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1.
Hinyokika Kiyo ; 67(8): 395-398, 2021 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-34472323

RESUMO

A 56-year-old man visited a clinic with the chief complaint of frequent micturition and residual sensation of urine. He was referred to our hospital for close examination. Cystoscopy showed a tumor protruding toward the bladder neck from the prostate with stones and debris on the surface. Magnetic resonance imaging showed an encapsulated tumor of iso-intensity in the prostate in T2-weighed images. Prostate specific antigen was 0.88 mg/dl. Transurethral resection of prostate was performed under the diagnosis of benign prostate hyperplasia. During the operation, a solid tumor with mucus deposit was observed. Intraoperative rapid pathological diagnosis was mucinous adenocarcinoma. A radical cystectomy was performed. Pathologically, mucinous adenocarcinoma was distributed in the bladder neck, the prostate and surrounding tissue, but the prostatic urethra was intact. The surgery was assessed to be curative. Neither neoadjuvant nor adjuvant chemotherapy was performed, since the effectiveness of chemotherapy for mucinous adenocarcinoma arising from urothelial epithelium has not been established.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias da Próstata , Ressecção Transuretral da Próstata , Adenocarcinoma Mucinoso/diagnóstico por imagem , Adenocarcinoma Mucinoso/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia , Bexiga Urinária
2.
Arch Esp Urol ; 74(7): 656-663, 2021 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-34472434

RESUMO

OBJECTIVE: To determine predictors of BCR in patients with localized PCa undergoing RP at an oncology reference center in Colombia. MATERIALS AND METHODS: A retrospective analytical study was conducted on patients with localized PCa undergoing RP and who at least had one adverse pathological factor for BCR. We consider BCR as two consecutive elevations of PSA after RP, greater than 0.2 ng/ml. For the bivariate analysis we used Kaplan-Meier, and Cox proportional risk analysis to estimate the hazard ratio as well as to determine variables independently associated with the outcome. RESULTS: 280 patients were included. The medianage was 65.3 years, with a median follow up of 52.2 months. BCR occurred in 39% of patients, with a median BCR time of 24.8 months. In the multivariate analysis, high risk [HR 2.07 (95% CI 1.11 - 3.86)], positive surgical margins [HR 2.79 (95% CI 1.66 - 4.69)] and tertiary Gleason pattern [HR 2.16 (95% CI 1.16 - 4.01)] were identified as independent variables associated significantly with BCR. Limitations include retrospective design and sample size. CONCLUSIONS: High risk, positive surgical margins and the presence of tertiary Gleason pattern are the predictive factors of BCR after RP in the Colombian population.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Colômbia , Humanos , Masculino , Gradação de Tumores , Recidiva Local de Neoplasia/epidemiologia , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
4.
Harefuah ; 160(9): 594-597, 2021 Sep.
Artigo em Hebraico | MEDLINE | ID: mdl-34482672

RESUMO

BACKGROUND: Urinary Incontinence (UI) following Robot-Assisted Laparoscopic-Radical Prostatectomy (RALP) adversely affects patients' quality of life. OBJECTIVES: To find parameters that predict full urinary continence (FUC) following RALP. METHODS: Out of an established prospective RALP database, we retrieved and analyzed parameters that potentially predict FUC: age, Body Mass Index, American Anesthesiology Association (ASA) score, previous abdominal surgeries, pre-operative IPSS (International Prostate-Symptom Score), operative time (OT), estimated blood loss (EBL), peritoneum closure and prostate weight. FUC has been defined as 0 pads/day. Univariate analysis has been executed for comparison between patient groups, whereas multivariate analysis has been implemented for the detection of predicting factors for FUC. Data are presented as median (interquartile range) or numeric value (%). RESULTS: A total of 431 RALP cases were recorded between the years 2010-2019. Final analysis included 364 patients with full medical records; 81% gained FUC within 15 weeks (8-28); 96% gained FUC or used 1 pad/day within 17.5 weeks (8-36). Among those who gained FUC, smaller prostates (p=0.028) and low EBL (p=0.025) have been observed. On multivariate analysis EBL has been associated with UI (OR=0.9). CONCLUSIONS: Most patients gained FUC following RALP. EBL was found as risk factor for UI.


