-year-old patient underwent chemotherapy combined with local radiotherapy. OUTCOMES: PS showed diffuse enlargement of the prostate on sonography, and the necrotic liquefying area within the large vessels could be clearly displayed by CEUS. CEUS can be advocated as a valuable noninvasive and safe imaging diagnosis method for PS.


Asunto(s)
Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Adulto , Humanos , Masculino , Persona de Mediana Edad , Prostatectomía , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/cirugía , Sarcoma/diagnóstico , Sarcoma/cirugía , Sarcoma de Ewing/patología , Sarcoma de Ewing/cirugía , Ultrasonografía
16.
Int J Clin Oncol ; 26(4): 764-769, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33385274

RESUMEN

BACKGROUND: It has been argued that grade group 2 (GG2) with a low Gleason pattern 4 (GP4) proportion should be an indication for active surveillance (AS) of prostate cancer (PCa). However, the cut-off GP4 proportion for AS remains unclear. Here, we evaluated the effect of GP4 proportion and IDC-P on cancer recurrence following radical prostatectomy (RP) in GG1 and GG2 patients, and identified candidates for AS. METHODS: We retrospectively evaluated 646 patients with PCa who underwent RP between 2005 and 2014, and whose specimens were of GG1 or GG2 status. RESULTS: The GGs were as follows: GG1, 25.2% (n = 163); GG2 (5% ≥ GP4), 11.4% (n = 74); GG2 (5% < GP4 ≤ 10%), 25.9% (n = 167); and GG2 (20% ≤ GP4), 37.5% (n = 242). IDC-P was detected in 26 patients (4%), i.e., in 2/167 GG2 (5% < GP4 ≤ 10%; 1%) cases and 24/242 GG2 (20% ≤ GP4; 10%) cases. GG2 patients with IDC-P exhibited a significantly poorer prognosis than did those without IDC-P (P < 0.0001), as did GG2 (20% ≤ GP4) patients without IDC-P (P < 0.05). The GG2 (5% ≥ GP4) and (5% < GP4 ≤ 10%) groups exhibited prognoses similar to those of the GG1 patients. In multivariate analysis, GG2 (20% ≤ GP4) without IDC-P, the presence of IDC-P, and the prostate-specific antigen level at diagnosis significantly predicted prognosis (P < 0.05, < 0.0001, and < 0.0001, respectively). CONCLUSION: Our findings suggest that GG2 (GP4 ≤ 10%) patients could be indicated for AS, similar to GG1 patients, given the risk of IDC-P tumors.


Asunto(s)
Carcinoma Intraductal no Infiltrante , Neoplasias de la Próstata , Humanos , Masculino , Clasificación del Tumor , Recurrencia Local de Neoplasia , Próstata/cirugía , Prostatectomía , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos
17.
Int J Clin Oncol ; 26(4): 744-752, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33387085

RESUMEN

BACKGROUND: The salvage treatments for biochemical recurrence (BCR) include local external beam radiation therapy (RT) and systemic androgen-deprivation therapy (ADT). METHODS: We reviewed patients who underwent radical prostatectomy (RP) and developed BCR at three institutions. After excluding patients whose nadir prostate-specific antigen (PSA) was higher than 0.2 ng/mL, those who received neoadjuvant/adjuvant therapy, and those whose BCR was not treated until their PSA exceeded 4.0 ng/mL, the remaining 335 patients comprised the cohort of this study. Salvage RT and ADT were performed for 154 and 181 patients, respectively. After the failure of salvage RT, all patients received subsequent ADT. The starting point of this study was the timing of BCR and the endpoint was the development of castration-resistant prostate cancer (CRPC). RESULTS: During the mean follow-up period of 8.5 years after BCR, CRPC was observed in 13 patients administered RT and 24 patients administered ADT. Kaplan-Meier curves demonstrated no significant difference in CRPC-free survival between the RT and ADT groups (10-year CRPC-free survival 89.9 vs. 86.3%, p = 0.199). On the other hand, we found a significant difference in CRPC-free survival between the RT and ADT groups in 50 high-risk patients with two risk factors of Grade Group ≥ 4 and PSA-doubling time < 6 months (10-year CRPC-free survival 73.4 vs. 40.3%, p = 0.040). CONCLUSION: This study revealed that salvage RT increases the CRPC-free survival rate compared with salvage ADT in high-risk patients with Grade Group ≥ 4 and PSA-doubling time < 6 months.


