Oncologic outcomes after minimally invasive radical prostatectomy in patients with seminal vesicle invasion (pT3b) without adjuvant therapy.

PURPOSE: To evaluate the long-term outcomes of patients with prostate cancer who have pathological pT3b N0-Nx, with postoperative PSA < 0.1 ng/ml and no systematic adjuvant treatment. MATERIALS AND METHODS: Using a monocentric prospectively maintained database, we identified among 2,142 men who underwent minimally invasive radical prostatectomy, 104 pT3b N0-Nx patients, with postoperative PSA < 0.1 ng/ml and at least 5 years of follow-up. Patients were considered for salvage treatment at biochemical recurrence (PSA ≥ 0.2 ng/ml). RESULTS: The median time of follow-up was 83.5 months (interquartile range [IQR]: 69-99). Overall, 102 patients (98 %) had T2 clinical stage or less. Specimen Gleason score was 7 in 71 patients (68 %) and <7 in 15 (14 %). Thirty-eight patients (37 %) were upgraded for Gleason score after radical prostatectomy. The overall 5-year probability of freedom from biochemical recurrence for the entire cohort was 55.8 % (95 % CI 45.8-65.8) and 73.3 % for patients who had specimen Gleason score <7 (p = 0.005). In univariate analysis, specimen Gleason score and surgical margin status were significant predictors for biochemical failure after radical prostatectomy (p = 0.05 and 0.007, respectively). In multivariate analysis, only specimen Gleason score >7 was significantly associated with biochemical failure (p = 0.009). CONCLUSION: SVI is an adverse prognostic factor, but it is not associated with a uniformly poor prognosis. Specimen Gleason score and surgical margin status are significant predictors of recurrence after radical prostatectomy in patients with prostate cancer and SVI.

Robot-assisted Radical Prostatectomy with the Dexter Robotic System: Initial Experience and Insights into On-demand Robotics.

We report the world's first case series of ten robot-assisted radical prostatectomy (RARP) procedures performed with the Dexter robotic system (Distalmotion SA, Épalinges, Switzerland). The Dexter system is an open robotic platform that integrates into the existing operating room (OR) equipment. The optional sterile environment for the surgeon console provides flexibility for transition between a robot-assisted surgical procedure and a traditional laparoscopic setup, allowing surgeons to selectively use their preferred laparoscopic devices for specific surgical maneuvers on-demand. Ten patients underwent RARP ± lymph node dissection at Saintes Hospital (Saintes, France). Positioning and docking of the system were quickly mastered by the OR team. All procedures were successfully completed, without any intraprocedural complication, conversion to open surgery, or major technical failure. The median operative time was 230 min (interquartile range [IQR] 226-235), and the median length of stay was 3 d (IQR 3-4). This case series demonstrates the safety and feasibility of RARP with the Dexter system and provides the first insights into what an on-demand robotics platform could offer to hospitals willing to start or expand their robotic surgery program.

The value of urinary prostate cancer gene 3 (PCA3) scores in predicting pathological features at radical prostatectomy.

UNLABELLED: Study Type - Diagnostic (exploratory cohort) Level of Evidence 2b What's known on the subject? and What does the study add? PCA3 scores correlate to numerous histoprognostic factors, specifically tumour volume and positive surgical margins. These results may have a clinical impact in the near future on the selection of patients eligible to undergo active surveillance and nerve-sparing surgery. OBJECTIVE: To assess correlations between Prostate CAncer gene 3 (PCA3) levels and pathological features of radical prostatectomy (RP) specimens, which define cancer aggressiveness. PATIENTS AND METHODS: After digital rectal examination (DRE), first-catch urine was collected from 160 patients with localized prostate cancer. The PCA3 score was calculated using the Gene Probe Progensa(™) assay. PCA3 scores were then correlated to the pathological features of the RP specimens. RESULTS: PCA3 scores correlated significantly with tumour volume (r= 0.34, P < 0.01). A PCA3 score of >35 was an independent predictor in a multivariate analysis of a tumour volume >0.5 mL (odds ratio [OR] 2.7, P= 0.04). It was also an independent predictor of positive surgical margins (OR 2.4, P= 0.04). Receiver-operator characteristic curves indicated PCA3 as the most accurate predictor of positive margins (area under the curve [AUC] 0.62), in addition to a positive biopsy percentage (AUC 0.52). There was also a significant difference in the mean PCA3 score between Gleason score patient groups (6 vs ≥ 7) and pathological stage groups (pT0/2 vs pT3/4). CONCLUSIONS: PCA3 scores correlate to numerous histoprognostic factors, specifically tumour volume and positive surgical margins. These results may have a clinical impact in the near future on the selection of patients eligible to undergo active surveillance and nerve-sparing surgery.

Renal colic due to fatty tissue obstruction of the ureter following selective arterial embolisation of a 10 cm angiomyolipoma.

A 47-year-old man was admitted for preventive embolisation of a 10 cm angiomyolipoma (AML) of the right kidney. Three weeks after embolisation, he was readmitted at the emergency unit for a right renal colic. The CT scan confirmed the obstruction of the right ureter due to the presence of fatty tissue into the lumen. Understanding fatty tissue migration into the collecting system is not simple. We hypothesised that the use of alcohol during the embolisation procedure could have led to focal necrosis of the collecting system, thus enabling migration of fatty tissue into the renal calyces.