Assuntos
Laparoscopia , Neoplasias da Próstata , Robótica , Humanos , Masculino , Estudos Prospectivos , Próstata/cirurgia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Qualidade de Vida
6.
BMJ Case Rep ; 14(8)2021 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-34353827

RESUMO

We present two 85-year-old men, with a similar history of prostate cancer treated more than 10 years ago with radiotherapy, who were in remission, but sought medical care at a time, due to alarm sign and symptoms. Case 2 resulted in a locally advanced secondary radiation-induced sarcoma of the penile base. Case 1 suffered from a round, 2 cm soft-tissue lesion with spiculated borders at the ureterovesical junction responsible for ipsilateral iliac vein compression and urinary obstruction without proven biochemical prostate cancer relapse, raising concerns about recurrence or secondary tumour. Both patients followed an oncological geriatric assessment and were 'vulnerable' at their presentation. Hence, we describe the effort to perform medical care adequacy regarding patient's frailty and the anatomic locations within the prior radiation field. In case 2, we got a pathological diagnose and followed sequential multimodal treatments without success. But in case 1, minimal intervention resulted in improvement.


Assuntos
Segunda Neoplasia Primária , Neoplasias da Próstata , Idoso , Terapia Combinada , Humanos , Masculino , Recidiva Local de Neoplasia/radioterapia , Prostatectomia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia
7.
Rev Assoc Med Bras (1992) ; 67(2): 260-264, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34406250

RESUMO

OBJECTIVE: Metabolic changes caused by anxiety can interfere in both the surgery itself and the recovery process. One way to reassure the patient is to clarify how the procedure will be performed and discuss the possible complications. This study aimed to investigate the anxiety level of candidates for radical prostatectomy at a university hospital. METHODS: Thirty-four patients with a diagnosis of prostate cancer were studied prospectively. Data collection involved the administration of the Hospital Anxiety and Depression Scale and a radical prostatectomy knowledge test. RESULTS: The results showed that 94.1% of the patients reported having received clarifications from the physician or healthcare team regarding the surgery and 23.5% reported having received information on the probability of a medical error during surgery. The most cited postoperative complications were sexual impotence and urinary incontinence. A significant association was found between the total Hospital Anxiety and Depression Scale score and the complications cited (p=0.0004); patients who marked a larger number of possible complications had a higher Hospital Anxiety and Depression Scale score. CONCLUSION: The present study demonstrates that the explanations given by the multidisciplinary health team are not achieving their maximum potential in terms of lowering patient anxiety.


Assuntos
Neoplasias da Próstata , Incontinência Urinária , Ansiedade/etiologia , Hospitais , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Próstata , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Incontinência Urinária/etiologia
8.
In Vivo ; 35(5): 2895-2899, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34410984

RESUMO

BACKGROUND/AIM: Pelvic drain (PD) placement is commonly performed after robot-assisted radical prostatectomy (RARP), but the need for PD placement is unclear. This study aimed to assess the need for PD placement after RARP. PATIENTS AND METHODS: This retrospective study analysed the effect of PD placement on postoperative complications in patients who underwent RARP between 2009 and 2018. All patients prior to October 1, 2016 had a PD placed; those after did not. RESULTS: Of the 308 study patients, 231 received a PD (PD group) and 77 did not (ND group). The incidence of ileus, urinary tract infection and anastomotic leak did not differ significantly between the groups; nor did the incidence of asymptomatic and symptomatic lymphocele at 2 weeks and 1 year after surgery. Multivariate analysis showed that lymph node dissection is a predictor of asymptomatic lymphocele development two weeks after surgery. CONCLUSION: PD placement is not necessary after RARP.