Asunto(s)
Antagonistas de Andrógenos , Neoplasias de la Próstata , Antagonistas de Andrógenos/uso terapéutico , Andrógenos , Estudios de Seguimiento , Humanos , Masculino , Recurrencia Local de Neoplasia/tratamiento farmacológico , Recurrencia Local de Neoplasia/radioterapia , Antígeno Prostático Específico , Prostatectomía , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Terapia Recuperativa
18.
Int J Clin Oncol ; 26(4): 736-743, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33415570

RESUMEN

BACKGROUND: To report on our primary experience with the placement of a hydrogel spacer following stereotactic body radiation therapy (SBRT) in low- and intermediate-risk prostate cancer patients and assess its impact on dosimetry as well as acute toxicity. METHODS: A total of 70 patients treated with SBRT (total dose of 36.25 Gy) in 5 fractions were included. Hydrogel spacers were inserted in 53 patients along with gold fiducial markers. For dosimetry, we trisected the rectum on the sagittal image of magnetic resonance imaging and defined it as the upper rectum (UR), middle rectum (MR), and lower rectum (LR). We compared the dose to each part of the rectum with and without hydrogel spacer using dose volume histograms. Genitourinary (GU) and gastrointestinal (GI) toxicity assessments were conducted until 6 months of follow-up visits. RESULTS: The median volume of the hydrogel spacer was 12.3 mL. Overall, the hydrogel spacer could significantly reduce the rectal dose in the middle-to-high-dose region (V20-V35). The rectum doses at the UR and MR were significantly lower in the spacer group in the middle to high dose region (V20-V35); the dose at the LR was significantly lower in the spacer group in the high-dose region (V30-V35). There was no grade ≥ 3 toxicity observed, but grade 2 toxicity of GU and GI occurred in 17.1% and 1.4% of the patients, respectively. CONCLUSION: Hydrogel spacers could contribute to rectal dose reduction, especially in high dose regions, by creating a prostate-rectum distance.


Asunto(s)
Neoplasias de la Próstata , Radiocirugia , Humanos , Hidrogeles , Japón , Masculino , Órganos en Riesgo , Neoplasias de la Próstata/radioterapia , Neoplasias de la Próstata/cirugía , Radiocirugia/efectos adversos , Dosificación Radioterapéutica , Recto
19.
Int J Clin Oncol ; 26(3): 461-484, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33387088

RESUMEN

Cryoablation (CA), high-intensity focused ultrasound (HIFU), irreversible electroporation (IRE), and vascular-targeted photodynamic therapy (VTP) have been evaluated as novel strategies for selected patients with prostate cancer (PCa). We aim to determine the current status of literature regarding the clinical outcomes among these minimally invasive therapies. A systematic search of PubMed, EMBASE, and the Cochrane Library for all English literature published from January 2001 to December 2019 was conducted to identify studies evaluating outcomes of CA, HIFU, IRE or VTP on PCa. Proportionality with 95% confidence intervals (CIs) was performed using STATA version 14.0. 56 studies consisting of 7383 participants were found to report data of interest and fulfilled the inclusion criteria in the final meta-analysis. The pooled proportions of positive biopsy after procedure were 20.0%, 24.3%, 24.2%, and 36.2% in CA, HIFU, IRE and VTP, respectively. The pooled proportions of BRFS were 75.7% for CA and 74.4% for HIFU. The pooled proportions of CSS were 96.1%, 98.2%, and 97.9% for CA, HIFU, and IRE, respectively. The pooled proportions of OS were 92.8% for CA and 85.2% for HIFU. The pooled proportions of FFS were 64.7%, 90.4%, and 76.7% for CA, IRE and VTP, respectively. The pooled proportions of MFS were 92.8% for HIFU and 99.1% for IRE. This meta-analysis shows that CA, HIFU, IRE, and VTP are promising therapies for PCa patients with similar clinical outcomes. However, further larger, well-designed randomized controlled trials are required to confirm this assertion.


Asunto(s)
Criocirugia , Fotoquimioterapia , Neoplasias de la Próstata , Biopsia , Electroporación , Humanos , Masculino , Neoplasias de la Próstata/tratamiento farmacológico , Neoplasias de la Próstata/cirugía , Resultado del Tratamiento
20.
Rev Med Suisse ; 17(720-1): 90-94, 2021 Jan 13.
Artículo en Francés | MEDLINE | ID: mdl-33443838

RESUMEN

Over the last year, urologic progress remains driven by the quick technologic evolution, with a focus on Laser and robotics. The latter appears to potentially contribute to the drift towards ambulatory surgery, in particular for distinct sub-populations harbouring kidney or prostate cancer. The Da Vinci robot appears also to increase the drive towards minimally invasiveness with respect to female incontinence and the laparoscopic placement of an artificial urethral sphincter. Last, a new Laser is in the midst to offer its polyvalence in terms of endoscopic stone surgery, so as that of benign prostatic hyperplasia. Facing this technologic pressure, it remains of utmost importance to scrupulously validate on a short so as longer-term basis the true hoped advantages.


Asunto(s)
Laparoscopía , Rayos Láser , Robótica , Urología/instrumentación , Urología/métodos , Humanos , Cálculos Renales/cirugía , Masculino , Neoplasias de la Próstata/cirugía , Uretra/cirugía
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