Assuntos
Neoplasias da Próstata , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Excisão de Linfonodo , Masculino , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos
9.
Int J Hyperthermia ; 38(1): 1205-1216, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34375163

RESUMO

PURPOSE: This study aimed to analyze technical and clinical factors related to oncological outcomes in patients with localized prostate cancer (PC) who were treated with whole-gland high-intensity focused ultrasound (HIFU). MATERIALS AND METHODS: From 2007-2014, patients diagnosed with localized PC who underwent whole-gland HIFU were consecutively included retrospectively. Biochemical failure was defined according to the Phoenix ASTRO guidelines. The relationship between oncological outcomes and technical and clinical factors was evaluated. RESULTS: The study cohort included 428 patients. The median age was 67 years, and the median prostate-specific antigen level was 7.61 ng/mL. Patient risk classifications were low (n = 102), intermediate (n = 240), and high (n = 86). Biochemical disease-free survival rates of patients with HIFU for localized PC in the total, low-, intermediate-, and high-risk groups according to D'Amico risk groups over a median follow-up period of 5 years (range 9-144) were 68.4%, 80.4%, 65.6%, and 61.6%, respectively. In multivariate logistic regression analyses to predict biochemical failure of the treatment, neoadjuvant hormonal therapy (NHT) in the high-risk group (OR 0.225, p = 0.015), and compression method in the low- (OR 0.178, p = 0.030), intermediate- (OR0.291, p < 0.0001), and high-risk (OR 0.316, p = 0.049) groups were significant factors that reduced the risk of biochemical failure after treatment. There were no significant differences in complications between patients treated with compression and those treated conventionally. CONCLUSIONS: NHT may potentially improve oncological outcomes for patients in the high-risk group, and compression methods can improve the oncological outcomes of whole-gland therapy with HIFU.


Assuntos
Neoplasias da Próstata , Ultrassom Focalizado Transretal de Alta Intensidade , Idoso , Seguimentos , Humanos , Masculino , Neoplasias da Próstata/cirurgia , Neoplasias da Próstata/terapia , Estudos Retrospectivos , Resultado do Tratamento
10.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(4): 692-696, 2021 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-34393230

RESUMO

OBJECTIVE: To evaluate the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and preoperative prostate apex depth (PAD) on magnetic resonance imaging (MRI). METHODS: We retrospectively analyzed 184 patients with pathologic confirmed prostate carcinoma who underwent LRP in Department of Urology, Peking University Third Hospital. All the patients received MRI examination before surgery. Membranous urethral length (MUL) was defined as the distance from the apex of prostate to the level of the urethra at penile bulb on the coronal image. PAD was defined as the distance from the apex of prostate to the suprapubic ridge line on sagittal MRI. PAD ratio (PADR) was defined as PAD/pubic height. All the patients received extraperitoneal LRP. The patients' reporting freedom from using safety pad (0 pad/d) were defined as urinary continence. Univariate and multivariate regression analyses were used to identify independent predictors of early continence recovery after LRP. Kaplan-Meier analyses and log-rank test were used to compare time to continence recovery between the groups. RESULTS: For all the 184 patients, the average age was (69.0±7.7) years, the ave-rage mass index(BMI) was (25.07±3.29) kg/m2, and the pre-biopsy PSA was (16.80±21.99) g/L. For all the patients who underwent MRI preoperatively, the mean PV was (39.35±25.25) mL and the mean MUL was (14.0±3.7) mm. The mean PAD was (24.52±4.97) mm and the mean PADR was 0.70±0.14. The continence rate for all the patients after LRP was 62.0% and 96.2% in three months and one year. The patients achieving early continence recovery had significant smaller PV (P=0.049), longer MUL (P < 0.001) and higher PADR (P=0.005). Multivariate analysis revealed MUL (P < 0.001) and PADR (P=0.032) were predictors of continence recovery after LRP. Kaplan-Meier analyses and Log-rank test revealed that MUL (≥14 mm vs. < 14 mm, P < 0.001) and PADR (≥0.70 vs. < 0.70, P < 0.001), PV(< 50 mL vs. ≥50 mL, P=0.001) were all significantly associated with continence recovery. CONCLUSION: MUL and PADR are independent predictors of early continence recovery after LRP. MUL, PADR and PV are significantly associated with recovery of urinary continence.


Assuntos
Laparoscopia , Neoplasias da Próstata , Incontinência Urinária , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Próstata/diagnóstico por imagem , Próstata/cirurgia , Prostatectomia , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Incontinência Urinária/etiologia
11.
Beijing Da Xue Xue Bao Yi Xue Ban ; 53(4): 697-703, 2021 Aug 18.
Artigo em Chinês | MEDLINE | ID: mdl-34393231

RESUMO

OBJECTIVE: To evaluate urinary continence recovery time and risk factors of urinary continence recovery after robot-assisted laparoscopic radical prostatectomy (RARP). METHODS: From January 2019 to January 2021, a consecutive series of patients with localized prostate cancer (cT1-T3, cN0, cM0) were prospectively collected. RARP with total anatomical reconstruction was performed in all the cases by an experienced surgeon. Lymph node dissection was performed if the patient was in high-risk group according to the D'Amico risk classification. The primary endpoint was urinary continence recovery time after catheter removal. Postoperative and pathological variables were analyzed. Continence was rigo-rously analyzed 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks after catheter removal. Continence was evaluated by recording diaper pads used per day, and all the patients were instructed to perform the 24-hour pad weight test until full recovery of urinary continence. The patient was defined as continent if no more than one safety pad were needed per day, or no more than 20-gram urine leakage on the 24-hour pad weight test. Time from catheter removal to full recovery of urinary continence was recorded, and risk factors influencing continence recovery time evaluated. RESULTS: In total, 166 patients were analyzed. The mean age of the enrolled patients was 66.2 years, and the median prostate specific antigen (PSA) was 8.51 µg/L. A total of 59 patients (35.5%) had bilateral lymphatic dissection, and 28 (16.9%) underwent neurovascular bundle (NVB) preservation surgery. Postoperative pathology results showed that stage pT1 in 1 case (0.6%), stage pT2 in 77 cases (46.4%), stage pT3 in 86 cases (51.8%), and positive margins in 28 patients (16.9%). Among patients who underwent lymph node dissection, lymph node metastasis was found in 7 cases (11.9%). Median continence recovery time was one week. The number of the continent patients at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 65 (39.2%), 32 (19.3%), 34 (20.5%), 24 (14.5%), and 9 (5.4%). Two patients remained incontinent 24 weeks after catheter removal. The continence rates after catheter removal at the end of 48 hours, 1 week, 4 weeks, 12 weeks, and 24 weeks were 39.2%, 58.4%, 78.9%, 93.4%, and 98.8%, respectively. Univariate COX analysis revealed that diabetes appeared to influence continence recovery time (OR=1.589, 95%CI: 1.025-2.462, P=0.038). At the end of 48 hours, 4 weeks, 12 weeks, and 24 weeks after catheter removal, the mean OABSS score of the continent group was significantly lower than that of the incontinent group. CONCLUSION: RARP showed promising results in the recovery of urinary continence. Diabetes was a risk factor influencing continence recovery time. Bladder overactive symptoms play an important role in the recovery of continence after RARP.


Assuntos
Neoplasias da Próstata , Robótica , Incontinência Urinária , Idoso , Humanos , Masculino , Prostatectomia , Neoplasias da Próstata/cirurgia , Recuperação de Função Fisiológica , Resultado do Tratamento , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
12.
Trials ; 22(1): 547, 2021 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-34407860

RESUMO

BACKGROUND: Randomised controlled trials (RCTs) for surgical interventions have often proven difficult with calls for innovative approaches. The Imperial Prostate (IP4) Comparative Health Research Outcomes of Novel Surgery in prostate cancer (IP4-CHRONOS) study aims to deliver level 1 evidence on outcomes following focal therapy which involves treating just the tumour rather than whole-gland surgery or radiotherapy. Our aim is to test the feasibility of two parallel RCTs within an overarching strategy that fits with existing patient and physician equipoise and maximises the chances of success and potential benefit to patients and healthcare services. METHODS AND DESIGN: IP4-CHRONOS is a randomised, unblinded multi-centre study, including two parallel randomised controlled trials targeting the same patient population: IP4-CHRONOS-A and IP4-CHRONOS-B. IP4-CHRONOS-A is a 1:1 RCT and the other is a multi-arm, multi-stage (MAMS) RCT starting with three arms and a 1:1:1 randomisation. The two linked RCTs are discussed with patients at the time of consent and the choice of A or B is dependent on physician and patient equipoise. The primary outcome is the feasibility of recruitment, acceptance of randomisation and compliance to allocated arm. RESULTS: This paper describes the statistical analysis plan (SAP) for the feasibility study within IP4-CHRONOS given its innovative approach. Version 1.0 of the SAP has been reviewed by the Trial Steering Committee (TSC), Chief Investigator (CI), Senior Statistician and Trial Statistician and signed off. The study is ongoing and recruiting. Recruitment is scheduled to finish later in 2021. The SAP documents approved methods and analyses that will be conducted. Since this is written in advance of the analysis, we avoid bias arising from prior knowledge of the study data and findings. DISCUSSION: Our feasibility analysis will demonstrate if IP4-CHRONOS is feasible in terms of recruitment, randomisation and compliance, and whether to continue both A and B or just one to the main stage. TRIAL REGISTRATION: ISRCTN ISRCTN17796995 . Registered on 08 October 2019.


Assuntos
Neoplasias da Próstata , Estudos de Viabilidade , Humanos , Masculino , Neoplasias da Próstata/cirurgia , Resultado do Tratamento
13.
Ann Palliat Med ; 10(7): 7747-7758, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34353062

RESUMO

BACKGROUND: Patients following radical prostatectomy will encounter various symptoms that may vary depending on the recovery of surgery and the use of adjuvant treatments. However, few studies have used the scale developed for prostate cancer to longitudinally assess the course of symptoms in Chinese patients. This study aimed to identify the symptom trajectories and the influencing factors in the prostate cancer patients of our area. METHODS: A prospective observational study was conducted, and 155 patients with prostate cancer from 3 hospitals in Shanghai were recruited. Demographic and disease-related information was collected during the hospitalization. Further information on symptoms, adjuvant treatment, and functional exercise was collected across 4 time points. Growth mixture modeling was used to identify the trajectory patterns of symptoms, and logistic regression was used to determine the predictors. RESULTS: A total of 143 patients completed the investigation of all points, with a lost-to-follow-up rate of 7.7%. Urinary incontinence, urinary tract irritation, sexual dysfunction, pelvic pain, and hormone related symptoms all had group heterogeneity, and the number of latent category trajectories obtained was 4, 3, 3, 4, and 3 respectively. There were differences in demographic, disease, and treatment-related information between the groups. CONCLUSIONS: Patients with prostate cancer have different symptom levels across different periods after radical prostatectomy. Medical staff can predict these changes based on the initial level of symptoms and related factors such as age, prostate volume, medical comorbidities, drug of adjuvant treatment to clarify the critical points, populations, and symptoms that require monitoring during follow-up.


Assuntos
Disfunção Erétil , Neoplasias da Próstata , China , Humanos , Masculino , Prostatectomia , Neoplasias da Próstata/cirurgia , Qualidade de Vida
14.
J Sex Med ; 18(8): 1467-1472, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34275768

RESUMO

BACKGROUND: Sildenafil citrate has been shown to be protective of sexual function when given concurrently and following prostate radiation therapy (RT), but some evidence suggests an increased biochemical recurrence (BCR) risk in patients taking sildenafil after radical prostatectomy. AIM: To evaluate whether sildenafil use is associated with increased risk of BCR in patients receiving prostate RT, we performed a secondary analysis of a randomized placebo-controlled trial (RPCT) that compared sildenafil citrate to placebo during and after prostate RT. METHODS: The study population consisted of prostate cancer patients who initiated radiation treatment at our institution and participated in our multi-institutional RPCT that compared 6 months of sildenafil 50 mg once a day to placebo with a 24-month follow-up. Androgen deprivation therapy (ADT) was allowed. Prostate cancer prognostic risk grouping was not an exclusion criterion, but most study participants had low- or intermediate-risk prostate cancer. Statistical analysis was performed using Kaplan-Meier plots and log-rank testing. OUTCOMES: The primary outcomes of this report were biochemical recurrence and overall survival rates, where BCR was defined according to the Phoenix definition. RESULTS: Data of 162 men were analyzed. Nine men had inadequate PSA follow-up and the remaining 153 men were included in the final report. Median age was 61 years. At a median follow-up of 8.3 years (range: 3.0-12.2), 5/94 (5.3%) and 2/59 (3.4%) patients developed BCR in the sildenafil and placebo groups, respectively. The 6-year BCR-free survival was 98.8% for all patients, 98.1% for the sildenafil cohort, and 100% for the placebo cohort. The 10-year BCR-free survival was 94.4% for all patients, 95.6% for the sildenafil cohort, and 92.9% for the placebo cohort. There was no difference in BCR-free survival between the sildenafil and placebo groups by log-rank comparison (p = 0.36). CLINICAL IMPLICATIONS: This analysis informs clinical decision making about the safety of using sildenafil during and after prostate RT. STRENGTHS AND LIMITATIONS: This study included patients who were treated in the setting of a prospective, randomized placebo-controlled trial, and who attained high medication compliance. However, the study was limited by the post-hoc nature of the analysis, use of ADT in some patients, inadequate study power to detect a difference in BCR between sildenafil and placebo groups. CONCLUSION: Prophylactic sildenafil citrate was not associated with biochemical recurrence risk in prostate cancer patients treated with radiation. However, the study was inadequately powered to definitively conclude a negative finding. Haseltine JM, Hopkins M, Schofield E, et al. Sildenafil Citrate and Risk of Biochemical Recurrence in Prostate Cancer Patients Treated With Radiation Therapy: Post-Hoc Analysis of a Randomized Controlled Trial. J Sex Med 2021;18:1467-1472.


Assuntos
Antagonistas de Androgênios , Neoplasias da Próstata , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estudos Prospectivos , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/tratamento farmacológico , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia , Citrato de Sildenafila/efeitos adversos
15.
Artigo em Inglês | MEDLINE | ID: mdl-34199008

RESUMO

PURPOSE: to quantify and compare pre- and post-surgical incontinence pad use between men treated with radical prostatectomy (RP) for prostate cancer (PCa) and cancer-free controls, using population-based Austrian insurance claims data. METHODS: Men who underwent RP for treating PCa between 2013-2015 were identified. Cancer-free men ≥45 years with and without benign prostate hyperplasia (BPH) were used as controls. Longitudinal data on ICD-diagnoses, type of surgery, prescribed incontinence pads, and hospitals' surgery volumes were aggregated between 2011-2018 to capture pre- and up to three years post-RP follow-up. Monthly rates of pad use were calculated and compared between RP types and cancer-free controls. RESULTS: A total of 6248 RP patients, 7158 cancer-free men with BPH, and 50,257 cancer-free men without BPH were analyzed. Comparing to pre-RP (0.03, 95%CI: 0.02-0.05), RP resulted in significantly higher rates of prescribed pads (at 3 months: 12.61, 95%CI: 11.59-13.65; 12 months: 6.71, 95%CI: 6.10-7.34; 36 months: 4.91, 95%CI: 3.76-4.62). These rates were also higher than those for cancer free controls (with BPH:0.06, 95%CI: 0.04-0.09; without BPH:0.12, 95%CI: 0.10-0.14). The rate of prescribed pads after surgery continued to decline over time and remained higher among men who underwent minimally invasive RP compared to those who underwent an open procedure. CONCLUSION: Despite progress in surgical techniques, post-RP incontinence remains a prevalent adverse event. The rate of pad usage steadily improved over the first three years post RP. The rate of patients with incontinence needing pads was higher among those who were treated minimally invasive compared to open approach.


Assuntos
Seguro , Neoplasias da Próstata , Áustria , Humanos , Tampões Absorventes para a Incontinência Urinária , Masculino , Pessoa de Meia-Idade , Próstata , Prostatectomia , Neoplasias da Próstata/epidemiologia , Neoplasias da Próstata/cirurgia
16.
Radiologe ; 61(9): 829-838, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34251481

RESUMO

CLINICAL/METHODOLOGICAL ISSUE: Multiparametric magnetic resonance imaging (mpMRI) of the prostate plays a crucial role in the diagnosis and local staging of primary prostate cancer. STANDARD RADIOLOGICAL METHODS: Image-guided biopsy techniques such as MRI-ultrasound fusion not only allow guidance for targeted tissue sampling of index lesions for diagnostic confirmation, but also improve the detection of clinically significant prostate cancer. METHODOLOGICAL INNOVATIONS: Minimally invasive, focal therapies of localized prostate cancer complement the treatment spectrum, especially for low- and intermediate-risk patients. PERFORMANCE: In patients of low and intermediate risk, MR-guided, minimally invasive therapies could enable local tumor control, improved functional outcomes and possible subsequent therapy escalation. Further study results related to multimodal approaches and the application of artificial intelligence (AI) by machine and deep learning algorithms will help to leverage the full potential of focal therapies for prostate cancer in the upcoming era of precision medicine. ACHIEVEMENTS: Completion of ongoing randomized trials comparing each minimally invasive therapy approach with established whole-gland procedures is needed before minimally invasive therapies can be implemented into existing treatment guidelines. PRACTICAL RECOMMENDATIONS: This review article highlights minimally invasive therapies of prostate cancer and the key role of mpMRI for planning and conducting these therapies.


Assuntos
Inteligência Artificial , Neoplasias da Próstata , Humanos , Biópsia Guiada por Imagem , Imageamento por Ressonância Magnética , Masculino , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/cirurgia
17.
Andrologia ; 53(9): e14122, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34319588

RESUMO

Radical prostatectomy, radiotherapy and active surveillance are three widely used treatment options for patients with low-risk prostate cancer, but the relative effects are controversial. We searched PubMed, Embase and Web of Science until June 2020, focusing on the studies comparing the effect of radical prostatectomy, radiotherapy and active surveillance in patients with low-risk prostate cancer. Through the random-effects model, dichotomous data were extracted and summarised by odds ratio with a 95% confidence interval. Twenty-two studies containing 185,363 participants were pooled for the comprehensive comparison. The Bayesian mixed network estimate demonstrated the cancer-specific mortality of radical prostatectomy was significantly lower than active surveillance (OR, 0.46; 95% CI 0.34-0.64) and external beam radiation therapy (OR, 0.66; 95% CI 0.46-0.96), but not brachytherapy (OR, 0.63; 95% CI 0.41-1.03). The brachytherapy demonstrated the best treatment ranking probability results in terms of all-cause mortality, while no significant difference was observed when compared with other three treatment modalities. Brachytherapy and radical prostatectomy were associated with a similar risk of cancer-specific mortality, and both of them were significantly superior to active surveillance and external beam radiation therapy; nevertheless, there was no significant difference among the aforementioned treatment methods in all-cause mortality.


Assuntos
Braquiterapia , Neoplasias da Próstata , Teorema de Bayes , Humanos , Masculino , Metanálise em Rede , Prostatectomia , Neoplasias da Próstata/radioterapia , Neoplasias da Próstata/cirurgia
18.
Cancer Imaging ; 21(1): 46, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225808

RESUMO

PURPOSE: To investigate the performance of magnetic resonance imaging (MRI)-based radiomics models for benign and malignant prostate lesion discrimination and extracapsular extension (ECE) and positive surgical margins (PSM) prediction. METHODS AND MATERIALS: In total, 459 patients who underwent multiparametric MRI (mpMRI) before prostate biopsy were included. Radiomic features were extracted from both T2-weighted imaging (T2WI) and the apparent diffusion coefficient (ADC). Patients were divided into different training sets and testing sets for different targets according to a ratio of 7:3. Radiomics signatures were built using radiomic features on the training set, and integrated models were built by adding clinical characteristics. The areas under the receiver operating characteristic curves (AUCs) were calculated to assess the classification performance on the testing sets. RESULTS: The radiomics signatures for benign and malignant lesion discrimination achieved AUCs of 0.775 (T2WI), 0.863 (ADC) and 0.855 (ADC + T2WI). The corresponding integrated models improved the AUC to 0.851/0.912/0.905, respectively. The radiomics signatures for ECE achieved the highest AUC of 0.625 (ADC), and the corresponding integrated model achieved the highest AUC (0.728). The radiomics signatures for PSM prediction achieved AUCs of 0.614 (T2WI) and 0.733 (ADC). The corresponding integrated models reached AUCs of 0.680 and 0.766, respectively. CONCLUSIONS: The MRI-based radiomics models, which took advantage of radiomic features on ADC and T2WI scans, showed good performance in discriminating benign and malignant prostate lesions and predicting ECE and PSM. Combining radiomics signatures and clinical factors enhanced the performance of the models, which may contribute to clinical diagnosis and treatment.


Assuntos
Extensão Extranodal , Margens de Excisão , Imageamento por Ressonância Magnética Multiparamétrica/métodos , Neoplasias da Próstata/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Imagem de Difusão por Ressonância Magnética/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias da Próstata/diagnóstico por imagem , Estudos Retrospectivos
19.
Arch Esp Urol ; 74(6): 554-563, 2021 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-34219057

RESUMO

OBJECTIVE: To compare the classification CAPRA (based on clinical-pathological findings) and minimal residual disease (MRD) (based on biological characteristics) to predict biochemical failure (BF). METHOD AND PATIENTS: The clinical-pathological findings of the prostate biopsy were used to determine the CAPRA score, classifying patients into low, intermediate and high risk. Blood and bone marrow samples to detect circulating prostate cells (CPCs) and micro-metastasis were taken. The samples were classified as positive if ≥1 prostate cell was detected, forming three subgroups; Group A (MRD negative), Group B (micro-metastasis positive, CPC negative) and Group C (CPC positive). Patients were followed-up for 10 yearsor BF. Kaplan-Meier biochemical failure free survival (BFFS) curves, a predictive flexible parameter survival model and mean restricted survival times (MRST) were determined. RESULTS: 347 men participated, BF risk increased with increasing CAPRA score, HR 1.21 intermediate, 1.64 high risk; versus MRD HR 1.91 and 4.43 for Groups Band C. After 10 years the BFFS and MRST were 76%, 50% and 17% and 9, 7 and 5 years respectively for CAPRA versus 94%, 57% and 26% and 10, 9 and 6 years respectively for MRD. The concordance between observed and predicted BFFS was acceptable for CAPRA (Harrell´s C 0.64) and very good (0.92) for MRD. The BFFS curves for MRD were not proportional with time, they were similar for 5 years for Groups A and B, with increasing BFFS in Group B there after.The CAPRA score did not distinguish between Groups A and B, one third of low risk CAPRA patients had CPCs detected. CONCLUSIONS: The MRD classification was superior to CAPRA, differentiating between early and late failure.


Assuntos
Antígeno Prostático Específico , Neoplasias da Próstata , Animais , Cabras , Humanos , Masculino , Recidiva Local de Neoplasia , Neoplasia Residual , Prostatectomia , Neoplasias da Próstata/cirurgia , Medição de Risco
20.
Arch Esp Urol ; 74(6): 599-605, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34219063

RESUMO

OBJECTIVES: We aimed to determine the parameters that predict Gleason Score (GS) upgrading in patients undergoing robot-assisted laparoscopic radical prostatectomy (RARP) and especially the ability of neutrophile to lymphocyte ratio (NLR) in predicting the upgrading. METHODS: Patients who underwent RARP for prostate cancer in our clinic between January 2013 and January 2018 were retrospectively analyzed. Patients' demographic data, preoperative and postoperative parameters were all recorded in the database. NLR was calculated by dividing the absolute neutrophil count (NC) by the absolute lymphocyte count (LC). Patients were classified as low, moderate and high risk according to the National Comprehensive Cancer Network (NCNN) Guidelines. Any increase in GS between biopsy results and radical prostatectomy specimens were consideredas an GS upgrading. RESULTS: After applying the inclusion and exclusion criteria, a total of 571 patients, 205 patients without GS upgrading (Group 1) and 366 patients with GS upgrading (Group 2), were included. The mean preoperative PSA values and prostate volumes were 10.8 ± 8 ng/dL and 45 ± 18.8 ml, respectively. Group 2 had a significantly high NC and NLR, significantly low platelet count (PC) and LC, (p=0.0001, 0.0001, 0.001 and0.002, respectively). Group 2 was found to have significantly higher positive surgical margin (PSM), extraprostatic extension (EPE) and seminal vesical invasion (SVI) (p<0.001). There was no significant correlation between the parameters of NLR and PSM, EPE, SVI, and lymph node invasion (LNI). Binomial logistic regression showed patients with increased NLR had 1.68 times higher odds to exhibit an upgrade in GS in the post-surgical histopathological analysis. CONCLUSIONS: NLR calculated preoperatively is an easy diagnostic method that can predict GS upgrading in patients scheduled for radical prostatectomy for prostate cancer.


Assuntos
Neutrófilos , Neoplasias da Próstata , Humanos , Linfócitos , Masculino , Gradação de Tumores , Antígeno Prostático Específico , Prostatectomia , Neoplasias da Próstata/cirurgia , Estudos Retrospectivos
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